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?