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Raising Medicare Age Would Increase Costs?

NPR’s Julie Rovner makes a novel argument: Raising the Medicare eligibility age would actually increase the cost of Medicare.

Let’s focus on those 65- and 66-year-olds. In Medicare, they’re currently the youngest and healthiest people. So by delaying their entry into the program, says Neuman, you raise costs for everyone else already there.

The result would be that “people on Medicare pay higher premiums,” she said. “That’s because you’re taking the healthiest people out of the Medicare risk pool, leaving sicker people to pay higher premiums.”

At the same time, those same 65- and 66-year-olds would be the oldest and, likely, among the sickest people remaining in the insurance pools of the working-age population, particularly in the new health insurance exchanges.

“That means that they are raising the average risk of people in the exchanges, so that younger people in the exchanges, everybody in the exchanges, will see premiums rise, but especially so for those who are younger,” [Tricia Neuman, senior vice president of the nonpartisan Kaiser Family Foundation and director of its Medicare Policy Project] says.

That’s because under the federal health law for the first time, insurance companies won’t be able to charge older people many times more than younger people for the same insurance coverage.

Presumably, though, this would keep more 65- and 66-year-olds working and paying into Medicare. And, while the relative costs for those remaining in the pool might increase marginally, a rather sizable cohort would be kept from draining the pool for an entire year. And, of course, not all of them will make it to 67 to start collecting; my father didn’t.

Regardless of the economics, I’m not sure raising the eligibility age makes sense. Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.

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About James Joyner
James Joyner is the publisher of Outside the Beltway, an associate professor of security studies at the Marine Corps Command and Staff College, and a nonresident senior fellow at the Atlantic Council. He's a former Army officer and Desert Storm vet. He has a PhD in political science from The University of Alabama. Views expressed here are his own. Follow James on Twitter.

Comments

  1. Just Me says:

    I will also add that people making these decisions need to realize that while they have spent their lives working in suits and doing very little hard physical labor can probably work until closer to 70 there are a large number of people out there in jobs where a 67 year old is going to struggle.

    Sixty Seven year old roofers and steel walkers doesn’t sound all that ideal.

    Raising the age of eligibility is an option but at some point it is going to result in a work force in some occupations that should be retired.

    Like or Dislike: Thumb up 4 Thumb down 0

  2. rodney dill says:

    The result would be that “people on Medicare pay higher premiums,” she said. “That’s because you’re taking the healthiest people out of the Medicare risk pool, leaving sicker people to pay higher premiums.”

    I think that would only be if the cost of Medicare only came out of the premiums collected, and was not otherwise subsidized by the government. (Is this the case? I didn’t think it was.) If medicare is totally self funded by premiums I don’t see a need to change the start age to save costs.

    Also the cost talked about is the premium cost per individual, not the total cost of the program which still could be less with a later start age.

    Like or Dislike: Thumb up 0 Thumb down 0

  3. steve says:

    The total cost of the program would likely be lower, but not as much as expected. There is literature showing that people delay care until they are on Medicare (I see it all of the time). Thus, the people entering Medicare at 67 may be sicker, or just stacking up the procedures they would have earlier gotten at 65, like knee replacements.

    There are at least two other problems. First, total health care costs in the country may increase. W/o Medicare as an option people will need to have private coverage which will cost substantially more. Since insurance companies dont really sell much full coverage to people this old we dont know how much more. Second, we dont know how many in this group will not be able to afford insurance and will end up uninsured. If the ACA stays intact, that is less of a problem, but I am not in the camp that thinks the GOP is dead. This may actually kind of mitigate the total cost issue, but will then affect as above, the costs for Medicare for those 67 and above.

    In short, raising the age likely increases total health care spending while slightly reducing Medicare total spending, with increased per capita costs for beneficiaries.

    Steve

    Like or Dislike: Thumb up 5 Thumb down 0

  4. SKI says:

    @rodney dill:

    I think that would only be if the cost of Medicare only came out of the premiums collected, and was not otherwise subsidized by the government. (Is this the case? I didn’t think it was.) If medicare is totally self funded by premiums I don’t see a need to change the start age to save costs.

    Not totally self-funded by premiums but a portion is. As overall per capita costs rise, the premiums required rise as well.

    If we are being honest (and smart), we’d quickly realize that monkeying around with Medicare eligibility only cost-shifts. If doesn’t significantly change the overall burden on the country or the economy. If we force more people off Medicare, they are still getting sick. If they don’t have adequate insurance, we are simply crippling them, their family, their employers and their providers who end up getting stiffed. We, as a country, pay either way.

