The Pros and Cons of Increasing Medicare Eligibility
January 16, 1998
in this forum:
Is the Medicare proposal a federal government power grab? If the proposal is "revenue neutral", why not expand Medicare? Is there the political will to increase premiums if health care costs continue to rise? Who can afford $3600 to $4000 a year for Medicare? How will this proposal impact health care generally? Will this allow business to start reducing its health coverage? Robert Oscar from Richmond, VA asks: What do you think the effect of this policy will be on the cost and quality of health care in the long term?
Joseph White responds:
Close to none. It is unlikely to involve enough people, and doesn't really change the set of cost control methods being imposed on the system.
The wild card is how private payers would react to the creation of this new option. If there is an unexpected decline in private insurance in response, that the legislation doesn't find some clever way to prevent, then Medicare will become an even more important payer than it is today. Those of us who think the main Medicare cost controls are less dangerous than what gets called "managed care" would sort of like that. But, then, we don't know to what extent "managed care" will become a larger part of Medicare in the meantime.
The National Taxpayers Union responds:We believe that the latest proposal to expand Medicare addresses neither cost nor quality problems over the long-term. Indeed, it would take us in precisely the wrong direction.
Your point about long-term effects brings up an important distinction. The White House may be gambling on the fact that over the short-term, public opinion will favor this Medicare expansion out of the simple belief that it would provide "goodies" at "no cost." But polling data suggest that when they consider Medicare's long-term future, they are much less enthusiastic. Even in 1995, when Clinton's "MediScare" campaign was having its full effect, nearly 50 percent of Americans surveyed by the firm Mathew Greenwald & Associates said they would be unwilling to pay even a single penny more in taxes to preserve existing Medicare benefits. A whopping 85 percent opposed paying more than $500 -- still a far cry from the amount that will be needed to bail out Medicare in the future. Other polls suggest high support levels for the concept of Medical Savings Account.