Congress should seize rare opportunity to fine-tune Medicare

Lower eligibility to age 60 and expand standard care to include dental, vision and hearing services.



August 31, 2021 - 10:05 AM

U.S. Senate Majority Leader Chuck Schumer, right, and Sen. Bernie Sanders hope to expand Medicare so it covers dental, vision and hearing services. (Samuel Corum/Getty Images/TNS)

The opportunity for Congress to expand Medicare is a real possibility if Democrats hang together during the upcoming budget resolution talks.

Two changes would make a huge difference:

1. Lower the eligibility age to 60; and 

2. Include dental, vision and hearing coverage as standard care.

Currently, these three services are outside the scope of Medicare, the federal health insurance program for those 65 and older, creating a significant burden on those with limited budgets. Of its 64 million enrollees, more than half live on less than $30,000 a year. 

A result is that hearing aids, routine dental maintenance and eye exams are postponed or altogether ignored because of their expense.

No big deal?

Recent studies show that of the Medicare beneficiaries who need a hearing aid, 75% did not have one; of those who have trouble eating because of their teeth, 70% did not go to the dentist in the past year and of those who had trouble seeing, 43% did not have an annual eye exam.

Such deferred maintenance is jeopardizing the health of millions of Americans.

Currently, about 40% of Medicare enrollees pay for  limited coverage for dental, hearing and vision, by purchasing additional “advantage” plans, but the care is by no means comprehensive.

The better option is to make the benefits the standard for all enrollees.

Yes, it would mean that seniors’ Medicare premiums would increase — predictions are $25 a month — but that falls far short of what even one of these services typically cost. 

MEDICARE became law in 1965 under the administration of Lyndon B. Johnson. Over its 55 years, it has remained popular because of its wide scope of care. 

But it could use some fine-tuning. 

Many suggest lowering the age of eligibility to 60, which President Joe Biden supports. 

Too many Americans postpone necessary procedures such as joint replacement and expensive medicines necessary to manage chronic conditions such as arthritis, until they are on Medicare. 

Postponing such actions guarantees worse outcomes. The best time to get a knee replaced is when symptoms first present themselves. Waiting for such a procedure can increase the risk of additional complications and a more complex procedure.

Increasingly, corporate executives support lowering the Medicare eligibility age — some suggest as low as 55 — because of the unceasing escalation of private insurance premiums and prescription drug costs. In the last decade, health insurance premiums have increased 55%, more than twice the pace of inflation and wages.

And while we’re at it, let’s have the guts to address the price of prescription drugs.

On average, Americans pay more than twice as much for medications as do people in other countries. Medicare could save hundreds of billions of dollars by negotiating drug prices for seniors. 

The best example is the Department of Veterans Affairs, which negotiates the price of drugs for more than 52 million veterans. In a sample of 399 brand-name and generic prescription drugs, the VA paid an average of 54% less per unit than Medicare, even after taking into account rebates and discounts.

The difference is because the VA buys drugs directly from manufacturers while Medicare’s Part D program offers numerous prescription drug plans, each negotiated separately. 

In addition, the VA has access to significant discounts defined by law, and can then negotiate further for lower prices. 

Flat out, Congress should allow Medicare to negotiate drug prices and use the savings to pay for the other improvements mentioned above.