It’s Universal Coverage, Stupid

I’ve read all the arguments against (and for) raising the age of Medicare eligibility, but not this one: the ambition of universal coverage — or at least universal access to affordable, comprehensive care — is not itself universal. If you haven’t noticed, there is still lots of opposition to the ACA. There are still efforts at repeal. There are still legal challenges. Some are still trying to delay or obstruct implementation or otherwise encouraging failure. Medicaid won’t be expanded in all states, not immediately anyway. Expect exchange setup to be a huge lift, with many start-up problems that could undermine support.

In that context, nobody can say for sure how things will play out. Nobody knows the outcome of the next few election cycles. Progress toward universal coverage could stall or be reversed. Even a fully implemented ACA won’t achieve it.

Why, then, would anyone in favor of universal coverage, anybody pro-ACA, or anyone who voted for the legislation support increasing the age of Medicare eligibility? Why would they risk the chance that some 65 and 66 year olds would lose access to insurance?

Those in favor of raising the eligibility age say in reassuring tones that it’s risk free since we’ll have the ACA exchanges and Medicaid expansion to help fill the gap. But those same people aren’t putting their full weight behind ACA implementation. Some are actively opposing it. And they look dumbstruck at anyone who resists erosion of Medicare.

Well, it’s really not so hard to explain. It’s universal coverage, stupid. Why should we expect any two people who disagree over that to agree on revoking Medicare eligibility to anyone?

[Cross-posted at The Incidental Economist]

Austin Frakt

Austin Frakt is a health economist and an assistant professor at Boston University's School of Medicine and School of Public Health. He blogs at The Incidental Economist.