It’s been a long time since she was tasked with reforming health care and the reimbursement associated with it, and a long time since she was blamed for the failure to enact such reform. Many have speculated, and been concerned, with what Hillary Clinton would propose as part of her Presidential platform. Now we know – she would expand Medicare by lowering the eligibility age to either 50 or 55. This stirs a few thoughts (of course):

1) Some have tried to raise the Medicare age, since the actuarial expectations first derived in 1965 have gone, well, missing, given that the average life expectancy has increased so much since that time. As a result, Medicare keeps raising its fees, but still loses money. Not only are people living longer, but the cost of care and treatment for them once they hit a certain age has risen astronomically.

2) Many cost saving mechanisms have been instituted to reduce the continued and expanding losses attributed to Medicare, and still Medicare loses money and its end is predicated annually (they should form a betting pool on the date of its supposed demise)
The current projection is bankruptcy of Medicare by 2030.

3) Mrs. Clinton has suggested that younger retirees would have to buy in to the program to some extent (yes, more fees), they “would be buying into such a big program that the costs would be more evenly distributed” This is and should not be true. Insurance carriers have huge pools of participants, but at some point there are diminishing returns. A pool can only grow so much before its size is of no real consequence. In the meantime, Medicare would be adding an additional cohort of older Americans who will need to use its services. When you have a bigger pool of less desirable risks, what you have is even more trouble.

4) This is recycled Clinton rhetoric – under President Bill Clinton a proposal was made to allow those age 55 or above who had retired to buy in to Medicare with a cost of $400 per month (and that was then – what would they charge now?). Congress didn’t like it then, so how much more will they like it now (especially with Republicans in control) That detail, of how much the government, and the newly Medicare eligible would pay, is still missing from the proposal

5) Expanding Medicare to younger retirees could lead to more provider cost shifting to those covered by employer plans

6) There is discussion of how the cost of this would be offset – using Health Reimbursement Accounts to pay for the premiums – but HRAs are themselves being changed and restricted

7) This wouldn’t be pandering to another class of voters, would it?