    We don’t have a medicare problem, we have a HEALTH CARE problem. Our system is too expensive and inefficient and fragmented. We aren’t keeping people healthy and we aren’t providing care continuity. Only 13% of hospital care is based on evidence-based protocols. That number should be around 50%.

    Like or Dislike: Thumb up 10 Thumb down 0

  5. Rafer Janders says:

    Presumably, though, this would keep more 65- and 66-year-olds working and paying into Medicare.

    Yes, because the job market for 65-67 year olds is so strong and vibrant. Especially with all the new technology which the elderly are so expert in.

    And the issue of whether 65-67 year olds can even find or keep jobs in the first place aside, do we want them to work? Do we want 67 year old cops, firefighters, factory workers, home health care aides, construction workers, nurses, bus drivers, air traffic controllers, pilots, etc. on the job?

    And if they do keep working, it means those jobs don’t open up for younger workers, contributing to unemployment down the age ladder.

    Like or Dislike: Thumb up 4 Thumb down 0

  6. Rafer Janders says:

    My preference would be, frankly, to LOWER the eligibility age — or, heck, just go single-payer and make it Medicare for everyone.

    Like or Dislike: Thumb up 8 Thumb down 0

  7. john personna says:

    Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.

    +5

    Highly-rated. Helpful or Unhelpful: Thumb up 15 Thumb down 0

  8. Rafer Janders says:

    Regardless of the economics, I’m not sure raising the eligibility age makes sense. Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.

    Well said, James. It’s both more efficient and more comprehensive, and would in the long run save us money while also ensuring better health care outcomes.

    Like or Dislike: Thumb up 6 Thumb down 0

  9. Hal 10000 says:

    His statement is bizarre though. He appears to be claiming that moving people off of Medicare will raise costs for both Medicare and private insurance. Those can’t both be true.

    I will also add that people making these decisions need to realize that while they have spent their lives working in suits and doing very little hard physical labor can probably work until closer to 70 there are a large number of people out there in jobs where a 67 year old is going to struggle.

    There are exceptions currently for those under 65 who can’t work anymore. I suspect that any change to the Medicare law would have to account for this.

    Like or Dislike: Thumb up 0 Thumb down 0

  10. OzarkHillbilly says:

    @Just Me:

    Sixty Seven year old roofers and steel walkers doesn’t sound all that ideal.

    In the CDC of the Carpenters Union we have the “Rule of 90″. When one’s age added to your years of service equals 90, one can retire with full pension benefits. A 55 yr old man with 35 yrs of service qualifies. I am 54 with no where near 36 yrs. Trying to figure out how I am going to make it the rest of the way, ’cause this body just ain’t going much further.

    Like or Dislike: Thumb up 1 Thumb down 0

  11. john personna says:

    @rodney dill:

    Ultimately there are only 2 ways to reduce medical costs. Either you lower cost of treatment, or you treat fewer people. You are right that if the same number of people are paying for the same treatment, it nets out the same.

    Of course we know that wouldn’t be true. Some number would drop out of insurance, and I believe private insurance has higher costs for a 66 YO than Medicare.

    Like or Dislike: Thumb up 2 Thumb down 0

  12. Tsar Nicholas says:

    If the U.S. were a stock I’d be short selling it.

    Speaking of which, a few points are worth noting, mostly because they relate to the staggering degree of ignorance in media-Internet-academe circles about how Medicare and other government programs actually work and how those programs tie into the country’s fiscal, monetary and economic situations.

    – Medicare is not an insurance program. Medicare is a government tax and spending program. The government spends public dollars on healthcare for old people. That spending is funded almost entirely by taxes.

    – Medicare Part A has no premium whatsoever for beneficiaries. Part B has a monthly premium that’s tied to how much the beneficiaries earn. The more you earn the more you pay out of pocket. Part D has a deductible and a premium, again based upon income. People earning more pay more out of pocket.

    – The premiums for Medicare are set by the government. Again, this is not insurance. It’s not based upon market forces. The analysis is not the same as it would be for a private, for-profit health insurer. The government can hike premiums the same way it could hike the tax rate, by fiat. It really makes no difference how healthy or unhealthy is the collective pool of beneficiaries. If the government wants to spend less on Medicare they’ll spend less. It could lower the eligibility age and then increase in any event the premiums paid by beneficiaries, merely by fiat. Again, this is not insurance. There’s no competition. There’s only one federal government.

    – Medicare coexists with actual private insurance. Vast numbers of people aged 65 and over still are in the employed workforce (or their spouses still are in the employed workforce) and thus are beneficiaries under private, group health insurance programs. For those people, unless the plan sponsor is a very small employer, the private, group health insurance pays first; Medicare only pays after the private layer of coverage stops paying. So it’s already the case for large numbers of people and for substantial elements of their healthcare needs that even though they’re age-eligible and even though they’ve actually gone ahead and filed for Medicare they’re still not receiving any benefit from the program.

