Here is why we should bring the entry age for Medicare from 65 to 64, allowing a buy-in at that slightly lower age: because small steps matter; they demonstrate what is possible, and create evidence that the system will not be thrown into disarray if further steps in that direction are taken. At the same time, because they are small steps, they are hard to demonize and fight against.
Give me your answer, fill in a form
Mine for evermore
Will you still need me, will you still feed me,
When I'm sixty-four?
- Lyrics by Paul McCartney
Now, I want to be very careful in outlining the proposal itself that I think should be put forth. Persons who have reached the age of 64 should be able to "buy in" to Medicare coverage the same way that they can buy a private insurance policy, and at rates comparable to competitive rates for private plans.
Why 64? Why not 55? Why not 62? After all, 64 is a measly one year change on what is already available. But it is exactly because 64 is a measly one year change that it would be almost impossible to fight against. Sure, some conservative blowhard who opposes Medicare itself "on principle" could make a straightfaced stand against it. On the other hand, those right-wingers (and Lieberman) who call themselves "moderate" - and who have even of late been "defending" Medicare against the supposed diminution of that program through Democrat-backed cost-saving measures - can hardly find a rational hook to hang any opposition to a measly one year change in the age of entry. Not even a straight up one year change, even, but an opportunity for people in that one-year range to pay a competitive rate to get into the program. We could perhaps begin by pushing towards 60, or 62-and-a-half, but without settling for a day less than that one full year, to 64.
Now, the upside. A successful reduction of the age of entry will create measurable results. How much, if anything, does it actually cost to add that one year of coverage? How much revenue derives from it? What proportion of people will opt to buy in early? How is the insurance industry affected? I predict that enacting one year reduction will yield results which make it crystal clear that Medicare can be further expanded with an opportunity to buy in at a lower age, without causing the financial meltdown or the market chaos that naysayers predict.
Some may contend that so small a change is not bold enough, that it effects too little to be worth doing. I say that any movement in the right direction is better than no movement at all, and that sometimes the shifting of tiny stones is what enables the avalanche. I suspect that the millions of Americans who happen to be 64 years old right this moment, or are soon to turn 64, or have parents or grandparents right at that threshold, would agree. So let us push for this small change, and establish the precedent.