This isn’t so much legislation as it is a wish list in op-ed form from a retiring, disliked Senator. But Joe Lieberman’s attack on Medicare is noteworthy, given the trajectory of his history with Medicare.
I’m so old I can remember when Lieberman wanted to expand Medicare. It was in 2009. He endorsed at that time a plan to lower the eligibility age for Medicare to 55 and allow people from 55 to 64 to buy into the program. Then he got wind that liberals liked that idea, and revoked his support, killing the idea when it was on the precipice of passing as part of the Affordable Care Act. Now, in this op-ed, he’s gone completely in the other direction, by endorsing a plan to “raise the Medicare eligibility age every year starting in 2014 by two months until it reaches 67 in 2025.”
This is a pretty cruel idea, mainly because it will actively harm seniors without any financial benefit.
This is not guesswork on our part; there’s clear evidence in the literature. In several papers, Michael McWilliams and colleagues found that utilization, spending, and outcomes for age-eligible Medicare beneficiaries differed for those who had been uninsured prior to turning 65 vs. those who had been insured. Their work was based on survey data, sometimes merged with Medicare claims. This is a relatively strong analytic approach since it exploits a discontinuity in coverage that potentially applies to nearly all individuals: the vast majority of the population enrolls in Medicare at age 65.
The authors found that, relative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal government’s bottom line.
It makes no sense to raise the Medicare age. It costs more in the end and increases human suffering. In other words, it’s the perfect Joe Lieberman plan.
And the rest of his ideas in this op-ed are really not much better. He wants to shift costs to seniors by adding co-pays to Medicare and increasing premiums to 35% of program costs. He also wants to “reform Medigap,” which he says leads to overutilization, and he wants to raise additional taxes on the wealthy to pay for the program. But what Lieberman fails to address are delivery system reforms that would, at the root, attack overstuffed provider payments. Notice who Lieberman puts the burden on in his reforms: patients. Notice who he leaves out. He wouldn’t allow Medicare to negotiate for prescription drugs to lower costs. He wouldn’t put dual eligibles into Medicaid, to provide similar care to patients with lower provider costs for the government to pay. He wouldn’t touch reimbursement rates. He wouldn’t further phase out Medicare Advantage, the private insurance alternative to Medicare.
In other words, Lieberman’s plan lets all the industries around health care off the hook. And given that he has represented the interests of the Connecticut insurance and pharmaceutical industries throughout his entire career, none of this is surprising.
Lieberman calls his ideas “a starting point for discussion.” The fear is that, just as raising the retirement age gained traction in the Social Security debate, this just-as-wrong increase in the Medicare eligibility age would gain adherents. And seniors would lose.