Lowering the age for Medicare

[harllee]

Rather than a flat age, what if you could claim Medicare after paying into the system for 30 years? I've paid into the system for 40 years but an over two years from Medicare. I would love to retire, but can't because of the great employer-provided healthcare. I would be happy to apply for Medicare right now!

That would work great for some of us (I started paying in at age 16) but what about stay at home parents?

 

[Midpack]

Rather than a flat age, what if you could claim Medicare after paying into the system for 30 years? I've paid into the system for 40 years but an over two years from Medicare. I would love to retire, but can't because of the great employer-provided healthcare. I would be happy to apply for Medicare right now!

That would also just make it more expensive for everyone. You're proposing adding more people to Medicare, a system already running deficits, and who are you proposing will pay the difference to just keep the deficits from increasing further? There's no free lunch...

 

[aja8888]

Medicare for all?

I had my right hip replaced under Medicare/supplement coverage Monday. I was home yesterday afternoon. Medicare is going to require hip and knee replacements to be done "outpatient" starting next year, which means same day surgery and sending home. That's one way Medicare will be cutting costs.

No formal PT was ordered for my hip replacement recovery. All knee and hip surgery patients were collected together in a room and given PT exercise instruction on the way out the door.

I suspect Medicare is looking for other ways to cut hospital and caregiver/doctor costs going forward.

 

[karen1972]

Rather than a flat age, what if you could claim Medicare after paying into the system for 30 years? I've paid into the system for 40 years but an over two years from Medicare. I would love to retire, but can't because of the great employer-provided healthcare. I would be happy to apply for Medicare right now!

Seems just as arbitrary as anything else. I retired after only 28 years of work history; however, given my high income, I put in substantially more than most since medicare isn't capped...so now I wouldn't be eligible? really?

I'm not asking the government to pay for Medicare prior to 65, I'm asking them to allow us to buy-in to medicare prior to 65. So my understanding is Part A premium is $458 if you lack credits, Medicare Part B $460.50 if high earner and I think Medicare D averages $40 for a true cost of $958. If I understand that correctly, then that is still cheaper than almost every plan I've seen on healthcare.gov for people over 60 and it has far lower deductibles and out of pocket costs. Its simple math, if the government is having to give someone an ACA credit for greater than what Medicare costs, then you should have the option of putting them on Medicare to save money... and those of us without ACA credits would also be getting cheaper and better insurance.

 

[6miths]

Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

 

[meleana]

My husband (65) is going on Medicare come 1/1/20. His (NY) Part F Premium is $230, Part D premium is $14 and Part B premium is $144. That leaves me (63 years old) with COBRA (Aetna POS Choice II High Deductible) at $529 which is $16 less than the company's Retiree Medical Premium ($545). Go figure.



I looked into the ACA plans in NY but they are all EPO's or HMO's. We are going to be living off savings in 2020, so I would qualify for a subsidy and cost sharing.


But we are also moving sometime after the first of the year to another state, so I am staying on Cobra as it is national and good in the state we are going to. No referrals. Can go out of network if want to (but for higher cost, of course). I will check into ACA in that state if I get a chance. Just will be in a flux and busy with all the logistics of the move. Hubby will have to change his Part D plan right away and we think he can keep the Part F because the same carrier is also in that state. We will have to call on that also.



I personally think we need a system like Canada's. Our healthcare system is totally convoluted.

 

[Bir48die]

A few things. It's not that I wouldn't like to see a single payer system. It's just not going to happen, in our lifetime. We are not set up to handle this big of an issue without either screwing it up like the current ACA without extreme backlash. Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost. As I said earlier, it's just not that you paid into the system X years. I did all that and more. It's that even if you pay $450/mth or whatever to get Medicare early the lower negotiated pricing will not sustain the system.

 

[meleana]

A few things. It's not that I wouldn't like to see a single payer system. It's just not going to happen, in our lifetime. We are not set up to handle this big of an issue without either screwing it up like the current ACA without extreme backlash. Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost. As I said earlier, it's just not that you paid into the system X years. I did all that and more. It's that even if you pay $450/mth or whatever to get Medicare early the lower negotiated pricing will not sustain the system.

I actually have spoken with many Canadians.

https://www.washingtonpost.com/heal...71c78e-d4d6-11e9-9610-fb56c5522e1c_story.html

 

[Sarah S]

I had my right hip replaced under Medicare/supplement coverage Monday. I was home yesterday afternoon. Medicare is going to require hip and knee replacements to be done "outpatient" starting next year, which means same day surgery and sending home. That's one way Medicare will be cutting costs.

