One of the ideas being batted around in the attempt to find a compromise health bill is to lower the eligible age for Medicare to 55. This looks at first blush like a brilliant political move becuase even as critics of reform scream about "not socializing medicine", they shout equally loud about keeping hands off Medicare (the most socialist form of health care we have).
Apparently socialized medicine is bad for other people.
There may be a solution coming soon. Medicare may shortly have a buy-in for individuals between 55 and 64 years of age. This could solve a great many problems. The doctors and hospitals would get paid. The insured would be able to continue with their services and with their personal physician in most cases and the Medicare system would have money coming in to offset the expense of treating this group of people.
In addition, statistics show that people age 55 to 65 usually have less medical issues and less medical treatment than most people 65 and older. As a group, they have taken care of themselves better, they are healthier – or at least, the onset of serious health issues that come with age haven’t set in yet – and they tend to see the doctor less, using prevention rather than a cure.
The Medicare Buy-In may take a little time to put into place. Lawmakers are working out the details that would help cover the over 5 million boomers between age 55 and 64 who are uninsured. There would be premiums on a monthly basis to the tune of a few hundred dollars, but the premiums should be less than keeping up with payments for the insurance from the old job and COBRA. [More]
There are intriguing implications for this action. First, would it affect jobs by eliminating one big reason older workers are hanging on? If so, this might free up some openings for younger workers who are facing a dismal job market.
New data shows that older workers are staying on the job longer causing younger job seekers to be squeezed out of the job market.
A new report by the Pew Research Center's Social and Demographic Trends project revealed that the recession is having a very different impact by age. The downturn is keeping older adults in the workforce longer and younger adults out of the workforce longer.
But according to local employment agencies it is not just the recession causing older workers to stay on longer, they want to keep working and employers want them. [More]
Another consideration is how this might impact rural America, where health providers have long felt improperly compensated.
This is a totally fair complaint. If we’re going to have two different houses of congress, I think it would make sense to elect one of them on some non-geographical basis so as to cut down on the level of parochialism. And if we’re going to have geographically based representation, it ought to be done fairly, not with a system that lets North Dakota have much more representation than Los Angeles County which has 15 times the population. And if we’re going to have an unfair system, it would be nice to at least see some more high-mindedness from the people representing the giant empty square states.
All that said, there’s a real issue here that’s been lurking in the background of a lot of these health reform debates. The system Medicare uses to determine how much money doctors and hospitals get for treating patients contains a heavy geographical component. In other words, the same procedure gets a different level of payment depending on where it happens. Not surprisingly, the political result of this is that everyone is perpetually convinced that their area is underpaid. And in particular, politicians from rural areas believe very strongly that Medicare is underpaying their health care providers.
But is this actually true? I’ve been trying to figure it out for months and . . . it’s hard to say. This post on the Health Beat Blog is an excellent primer on how Medicare payment works. But merely knowing the facts doesn’t really answer the question. That’s because a big part of the issue is a somewhat normative dispute over what we should be trying to accomplish with our policy. In general, the costs of things are lower in rural areas. But when you get into highly specialized medical care, it’s very inefficient to try to provide them in low-density areas. This is why hospitals are generally clustered in central cities. And for people who live in low-density portions of metropolitan areas, the fact that you might need to travel a ways to get specialized medical care isn’t such a big problem—you’re more concerned about getting treated than about the long commute.
But in large swathes of the United States, there’s just no major urban area anywhere even vaguely nearby. Washburn, ND is four hours from Fargo and almost eight hours from Minneapolis. Naturally, people who live in rural areas would like as wide a range of services available to them as possible. So to them an appropriate reimbursement rate is one which is high enough to attract such a level of provider-capacity, and anything that falls short of that constitutes “underpayment.” But from a metropolitan perspective, that’s backwards. It’s just that like how you don’t see art house movie theaters in rural areas, it’s not possible for provision of certain services to be viable in some places without overpaying to specially subsidize them. [More]
Finally, doesn't this seem like a public option by steps? With even more Americans enjoying the benefits/costs of Medicare, the comparisons will be even more available. I could see gradual rolling downward in the entry age as politics permit. Especially if the alternative private solutions simply continue their current trajectory of costs and coverage even after their reforms.