• Waiting for Medicare

    From Affording to Wait: Medicare Initiation and the Use of Health Care, by Guy David, Phil Saynisch, Victoria Acevedo-Perez, and Mark Neuman:

    Our examination of data from Florida and North Carolina finds an abrupt increase in utilization of colonoscopy and lens and cataract procedures at age 65 years, not observed for any other age threshold between 50 and 75 years. We find this increase to be attributable almost entirely to the initiation of Medicare benefits at this age. Not surprisingly, a comparable discontinuity does not occur for procedures that are not typically covered by Medicare, such as elective cosmetic surgery, or are required for treatment of a set of life‐threatening emergencies or a set of acutely painful conditions. […]

    Our findings have important policy implications. These findings support an argument that uninsurance or underinsurance among adults younger than 65 years may result in potentially harmful delays in receipt of necessary diagnostic and therapeutic procedures. However, our work further argues that taxpayer‐funded insurance programs may effectively finance procedures that could have been performed at a younger age but instead have been delayed until after age 65 years. We urge further research to evaluate the potential costs of such delays in care on both individual health outcomes and the costs borne by taxpayer‐funded health care in the USA.

    See also the work of Michael McWilliams and colleagues.


    • I would be interesting to know the consequences of delaying these procedures. Do delayed colonoscopies lead to more expensive colon cancer? Do delayed cataract operations lead to decreased functioning or dangerous driving?

      Certainly for the colonoscopies, it looks like people put them off for a year or two. Given that they are recommended only every 10 years, how much does putting off your colonoscopy for a year or two matter?

      Do the hernias cause disability? For a self-insuring company, the cost of putting a 64 year old guy on disability for a year might not be much greater than the cost of surgery and recuperation and having him work until he’s 65 — with limitations on what he can do.

    • Anecdotal experience here.
      A friend turned 65 and had a few palpitations. The ER doc cleared him but the other docs started circling. He ended up with full cardiac workup plus bonus colonoscopy!
      I turn 65 in a few months and am due for a colonoscopy.