Do you have a source for that? All I could find is starting next year reimbursements will be higher for these done in some outpatient settings. There will be incentives for surgeons not to do inpatient but the will be allowed according to several things I read. If your surgeon told you I would wonder if s/he was not willing to take the lower reimbursement

Not everyone can have the new procedures that make outpatient possible nor does everyone have support at home and good enough health/ physical condition to be sent directly home. While many Medicare rules are cruel ( or to put it more kindly misguided) I could not find this one

 

[aja8888]

I had my right hip replaced under Medicare/supplement coverage Monday. I was home yesterday afternoon. Medicare is going to require hip and knee replacements to be done "outpatient" starting next year, which means same day surgery and sending home. That's one way Medicare will be cutting costs.

Do you have a source for that? All I could find is starting next year reimbursements will be higher for these done in some outpatient settings. There will be incentives for surgeons not to do inpatient but the will be allowed according to several things I read. If your surgeon told you I would wonder if s/he was not willing to take the lower reimbursement

Not everyone can have the new procedures that make outpatient possible nor does everyone have support at home and good enough health/ physical condition to be sent directly home. While many Medicare rules are cruel ( or to put it more kindly misguided) I could not find this one

Sarah, the only source I have is the RN and Doctor that gave us our pre-op surgery class last week. Also, the RN in our post op class mentioned the same thing, about how we were lucky to get to stay the second day after (knee/hip replacement) surgery.

Oh, the anesthesiologist (an MD) went over the new procedure with me before I was rolled into surgery for administering the "stuff" so that patients came out of it quicker (pain block in hip (for me), spinal tap, followed by slightly more anesthesia than would normally be given for a colonoscopy). He said that was being done now to support outpatient stays for these kinds of operations. In other words, we were test cases.

 

[6miths]

Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost.

First, I apologize for stepping out of character as a polite Canadian.

I'm pretty familiar with 'their' system since it is 'ours'. There is a reason most Canadians are fiercely proud of their health care system. Having worked in the systems in both Canada and the US (as well as a couple of other systems and having been exposed to several more), there is no way I would ever choose the US system either as a consumer or a provider. There are many reasons that the US system will not change but in the end it comes down to money and I think most recognize this. Every system has flaws but it is unlikely that any OECD country's system has more major flaws than that of the US.

At the end of the day no one is spending any significant amount of money promoting universal healthcare in the US while the other side of the argument is supported by countless dollars from many sources. It is instructive reading the threads on the various plans available in the US and the angst that Obamacare caused in some circles.

For a second, imagine if you can, what it is like to not be concerned about how you are going to pay for essential health care services for yourself, spouse and family. And knowing that all of the other people in your country enjoy the same benefits.

 

[MRG]

Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

+1

Not an economist but I saw the Megacorp I w*rked for rake in hundreds of millions by doing processing for the healthcare industry. None of that added any value to anyone's healthcare; it simply fed the machinery. Why do we need a machine?

 

[Midpack]

A few things. It's not that I wouldn't like to see a single payer system. It's just not going to happen, in our lifetime. We are not set up to handle this big of an issue without either screwing it up like the current ACA without extreme backlash. Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost. As I said earlier, it's just not that you paid into the system X years. I did all that and more. It's that even if you pay $450/mth or whatever to get Medicare early the lower negotiated pricing will not sustain the system.

Those are the kinds of deliberately vague criticisms uninformed Americans use casually to defend the status quo - for a disjointed “system” that costs us twice as much as all other developed countries, with middling results in the US. If you can’t be specific you have no business throwing out blanket criticisms. Wait times is largely out of date. Canadians engaging in medical tourism to the US are exceptions, often wealthy Canadians and/or in need of leading edge procedures - not the routine stuff that makes up the bulk of health care.

Like they’re aren’t “incredible flaws” in US healthcare. Ask the millions of Americans without healthcare or those who can’t afford the care they need even with very limited HC insurance.

 

[Midpack]

Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

 

[Midpack]

Repeated by many, many times. Why so many Americans defend a “system” that costs much more, delivers middling results and leaves out millions is beyond me. Americans are paying much more, but it’s indirect - many naively think their premiums and out pocket costs are all they’re paying.

