TL: How about raising the Medicare eligibility age?
HA: Most people now go on Social Security well before they become eligible for Medicare at age sixty-five. Right now, many have no health insurance between when they leave work and become eligible for Medicare. That gap is a problem. Raising the age of eligibility for Medicare would make it worse. If and when the Affordable Care Act is enforced and operating smoothly, it would be much less of a problem. Currently there is an additional problem with raising the age of eligibility. It would actually increase total health care spending because the private plans into which people would move are more costly than Medicare is, and it saves less for the federal budget than one might suppose, because of the added payments that cutting people out of Medicare generates in such programs as Medicaid. This change needs to remain on the table, however, as part of a long-term effort to encourage people to remain economically active to a later age than they do now. That trend is already underway.
TL: Medicare has low administrative expenses, about 3 percent of outlays compared to private insurance carriers. You’ve said they might be too low. What do you mean by that?
HA: Medicare collects several dollars for each dollar it now spends on enforcement. It should spend more to find cheats. Medicare has too little money and staff to make sure, when it approves a drug or a procedure for a particular condition but not for others, that payments are made only in the approved cases. Medicare now mostly pays bills, but it should also be collecting data to support comparative effectiveness research. Spending more on administration would lower total program costs and improve quality.
TL: How well has the press covered Medicare?
HA: Health policy and social insurance in general are not well covered. Health policy analysts spend their lives trying to understand the staggering complexity of the U.S. health care system. Reporters and editorial writers don’t have that luxury. They are largely at the mercy of one or another self-interested party to whom they may speak. This is an area where it’s extraordinarily difficult to do a good job, unless you specialize to some degree.
TL: So do you have any advice for the reporter who may not be an expert but covers these subjects sporadically?
HA: They should be careful of politically committed groups using the trappings of science not in the pursuit of truth but to make a case. Understand that even honest organizations are going to be attacked from both sides.
TL: Any other advice?
HA: Try to identify sources of honest analysis. If you want some suggestions, give me a call.