Expanding Medicare would be nice if added costs can be met all around

The Outlook

January 18, 1998|By M. William Salganik

PRESIDENT CLINTON this month proposed expanding the Medicare program, which now provides health insurance for those over 65. Under the Clinton plan, early retirees and those displaced by corporate downsizing, some as young as 55, would be able to buy insurance through Medicare. They would pay premiums designed to meet the costs of the extra coverage -- both before they reach age 65 and in addition to regular Medicare premiums afterward.

Supporters of the Medicare extension say it is a good way to reduce the number of uninsured in the country. Critics doubt whether it could be supported by premiums, saying the expansion further threatens the solvency of the Medicare program.

Andrew L. Stern

President, Service Employees International Union

Now, 44 million people in America don't have health insurance. Anything that begins to piece together more coverage is good.

At a time when corporate health care is more interested in the pursuit of profit than the pursuit of quality, Americans, and especially older Americans, are left without adequate care when they need it the most.

When we talk about having a budget surplus, I can't think of anything more important. We believe that in a country as rich as ours, it's a crime when people don't have health care. Our basic philosophy is: We should join the rest of the industrialized world, and make sure that, in the richest country in the world, nobody ever suffers again because they don't have health care.

Paul R. Huard

Senior vice president, policy and communications, National Association of Manufacturers

Adding more people to Medicare before the system is shored up is like securing a decaying bridge with toothpicks and then sending Army tanks across it. It is premature and risky, at best, to expand a system that is quickly crumbling.

President Clinton recently appointed a commission to review Medicare and make recommendations for its reform. It seems a bit disingenuous for Clinton to then, a few weeks later, recommend expanding the very program he's assigned a group of people to save from bankruptcy.

Every day we delay reform, Medicare continues spending $40 million more than it takes in. Changes made in 1997 extend the life of the trust fund for a short while, but it is still due to be insolvent just as the first wave of baby boomers begins to retire. When the fund is exhausted, there is no mechanism to pay the hospital costs of senior citizens. But I'm afraid the politics of an election year has an effect on the president's judgment.

Deborah Briceland Betts

Executive director, Older Women's League

We like the proposal because it would expand health care to a portion of the population that needs it, but we have two key issues that we think amount to gender bias in the plan.

Women have less than half the income men have in retirement. We've been struggling to find people who might be eligible for the program, but in the days and weeks we've been looking, we can't find one who can afford it. We think there needs to be low-income protection to extend coverage to people who would not be able to afford the premiums.

Also, women live an average of seven years longer, so they will be paying [additional premiums] much longer than men. If there would be a cap on the premiums, say at age 75, that would address this problem.

Diane Rowland

Executive vice president, Kaiser Family Foundation, and adjunct associate professor of health policy and management, Johns Hopkins School of Public Health

Insurance coverage matters for people; [more than] 40 million people are uninsured and 3 million are in this age group. In an era of incremental expansion of health insurance coverage, this proposal puts another option on the table.

However, many in this age group are not affluent and may not be able to afford the kind of premiums in the president's proposal: $300 a month for an individual, $600 for a couple. For a couple at 200 percent of the poverty line, roughly $21,000 a year, this would amount to one-third of their income on premiums.

To make this workable, the government may need to subsidize the cost.

I don't think this proposal would destabilize Medicare, because it is designed to be self-financing. It operates outside the financing structure of Medicare but uses the administrative framework. Medicare offers a good model for insuring older Americans with low administrative costs. Some have proposed expanding Medicare to all, or to uninsured children.

Pub Date: 1/18/98

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