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More on Raising the Medicare Eligibility Age

Jon Chait has clarified some of his points on raising the Medicare eligibility age, and with the temperature now lowered a bit, let’s just assess his argument.

I find it kind of amusing that he quotes me quoting him talking about the debt limit deal in 2011, where he said, essentially, “exchanging a series of cuts to Medicare and Social Security and the domestic budget in exchange for the $800 billion in letting the top-end tax cuts expire, a pitiful sum of new revenue, would make a decent liberal vision of government impossible and represent a sellout of these ideals by the President.” After quoting me quoting him, he says, “I agree!” It’s a strong endorsement he makes in favor of himself.

Chait’s subsequent argument is that Obama can pretty much get a cost-free $800 billion through the expiration of the Bush-era tax rates, but if he wants more, he needs to make concessions, and that this is important because, he says, “I place a pretty high value on more revenue.” Matt Yglesias deals with this pretty well. High revenue in and of itself is nothing much to place a high value on. The point of obtaining high revenue, at least in the non-Modern Monetary Theory world of Washington, is to properly fund government. Chait sees this as a goal, to use the revenue to loosen the spending cap ushered in by the debt limit deal. But getting high revenue and then CUTTING productive spending is a bad trade. It’s particularly a bad trade in the short term, when we need to run higher deficits to return to solid growth and reduce unemployment. But just the whole premise of a revenue-for-social insurance cuts trade doesn’t strike me as worthwhile.

If the deal includes short-term deficit expansion in terms of stimulus like unemployment insurance extensions and some form of payroll tax cut, at least you’re getting toward equitability, though I don’t think far enough (also, the President could make some stimulus measures, in the form of mortgage debt relief, all by himself, without relying on Congress). But at that point you have to look at the impact of raising the eligibility age, against the perceived political benefits. Chait sees that political benefit in terms of increasing the political coalition for the Affordable Care Act. On Twitter Chait acknowledged this adding 65 and 66 year-olds to the mix comprises an “incremental” increase in the coalition, and admits in the piece that “this is a bit of a guess.”

So then you have to weigh that guess against the reality of 435,000 65 and 66 year-olds losing their insurance coverage as a result, to say nothing of the unnecessary deaths such an increase in the ranks of the uninsured contemplates. As well as raising costs through the entire health care system. And the fact that this would impact low-income individuals and minorities disproportionately. And the permanent loss of 10-15% of the lifetime Medicare benefit, and all the chipping away of that popular, effective system (among the only keeping costs down in all of US health care) that such a reduction implies. Keep in mind that the only beneficiaries of the exchanges are those not getting health insurance through an employer who are also earning up to 400% of the poverty line, not everyone. So that’s a small sliver of the population added to this perceived constituency, in exchange for all that harm.

To even make an argument on Chait’s terms, you have to accept the premise that bad stuff must happen in order to get through this period. But even if you do grant that, I don’t see the argument for raising the Medicare eligibility age, given a pure cost/benefit analysis.

UPDATE: I recognize this could be all an academic discussion, after Dick Durbin gave assurances from the White House that this is “no longer one of the items being considered.” Effective engagement from outside the talks had a lot to do with that, I’d gather. And anyway, it’s worth doing the analysis and looking at the benefits and costs.

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David Dayen

David Dayen