The Plot Against Medicare?

In The New York Times opinion page on November 6, 2022, the economist Paul Krugman identified a political movement to reduce Medicare benefits and increase the age of eligibility to access Medicare from age 67 to 70 years. For many health care providers who routinely work with older adults, 70 is the new 50; however for people who have had occupations that required a great deal of physical labor, Medicare benefits at age 70 may be unattainable. 

Is it in the best interest of the long-term care industry for Medicare benefits to be delayed? Is it in the best interest of society for individuals to access benefits at age 70? For those who take care of chronically ill individuals, the answer to those questions is a resounding no.

If the US health care system was not based on rescue but rather the prevention of illness, our society may be better positioned to raise the age of Medicare eligibility, however for many people, access to health care, including preventive health services is limited or completely unattainable.

In countries where health care is less costly and more effective, the delivery model is heavily focused in primary care with less specialization. In the United States, the opposite is true. For those politicians who propose to raise the age of eligibility for Medicare, the entire health care system will need to be changed to embrace a focus away from the rescue of individuals who have already developed significant disease to the promotion of health and prevention of disease. It would require that we change the reimbursement for primary care to discourage specialization. 

It is not possible under our current system to have both the delay in Medicare eligibility and a focus on rescue rather than prevention. If such a proposal was to advance, it would jeopardize the health of current patients and those of the subsequent generations.