    – So in thinking about the eligibility age for Medicare the question has very little to nothing to do with the overall costs of healthcare tied to the program. It’s a question whether you want to spend more public (i.e., taxpayer) dollars or less taxpayer dollars. And whether you want to spend more taxpayer dollars sooner or some amount of taxpayer dollars (more or less, largely depending upon Congressional fiats) later.

    – Lastly, regarding the single payer issue, the best way to analyze that is to put Britain and the U.S. side by side over the past four decades and to compare and graph the following: average annual unemployment rates, per capita incomes, per capita net wealth. Then to keep in mind that when Britain implemented single payer they didn’t nearly have a debt-do-GDP ratio in excess of the Rubicon level of 100% nor did they have a budget deficit well in excess of the Rubicon level of 5% of GDP. If the U.S. implemented a single payer system now, despite its current budget deficit and its national debt scenarios, quite literally it would destroy the entire economy in one fell swoop; we’d smell a lot worse than PIIGS.

    Like or Dislike: Thumb up 1 Thumb down 7

  13. john personna says:

    @Tsar Nicholas:

    If the U.S. were a stock I’d be short selling it.

    LOL, there he is again. It’s not just gen-y slackers anymore.

    And of course, he hasn’t learned that he CAN short the US. Or he’s too chicken to take a position.

    Like or Dislike: Thumb up 4 Thumb down 0

  14. john personna says:

    @Tsar Nicholas:

    Lastly, regarding the single payer issue, the best way to analyze that is to put Britain and the U.S. side by side over the past four decades and to compare and graph the following

    No. The “best way” would be to chart all of the single payer systems in use across the developed world.

    Like or Dislike: Thumb up 8 Thumb down 0

  15. rudderpedals says:

    @Hal 10000:

    There are exceptions currently for those under 65 who can’t work anymore

    If you’re talking about Soc Sec disability you should mention the two year waiting period before Medicare eligibility. The gap is so long and so far out for people with immediate medical needs that bankruptcy during the gap becomes inevitable.

    Like or Dislike: Thumb up 1 Thumb down 0

  16. Rafer Janders says:

    @Hal 10000:

    There are exceptions currently for those under 65 who can’t work anymore. I suspect that any change to the Medicare law would have to account for this.

    That’s for those who can’t work. But we’re talking about those who could work, but only with great difficulty and pain and by inflicting further damage to their bodies, or who could work but shouldn’t because they’re putting themselves and others in danger.

    Like or Dislike: Thumb up 1 Thumb down 0

  17. Stan says:

    @Tsar Nicholas: “Lastly, regarding the single payer issue, the best way to analyze that is to put Britain and the U.S. side by side…”

    Great Britain doesn’t have a single payer system. Its medical system, like Spain’s and like our medical care for the active duty and retired military, is true socialized medicine. If you want to make comparisons with countries that actually use a single payer system, compare Medicare with France or Canada.

    Like or Dislike: Thumb up 6 Thumb down 0

  18. James Joyner says:

    @Stan: Actually, most of our active and all of our retired military have been moved out of military care and into Tricare, which is an insurance system. It’s still possible to get treatment at Walter Reed and a few places but, for the most part, our military and their families are treated in the civilian system.

    Like or Dislike: Thumb up 0 Thumb down 0

  19. Stan says:

    @James Joyner: Very interesting. Is Tricare purely private, like Aetna, or is there some governmental oversight?

    Like or Dislike: Thumb up 0 Thumb down 0

  20. Dave Schuler says:

    @Rafer Janders:

    The labor force participation rate for workers over age 65 has been increasing fairly rapidly over the period of the last 15 years. The unemployment rate for workers over age 65 is lower than that of nearly all other age groups.

    Like or Dislike: Thumb up 0 Thumb down 0

  21. James Joyner says:

    @Stan: It came about after my time, although my parents were converted to it. It’s an outgrowth of the old CHAMPUS program, which was supplemental insurance, but it’s now pretty much the whole enchilada. Wikipedia has a good treatment. It’s DoD-managed, under the ASD for Health.

    Like or Dislike: Thumb up 0 Thumb down 0

  22. john personna says:

    @Dave Schuler:

    From that, labor force participation of 65 YO males is 20%? And for women about 12%?

    That leaves 80-90% looking elsewhere for insurance.

