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December 14, 2012 12:40 PM Getting to Yes Doesn’t Have to Mean Terrible Policy

By Aaron Carroll

I’ve been following the tussle in the blogosphere between Jon Chait (and to a lesser extent Ezra Klein) and others with respect to “caving” on raising the eligibility age for Medicare. Jon’s argument is basically that this policy holds some special meaning for Republicans, and that giving in on it might allow Democrats to get things which are more important; those things may have a larger positive impact than what will be lost. I guess that’s possible. It’s also true that some of the criticism against him has that ring of “NEVER GIVE IN ON ANYTHING!!!!” I don’t care much for that kind of all-or-nothing gambling. I still get emails telling me it’s my fault we don’t have a single payer health care system in America.

That said, I still disagree with Jon here. It’s not that I’m opposed to negotiation. I understand that sometimes you have to give something to get something. I just think this is the wrong thing to give.

We need to find a way to control Medicare costs. That’s what everyone says they want. There are many, many ways to do that. This is one of the worst ways.

Raising the eligibility age for Medicare will increase the number of uninsured in the United States. It will likely lead to some negative health outcomes for seniors. It will repressively hurt the poor more than the rich. It actually removes benefits from many Americans instead of adjusting for increased life expectancy. It will raise the price of health care insurance for the rest of seniors. It will raise the price of health care insurance for the rest of America. Oh – and it actually costs more than it saves.

Seriously – what’s the upside again?

There are ideas out there that I don’t favor, but that I don’t wholly oppose. I think premium support and competitive bidding, if done correctly, might reduce costs in some markets. But at least there was an argument that it might do some good. I think means testing Medicare won’t actually save much money, but I could see letting that one go to get some greater good. That wouldn’t be so regressive, and arguments against it are mostly political.

But let’s face it. Raising the eligibility age for Medicare isn’t something most Americans want. It isn’t something that even most Republicans want. It seems this is something politicians want. If there was any good side to this, if it saved money, if it wasn’t so regressive, if it didn’t make people uninsured – then maybe I could understand the way that some seem to be so willing to do it.

I’m totally willing to negotiate. I’m totally cognizant of the fact that I won’t get everything I want. I’m totally ready to concede on some issues. But on this one? It’s just such a bad policy. Pick another.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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