What does the United States have in common with Peru, Zimbabwe, Bangladesh, and Uzbekistan? Answer: none of them have a universal health care system. The US is the only country in the developed world that does not provide health care to all of its citizens.

The US federal government actually pays for a lot of health care. If you are old, very poor, or ex-military, the government foots the bill. That’s 37% of the population. But the system is hardly efficient. What the US pays for less than half of its population is more than what every other country pays to look after all their citizens, even after you have adjusted for population size (Norway and the Netherlands are the only exceptions).

Size, culture and politics are barriers to reaching universal healthcare in the US - but aren’t enough to explain why the US doesn’t provide health benefits for all. What does? Vested interests, diversity, and a fortunate history.

Vested interests. Spending on health care makes up a staggering 17.4% of American GDP. That’s double what Australia or Japan spends, and more than 5% more than its nearest competitor. There are a lot of people making a lot of money from the current health care system in the US. That includes hospitals, doctors, pharmaceutical corporations, and insurance companies. The only way the US could afford universal care would be to cut costs. That would mean confronting some or all of those who benefit from the current state of affairs. That would be very hard. It might even be impossible.

Universal health care works best in countries where people feel strong solidarity with one another. They think that everyone else in society is basically the same as them. But that’s never been the case in the US. The sheer size and cultural diversity of the country, and especially the old and painful divisions over race mean that it’s all too easy for Americans to feel that their fellow citizens are not like them at all. So why should they pay taxes for other people to get looked after?

Most European countries set up universal health systems after the Second World War. So many had died (tens of millions), so many made homeless (tens of millions), so many bereaved (hundreds of millions) that it was hard to argue against the idea that every citizen deserved the chance of a decent, healthy life.

The American experience of the Second World War was very different. 400,000 died, but the country looked better after it than before. The war had brought the US out of the Great Depression and the country was now the leader of the free world. It still had big problems, as the Civil Rights movement would show, but the postwar mood was triumphant, not somber. America was the richest, strongest country ever. It was easy to overlook those who couldn’t afford eyeglasses, let alone surgery.

https://restoftheiceberg.org/posts/2017/11/14/why-doesnt-the-us-have-universal-health-care

Paying more for less

Despite the evidence that a single-payer system would be a more efficient and cheaper choice, introducing it in the US is not a serious option. Trying to dismantle the current system would be a mammoth task. For one thing, it would cost a great many jobs: Health- and life-insurance companies employ some 800,000 people, with yet more employed by the medical industry just to deal with insurance companies. Though the savings from eliminating them could be invested in retraining those people for other professions, it would be difficult for any party to convince voters that it’s a necessary step.

And with a market worth more than $3 trillion, drug firms, medical providers, and health technology companies have an incentive to maintain a system that lets them set prices instead of negotiating with a single government payer. Both the GOP and the Democratic party are under the influence of the medical-industrial complex: In 2016, hospitals and nursing homes contributed over $95 million to electoral campaigns in the US, and the pharmaceutical sector gave nearly $250 million.

https://qz.com/1022831/why-doesnt-the-united-states-have-universal-health-care/

 

[marko]

Haven't read every post here but why not just increase the ACA income threshold to $100k for those over 50 or 55?

How many people take SS at 62 just to pay for health insurance? One could offset the other.

 

[6miths]

Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

I am not going to quote any articles, academic or otherwise, there are many sources on this and given that you just threw up a graph that shows the US spent twice as much on healthcare as Canada (and we can put up graphs that show many health indicators in the US are not as good - I am not going to do that either). As mentioned, the front end of the US system is deeply flawed and a huge burden, as well vast sums are spent on things that do not improve quality of life while relatively small amounts are not invested in preventative and basic healthcare that could be transformative. This is a retirement forum and I am sure that if you are informed you are already well aware of the issues. At every turn there will be many arguments about why this or that can't be or shouldn't be done. That side of the discussion is very well funded. In the meantime, the system should be a national embarrassment. My apologies.

 

[6miths]

Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

Again my apologies as it is easy to get worked up about this. I think a starting place could be articles written by Dr. Atul Gawande such as Overkill: America's Epidemic of Unnecessary Care. Or 'An American Sickness: How Healthcare Became Big Business and How You Can Take It Back' by Dr. Elisabeth Rosenthal. Both of these authors are Harvard educated MDs and have been frontline physicians though my understanding is that Dr. Rosenthal has given up active practice. Her book is well referenced, eye opening and somewhat depressing.

