- It’s truly excellent work, carefully done with sound methods by top scholars: Michael McWilliams, Ellen Meara, Alan Zaslavsky, and John Ayanian. They deserve every bit of recognition and credit for the research. I recommend reading their papers on this topic in full. (They’re listed at the end of this post.)
- It seems that some have interpreted our words as meaning that delaying Medicare eligibility would cost Medicare more overall, that is, increase the total Medicare budget. That’s not what we meant. We meant that delaying Medicare eligibility could cause per person Medicare spending to rise. On average, delaying Medicare eligibility is bad for health and increases utilization in the long run. An increase in age-eligibility may save the Medicare program more than it spends, but some of the savings would be offset by increased utilization later.
- Delaying Medicare eligibility to, say, age 67 could also cause overall health care spending to rise, depending on what the 65 and 66 year olds do. If they purchase more expensive private insurance that pays higher rates to providers, spending would rise unless there were additional constraints on utilization that offset the higher per unit prices.
- We highlighted just two papers by McWilliams and colleagues, but they have done other, related work. Here’s a fuller list of references:
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Medicare spending for previously uninsured adults. Ann Intern Med. 2009;151:757-766.
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of Medicare coverage. Ann Intern Med. 2009;150:505-15.
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298:2886-94.
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Use of health services by previously uninsured Medicare beneficiaries. N Engl J Med. 2007;357:143-53.
McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Health insurance coverage and mortality among the near-elderly. Health Affairs. 2004;23(4):223-233.
McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA. 2003;290:757-64.