There is concern about the long-term viability of Medicare, in view of the large costs incurred by the program and the budget deficit. The usual proposed solutions are improving fraud vigilance, re-negotiating fees with health-care providers and institutions, and maybe limiting services that don’t translate into tangible health benefits.
I’d like to argue that the most crucial intervention to ensure Medicare longevity is universal health care. Contrary to the conventional premise that extending health care coverage to everybody will limit resource allocation to the elderly, ensuring that more healthy people enter Medicare will improve outcomes and decrease costs.
This is not only logical, but also backed with data. An analysis of the Health and Retirement Study by Baker and colleagues showed that lack of health insurance led to a decline in overall health among 51-61 year-old individuals. A related study by McWilliams and colleagues showed that uninsured individuals with cardiovascular risk factors enrolling in Medicare were more likely to have hospitalizations than counterparts with insurance prior to enrollment. In fact, the cost of health care incurred by the latter was much less (relative difference of 51%). The authors conclude that:
“…providing health insurance coverage for uninsured near-elderly adults may improve their health outcomes and reduce their health care use and spending after age 65. Particularly for those with cardiovascular disease or diabetes, these benefits may be substantial and may partially offset the costs of expanding coverage.”
The House Committee on the Budget released recently its “Path to Prosperity,” a summary of the budget resolution of fiscal year 2012. The initial section of this document contrasts “a choice of two futures:” a right future, where Medicaid is defunded and the implementation of the Affordable Care Act is derailed, and the alternative, a future where the government has an actual responsibility to improve people’s life. Paul Ryan, chairman of the committee, clarified that this is not a budget, but “a cause.” The most interesting aspect of this statement is that it was uttered by someone who claims being conservative. Here we have the case of an ideologue who is apparently unaware that the conservative mind abhors all forms of ideology. This is quite a departure from the idea of classical conservatism, a wisdom based on time-honored traditions and a flexibility of the mind divorced from rigid systems of thought. The “Path to Prosperity” is nothing but a teller’s manifesto—the ideology of myopic accountants, not visionary leaders.
One of the most powerful articles of the American Constitution reads: “no title of nobility shall be conferred by the United States.” And yet, I keep a nobility title in my wallet: a health insurance card with my name embossed on it. This privilege is bestowed upon me by a corporation, not because of personal merit or the dignity that I have in common with every human being, but because of my acquisitive power. Without universal health care, we are in fact perpetuating a system of castes based on personal wealth, where some citizens are ineligible for health care, risking bankruptcy, disability or abandonment if they become seriously ill. Paul Ryan’s paradigm of two futures is numerically wrong. His right future is not a future at all.