 

[Bir48die]

Well by golly, I certainly ruffled a few feathers. I love Canada. I did business there for twenty years. Many are my best friends. I love and used to play hockey. I've known the anthem since grade school. I love their maple syrup. I'll go there for my next open heart surgery. I promise

 

[Car-Guy]

In my way of thinning the biggest/best argument for Medicare for all is what has happened to private insurance in the past decade or so. Medicare, even with it's problems, is sooooo much better than private insurance, IMO. Why not at least make it an option for those under 65, at a comparable price to private insurance of course.

 

[Bir48die]

Just as a disclaimer, I have spent hours and hours speaking with my friends on this subject for Canada. My guy that ran the business there and worked for me asked me to bonus him with money going to supplemental insurance to cover the gaps.

The U.S. system is flawed. I admitted That and it is the largest expenditure I have by 2x and that’s just for me. I’ve never wanted to be 65 so badly. It’s sad

 

[ziggy29]

In my way of thinning the biggest/best argument for Medicare for all is what has happened to private insurance in the past decade or so. Medicare, even with it's problems, is sooooo much better than private insurance, IMO. Why not at least make it an option for those under 65, at a comparable price to private insurance of course.

I want to agree but some things need to be fixed. I don't know how many providers will stay afloat or continue to see Medicare patients if every patient brought in Medicare reimbursement rates. As it is, folks with private insurance (or uninsured, if they can pay) are subsidizing Medicare patients because of the difference in reimbursement rates.

So if M4A, or even an opt-in to purchase Medicare (even if only 50+ or 55+), is enabled something might have to give with Medicare reimbursement rates, which would of course mean more money (taxes and/or buy-in cost) to pay for it.

If you would have told me 20-30 years ago that Medicare would be considered a "good standard" for health insurance, I would have laughed in your face. I'm not laughing any more.

 

[Midpack]

I am not going to quote any articles, academic or otherwise, there are many sources on this and given that you just threw up a graph that shows the US spent twice as much on healthcare as Canada (and we can put up graphs that show many health indicators in the US are not as good - I am not going to do that either). As mentioned, the front end of the US system is deeply flawed and a huge burden, as well vast sums are spent on things that do not improve quality of life while relatively small amounts are not invested in preventative and basic healthcare that could be transformative. This is a retirement forum and I am sure that if you are informed you are already well aware of the issues. At every turn there will be many arguments about why this or that can't be or shouldn't be done. That side of the discussion is very well funded. In the meantime, the system should be a national embarrassment. My apologies.

Again my apologies as it is easy to get worked up about this. I think a starting place could be articles written by Dr. Atul Gawande such as Overkill: America's Epidemic of Unnecessary Care. Or 'An American Sickness: How Healthcare Became Big Business and How You Can Take It Back' by Dr. Elisabeth Rosenthal. Both of these authors are Harvard educated MDs and have been frontline physicians though my understanding is that Dr. Rosenthal has given up active practice. Her book is well referenced, eye opening and somewhat depressing.

These are answers to a question I didn’t ask.

Now you’re talking about what’s wrong with US healthcare system, where I clearly agree.

What I challenged, now clearly highlighted in red was your statement “Many health economists would say that the money to pay for universal healthcare in the United States is already in the system.” You said “many” - share one that credibly shows that. It’s not a simple as replace the US system with Canada’s (or any other country)...

Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

 

[ckelly78z]

I would be all for lowering the Medicare age to say 60. I have plans of retiring at 63.5, and paying for COBRA for the 1.5 years until I turn 65. If it could be half the cost of COBRA, I could possibly retire at 62.

I haven't really priced out having ACA instead of COBRA...still 8 years to go before I turn 62, and can start drawing SS. Alot of political posturing/promises, and failings will happen over that time period, so waiting to see what is available closer to my F.I.R.E date.

 

[ncbill]

ACA is a bargain compared to Medicare if you are RE and can "manage" your MAGI for the maximum premium subsidies & cost-sharing reductions (i.e. stay just over 100% of FPL, 138% in Medicaid expansion states)

Not so much if you're over the "cliff" (MAGI over 400% FPL)

I doubt Medicare will be so generous once I get there (~15 years)

Most likely every supplement plan with be some form of Advantage, with only a fixed amount (capitation) allowed annually based on one's age & health (e.g. is the patient compliant with doctor's orders?)