this relationship is over

I'm referring to the one between me and the Kenyan Islamocommunofascist phony usurper President of the United States. He lost me when he proposed raising the age of Medicare eligibility to 67. Perhaps, as some maintain, this is just another profound move in his continual game of 11th dimensional chess, but straight up, it's total capitulation to the far right extremist version of reality.

If we truly want to rein in spending on health care and reduce the federal budget deficit, the right thing to do is to lower the age of eligibility for Medicare. Actually lowering it to the moment of conception would be the best thing to do, but let's just say we lower it to 60. Below 65, you'd have to buy in. Medicare figures out what it would cost to provide people in that age range with Medicare, and that's your premium. If you already get employer provided insurance, your employer can offer Medicare as an option, paying whatever they already pay toward your health insurance. If you like the deal -- based on your premium share, co-pays and deductibles -- you can go for it. If not, keep your Blue Cross/Blue Shield. If you don't have employer-provided insurance, and you can come up with the premium, it's an option for you. Since you'll be eligible for the ARRA subsidies if your income is moderate or low, it may well work -- and it will be your best option because it's cheaper than private insurance that offers the same benefits!

Yes, there is moral hazard. Medicare doesn't do medical underwriting, so people who have more need of health care would be more likely to sign up. But think about it -- unless they die, they're going to hit the Medicare roles in a year or two or three, and then we'll have to pay to deal with their problem, which will likely be worse and more expensive -- unless of course Medicaid is already paying for it. Right now, when people hit 65, they suddenly show up with all sorts of neglected, untreated conditions that would cost less to treat if they'd been dealt with earlier.

Meanwhile, Medicare now has a larger beneficiary and revenue base, so it can spread its fixed costs over more income. And, with appropriate changes to the law and regulations, it can use its market power to make health care even cheaper and better. Here's a no-brainer example. Using generic instead of brand name drugs for blood pressure control reduces the cost from $52,983 per quality-adjusted life-year to $7,753 -- and just possibly there's actually an almost unheard of net savings, in health care costs because you avoid kidney disease, heart disease, and strokes. All you need is for Medicare to have the legal authority -- which it doesn't now have -- to establish a formulary for Part D in which generic drugs must be prescribed for this purpose unless the physician can make a credible, evidence based case why a brand name is needed. (Which in this case will be impossible, basically.) And note that if we get people's blood pressure controlled at age 60 instead of waiting till they're 65, Medicare won't be paying for all those kidney transplants and stroke rehabs.

Now, the "president" could say all this, and a whole lot of other wonderful true stuff, instead of retransmitting Republican lies and totally buying into the utterly bogus rhetoric about the deficits and the economy. But he doesn't. I assume it's because he's a spy.