A viable alternative to Medicare-for-all? We can and must do better!

Medicare buy-in option for individuals younger than 65 could improve health outcomes without imposing a controversial mandate or increasing government costs, proposed in The American Journal of Medicine

Philadelphia, March 25, 2019

Medicare-for-all, a solution that would bring United States healthcare policies more inline with other industrial nations, faces strong opposition and is unlikely to be enacted in the foreseeable future. A commentary appearing in The American Journal of Medicine, published by Elsevier, proposes another approach that the authors believe would achieve wider access to care without triggering widespread opposition: a Medicare buy-in option for individuals under 65 years of age.

With the most expensive medical care in the world, shorter life expectancies, lower immunization rates, and higher infant and maternal mortality rates than other OECD nations, the US continues to be in the throes of a healthcare crisis. The authors of this commentary demonstrate a link between these poor outcomes and the fact that millions of Americans have limited or no access to ongoing medical care, due to the lack of health insurance even after the Affordable Care Act narrowed the gap.

“Americans without health insurance receive sub-optimal healthcare and do not live as long as those who are insured. They are less likely to have a usual source of healthcare, less likely to fill prescriptions, and more likely to postpone or go without care due to cost. Patients with chronic conditions such as heart disease, diabetes, and asthma, who lack a regular source of healthcare are at a greater risk of premature mortality than the insured. Medicare-for-all would solve most of these problems,” noted Joseph S. Alpert, MD, Professor of Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA, and Editor-in-Chief, The American Journal of Medicine.

StudyYearIncreased Mortality Percentage
Franks et al1199325 percent
Institute of Medicine2200325 percent
Wilper et al3200940 percent

Annual Mortality of Uninsured Americans Compared to Insured. The most concerning fact about those who are uninsured in the United States is that they do not live as long as those who are insured.
1Franks P, Clancy CM, Gold MR. Health Insurance and mortality. JAMA 1993;270:737-741.
2Institute of Medicine, Care Without Coverage, Too Little, Too Late. Washington DC: The National Academies Press; 2002.
3Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor, DH, Himmelstein DU. Health insurance and mortality in US adults. Am J Public Health. 2009;99:2284-2295.

The authors attribute the fierce legislative and public opposition to Medicare-for-all to concerns about disruption of the healthcare industry, which is the nation’s largest with more than 16 million jobs. With much at stake, interests like the health insurance business, pharmaceutical industry, and for-profit HMOs and hospitals have stoked unwarranted fears of expanded Medicare. The authors point to another solution that has been proposed, to expand Medicare by lowering the age of eligibility, but because it would require an increase in the Medicare tax rate, it is not likely to gain much popularity.

“A much better alternative is to allow Americans younger than 65 the option to buy into Medicare and pay a premium until they reach the age of eligibility. Many of America’s 27 million uninsured would finally have access to lifesaving preventive care without increasing government costs,” explained lead author James E. Dalen, MD, MPH, Dean Emeritus and Professor Emeritus, University of Arizona College of Medicine, Tucson, AZ, USA. “A voluntary program would allow individuals to keep their employer-based and other private insurance. Without an unwanted mandate and increased government spending, we believe the proposal has a good chance of success and could pave the way to enact universal coverage in the US.”

According to Dr. Dalen, “If the price were right to buy into Medicare, this option would likely be very popular. Companies that provide health insurance to their employees may find that Medicare provides better coverage for their employees at a lower cost and may want to opt in.”


Notes for editors
The article is “An Alternative to ‘Medicare-for-All’,” by James E. Dalen, MD, MPH; Jennifer L. Plitt, MD; Neha Jaswal, MD; and Joseph S. Alpert, MD (https://doi.org/10.1016/j.amjmed.2019.01.007). This article will appear in The American Journal of Medicine, volume 132, issue 6 (June 2019) published by Elsevier.

This study is openly available and can be downloaded by following the DOI link above.

Full text of this article is available to credentialed journalists upon request. Contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com to obtain copies. Journalists who would like to interview the authors should contact James E. Dalen, MD, at +1 520 299 3148 or jdalenmd@gmail.com.

About The American Journal of Medicine
The American Journal of Medicine
, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. The official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus US medical schools, AJM publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. www.amjmed.com

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
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+1 406 542 8397