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OpEdNews Op Eds    H2'ed 4/16/19

Medicare for All 64-Year-Olds

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The push for universal Medicare was given new momentum by Bernie Sanders campaign for the 2016 Democratic nomination. While it is still quite far from becoming law in even an optimistic scenario, it is certainly now treated as serious political position. This is probably best demonstrated by the fact that the Medicare for All (M4A) bill put forward by Washington representative Pramila Jayapal has 107 co-sponsors, nearly half of the Democratic caucus in the House.

As much progress as M4A has made, it will still be a huge lift to get it implemented. A universal Medicare system would mean shifting somewhere around 8 percent of GDP ($1.6 trillion at 2019 levels) from the private system to a government managed system. It would also mean reorganizing the Medicaid program and other government-run health care programs, as well as the Medicare program itself. The current system has large co-pays and many gaps in coverage, such as dental care, that most proponents of M4A would like to fill. It also has a large role for private insurers in the Medicare Advantage program, as well the Part D prescription drug benefit.

The difficulty of a transition is demonstrated by the fact that there is no agreed upon mechanism for paying for this expansion of Medicare. Instead of a specific financing mechanism, the Jayapal bill features a menu of options. Actual legislation of course requires specific revenue sources, not a menu. The fact, that even the most progressive members of the House could not agree on a financing proposal that they could put their names to, shows the difficulty of the transition.

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If it is not likely that we will get to M4A in a single step, then it makes sense to find ways to get there piecemeal. There have been a variety of proposals that go in this direction. Many have proposed lowering the age of Medicare eligibility from the current 65 to age 50 or 60. The idea is that we would bring in a large proportion of the pre-Medicare age population, and then gradually go further down the age ladder. (We can also start at the bottom and move up.)

This sort of age reduction approach is a reasonable incremental path, but going to age 50 or even age 60 would still be a considerable expense. There are over 60 million people in the age cohorts from 50 to 64. Including these people in Medicare at a single point would be a very serious lift. Even the more narrow group from age 60 to 64 still has almost 20 million people. That would a substantial expense.

But we can make the first step even more gradual. We can just add people when they turn age 64 instead of the current 65. At first glance, this would be a bit less than 4 million people. Medicare's payments per enrollee (net of premiums) are roughly $11,500. That would translate into $46 billion annually, roughly 1.0 percent of the total budget.

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But this is likely to hugely overstate the actual cost for two reasons. First, many 64-year-olds will already have their insurance covered by the government. Roughly 20 percent of this age group is on Medicare as a result of being on Social Security disability. At least 10 percent more is covered by Medicaid. If we add people who are getting insurance as current or former government employees, we would almost certainly get over 40 percent already being insured through some government program, and possibly as high as 50 percent.

In addition, the Medicare costs for the new group of 64-year-olds is likely to be far less than the overall average. On average people in this age group would have health care costs of around 70 percent of the over-65 population as a whole. But the least healthy portion of the 64-year-old population is likely already covered by either Medicare, as a result of disability, or Medicaid.

If we assume that the average costs for the people we are adding to the government's tab are half of the overall average for Medicare, this gets us $5,750 per person. If we assume that we are adding 60 percent of this age group, that comes to 2.4 million people. That gives us a total tab of $13.8 billion, less than 0.3 percent of total spending, or roughly the amount the Pentagon spends in a week. It would be pretty hard to argue that this is not an affordable tab.

If even that expense proves too much for the deficit hawks to handle, then maybe we can move up the age of eligibility by one month or one week. At that point, we're talking about the cost of a few weekends for Donald Trump at Mar-A-Lago.

Doing this one-year reduction in the Medicare age would be a test of how easily a reduction in the age of eligibility can be done. It should open the door to further reductions in future years. It is also likely to be popular politically. People in their late 50s and early 60s will surely appreciate the fact that they are one year closer to qualifying for Medicare. That is especially likely to the case with people who do not have good insurance through their employer and/or have serious health conditions.

The proposal for a one year reduction in the age of eligibility should also help to clarify where things stand within the Democratic caucus. Many members have argued against having the party endorse M4A.

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Some of this opposition undoubtedly reflects realistic political concerns that a quick switch-over from the current system to M4A will not be popular in many districts. Many people are satisfied with the insurance they have now and will be reluctant to support what they will view as a big leap into the unknown. Perhaps these people can be convinced over time that a universal Medicare-type system will be at least as good for them, but they are not there now.

However, some of the pushback stems from the fact that many Democrats have long depended on campaign contributions from the health care industry. While the party has not gotten as much money as the Republicans, many members do get substantial contributions, which they are not prepared to abandon.