    Like or Dislike: Thumb up 2 Thumb down 0

  23. Dave Schuler says:

    @john personna:

    My reply was specific to Rafer Jander’s comment implying that there were no jobs for people over 65. I think it’s actually easier for people over 65 to get a job than it is for people under 20.

    As to the meat of the post, I think that Medicare was an error. 45 years ago we should have gone to a needs-based plan with different standards of need for those over 65 and those under 65. 20 years ago we should have gone to a single-payer system.

    At this point we’ve screwed up our healthcare system so badly I don’t know how the pieces can be put together again.

    Like or Dislike: Thumb up 3 Thumb down 0

  24. James Joyner says:

    @Dave Schuler:

    At this point we’ve screwed up our healthcare system so badly I don’t know how the pieces can be put together again.

    It’s an interesting question. I’m not sure how we survive, regardless of how we pool money, with a fee-for-service structure.

    Like or Dislike: Thumb up 1 Thumb down 0

  25. Rafer Janders says:

    @Dave Schuler:

    My reply was specific to Rafer Jander’s comment implying that there were no jobs for people over 65. I think it’s actually easier for people over 65 to get a job than it is for people under 20.

    A job that offers full medical benefits that would be the equivalent of Medicare? Because that, after all, is the context of this discussion.

    Like or Dislike: Thumb up 1 Thumb down 0

  26. Ron Beasley says:

    I was in my late 50s when the tech bubble burst and my engineering job went away. I had Cobra for a year but after that discovered that no insurance company would even consider me for a policy – too old. When I turned 65 I went onto Medicare but I had not been to a doctor for nearly 6 years so I was not as healthy as I could have been so the cost to Medicare will be more. Pushing back the age of Medicare could actually save money.
    On a side note it defies logic that switching people from a system that has 3% overhead to private insurance with 25% overhead could save money.

    Like or Dislike: Thumb up 3 Thumb down 0

  27. michael reynolds says:

    Yes, we should have gone to a single payer, national system a long time ago. Unfortunately we have an infestation of these creatures called Republicans who oppose all rational solutions on the grounds that they don’t want nigras and messicans gettin’ none o’ their money. So it’s very hard to get from here to there.

    The path we’ve followed recently is to cobble together a jury-rigged system called Obamacare that would preserve all the worst of the “free market” and thus was just stupid enough to get the votes of Democratic senators (looking at you, Ben Nelson) from backward Republican states (you know who you are, Nebraska.)

    But, and it’s a big BUT: we have now established the principal that Americans get insured and it’s everyone in the pool and insurance companies can’t cut you off as soon as you get sick. That principal will survive. And on the basis of that principal we can now dick around for another 20 or 30 years, wasting trillions in the process, as we gradually get to where we could have gone decades ago if it were not for the fact that Republicans are retarded.

    It’s much the same story when it comes to race relations, immigration, abortion, tax reform and gay rights. We could do all sorts of sensible things efficiently if Republicans weren’t so fwcking stupid.

    Like or Dislike: Thumb up 12 Thumb down 1

  28. anjin-san says:

    Where have Florack and Drew gone? The day after Romney’s debate win in Denver, those cats were posting like a bat out of hell. Now they seem to have gone dark…

    Like or Dislike: Thumb up 1 Thumb down 1

  29. Moosebreath says:

    “Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.”

    Yes, we would. But that would be that SOCHULIZED MEDICINE that Republicans have been campaigning against since Ronald Reagan made speeches against the passage of Medicare in the ’60’s.

    Like or Dislike: Thumb up 3 Thumb down 0

  30. Rafer Janders says:

    @Rafer Janders:

    To continue my point, there are of course jobs that 65 year olds can get — greeter at Walmart, cashier at McDonald’s, etc. — since we seem to be a society that would rather punish the elderly with more work rather than having them suffer the horror of a dignified retirement after a lifetime of work. But few to none of those jobs will offer the sort of full medical benefits that would replace Medicare, so any working 65 year old will be much worse off in the private market than they would be on Medicare.

    Like or Dislike: Thumb up 1 Thumb down 0

  31. Whitfield says:

    One of the problems with Medicare is some of the doctor visits are excessive. One of my parents was in a nursing home, no health problems. About every 3-4 months they would send him to a doctor for just a routine check: bp, pulse rate, breathing, and that was it. After the second time, I inquired around about why this was being done and was told, “oh, Medicare pays for a certain number of visits per year, sick or not.” I put to stop to that and told them, barring an emergency, call me before sending him to any more doctors. See why our medical care is so expensive ? Some of the doctors are riding the “gravy” train !

