Categories:Wall street journal
 
First published on WSJ.com on Nov. 19, 2013

[In response to the question: “Should the eligibility age for Medicare be raised?”]

No. Raising Medicare eligibility age across the board would inevitably eliminate healthcare coverage for some people who simply cannot financially afford it. Why would a compassionate nation want to do that?

At the very least, any proposal to increase Medicare’s eligibility age should add means-testing, so that persons who can afford to pay for their healthcare do so.

This will probably be insufficient, however. Healthcare is already so expensive that the percentage of the population older than 65 who can afford to buy insurance is limited (and declining). Means-testing, therefore, may not exclude enough people to appreciably lessen needs for publicly funded healthcare.

Long term, only one strategy makes sense: give people significant financial incentives to eschew unhealthy lifestyles and to adhere to proven plans that reduce disease burden. It would be the healthcare equivalent of good driver discounts in automotive insurance, and, as with driving, it can have huge effects.

Consider, for example, former Vice President Cheney. Had financial incentives kept him from smoking cigarettes from ages 12 to 37, it is quite possible that onset of his heart disease could have been delayed by 10 years. That would have made him age 79 (not 69) when he was faced with the decision to undergo implantation of an expensive heart-assist device – which ultimately required a 5-week hospitalization, most of it in intensive care – and would have made him 81 (not 71) when he needed a heart transplant – too old to be eligible. He might, therefore, have undergone neither of these very expensive procedures, lowering dramatically his consumption of healthcare resources.

Physicians call such deferral of medical problems (and, therefore, costs) “Compression of morbidity” and view it as the ideal for aging. Helping all Americans attain it would be both compassionate and fiscally sound.

Multi-system effects of cobalt-containing hip prostheses

Rejected by the New England Journal of Medicine in 2014.
Co-authored with Stephen S. Tower, MD
Allen et al (1) courageously report a woman who underwent heart transplantation when he...… Continue reading