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Dr. Dean Baker is a macroeconomist and Co-Director of the Center for Economic and Policy Research in Washington, D.C. He previously worked as a senior economist at the Economic Policy Institute and an assistant professor at Bucknell University. (more...)
 
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3 people are discussing this page, with 5 comments  Post Comment


lila york

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Reform is not an option. The entire system needs to be dumped. Even for Medicare recipients the current system sucks. This is how it works: The primary care physician refuses to even attempt to diagnose a symptom. He/she refers you to a minimum of 3 specialists to diagnose the complaint. copay $50 for each specialist. The specialists order 3 or 4 tests. copay for each test $50. Drug prescribed not covered by any insurance company $350 per month. Last month I had $1200 in copays. Each specialist then requested a follow-up visit (which I declined) no doubt to be followed by more tests, even though the complaint was easily diagnosed, minor, so innocuous I cured it myself with a $5 bottle of wild yam root extract. Medicare recipients would be relieved of the onerous, burdensome and unnecessary expenses in a real medicare system - one where a GP or even a pharmacist was allowed to and urged to diagnose a medical complaint. That is the case in many European countries - where I have even experienced house calls when needed. Our entire system is hopeless and corrupt and needs to be ditched wholesale.

Submitted on Tuesday, Apr 16, 2019 at 7:18:23 PM

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Michael Payne

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It is a national disgrace that the U.S. is the only one of the 32 developed nations of the world that does not have some form of universal healthcare. We could have it even thought it would be a complicated process to adopt it. It would have to be phased in over a period of time. But once it was done we would not be paying 2 to 2-1/2 times more than the average of those other countries and our annual costs would be reduced dramatically.


What is holding all this up is the vice grip that Corporate America, the insurance companies, and big Pharma have on this totally corrupted Congress. That is a massive obstacle to getting this done but one way or another we must find a way to do just that.


What we need is many more people like you and Claudia to come forward and demand that change be made. I will very shortly write an article on this subject and put forth some ideas on how to go about this monumental task. Keep up the good work.

Submitted on Wednesday, Apr 17, 2019 at 6:34:52 PM

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Claudia Davison

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Or, legislators could abandon "substantial contributions" and yielding to pressure from the health care (or any) industry by implementing a public campaign financing option. "Free Speech" contributors "born" in administrative offices for the purpose of conducting business, and self-funded candidates will remain in effect, at least until we can amend the Citizens United decision.

Imagine if each individual IRS tax filer paid $7.00/year into a fund for federal office candidates approved by 0,000s of their Registered Voters. Scale down to state and local offices. Yes, they could still belong to political parties, but would need to serve their real, breathing constituents. All people need food, clothing, shelter, safety, income, and health care, but differ on implementation and financing. It's time to focus on peaceful and sustainable life on Earth; not more profits for the few.

We, the People failed Civics 101 when we left candidates to beg for political campaign contributions. Who bites the hand that feeds it? We have the kind of government we deserve. It's time to take responsibility for the kind of government we want. Draft legislation based upon my still-in-effect Street Performer Program at Fisherman's Wharf is at www.thefairelectionsfund.com. Free Speech for all performers (candidates), extra benefits for Licensees (publicly funded candidates), and revenue for Port of San Francisco (FEC), an enterprise agency. @thefairelection

Submitted on Tuesday, Apr 16, 2019 at 8:52:54 PM

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Michael Payne

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Reply to Claudia Davison:   New Content

The comment I made to Lila's is also for you. An article like this should have a great many more comments but that's not happening.

Submitted on Wednesday, Apr 17, 2019 at 6:36:33 PM

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Claudia Davison

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Or, legislators could abandon "substantial contributions" and yielding to pressure from the health care (or any) industry by implementing a public campaign financing option. "Free Speech" contributors "born" in administrative offices for the purpose of conducting business, and self-funded candidates will remain in effect, at least until we can amend the Citizens United decision.

Imagine if each individual IRS tax filer paid $7.00/year into a fund for federal office candidates approved by 0,000s of their Registered Voters. Scale down to state and local offices. Yes, they could still belong to political parties, but would need to serve their real, breathing constituents. All people need food, clothing, shelter, safety, income, and health care, but differ on implementation and financing. It's time to focus on peaceful and sustainable life on Earth; not more profits for the few.

We, the People failed Civics 101 when we left candidates to beg for political campaign contributions. Who bites the hand that feeds it? We have the kind of government we deserve. It's time to take responsibility for the kind of government we want. Draft legislation based upon my still-in-effect Street Performer Program at Fisherman's Wharf is at www.thefairelectionsfund.com. Free Speech for all performers (candidates), extra benefits for Licensees (publicly funded candidates), and revenue for Port of San Francisco (FEC), an enterprise agency. @thefairelection

Submitted on Tuesday, Apr 16, 2019 at 8:56:06 PM

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