The Amazing Maze of US Health Care

The Senate Dems are talking about expanding Medicare.  Well, expanding Medicare to people over 55.  Um, expanding Medicare to some people over 55.  Er, expanding Medicare to some people over 55 who can afford to pay the price.

Is this a good idea, or part of a good idea? What and Why?

The details are sketchy at this point.   The so-called expansion of Medicare is tied to discussions about killing the public option because that insurance company lackey, Senator Joe Lieberman (I, CN), could otherwise kill health care reform demanded by the majority of Americans.

And those right wing nut cases think we lefties are jamming health care reform down their throats?

Expanding Medicare has some appeal, but the Senate solution, like so many Congressional fixes, manages to muck it up.

We turn to the New York Times

The New York Times offered a variety of perspectives on the issue.

From Stuart Butler, adjunct professor in public policy at Georgetown University, and  vice president for domestic policy at the Heritage Foundation.

One in ten  55- to 64-year-olds are uninsured and can face crippling health costs, which rise with age. So why not let them join Medicare?

One problem is the steep premium required if these new beneficiaries pay the full cost. Individual coverage would cost nearly $8,000 annually (including prescription coverage). And Medicare still has gaps requiring costly supplemental coverage. That would make it unaffordable to many eligible Americans….

A Medicare buy-in program would further unravel employer-sponsored retiree coverage, as firms nudged younger retirees into Medicare to cut their benefit costs. So the number of new enrollees, and total costs, could escalate.

From Robin Hanson, an associate professor of economics at George Mason University.

If we were to move everyone over 55 into Medicare, and raise worker premiums to match, that would be a big slip down the slope toward a European style state-run medical system, but at least it would be straightforward and workable. Medicare works now for folks 65 and over; it could similarly work for folks 55 and over.

Letting folks 55 and over opt in to Medicare from less generous plans, with no pre-existing condition penalties, risks disaster via adverse selection.

From Jonathan Oberlander,  associate professor of Social Medicine and Health Policy and Management at the University of North Carolina-Chapel Hill.

The U.S. health care system is fragmented and that produces fragmented solutions that try to build on our bizarre, complex mix of public and private programs.

This is an example of that, to be sure, but given the other policies being proposed, this at least has the virtue of building on a popular program. Moreover, the public plan in the Senate bill is so watered down that it is not clear that this, from liberals’ perspectives, (is) really a lesser option.

From Gerard Anderson, a professor of health policy and management and professor of medicine at Johns Hopkins University. His research focuses on comparative health care systems, health care payment reform, and technology diffusion.

It is disappointing that only people age 55 and above will be able to purchase Medicare coverage. However, it is a start. People age 54 will see it is a good deal and will start to argue for it in the coming years….

There is no reason why a Medicare beneficiary at age 55 should pay more than a Medicare beneficiary at age 65 for the same service, certainly not 20-30 percent more. In fact, they should pay less because they likely have fewer complications and are less costly to treat.

There are economies of scale associated with having them treated exactly like other Medicare beneficiaries. Setting up two parallel systems simply is not efficient or effective.

From J. Michael McWilliams, assistant professor of health care policy and medicine at Harvard Medical School and Brigham and Women’s Hospital.

A Medicare buy-in option for adults ages 55-64 could provide an important complement to other health care reforms being considered by the House and Senate….

Near-elderly adults may not cost as much as previously thought, because they would enter traditional Medicare at age 65 with lower risks of costly complications….

Indeed, growing evidence suggests that when older uninsured adults gain Medicare coverage at age 65, their use of effective health services increases, their health trends improve, and their risk of cardiovascular complications diminishes. Near-universal Medicare coverage is also associated with reduced death rates for hospitalized patients and reduced racial and socioeconomic disparities in control of blood pressure, blood sugar and cholesterol….

An effective buy-in may help control national spending because a greater fraction of care for the chronically ill would be affected by innovative changes to Medicare’s payment and delivery systems currently proposed by Congress.

From Steffie Woolhandler, professor of medicine, and David Himmelstein, associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program.

Milk and lemon both taste good in tea. But mix them together and it’s a curdled mess. Similarly, the latest Senate health reform compromise combines two appetizing elements — a Medicare expansion and tighter insurance regulations –- to create a noxious brew….

The Senate plans to take some of these high-cost patients off private insurers’ books, and make them Medicare’s problem. Consequently, the costs of this Medicare buy-in will be high — both for patients and for the taxpayers who will subsidize the near-poor starting in 2014….

But even though it’s bad health policy, this new compromise is brilliant politics. For insurers, it offers a hidden subsidy. Meanwhile, it gives the appearance of responding to the vocal and growing legion of single payer supporters who want Medicare for All….

Medicare for All won’t grow from the Senate compromise, but from its ashes.

Not exactly a ringing endorsement from any part of the political spectrum.

This entry was posted on Saturday, December 12th, 2009 at 4:00 pm and is filed under Health Care Reform, Medicare. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.