    Like or Dislike: Thumb up 2 Thumb down 0

  32. Andre Kenji says:

    @SKI:

    We don’t have a medicare problem, we have a HEALTH CARE problem. Our system is too expensive and inefficient and fragmented. We aren’t keeping people healthy and we aren’t providing care continuity. Only 13% of hospital care is based on evidence-based protocols. That number should be around 50%.

    More or less. Medicare has no cost controls, it´s very easy to defraud. It´s part of the problem. Public healthcare should be a safety net. So, if you don´t want to wait for medical procedures and if you want to have all kinds of medical procedures to keep you alive regardless of the costs then you should look for Private Care.

    On the other hand, the main opposition for cost controls on Medicare comes from the Republicans. That´s insane. The best Conservative option for healthcare would be universal health coverage to everyone, coverage that could be complemented with Private Insurance.

    By the way, the United States has no budget for Healthcare, and it´s government spends one of the largest amounts of it´s Federal Budgets with Healthcare in the world.

    Like or Dislike: Thumb up 2 Thumb down 0

  33. Andre Kenji says:

    @Whitfield:

    See why our medical care is so expensive ? Some of the doctors are riding the “gravy” train !

    Sure that they are. I know several doctors. Many of them have very comfortable lives, but they don´t belong to the 1%. The United States is the only country that I know where most doctors are millionaires, no wonder that healthcare is expensive.

    Like or Dislike: Thumb up 1 Thumb down 0

  34. Gustopher says:

    Not sure how it works out for the government’s budget and taxes, but increasing the age of Medicare eligibility will definitely cost each individual person more.

    Medicare Advantage, the private option for Medicare, is more expensive and requires subsidies to keep it going. We would effectively be forcing each person into the more expensive Medicare Advantage for two years, and making them shoulder the costs 100%.

    Or making them skip health care (and pay the mandate tax, since it will be cheaper), at an age where small problems can become big problems very quickly, wipe out their savings, send them into bankruptcy, leave piles of unpaid bills that then get factored into the costs for everyone else.

    I really wonder about some people. Do they hate taxes that much that they want to pay more to a private company for the same (or lesser) service?

    Like or Dislike: Thumb up 4 Thumb down 0

  35. James Joyner says:

    @Rafer Janders: Presumably, the 65-year-olds who are now transitioning to Medicaid wouldn’t go out and seek jobs as Wal-Mart greeters if they were made to wait a year. Rather, they’d continue working in their current jobs.

    Like or Dislike: Thumb up 0 Thumb down 0

  36. Stan says:

    Before retirement I did academic research in a branch of applied mathematics. Before starting a new study my students and I would see what the competition was up to. If they used a really good numerical procedure for solving a problem, we’d use it too if it was suited to our problem. So I think we should see how other industrial countries cope with medical costs.

    In the US the cost of a standard MRI is $1080. In France it’s $280. See
    http://tinyurl.com/d389ahy for a discussion. Google “It’s the prices, stupid”, and you’ll find this example duplicated for all sorts of medical procedures. Americans get less medical care than Europeans or Canadians and have shorter hospital stays, but the cost of their treatment is much higher here than in Europe or Canada. It’s paid for by our insurers, but in reality we all pay for it in the form of lower wages.

    Why is this? The reason, at least according to many medical economists (see “It’s the prices, stupid”) is that our fragmented and highly inefficient insurance industry isn’t as good in bargaining for low prices as the single payer insurers in France and Canada or the sickness societies in Germany, Switzerland, and the Netherlands. In similar fashion, Walmart and Costco pay lower prices for their breakfast cereal than mom and pop bodegas.

    So my conclusion is that we’ll never get medical costs under control until we either a) develop a highly concentrated and tightly regulated private insurance industry, or b) go over to a government controlled single payer system. I don’t much care which. But I don’t think we can continue along the same path, and I reject the notion that Paul Ryan’s type of reform has anything to offer the country.

    Like or Dislike: Thumb up 6 Thumb down 0

  37. An Interested Party says:

    Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.

    And you are a Republican!? Oh my, it must be lonely…

    If the U.S. implemented a single payer system now, despite its current budget deficit and its national debt scenarios, quite literally it would destroy the entire economy in one fell swoop; we’d smell a lot worse than PIIGS.

    It’s bad enough that this idiot’s ranting includes the same trite clichés over and over and over again, but this “sky is falling” horse$hit just makes whatever he writes that much more rancid…

    Like or Dislike: Thumb up 2 Thumb down 0

  38. Just Me says:

    The reason, at least according to many medical economists (see “It’s the prices, stupid”) is that our fragmented and highly inefficient insurance industry isn’t as good in bargaining for low prices as the single payer insurers in France and Canada or the sickness societies in Germany, Switzerland, and the Netherlands.

