… then those of us not yet on Medicare can kiss our asses goodbye, and while you are doing that, you can kiss Medicare goodbye. Raising the age from 65 years to 67 years will only save the government some money on paper. In the real world, that is not going to happen. Private insurance at those ages? Only in your dreams!
From CatM @ DKOS om Friday, September 9,2011
Supposedly proposals have been floated by the president to raise the Medicare age to 67. This is in line with the Social Security retirement age of 67 for people born after 1960.
The premise is that shifting expenses for individuals 65 to 67 years of age from Medicare to private insurers will save taxpayers a lot of money without hurting access to coverage because, since these people will theoretically be employed to age 67, they will receive affordable private insurance through an employer or the insurance exchanges as mandated by the Affordable Care Act.
As Joan McCarter rightly highlights in her excellent diary, this would "[shift]costs to individuals, employers, and states. These increased costs would be twice as large as the net federal savings."
Who believes employers and insurers will eagerly absorb these higher costs? And that states will not raise taxes or fees to cover their increased expense for extended Medicaid to provide sole coverage for any people in this age group who meets the legal definition of poor (which, by the way, leaves out a lot of poor people)? Ultimately, the cost of this care will land on the back of the healthcare consumer, through increased premiums, higher coinsurance/copayments, reduced wages, and more taxes.
Even outside of a recession and despite anti-discrimination laws, it is challenging for older adults--even those younger than age 65--to find employment, and for older people in labor-intensive positions, early retirement may not be optional. We will have to confront the consequences of problems post-65 year retirement in the years to come, which was likely the point when politicians decided to "save money" by raising the Social Security eligibility age. After all, the real-world consequences of that decision would burden another president and another Congress down the road, while scoring political brownie points for the current officeholders.
Of course, somewhere in the decisionmaking process, someone neglected to explain to Congress that guys like Diabetes, Heart Disease, Cancer, and Stroke do not concern themselves with laws and do not wait for people to reach the legal age of retirement before making a career-ending introduction.
Since I am more familiar with cancer than most other diseases and it accounts for approximately half of Medicare spending, I will limit most of my analysis to how individuals with cancer might fare if we were to increase the Medicare eligibility age.
Who Gets Cancer?
Cancer can strike people of any age, but it is more predominant among Medicare-eligible Americans. The following are the median ages at which cancer is diagnosed, according to the Centers for Disease Control and Prevention:
TOTAL: 66 years
Men: 67.0 years Women: 65.0 years
One theory for why cancer is more likely to be diagnosed in older individuals (e.g., two-thirds of prostate cancer cases are diagnosed in those age 65 and older) is that the genetic mutations that cause cancer take time to accumulate. These mutations occur in response to environmental influences (eg, radiation, chemical exposure) and health conditions (viral infection, immunocompromise) that trigger mistakes during the DNA replication process. Most of these errors are harmless, but too many can lead to a cancer-causing mutation (an oncogene). More recent research suggests that in a small proportion of cancer cases, it only takes one mutation to cause cancer. Your risk of cancer is even greater if you already have certain cancer-causing mutations in one copy of a gene (like BRCA).
No Diagnosis? No Cancer!
Another reason why U.S. cancer rates might jump at age 65 is that nearly 100% of the population has easy access to medical care, whereas millions of Americans younger than 65 years of age do not and thus are more likely to see a physician and get a diagnosis.
Recent studies, for example, show that individuals 65 years of age are more likely to undergo colorectal cancer screening, a procedure designed to detect polyps--the precursors to colorectal cancer--allowing for their removal and preventing progression to colorectal cancer.
Colorectal cancer screening is increasing for those age 65 and older, and for this type of cancer, screening rates are higher for the elderly than for the pre-Medicare population for which screening is recommended (Chart 8).
Respondents aged ≥65 years had a greater prevalence of colorectal cancer test use compared with those aged 50--64 years, which might be associated with the availability of Medicare coverage for colorectal cancer screening after age 65 years.
The Centers for Medicare & Medicaid Services (CMS) touted that the Affordable Care Act has led to a more than 26% increase in Medicare beneficiaries who received a "Welcome to Medicare Exam," from 2010 to 2011. This examination must be completed within 12 months of enrolling in Part B Medicare; it is reasonable to assume that a high percentage of people taking advantage of this benefit fall in the 65-to-67-year age bracket.
Does the fact that more people were uninsured or underinsured than ever before in 2011 have anything to do with the surprising increase? Perhaps Medicare enrollment presented some people with their first opportunity to receive care in quite a while:
More workers also simply lost coverage over the last decade, the survey found. Fifty-two million adults ages 19 to 64 did not have insurance at some point in 2010, up from 46 million in 2003. That has left nearly half the working-age population without enough protection from illness. Altogether, 44% of U.S. adults were either uninsured or underinsured last year, according to the Commonwealth Fund.
We can expect the number of uninsured to increase, if people aged 65 to 67 years are forced to fend for coverage in the private market.
It is interesting that the government reports cancer rates continue to decline in the United States, despite tremendous increases in the prevalence of diseases associated with increased cancer risk (eg, diabetes, obesity), a minute decline in smoking rates in 2011, and a higher-than previously-thought rate of HPV infection among women. It prompts me to wonder why cancer rates are declining.
Could there be a correlation between the declining rate of cancer diagnoses and declining incomes, declining insurance rates, and declining access to health care? After all, someone with cancer is not going to count if they die without ever receiving a diagnosis.
