Medicare and the Election

Today is Election Day. The choice is stark. And it’s not just a matter of choosing a knowledgeable, capable, and rational, although flawed Democratic candidate over an ignorant, incompetent, bombastic narcissistic Republican candidate. The election matters for health issues and older people as well. Here’s how.

The Trump and Ryan plans call for a repeal of the ACA. That means more uninsured people who will be sicker and costlier to care for once they become Medicare eligible.  That’s bad for those individuals and it is bad for Medicare. Trump and Ryan want to permit interstate sales of health insurance, which they think will create more competition and bring down costs. They don’t seem to understand that regional insurers don’t want to expand nationally: they have to negotiate contracts and rates with the hospitals in every state whose market they enter. Health insurance is not the same kind of commodity as furniture. That goes for Medicare Advantage plans along with private plans for those under age 65. Trump and Ryan want to expand the use of health savings accounts—potentially to Medicare patients. These high deductible plans encourage people to make foolish decisions about their health. Moreover, they affect the first few thousand dollars of health care expenses—enough to make a difference to people with limited incomes, but of no consequence for the most expensive parts of the health care system, namely hospital care.

Clinton and the Democrats would make insurance coverage more affordable by increasing tax credits for low income households. That means fewer uninsured people who will be sicker and costlier to care for once they become Medicare eligible. Families USA wants to add dental coverage to all public and private health plans—the one big gap in coverage for older individuals, even though poor dentition has been associated with pneumonia, nutritional problems, and other disorders. Clinton et al favor Medicare negotiating drug prices with manufacturers, potentially controlling one of the major contributors to out of pocket spending among older people.

For a more detailed analysis of “the choices on health reform in the US presidential and congressional elections” that doesn’t focus on older people, see the viewpoint piece in today’s JAMA Internal Medicine. 

Go out and vote! It matters, for Medicare along with so much else.