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Old 12-10-2012, 12:56 PM  
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Raising Medicare's age limit.

It's been reported multiple times now that an age limit increase is on the table in the fiscal cliff talks.

Obviously, this is not going to be terrifically popular, and in my opinion I don't even think it'd be particularly smart. Raising the Medicare age doesn't reduce healthcare costs, it just reduces government healthcare costs, keeping seniors on the expensive private plans we introduced Medicare to save them from. Healthcare is not improved in any way as a result of it, and any and all forms of Medicare reform should be aimed at making the system work better -- savings should be the target, not cuts. Lord know there are many ways this can be had, and has already been had.

That said, if you're going to raise it, Ezekiel Emanuel introduces a really great way to do it: graduated eligibility.

Medicare eligibility stays the same for folks in the lower third of lifetime income levels. Medicare eligibility rises two to three years for folks in the middle third of lifetime income levels. And Medicare eligibility rises four to six years for folks in the highest third.

People in the lower third need Medicare the most, and the wealthiest need it the least. People in the lower third live the least healthy lifestyles due to lack of resources and, of course, tougher work over their lifetimes. The wealthier live on average six years longer, and have enough of their own resources to afford private insurance another few years as opposed to everybody else.

Again, I'd rather us take other methods of enacting savings on Medicare, but if this is something we're going to do, let's do it in a responsible way that doesn't strand the least wealthy seniors in a disproportionately tough healthcare situation.

http://www.washingtonpost.com/blogs/...ment-benefits/

Entitlement Reform For the Entitled
By EZEKIEL J. EMANUEL
May 20, 2012, 9:51 pm455 Comments

IF nothing is done about entitlement spending, and if our current tax breaks continue, then by 2025, tax revenue will be able to pay for Medicare, Medicaid, Social Security, interest on the debt and nothing else. The rest — defense, medical research, highways, education, energy — will have to be financed by deficits. Social Security’s funding is predicted to run short in 2033, Medicare’s trust fund in 2024.

Like much else in Washington, there is little bipartisan agreement on what to do about it. When it comes to Social Security and Medicare, Republicans emphasize cuts and privatization, while Democrats strongly oppose both approaches. Neither side was able to embrace the 2010 bipartisan Simpson-Bowles plan, which proposed lowering Social Security’s cost-of-living adjustments, increasing the taxable maximum income and raising the eligibility age to 69 by 2075.

But here is a better bipartisan reform: Graduated eligibility. Instead of having a fixed age at which people can get Social Security and Medicare, we should link the age of eligibility to lifetime wealth. The richer you are, the older you would have to be to be eligible for Social Security and Medicare.

Here’s how it would work. People in the bottom half of the lifetime earnings distribution would become eligible for normal retirement benefits at age 65 for Medicare and 66 for Social Security, just as they are today. But people in the next quarter of the lifetime earnings distribution would become eligible for the respective programs at 67 and 68, and those in the top quarter would become eligible at 70 and 71. All eligibility ages would increase over time, as they are scheduled to now.

In all income brackets, those choosing to retire later than the standard age would still receive higher Social Security benefits, called delayed-retirement credits. For those choosing to retire earlier and accept reduced benefits, on the other hand, nothing would change in the lower bracket, while the minimum age would increase in the two higher income brackets. And wealthier older people would have the choice of buying into Medicare at age 65, though they would have to pay for it before the age of 70.

Demographic changes since Social Security was first enacted are a good argument for raising the retirement age. In 1935, a man who reached the age of 65 was likely to live almost 13 more years (and a woman, almost 15). But today, Americans who reach 65 are likely to live nearly 19 more years.

But graduated eligibility also accounts for the fact that the rich live longer than the poor, and that the longevity gap is increasing. In 2007, the Social Security Administration did a study of mortality and income. Among 65-year-old men born in 1922, those with income in the top half lived an average of 2.2 years longer than those in the bottom half. But among 65-year-old men born in 1941, those with income in the top half were projected to live an average of 5.3 years longer. Thus, requiring wealthier Americans to wait five more years to claim Social Security and Medicare has the effect of giving an average rich and an average poor person nearly the same number of years of benefits.

This reform also combines several important values. The main reason Social Security and Medicare have such strong public support is that they are universal benefits; they are not just for the poor. With graduated eligibility, all Americans will still get benefits, regardless of income; the only thing that changes is when. And because the rich, on average, would live longer and get the same number of years of benefits as those in lower income brackets, the plan should appeal to those who still feel strongly that everyone should pay their fair share.

It also makes practical sense. Americans in the bottom half of the income distribution are more likely to have jobs in manual labor, which is more physically difficult for older people to perform. White-collar workers in the upper bracket don’t face the same physical demands. And their greater earnings mean they should be able to save more to support themselves longer.

Graduated eligibility should be based on lifetime earnings instead of any particular year’s income, which can be quite volatile. It would be administratively simple to determine each citizen’s lifetime earnings, because the Social Security Administration already has all this data. And this measure would have the benefit of encouraging personal responsibility; people making more than the median income would have an incentive to save. Anyone who earned a lot at one time but frittered it away would have to continue working longer.

Either in the lame duck Congressional session after the election or in 2013, there will surely be debate about a deal to address taxes and the deficit. Graduated eligibility should be on the table. It would not completely close the shortfall of the trust funds, but it would put Social Security and Medicare on a stronger financial footing, while reaffirming their universal nature and reflecting the fortunate fact that Americans are living longer.
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Old 12-10-2012, 01:32 PM   #2
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I think this is a decent way to get some cuts. The main problem I see with it is that you are going to have something akin to extremely high marginal tax rates at certain cutoff points, ie, if you earn 10 thousand dollars more in your last couple years of working you lose out on 3 years of Medicare eligibility. These types of cutoffs distort behavior strongly and are best avoided. If there is a way to deal with this problem then I support this plan.
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Old 12-10-2012, 03:44 PM   #3
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Why must we always try to divide people? Will you ever get tired of helping yourself to other people's money?

