The case for lowering Medicare eligibility to 50

The public health pitch for making Medicare available at 50 comes with some strong evidence and business opportunity for population health.

When it comes to the question of sustaining Medicare's finances, two major schools of thought diverge in a tangle of conventional wisdoms.

Staring down Medicare and Social Security's swelling costs over the coming decades, fiscal budgets hawks have pitched the idea of raising the eligibility age--to try to save money by avoiding the liability for senior's healthcare costs or their retirement pensions just a little while longer.

In 2012, Republican Senators Bob Corker  and Lamar Alexander, both from Tennessee, proposed a long-term budget plan to raise the Medicare eligibility age to 67 by 2027 and increase Medicare premiums for wealthier seniors.

This would be "a way to make Medicare solvent so 11 years from now seniors don't start falling over the fiscal cliff," Alexander said. "This is bad medicine for many people. But it is part of what we are supposed to do."

Bad medicine, indeed. Making wealthier seniors pay a little more for their healthcare is a reasonable policy idea that has been pitched for decades, along with raising the cut-off threshold for social security payroll taxes, currently about $117,000. The current projections suggest that the Medicare trust fund is solvent through 2030 and the Social Security fund solvent through 2035.

But the argument that the federal government could save money in the long-term by raising Medicare's age of eligibility only two years, and not until 2017, is highly dubious.

If anything, some evidence suggests that lowering the eligibility age and bringing seniors on to Medicare sooner would be good medicine for many people, including taxpayers.

On Medicare's 50th anniversary, amid the rise of the baby boomer retirement wave, Linda Fried, MD, dean of Columbia University's Mailman School of Public Health, argues that it would be a good time to lower the eligibility age to as young as 50.

"The investment would be worth it," Fried told Reuters, outlining an essay she wrote in Generations, the journal of the American Society on Aging. "It won't cost Medicare or the country more money, but having people living not just longer but healthier is essential to being able to experience the benefits of longer lives."

"In sharp contrast to 50 years ago, we now know that prevention matters for most disease and conditions, and works into the oldest ages," Fried wrote. "Investing in prevention and health promotion is a 21st century opportunity--and responsibility--of Medicare, in synergy with the U.S. public health system."

Citing a Health Affairs simulation of expanded prevention, Fried argues that clinical and population-based investments in preventive care can greatly extend people's life span and quality, and reduce costs by 30 percent in the long run.

A person's life between 50 to 65 is a period bringing some of the highest risk for disability related to cancer, heart disease and stroke, obesity and diabetes, according to Fried. That age can also be hard time in general, considering the challenges unemployed Americans 50 and older face trying to find work--stress can add to the health problems.

"It's a high-risk group, the time when really bad health things emerge, and so much of it is completely preventable," Fried told Reuters.

"There is strong evidence now that those who turn age 70 in good health are positioned for longer and healthier future lives--at no additional cost to Medicare," Fried wrote. Those are seniors, living a relatively good life in their golden years, who do not go on to joint the 10 percent of Medicare patients who account for 70 percent of Medicare's $91 billion in acute care spending. They may have one or two health problems, go to a primary care doctor, maybe see some specialists, and take medications, but they are not likely to spend months cycling in and out of hospitals and repeatedly visiting the emergency department.

Bringing robust preventive coverage to those over 50 could help prevent expensive diseases and health interventions later on in people's lives, potentially saving Medicare in the long-term. Fried suggests that there could even be benefits by extending Medicare coverage of U.S. Preventive Services Task Force-recommended clinical services to those older than age 50 who remain uninsured.

The idea of lowering Medicare's eligibility age to 50 is a slightly radical one, though not as impossible as a "Medicare For All" single payer program. Medicare coverage at 50 would be a major incentive to move the rest of the U.S. healthcare system into the prevention paradigm, which is already occurring. It could make private health insurance, especially the subsidized ACA plans, more affordable for young populations, without the membership of higher-risk, older adults. Likewise, employers would see huge savings to their health benefits costs.

And Medicare at 50 could be a big business opportunity for physicians, hospital systems and private insurers, if they're willing to adapt to what would still be a disruptive change. 

Many health systems already have modern acute care facilities that can serve as a safety net to treat complex, severe illnesses and accidents, and they could direct more resources to primary care clinic networks, community-based care, and high-value outpatient and speciality care. 

Americans at age 50 could sign up for Medicare and, as 17 million seniors do now, opt for a Medicare Advantage plan, run by a private insurer like Aetna, Humana, Blue Cross Blue Shield, UnitedHealthcare or a provider-sponsored health plan like UPMC For Life and Memorial Hermann Advantage Plan