    That’s because they don’t really bargain, they set the prices and tell the doctor’s and hospitals what they are going to pay.

    I do think the costs are a huge part of the problem, and this is a problem not limited to services and tests but also to medications (medications here in the US are often much more expensive).

    Like or Dislike: Thumb up 0 Thumb down 0

  39. michael reynolds says:

    It’s the costs, which in turn push doctors to order more procedures. It’s also a hypochondriac and immature population. And it’s a society that hasn’t figured out that keeping a comatose 90 year old alive to see 91 is maybe not as useful as sending a bright 18 year-old to college.

    But mostly it’s Republicans who cripple our capacity to deal with any of this with their ridiculous worship of clearly failed “free market” solutions and their tinfoil hat terror of all things government, not to mention their nativist ignorance in insisting that a steaming American turd of a system must be better than anything those socialist Europeans come up with.

    It’s fine to play engineer and say, “Hey the problem is we need to turn that screw tighter,” but if you have 50% of the politicians in the country determined to outlaw screwdrivers then the problem isn’t the screw.

    Like or Dislike: Thumb up 4 Thumb down 1

  40. Al says:

    @Tsar Nicholas:

    If the U.S. were a stock I’d be short selling it.

    Your “If X were a stock I’d short it!” line looks a lot less clever when there are actual methods to short X.

    Like or Dislike: Thumb up 6 Thumb down 0

  41. rudderpedals says:

    See http://tinyurl.com/d389ahy for a discussion.

    there is more time for loved ones to consider costs, but little emotional space to do so — no one wants to think there was something more they could have done to save their parent or child. It is not like buying a television

    As a society we deal with situations like this all the time but in the other contexts it’s called price gouging and it’s wrong.

    Like or Dislike: Thumb up 0 Thumb down 0

  42. Stonetools says:

    So James, a committed Republican, is in favor of single payer? Maybe James hasn’t been checking the Republican talking points, which says that ACA is soshulism, much less single payer.

    Just how Republican are you, James? Anyone, it’s good to see you being open minded about the health care debate.

    Like or Dislike: Thumb up 1 Thumb down 0

  43. Stan says:

    @Just Me: “That’s because they don’t really bargain, they set the prices and tell the doctor’s and hospitals what they are going to pay.”

    Within limits. If the government (France and Canada) or the sickness societies (Germany, Switzerland, the Netherlands) set the prices too low, a black market will develop. So I think it’s really a negotiation more than simply a command by the agencies that issue insurance.

    Like or Dislike: Thumb up 1 Thumb down 0

  44. Andre Kenji says:

    @Stan:

    Why is this? The reason, at least according to many medical economists (see “It’s the prices, stupid”) is that our fragmented and highly inefficient insurance industry isn’t as good in bargaining for low prices as the single payer insurers in France and Canada or the sickness societies in Germany, Switzerland, and the Netherlands. In similar fashion, Walmart and Costco pay lower prices for their breakfast cereal than mom and pop bodegas.

    The:United States has one of the lowest proportion of doctors per population inside the OECD. Insurance is not a problem per se. A big part of the problem is that almost impossible to pay out of pocket for medical expenses. In 2010, a Republican candidate for the Senate in Nevada was mocked when she talked about people paying the doctor with chickens, but part of the problem is that: it´s too expensive to pay directly a doctor, even for simple procedures, regardless of the poultry. In most countries, people can pay small procedures directly to the doctor. Like, you know, taking some bills from the pocket.

    Like or Dislike: Thumb up 0 Thumb down 0

  45. Spartacus says:

    James wrote: “Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.”

    I truly do mean this in a respectful way, but this is why you are perceived as a tribalist and not taken as seriously as someone with your knowledge and intelligence normally warrants.

    I don’t know how important things like the debt, the economy, unnecessary wars, equal rights for gays and global warming are to you, but many of your posts seem to suggest that these are all pretty big concerns of yours. Yet, you voted for Romney over Obama even though all the empirical evidence shows that Obama, while clearly flawed, is clearly superior to Romney on each of these issues.

    I suspect GOP rhetoric may resonate with you more than Democratic rhetoric, but when it comes to actual policies and governance, there simply is no empirical justification for having chosen Romney over Obama – unless you are a SoCon, which you clearly are not.

    Like or Dislike: Thumb up 2 Thumb down 0

  46. anjin-san says:

    keeping a comatose 90 year old alive to see 91

    There is good money in this. My grandfather was resuscitated after his second stroke in spite of having a DNR in place. He lived 9 more months, in misery the whole time. His convalescent care cost about 8K a month. Somebody made out on the deal, but it certainly was not my family.

