Examining Proposal To Expand Medicare
ROBERT SIEGEL, host:
So, how would it work to provide Medicare to a relatively younger crowd, people as young as 55? We're going to explore that question now with Marilyn Moon, who's an economist and Medicare expert with the nonpartisan American Institutes for Research, also a former trustee of the Medicare program. Welcome to our program.
Dr. MARILYN MOON (Economist, Medicare Expert, American Institutes for Research): Thank you.
SIEGEL: First of all, what are the demographics of these people between the ages of 55 and 64 who Medicare might cover according to the plans that you've heard rumored?
Dr. MOON: Well, this is a group of the population that is - I like the term pre-elderly that someone used that makes it sound a little bit exotic - but this is a population that's beginning to have the same kinds of problem that older people do in the United States - increasing amounts of chronic disease, so forth. They're a population that Medicare actually is very well-prepared to handle in many ways.
SIEGEL: And if indeed that population were to become part of Medicare, what impact would that have on reducing the number of uninsured in the country? What are we talking about in terms of numbers of people?
Dr. MOON: The numbers of people that are uninsured as a proportion of that age group are actually a little bit lower than the overall average, would be more in the range of 10 percent of that population. But they are the folks who tend to be the hardest to ensure because they do have pre-existing conditions and other health care problems.
SIEGEL: Now, we've just heard in Julie Rovner's report, we've heard the hospitals, the insurance companies, the Republicans saying this is going to break a system that's already strapped. Would it?
Dr. MOON: It would not have to. Certainly you would want to see some additional resources put into the program to cover these individuals. I don't think anyone would seriously talk about doing this without those resources. One of the things it would do, it would bring into the system, however, people who are going to transition onto Medicare. In many cases those are people who right now go on to Medicare after a period of not being insured and costing Medicare more. So it actually could lower some of Medicare's costs once people turn age 65.
SIEGEL: You're saying because it costs more to treat somebody whose condition may have been aggravated by not having medical attention during the previous 10 years before becoming Medicare eligible.
Dr. MOON: That's exactly right.
SIEGEL: How would the people you've described be able to afford buying into the program? Or would they presumably be subsidized?
Dr. MOON: Well, if they have lower incomes, they would be subsidized. This would operate the same way that people are talking about either private plan options or a public option through an exchange type arrangement, or that's what we're assuming. We don't know the details as yet. But presumably those who have very low incomes would receive a substantial subsidy. Others would have to buy that insurance and it could be relatively expensive, but still a good deal compared to what they have to do now.
SIEGEL: What about the argument we heard in Julie's story that because reimbursements for Medicare are lower than what doctors are getting from private insurance companies, that hospitals and physicians would be shifting as more people are being reimbursed at a lower rate? They'd be shifting their costs to people who have private insurance and other people's premiums would go up.
Dr. MOON: That's an area that's actually fairly controversial of whether or not that happens and to what degree it happens. We know, for example, in the case of hospitals, that most hospitals in the United States who are in a market where there's competition, where they've enforced to be efficient, get paid by Medicare enough to cover their costs. It's hospitals that are less efficient that have this problem.
So, to some extent this is going to force hospitals to work a little harder to be efficient. Physician services are different issue because physicians can't find efficiencies in the same way hospitals can. And I think there is some concern about making sure that physician payment is sufficient to serve these individuals.
SIEGEL: This is not a new idea extending Medicare to people younger than 65. But it's never been a very successful idea on Capitol Hill. What's different this time? What could make it work, actually?
Dr. MOON: Well, I think what can make it work is a recognition that this is a group of the population that if they lack insurance, need insurance much more than other folks in the population because of their health care problems. And it may be away to seamlessly, if you will, take care of older Americans who are going to eventually transition onto Medicare anyway. The challenge in the past has always been that it's expensive and it's going to be expensive. But we're talking about subsidizing these people anyway.
SIEGEL: Marilyn Moon, thank you very much for talking with us.
Dr. MOON: My pleasure.
SIEGEL: Marilyn Moon is director of health programs at the American Institutes for Research, a nonprofit social science research organization.
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