I agree with you that addressing rising costs is the top priority and that increasing the eligibility date is only a stopgap measure. Rising costs should have been the focus of healthcare reform. Where were you then?
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Old 12-10-2012, 04:20 PM   #4
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Quote:
Originally Posted by patteeu View Post
Why must we always try to divide people? Will you ever get tired of helping yourself to other people's money?

I agree with you that addressing rising costs is the top priority and that increasing the eligibility date is only a stopgap measure. Rising costs should have been the focus of healthcare reform. Where were you then?
Any program that will rob Peter to pay Paul will always have Paul's support.
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Old 12-10-2012, 04:26 PM   #5
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Originally Posted by patteeu View Post
Why must we always try to divide people?
Pragmatism, mostly.

The upper third of wage-earners are the absolute least likely to miss Medicare for the four- to six-year extension I'd favor. The middle third would suffer minimally for the two- to three-years they'd have to further wait.

The low third of wage earners is the class that relies on Medicare when they get old, and feel it the most as they are gradually charged more by insurance companies as they age.
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Old 12-10-2012, 04:28 PM   #6
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Originally Posted by fan4ever View Post
Any program that will rob Peter to pay Paul will always have Paul's support.
And yet Paul will continue to scratch by, whereas Peter continues to live comfortably.

Somehow I'm missing the crime that's being committed here.
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Old 12-10-2012, 04:46 PM   #7
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Quote:
Originally Posted by Direckshun View Post
Pragmatism, mostly.

The upper third of wage-earners are the absolute least likely to miss Medicare for the four- to six-year extension I'd favor. The middle third would suffer minimally for the two- to three-years they'd have to further wait.

The low third of wage earners is the class that relies on Medicare when they get old, and feel it the most as they are gradually charged more by insurance companies as they age.
Sick people are the people who rely on Medicare the most, not low wage earners. If you're going to give Medicare away early to people who need it most, why not base that on actual need instead of an income proxy?

By pushing these programs further and further toward welfare, you're going to undermine support for them.

Here's what John Rother, executive VP of AARP says about the subject:

Quote:
...Social Security and Medicare are not welfare programs. They are earned benefits that older Americans have contributed to over decades of hard work...

A means test for their earned benefits would erode the popular support that has sustained these programs and made them so effective in helping older households. Making Social Security more like welfare would surely lead to weaker benefits and a growing burden on young people to support struggling elders....
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Old 12-10-2012, 04:47 PM   #8
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Originally Posted by Direckshun View Post
And yet Paul will continue to scratch by, whereas Peter continues to live comfortably.

Somehow I'm missing the crime that's being committed here.
It was the "rob" part.
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Old 12-10-2012, 05:39 PM   #9
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Originally Posted by patteeu View Post
Sick people are the people who rely on Medicare the most, not low wage earners. If you're going to give Medicare away early to people who need it most, why not base that on actual need instead of an income proxy?

By pushing these programs further and further toward welfare, you're going to undermine support for them.

Here's what John Rother, executive VP of AARP says about the subject:
The truth is they are welfare programs though. They are not fully funded and today's beneficiaries will receive 3-4 times what they paid in. Until we start treating them as the welfare programs they are it will be impossible to make real spending cuts.
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Old 12-10-2012, 08:02 PM   #10
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The truth is they are welfare programs though. They are not fully funded and today's beneficiaries will receive 3-4 times what they paid in.
They are more like welfare programs today than they were when they were created, but they're less like welfare programs than they could be.

Quote:
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Until we start treating them as the welfare programs they are it will be impossible to make real spending cuts.
I agree that it will be easier to make cuts if we make them look more like welfare (or alternatively, if people start seeing/treating them more like welfare). In fact, we might as well eliminate Medicare altogether and just let Medicaid stand alone.
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Old 12-10-2012, 08:42 PM   #11
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Sick people are the people who rely on Medicare the most, not low wage earners.
And low wage earners are the ones with the most health issues by the time they're in their mid-sixties.

That's what this is all about.
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Old 12-10-2012, 08:43 PM   #12
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It was the "rob" part.
Yes, I know. Poor people looking for the most affordable healthcare are thieves. I got that.
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Old 12-10-2012, 09:17 PM   #13
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And low wage earners are the ones with the most health issues by the time they're in their mid-sixties.

That's what this is all about.
So again, why are you using a proxy? Why do you want to cover healthy 65 year old poor people who don't need medical care but not unhealthy 65 year old moderate income people?
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Old 12-10-2012, 09:18 PM   #14
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Yes, I know. Poor people looking for the most affordable healthcare are thieves. I got that.
No, the thieves would the the people who vote to take from one group to give to another. Some of those people might be poor, but others might just be liberals who think they have superior wisdom about how society should work.
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Old 12-10-2012, 09:26 PM   #15
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So again, why are you using a proxy? Why do you want to cover healthy 65 year old poor people who don't need medical care but not unhealthy 65 year old moderate income people?
Don't assign me to positions I don't have. I favor single-payer. I want everybody covered by a Medicare-type system.

I don't even want to raise the Medicare eligibility age. If we're going to do it, however, the working poor are the folks who categorically need Medicare the most at 65. The next third need it substantially less.

Conversely, you don't want anybody to be covered by Medicare at age 65.

That's the difference between us.
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