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The Surreal Nature of the Medicare Age Debate

The “Yes, Minister” Theory of the Medicare Age

Aaron Carroll can’t believe that we’re still talking about raising the age for Medicare eligibility; his disbelief is easy to understand. It is, after all, a truly terrible idea, for reasons he details in the linked post; it would inflict vast hardship on the most vulnerable, while saving the federal government remarkably little money, and would actually raise overall health spending, basically because private insurers have much higher administrative costs and much less bargaining power than Medicare, so shifting seniors out of the program ends up costing a lot of money.

Yet the idea just won’t go away. It’s almost surreal. What’s going on here?

One answer is that conservatives badly want a rise in the Medicare age, never mind the policy virtues or lack thereof. Why? Partly because liberals hate the idea: pay any attention to right-wing rhetoric and you learn that spite against liberals, even if there’s no gain for their side, is a major motivator. Beyond that, there is some actual strategic thinking here: by reducing the number of people receiving Medicare, they hope to undermine support for the whole program. No, really:

The most important likely effect is political. Reforming Medicare is difficult in part because of resistance by beneficiaries, who hold a lot of political influence … Diminishing the size of the beneficiary class is likely to diminish resistance to further change, and while it’s not enough, it might ultimately make reform easier.

“Reform”, in this case, means killing the program.

But that’s the right. What about centrists and deficit scolds; why are they for this?

One answer is that many “centrists” are actually right-wingers, at least in the sense that they are basically hostile to the welfare state and view shrinking it as a key goal; the same is true of most deficit scolds, who seem far more interested in cutting social spending than in shrinking the deficit per se.

But there is, I believe, another factor: raising the Medicare age sounds serious, even though it isn’t, and it’s something you can do, then congratulate yourself on your seriousness.

When I look at this whole discussion I keep thinking of a line from “Yes, Minister”: “We must do something. This is something. Therefore we must do it.”

And there’s a real possibility that this kind of logic will lead to huge suffering for hundreds of thousands of older Americans.

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