Thoughts on Expanding Medicare

I'll say it up front: I am a supporter of single-payer healthcare. My support derives from my actual lived experience in Canada, where I was forced to endure the statism and tyranny of socialized medicine lucky enough to indulge in state-run healthcare, even though I was not a citizen but merely a guest in that country.

I have heard a lot of discussion of Medicare for All among newly elected Democrats, and some older party members as well. I have the experience (and scars) necessary to know that Medicare for All just isn't going to happen any time soon, generally for two reasons: (1) People are loathe to give up the current system when they believe it is working for them; and (2) current Medicare recipients will be targeted relentlessly with ads invoking a zero-sum situation, where any expansion of Medicare would mean a reduction in their current benefits.

As to reason (1), I don't have much to add. If your employer currently picks up the tab for your health insurance, and you're reasonably healthy, the system certainly appears to be working for you and I understand why you wouldn't want to "fix" something that doesn't seem "broke." I do believe, however, that as costs continue to be dumped on individuals, in the form of higher deductibles, premiums, co-pays, etc., this will slowly and gradually change.

As to reason (2), I think that this can be dealt with strategically. As noted above, I have no reason to believe that the U.S. will adopt any sort of cradle-to-grave government-run healthcare in the remote future. However, if we're looking at expanding Medicare, we should be looking at the other end of the lifespan -- the young end.

As it currently sits, people get Medicare from 65 (or so, they keep monkeying with the formula) until they die. Any effort to lower the age for eligibility will be met with concern (2), neatly summed up as "I got mine; screw you."

On the other hand, if we extend Medicare to newborns starting tomorrow, and allow them to stay on it until they are 24 (to pick a random age), we have built in a dynamic where in 24 years there will be a significant constituency to keep raising the age where people are kicked out of Medicare and into the (brutal) private market.

A thought.

Of course, if you believe that nothing the government does will ever work, there is no convincing you of anything regarding policy changes. I would be better off arguing with my coffee table.