Thursday, October 08, 2009
In terms of health coverage, one date separates the most secure Americans from the least secure: a person's 65th birthday. Age 65 is when one qualifies for Medicare, the government insurance program for the elderly and disabled. It's become a source of intergenerational strife -- not so much between the old and young as between the old and the nearly old.
Baby boomers may not welcome their advancing years, but they do see 65 as kicking off one kind of glorious liberation -- freedom from fear of getting sick without good health coverage. Until then, they are the workers most likely to develop medical problems and, therefore, the group private insurers most avoid.
The Democrats' health care proposals would blur that line of anxiety, but many people already on Medicare believe that the health care security of others would come at their own expense. They don't want their government-run program touched to help pay for universal coverage.
The young also have dogs in this fight. And they should beware the right-wing campaign to unite the old and young against the middle-aged. Foes of reform keep warning 20- and 30-year-olds that they would be forced to obtain coverage or pay a penalty, and that's a bad thing. Actually, it's a fine thing. The whole point of insurance is to create large pools in which folks who don't need much of what's being covered subsidize those who do.
But younger Americans also have selfish reasons to want reform. For starters, they might like to advance into jobs that the boomers are holding onto with both hands, just to keep their health coverage. They may dream of starting their own businesses -- but don't, out of worry that they won't find affordable coverage for their families.
Meanwhile, everyone insured through the workplace pays a stiff price for our chaotic health care system. Make no mistake: The money an employer pays for medical coverage comes right out of your paycheck. If you are covered on the job and wonder why your raises have been meager of late, that's the answer.
And without reform, the situation will only get worse. If health care premiums increase at projected rates, the average cost of a family's employer-sponsored coverage will nearly double to $24,000 in 11 short years.
The tension between those on Medicare and older workers too young to qualify has put AARP in a tight spot. Its 40 million members split evenly into the two camps. To its credit, the powerful lobby for older Americans has come down on the side of reform. AARP contends that the thousands who noisily quit the group over this stance don't account for even 1 percent of its membership.
In truth, those on Medicare also have self-serving reasons to support reform. As Medicare devours ever-bigger portions of the federal budget, changes in the program are coming, like it or not. And the beneficiaries are probably going to prefer what is being done in the context of broad health care reform to what would happen were Medicare costs to be addressed later.
And really, is curbing the Medicare Advantage Program, which provides basically the same things as fee-for-service Medicare (but at far greater cost to taxpayers), such an enormous sacrifice? No, and the reforms contain new benefits that include closing the drug program's notorious "doughnut hole" and ending out-of-pocket payments for preventive-care screenings.
Properly drawn, reform promises a big plus for every generation: a stronger U.S. economy. Soaring health care costs are eating American businesses and consumers alive. These changes could lighten the burden for all of us -- however far we are from our 65th birthday, and in whichever direction.
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