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  47. john personna says:

    @James Joyner:

    Presumably, the 65-year-olds who are now transitioning to Medicaid wouldn’t go out and seek jobs as Wal-Mart greeters if they were made to wait a year. Rather, they’d continue working in their current jobs.

    When the employment rate in this group is sub 20%, why on earth would the vision be that they’ll “keep working?”

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  48. Barry says:

    @Just Me: “I will also add that people making these decisions need to realize that while they have spent their lives working in suits and doing very little hard physical labor can probably work until closer to 70 there are a large number of people out there in jobs where a 67 year old is going to struggle.”

    Please forgive me the shouting:

    It is not the physical labor; it’s getting a job at all.

    Age discrimination starts at what – 40 or so? – and goes up from there. If you are laid off after age 50 or so, I’d definitely place my bet you never getting a middle-class job again.

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  49. Barry says:

    @Tsar Nicholas:

    “If the U.S. were a stock I’d be short selling it. ”

    Yeah, right.

    If you believed a word of what you’re saying, you’d have emigrated.

    I’ll honestly ask here – when was the last prediction you made which was not 100% wrong?

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  50. Rafer Janders says:

    @James Joyner:

    Presumably, the 65-year-olds who are now transitioning to Medicaid wouldn’t go out and seek jobs as Wal-Mart greeters if they were made to wait a year. Rather, they’d continue working in their current jobs.

    I think it’s been quite some time since you’ve done any physical labor, James, or worked in a competitive office environment with constantly updating technology. If you do any sort of demanding physical work at all, or even work that requires you to be on your feet — farmer, cook, construction worker, waitress, cop, fireman, factory worker, soldier, sailor, nurse, carpenter, etc. — working a few more years is often not really an option because your body can’t handle it any more.

    And even if you have an office job, management will often push you out because they want new blood, or you may not be able to keep up with the work, pace and long hours, and with the new technology, the way that your 25-45 year old co-workers will be.

    Of course, it’s easy to keep working if all you really do is toss off a few blog posts now and then, read books, and sit in an office thinking deep thoughts. That you can do till you’re 90. But most people don’t have it so easy.

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  51. James Joyner says:

    @Spartacus: My position on healthcare simply isn’t represented in our political system, at least at the practical level. ObamaCare was actually a step in the wrong direction.

    @john personna: @Rafer Janders: I don’t necessarily think it’s a good idea in general to prolong the mandatory work life and have argued for years that it’s simply not doable for manual labor. I’m simply saying that that’s the vision here: People that now retire at 65 would keep their jobs another year.

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  52. john personna says:

    @James Joyner:

    Right but if the vision is based on a false impression, education is key.

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  53. Spartacus says:

    @James Joyner: “ObamaCare was actually a step in the wrong direction.”

    The issue isn’t whether you were supportive of ObamaCare, but whether you were supportive of the candidate that is more likely to support policies that are closer to your ideal. There also are many on the Left who think ObamaCare is a step in the wrong direction, but they recognize that it is a shorter step in the wrong direction than anything Romney or anyone else in the GOP would ever propose.

    And, like you, Obama and just about everyone on the Left acknowledges that a single-payer system is the most cost-efficient one. But, this country’s move in that direction is being impeded almost exclusively by people on the Right and in the center.

    So, again, on all of the big policy issues, as between Romney and Obama, the superior (not necessarily ideal) positions were held by Obama and not Romney. You seem to recognize that (or are at least capable of recognizing it) and yet you still voted for Romney. Assuming you have good intentions for the country (which I believe you do), there seems to be no justification for your choice of Romney other than tribalism.

    Based on the majority of comments on OTB, my perception that tribalism is your motivation is clearly the common one. If tribalism is not your motivation, then how did we all come to that conclusion?

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  54. swbarnes2 says:

    @Stonetools:

    Just how Republican are you, James?

    He’s Republican enough to support crazy and harmful Republican policies by voting for Republicans.

    That’s the only measure that matters.

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  55. swbarnes2 says:

    @Spartacus:

    So, again, on all of the big policy issues, as between Romney and Obama, the superior (not necessarily ideal) positions were held by Obama and not Romney.

    Read the post where James answers why he’s going to vote for Romney

    http://www.outsidethebeltway.com/why-romney/

    Notice how policies are nowhere on the list. He just doesn’t care.

    If tribalism is not your motivation, then how did we all come to that conclusion?

