Let’s imagine that, somehow, Americans reached agreement that universal, single-payer health care is the way to go. How could it be implemented? Clearly, the transition would have to be managed in stages. It might seem logical to gradually lower the eligibility age for Medicare—say, five years of eligibility every twelve months. In the first year, 60-year-olds would be eligible; in the second year, 55-year-olds; and so on.
It makes more sense, however, to start with the children. Shouldn’t the health of our children be our first priority? And aren’t families with young children the people most in need of affordable health care? The problem, however, is that taking the youngest people out of the private health insurance pool would make it impossible to cover the expenses of older Americans without enormous premium increases.
The solution, it seems to me, is to move people into Medicare from both ends of the age spectrum, so that the balance of people left in the private system—younger, healthier people and older people with more medical expenses—remains about where it is now. In that way we could both give children first priority, and avoid a huge spike in insurance premiums for those still in the private system.
Imagine a transition something like this:
| Year | Medicare for everyone ages . . . |
| 2020 | 0-10, 65—> |
| 2021 | 0-10, 60—> |
| 2022 | 0-20, 60—> |
| 2023 | 0-20, 55—> |
| 2024 | 0-20, 50—> |
| 2025 | 0-25, 50—> |
| 2026 | 0-25, 45—> |
| 2027 | 0-30, 45—> |
| 2028 | 0-30, 40—> |
| 2029 | 0-35, 40—> |
| 2030 | Everyone! |
In the first year, families with young children would immediately benefit. Those who already had health insurance would save money by removing their children from their policies, and those without insurance, or whose insurance included high deductibles and co-pays, would be able to take their children to the doctor without worrying about what it would cost. Both the finances and the health of working families would improve dramatically.
In the second year, people ages 60-64 would become eligible for Medicare. Every year thereafter, another group would be added, alternating between younger and older. Making the transition in this gradually like this would allow all the legal and bureaucratic and financial changes time to take place in an orderly way, and would give the private insurance companies time to move into other products. With experience, better arrangements would be discovered, and adjustments made. Companies providing insurance to their employees would have time to plan and implement the transition to the day when everyone would be covered by Medicare.
If the process began in 2020, then by 2030 every American would be covered by Medicare, and the United States would finally have caught up to the rest of the developed nations by providing health care to every citizen, with the costs borne by everyone through an equitable system of taxation—a non-profit, universal health insurance system that would benefit all of us, instead of filling the accounts of behemoth insurance companies with billions in profits, while leaving ordinary people scraping to pay medical bills, putting off medical care to save money, and fearing financial ruin should we suffer a major illness or injury.
I say, let’s do it.