The Magazine

Cutting off Granny

Medicare? Thanks, but no thanks.

Jun 27, 2011, Vol. 16, No. 39 • By JEFF BERGNER
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In a few months my wife and I will turn 65 years of age. I guess we’re the proverbial grandpa and grandma that our political leaders aim to protect. Our mailbox has been full lately with brochures describing the Medicare enrollment process, offering supplemental health coverage, and helpfully answering in advance any questions we might have. One question, however, hasn’t been answered: Why must we enroll in Medicare and give up our current health insurance? Why can’t we simply keep our current insurance coverage when we turn 65?

Medicare card

If we could, we would retain our existing coverage and opt out of Medicare altogether. Our current insurance plan is one with which we are thoroughly familiar; in one or another form we have had this type of insurance our entire adult lives. We’re familiar with its premium costs, its benefits, its copays, and even its shortcomings. We wish its dental coverage were better (though Medicare doesn’t look so good in that regard either), but on the whole we are reasonably satisfied with its pluses and minuses.

Why must turning 65 be so different from turning 63 or 64? Why is our health insurance plan adequate and appropriate when we are 64 but not when we turn 65?

It seems to be a given in all Medicare reform plans, including the Ryan plan, that the current Medicare program should not be touched for anyone age 55 or older. Perhaps it’s just too politically difficult to reform a major program like Medicare all at once. I appreciate that political reality. It is also sometimes said that there is some sort of “pact” or “promise” for seniors approaching age 65 that Medicare must remain in its current form, with no changes at all. About this I am less certain. Is there really a “right” to a program which is financially unsustainable? While it is reasonable to expect that some sort of program to provide adequate health coverage for seniors should exist, there is no entitlement for us seniors to the precise Medicare program that is now in place.

Indeed, over time—whether under the Ryan plan’s vouchers or the Obama plan’s board-mandated service reductions—Medicare will have to change. If our elected officials want to phase in these changes over time, I suppose that’s fair enough. And if under the Ryan plan, I and other seniors my age were to be reimbursed for some or all of our monthly health insurance premiums when we turn 65, I suppose that would be fair enough too. Indeed, switching over to a voucher plan strikes me as far easier and less complex than enrolling in Medicare and having to decide which among the mind-boggling array of supplementary plans should accompany it.

One gets the impression that some of our elected officials think that seniors are too old or too dumb to be able to live out their lives under market-based health insurance plans. They seem to think that only complete and guaranteed coverage is appropriate for seniors—though from what I can tell Medicare’s coverage is not all that complete in any event. One could almost take offense about this implication.

I do not take as given that seniors cannot function under a market-based health insurance regimen—which many of us have done our entire lives. Nor do I take it as given that those of us 55 years or older have a “right” to Medicare in its current form. 

What I would say is this: Thank you, Representative Ryan, for your concern for those of us between the ages of 55 and 64. But could you do us one more favor? Could you redraft your plan to allow those of us 55 and older the choice to decline our special grandfathered status, to opt out of Medicare, and to join voluntarily the same program you have proposed for those who are under age 55?

Jeff Bergner has worked in the private sector and in the legislative and executive branches of the U.S. government.

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