    I bet you know the conservative answer to this one already. It’s women, and blacks, and Asians, and Hispanics, and Jews, and gays, and Muslims, and young people, that is, everyone who isn’t an older white guy, who are tribal. Older white men are in fact the only class of Americans to have not a trace of tribalism, therefore, James can’t be voting on a tribal basis. QED.

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  56. Spartacus says:

    @swbarnes2:

    http://www.outsidethebeltway.com/why-romney/

    Wow! I hadn’t seen that. James is way more feckless and a lot less thoughtful and well-intentioned that I had imagined.

    Of the 5 reasons he listed (inertia, loyalty, the real Romney, the fiscal cliff and fixing the GOP), the fiscal cliff is the only one that takes into account what’s best for the country. When 80% of the reasons for your vote have nothing to do with bettering the country, you ought to just stay home.

    Moreover, when your #2 reason for voting for Romney is “loyalty” to the GOP, you are a tribalist by definition.

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  57. Stan says:

    @Andre Kenji: The question is why our prices are so high. The medical economists I cited suggest that the buyers of medical care in the US – for the most part, insurers – don’t have sufficient bargaining power to keep prices low.

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  58. Whitfield says:

    A friend told me that her 11 year old daughter’s monthly medical insurance premium recently jumped from $220 to around $300 ! First of all this is way too big of a jump in one month. Second, this way too much to charge for a child of that age. It astounds me that insurance for children is that high. This is a very low risk group for major medical problems. As a whole, the statistics show that most of the health issues for them are accidents (sprains, sometimes breaks and these usually can still be handled by the family doctor), flu, sore throats (these can be treated at home usually without a doctor visit). So why the huge insurance charges ?
    I can’t seem to get any clear answers as to why it would go up that much. There is one site that offered some information: Go to endoftheamericandream ; then search for past articles on health insurance going up.
    Is this the first symptoms of the Obama health care implementation ?

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  59. James Joyner says:

    @Whitfield: I’m not sure about 11-year-olds but, certainly, younger children are huge consumers of healthcare. They’re sick all the damn time. I’m sure mine get more than $300 a month in treatment on average.

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  60. Whitfield says:

    @James Joyner: When I was eleven years old, I probably went to a doctor about every 5-7 years. Hardly ever missed a day of school. Blessed with good health, but if I did get sick, it was in bed, shades drawn, no tv ! I got well quick !

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  61. James Joyner says:

    @Whitfield: Same here. I was pretty sickly in preschool but was healthy pretty much from when I had my tonsils out until I had little kids of my own.

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  62. wr says:

    @anjin-san: ” those cats were posting like a bat out of hell”

    Cats can only post like bats for so long before the cross-species issues get too hard to handle.

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  63. Whitfield says:

    @James Joyner: I don’t want to eat up your time but my doctor kept threatening the tonsil thing every time I went in with a sore throat. He never went through on that as doctors got away from a lot of tonsil removals . Most people will tell you that it won’t prevent future sore throats anyway.

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  64. Dave Anderson says:

    @Whitfield: The reimbursement rate for the 15 minute is fairly low, so while this is a problem, it is not a top 100 cost driver.

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  65. Dave Anderson says:

    @James Joyner: James — statistically, kids are dirt cheap to insure. Take a look at what full cost CHIP charges and that gives you a decent idea. In Pittsburgh, full-cost CHIP has an option at $135 a month for a kid between birth to 18.

    The medical profile for kids is lots of contact with the system (flu, broken ankles, that strange red rash on your arm that feels hot) but overwhelmingly at the primary care, or simple specialist level (orthopedist to get the arm set correctly). That is cheap to cover. Kids are far less likely to get cancer, far less likely to have chronic diseases, far less likely to have multiple compounding and interacting conditions. They don’t spend a lot of time in the hospital on average.

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  66. Dave Anderson says:

    Austin Frakt at the Incidental Economist has a good FAQ on why on a social basis, Medicare at 65 is way cheaper than Medicaer at 67. There are two drivers:

    1) Private insurance as a replacement for Medicare for the 65 and 66 year olds is extremely expensive, they don’t want to take on near-certain high cost users, so they are priced out of the individual market, and the group insurance market will see premium increases.

    2) Medicare has a much lower reimbursement rate (amazing what buying in bulk can do), so a given procedure is significantly cheaper for Medicare than it is for Wellspan or Blue Cross/Blue Shield for that same 66 year old.

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  67. Rob in CT says:

    Indeed, we’d almost certainly be better off as an economy if we radically lowered the eligibility age and simply pooled the entire country into a single payer system in lieu of the expensive and porous hodgepodge we have now.

    Well yeah. I’m up for it.

    This is just about cost-shifting. The costs are still there. This would just shift some of them off the governmental balance sheet… and onto others.

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