Sick People Should Stop Whining and Get a Job
According to a report in the Journal of Clinical Oncology, the disparity in cancer incidence between the young and old is only going to widen:
(Quote available here: http://www.physiciansweekly.com/...)
Between 2010 and 2030, a 67% increase in cancer incidence is anticipated for patients aged 65 and older as compared with only an 11% increase in cancer incidence anticipated for patients younger than 65,” Dr. Smith notes.
Remember, the median age at cancer diagnosis is 66 years. With an estimated 1,596,670 new cancer cases diagnosed in 2011, we can project that hundreds of thousands of thousands of cancer cases will be diagnosed in people aged 65 to 67 years.
In addition to age-discrimination hindering employment opportunities for those age 65 to 67 years, diagnosis of a chronic or serious condition, like cancer, causes your chances of being employed to plummet even further:
Overall, cancer survivors were 1.37 times more likely to be unemployed than healthy control participants (33.8% vs 15.2%) in the analysis, which appears in the February 18 issue of JAMA.
People with cancer can just get disability and Medicaid coverage, right? WRONG (although it may be easier once the Affordable Care Act provision extended Medicaid to childless adults goes into effect).
Subgroup meta-analysis showed that cancer patients were 2.84 times more likely than control participants to be disabled and unable to work or to receive disability benefits. "Therefore, the mechanism behind the higher unemployment rate among cancer survivors is likely to be a higher disability rate," write the authors.
Prayer Will Keep Good People Alive Until Medicare Eligibility Age
If you wind up being one of the tens of thousands to develop cancer between age 65 and age 67, who cannot work or qualify for disability or who continues to work but cannot afford copayments or prescriptions, I will keep my fingers crossed that you can hold on long enough for treatment until your Medicare kicks in at age 68. Sadly, your disease will likely have spread. It will be harder to treat and your chances of survival will be much lower. The cost burden of your disease on the government will be much higher than it would have been had you received diagnosis and treatment within the first year of your disease.
Surely, people with private insurance will have access to affordable cancer screening because of the Affordable Care Act, and that will improve rates of early diagnosis, right? It depends. Although the Affordable Care Act requires that insurers provide basic annual mammography screening for free, it does not require that the insurer pay for any follow-up mammorgraphy or more advanced screening when the mammography returns ambiguous results, as it often does. I wonder how many women age 65 to 67 will wait until they are Medicare eligible to get that follow-up test, when their small, curable breast lesion has grown into a large tumor and seeded tumors in the other breast or elsewhere?
How many people treated for polyps after colonoscopy screening will forego a follow-up colonoscopy needed prior to their next freebie to check for new polyps until they reach Medicare age, at which point easily treated polyps will have developed into full-blown colorectal cancer?
What's a Foot or Two?
Type 2 diabetes is another disease showing a dramatic, steady increase among the aging population. Inadequate insurance or prescription drug coverage will cause many diabetics aged 65 to 67 years to skip treatment or testing, leading to complications that emerge just in time for the government to pick up the tab.
Every medical expert will tell you that it is much cheaper to treat a diabetic for 2 years than to pay for the consequences of 2 years of uncontrolled diabetes--consequences such as blindness, kidney impairment, nonhealing ulcers, nerve damage and resulting disorders (gastropareisis, for example), permanently damaged hearts, and amputations.
Diabetics who are able to keep their disease under control are significantly less likely to require expensive nursing home care in their advanced age due to complications that cause mobility issues.
Raising Medicare Eligibility Age to 100 Balances Budget!
If the president and Congress truly wanted to reduce Medicare costs anywhere other than on paper, they would be contemplating lowering the Medicare age, rather than increasing it--in fact, they would lower it to zero. Private insurers reportedly have much higher overhead than Medicare, although the degree is debated by those who oppose "government takeover of healthcare."
But ignore that argument for a moment. Study after study proves that diagnosing and treating disease early in its course prevents complications and saves money and lives. Studies show uninsured/underinsured people are less likely to get preventive care, less likely to receive recommended treatment, and less likely to pursue appropriate follow-up care.
This contributes to long-term complications associated with far more expense than treating the underlying condition. It also hurts business, decreasing productivity among American workers--not only of the sick person but alsoof his or her caregivers.
The cost to U.S. businesses due to lost productivity of working caregivers is estimated at between $17.1 billion and $33.6 billion per year and growing.
And has anyone asked insurers how they feel about being expected to insure millions more high-risk individuals so that the government can save money, and without an option to increase rates to profitable levels? (Not that I care about their profits.)
Although the mandate is supposed to offset costs to insurers for expanding and improving care options for those up to age 65--something insurers already claim is not going to be enough--it is not likely to be enough to cover the additional costs for covering sicker, older people aged 65 to 67 years.
Don't Worry! Republicans Know How to Save the Dying Uninsured!
Of course, if the goal of increasing the Medicare age is to drive insurers out of business and convince employers to clamor for more government-run healthcare options, the argument could be made that the objective is noble. But it ignores a long history of Republicans unwilling to jump in and rescue uninsured Americans and instead recommending that they beg, borrow, or die to get proper care.
We must fight any drive to raise the Medicare age of eligibility--it is bad for the country and everyone living in it. On paper, it might look like a real cost saver, but as the effects of the change are realized, it will be clear how pie-in-the-sky those projects really were. It would not save Medicare--it would kill it. But before it does, it will kill thousands of Americans, which could be me or you or one of our children.
Originally posted to CatM on Fri Sep 09, 2011
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