MedCity Influencers

Opponents lining up against Medicare buy-in

Merrill Goozner sees opposition to the Medicare 55-and-over buy-in compromise. He explains why the main argument against it is bogus.

Merrill Goozner is an award-winning journalist and author of “The $800 Million Pill: The Truth Behind the Cost of New Drugs” who writes regularly at

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As I feared, opponents are already lining up to kill the Medicare 55-and-over buy-in compromise floated by Sen. Harry Reid last night. Igor Volsky over at the Wonk Room has the details, and points out why the main argument against it — that it will hurt rural and other hospitals because of Medicare’s low payment rates — is largely bogus, a smokescreen designed to hide inefficiencies in non-competitive and declining markets.

The political solution is to buy off the rural legislators (like Sen. Byron Dorgan of North Dakota) with special payments to maintain needed health care facilities in declining regions, just as we now provide special payments to urban hospitals that serve a disproportionate number of poor people.

Those fighting for this needed Medicare expansion shouldn’t forget the health-related arguments that favor it. It will save Medicare billions of dollars annually down the road.

The decade before people enter Medicare (55 to 64) is the time of life when many people develop the chronic diseases that will make them the most expensive patients in Medicare once they get there. Diabetes, heart disease and many cancers often emerge in late middle-age. Intervening when the warning signals of these diseases first appear can moderate or even eliminate many of these costly conditions.

Medicare is the ONLY insurer with a long-term interest in engaging in this kind of health care system-delivered secondary prevention. Every other insurer has a self-interest in kicking the can down the road because they know it will be the government and taxpayers that ultimately pick up the tab when those chronic conditions become the most costly.

Allowing the uninsured, the laid off and those with financially burdensome employer-provided plans to buy into Medicare at 55 will allow them to get good preventive care and intervention when it has the most potential to be  effective and to reduce Medicare’s long-term costs.