Over the last few days, I’ve reported that raising the age for Medicare eligibility is very much on the table in the fiscal cliff talks. That has led some to believe that I support the idea as part of a deal. I don’t.
I’ll be clear: Raising the Medicare eligibility age makes no sense. It cuts federal health-care spending but raises national health spending, which is what really matters. It doesn’t modernize the system or bend the cost curve. It doesn’t connect to any coherent theory of health reform, like increasing Medicare’s bargaining power, increasing competition in Medicare, ending fee-for-service medicine, or learning which treatments work and which don’t. I’m not opposed to cutting Medicare — quite the opposite, actually — but this is a particularly brain-dead way to do it.
Its importance in the negotiations is attributable to the fact that raising the age at which Americans can receive Medicare and Social Security has a weird, symbolic power in Washington. As House Minority Leader Nancy Pelosi puts it, the eligibility age is “a trophy” that Republicans can bring back to their base. Though the policy is deeply unpopular with voters, it’s quite popular among Republican elites.
It is deeply unpopular with voters. It is deeply, deeply unpopular with people who know anything about health care regulation and finance who are interested in seeing (a) a healthier and longer-lived America (b) achieved more efficiently at lower cost.
It is popular only with "Republican elites".
Who are these Republican elites, and why shouldn't they be ridden out of town on a rail?