I’m a bleeding heart, at heart, and don’t like the idea of any kind of cut on social welfare expenditures. But within the realm of reductions in social outlay, I think it’s surprising and upsetting that we don’t hear more about this option. Instead, everyone seems to want to raise the eligibility age for Social Security. This makes little sense to me for two reasons. One is that seniors can buy healthcare with money if they want to but can’t sell Medicare benefits in exchange for food or whatever. I’m not of the school of thought that believes cash benefits are always superior to in-kind benefits. But the merits of in-kind benefits, if any, are normally paternalistic in nature. And there’s really no reason to be paternalistic about senior citizens. Whatever total quantity of money we decide to dedicate to retirees, the retirees themselves should decide whether that money is used to buy hip replacements or presents for grandkids or whatever.
I suspect that part of the issue is that the implications of the Affordable Care Act haven’t really sunk in yet. Traditionally raising the Medicare eligibility age more than a teensy bit would be unthinkable, since absent Medicare an elderly person would be totally uninsurable. But under ACA that’s not the case. Of course subsidies will be needed for most retirees, but a workable highly progressive system would be in place to ensure that nobody has to go without access to health coverage.
Thinking harder about this, the real cost-saver is a twofer. You add a public option with Medicare payment to the ACA exchanges and you raise the Medicare eligibility threshold. Basically we’d transition over time from a single-payer system for seniors and a crap for non-seniors, to a means-tested single-payer system for everyone.