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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, 09:30 PM   #16
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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.
I'm pretty sure almost everybody who votes thinks they have superior wisdom about how society should work.

That's why we have elections here in the US of A. That's how it works.
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Old 12-10-2012, 09:45 PM   #17
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Originally Posted by Direckshun View Post
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.
Why are you avoiding the issue I've raised? Why is the bolded method appropriate when we could instead cover people who actually need health care instead of just a group who, on average, need health care?
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Old 12-10-2012, 09:52 PM   #18
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Originally Posted by Direckshun View Post
I'm pretty sure almost everybody who votes thinks they have superior wisdom about how society should work.

That's why we have elections here in the US of A. That's how it works.
That's not really true. Conservatives believe that individuals are a lot better at making decisions for themselves than they are at making decisions for everyone. That's why conservatives are skeptical of centralized power and government solutions. To the extent that a central authority is required, conservatives like to avoid micromanagement (e.g. block grants; low-rate, broad-based taxation, etc.) Liberals think they have brilliant ideas about how to micromanage society and they want to impose their ideas on everyone else. They like centralized power because it allows them to spread their awesome ideas far and wide. They like things like higher tax rates with targeted tax cuts to more effectively influence behavior.
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Old 12-10-2012, 09:53 PM   #19
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Why are you avoiding the issue I've raised? Why is the bolded method appropriate when we could instead cover people who actually need health care instead of just a group who, on average, need health care?
Because, by definition of the group they belong to, the folks in the upper two thirds of wage-earners are more able to compensate for having Medicare raised a few years. The lowest third is nowhere near being able to compensate for that.
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Old 12-10-2012, 09:59 PM   #20
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Because, by definition of the group they belong to, the folks in the upper two thirds of wage-earners are more able to compensate for having Medicare raised a few years. The lowest third is nowhere near being able to compensate for that.
So it's about money to you and not about health? That seems messed up.

And there are certainly going to be many exceptions to your theory that people with a lifetime income in the top two thirds are going to be more capable of fending for themselves. What about all the people who had pretty decent paying jobs for the first 30 years of their working lives but then the Obama economy hit and they finish the last 15 underemployed. Are they really going to be more capable of fending for themselves than the guy who made less over his whole working life but is at his peak income when he gets to the end of career?
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Old 12-10-2012, 10:08 PM   #21
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Lets just get rid of it all together right now. Problem solved.
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Old 12-10-2012, 10:09 PM   #22
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Lets just get rid of it all together right now. Problem solved.
You should post a Cannibal's Grand Bargain thread. I bet you'd get more agreement than Direckshun did.
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Old 12-10-2012, 10:15 PM   #23
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So it's about money to you and not about health? That seems messed up.
It's both. The lowest third of wage earners are categorically the least healthy.

Between the three thirds, they need Medicare the most and can afford private insurance the least.
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Old 12-10-2012, 10:23 PM   #24
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You should post a Cannibal's Grand Bargain thread. I bet you'd get more agreement than Direckshun did.
My parents and grandparents are dead and it won't really be there for me anyway. End it.
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Old 12-10-2012, 10:30 PM   #25
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It's both. The lowest third of wage earners are categorically the least healthy.

Between the three thirds, they need Medicare the most and can afford private insurance the least.
It's not both. There's certainly some overlap, but lifetime earnings group is, at best, a rough proxy for health and ability to afford private insurance. But for some reason that you refuse to explain, you seem married to the proxy instead of a more direct measure of need.
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Old 12-10-2012, 10:34 PM   #26
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It's not both. There's certainly some overlap
Once again, you tell me I'm wrong then you reinforce my point.

I love this dance we do. I'm having a great time.

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but lifetime earnings group is, at best, a rough proxy for health and ability to afford private insurance.
The lowest third of wage earners live six years less than people in the highest third. That's not a rough proxy, that's facts.

Meanwhile, they can afford private healthcare the least.

If there's a better measurement than that for who deserves the current eligibility age, I'd like to hear it.
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Old 12-10-2012, 11:26 PM   #27
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Once again, you tell me I'm wrong then you reinforce my point.

I love this dance we do. I'm having a great time.
Except that you're wrong. I didn't reinforce your point. I highlighted the fact that you're dodging my question. You and your article are proposing that we use a proxy instead of directly identifying the people who are most in need. Why is that? Why not figure out which states have the earliest need for health care and have a lower eligibility age in those states?

Quote:
Originally Posted by Direckshun View Post
The lowest third of wage earners live six years less than people in the highest third. That's not a rough proxy, that's facts.

Meanwhile, they can afford private healthcare the least.

If there's a better measurement than that for who deserves the current eligibility age, I'd like to hear it.
That's a rough proxy because they don't all live six years less. Some of them live quite a long time.

The obviously better measurement is income at the age of 65 (as to who can afford private insurance) and health at the age of 65 (as to who needs health care the most).

Just to be clear though, I think it's toxic to make the eligibility age different for different groups of people like this in the first place.
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Old 12-10-2012, 11:45 PM   #28
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That's a rough proxy because they don't all live six years less. Some of them live quite a long time.

The obviously better measurement is income at the age of 65 (as to who can afford private insurance) and health at the age of 65 (as to who needs health care the most).

Just to be clear though, I think it's toxic to make the eligibility age different for different groups of people like this in the first place.
I'm not opposed to that, really. Your first measurement, income at the age of 65, isn't much different than mine, which is lifetime income. Typically those two coincide. That's fine.

The other one, health at the age of 65, would be difficult to quantify, don't you figure? That would be my practical concern, but if you've read some way that it can be efficiently quantified, I'm open to hearing it. I'm not opposed to it, either, since the poorest wage earners would likely benefit from it.

We're not as far apart on the issue as you'd claim we are. We even both agree on principle that people should all have the same eligibility requirements -- you'd just prefer people to be eligible at a later age, while I believe it's critical we remain at 65.
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Old 12-11-2012, 06:55 AM   #29
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Originally Posted by Direckshun View Post
I'm not opposed to that, really. Your first measurement, income at the age of 65, isn't much different than mine, which is lifetime income. Typically those two coincide. That's fine.

The other one, health at the age of 65, would be difficult to quantify, don't you figure? That would be my practical concern, but if you've read some way that it can be efficiently quantified, I'm open to hearing it. I'm not opposed to it, either, since the poorest wage earners would likely benefit from it.

We're not as far apart on the issue as you'd claim we are. We even both agree on principle that people should all have the same eligibility requirements -- you'd just prefer people to be eligible at a later age, while I believe it's critical we remain at 65.
Health at age 65 is easy to quantify. If you're sick you're sick and if you're not you're not. The system we have now provides health care for people who are sick at age 65 but doesn't provide it for people who are healthy.
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Old 12-11-2012, 07:50 AM   #30
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Health at age 65 is easy to quantify. If you're sick you're sick and if you're not you're not. The system we have now provides health care for people who are sick at age 65 but doesn't provide it for people who are healthy.
See, you're confusing me here.

How would we quantify somebody's health and apply it to an appropriate age at which they can become eligible for Medicare?
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