gerson110409

On the homepage

Thanksgiving

Thanksgiving: More Americans to hit road

Out There

Vikings

Favre's stats put him in MVP picture

Pardon Board

Michael Gerson: Again, it is the young picking up the tab

Older adults have them to thank if health care reform passes.

By Michael Gerson, Washington Post

Last update: November 4, 2009 - 2:37 PM

Print this story

Follow Opinion Exchange on Twitter

As I was talking with the founder of a large American corporation, the conversation turned to health care reform. His employees in their 20s, on average, cost the company about $1,500 a year in health bills, those in their 50s 10 times more. The effect of proposed health care reform -- which limits the ability of insurers to charge higher premiums for older adults -- would be, he said, a large shift of America's health care burden to the younger generation.

This is not an unintended consequence of reform; it is the whole purpose. It is the main funding mechanism for reform. Because younger people have lower health costs, reformers want to draft them into the broader health insurance system so their premiums can subsidize the health expenses of older, sicker health care consumers. Thus, in every version of health care reform, the young are required to purchase coverage, on penalty of an "excise tax."

This mandate explains the political coalition behind health care reform. Insurance companies are willing to accept tighter government regulation on matters such as the coverage of preexisting conditions -- but only if they are given guaranteed access to millions of younger, healthier premium payers. Congress gets additional resources from the young to expand insurance coverage, with less need to raise taxes overtly.

Advocates for the elderly welcome an intergenerational subsidy that reduces premiums for older Americans.

Amazingly -- out of idealism, ignorance or both -- people in their 20s remain the strongest supporters of health care reform. They are also the most likely group to wake up the day after passage of Obamacare with a health reform hangover -- forced to buy coverage at higher premiums to reduce the cost of someone else's health insurance.

Legislators, perhaps fearing that future anger, seek to soften the blow. The Senate Finance Committee bill would allow insurance companies to charge older adults a maximum of four times more than young people -- reducing premium increases for the young by making the elderly carry more of their own weight. The House bill would set the maximum premium difference between old and young at two to one. Both the House and Senate bills also provide subsidies for those with low incomes to make health insurance more affordable.

There are arguments for mandating the purchase of higher-priced insurance by the young. It would, on the bright side, leave less disposable income for nose rings and tattoos. And perhaps the ownership of health insurance, in an ideal world, should be a social expectation, like the ownership of auto insurance.

But this burden on the young comes in a series. The most consequential element of the New Deal -- Social Security -- has been a large transfer of resources from young to old. The same is true of the Great Society's Medicare program. Two-thirds of Medicaid spending goes to nursing homes.

In our history, public programs helping the young -- say, the Civilian Conservation Corps or the GI Bill -- tend to be discretionary and temporary. Entitlements benefiting the elderly are eternal.

America's 60-year, cross-generational transfer of wealth counts moral achievements. In the 1960s, 30 percent of the elderly lived in poverty. In 2008, that figure was less than 10 percent. And the compassionate treatment of the elderly serves our future interests. The young grow old. But limited resources require the interests of young and old to somehow be balanced. And a society that consistently shifts burdens from old to young at some point becomes selfish. This is the inescapable shame of overwhelming budget deficits. But it applies to health care as well.

A nation that views the young as ripe for burdens instead of benefits has itself become old.

Michael Gerson's column is distributed by the Washington Post Writers Group.

Recent Commentary stories

Rochester Post-Bulletin: For hunters and deer watchers, better safe than sorry - November 4, 2009

Rochester Post-Bulletin: For hunters and deer watchers, better safe than sorry - We now have conclusive proof that the Minnesota Board of Animal Health, the U.S. Department of Agriculture and everyone involved were wise to take the unpleasant yet safe course -- destroying 560 elk near Rochester that may have been exposed to chronic wasting disease. More

A continuing reformation - November 4, 2009

A continuing reformation - Don't believe those who say ELCA's new policy on gays isn't a big deal -- it's a huge change for the better. More

Comment on this story | Read all 41 comments | Hide reader comments

New ideas for the public sector

THERE'S NEVER BEEN A BETTER TIME to create a more efficient Minnesota. Facing large budget deficits at the state, county and local levels, Minnesotans are seeing with new clarity that the public sector must adapt to new economic realities. Only the smartest, most strategic reinvention will ensure that our tax dollars are spent on the best programs and services. Read more

About Opinion Exchange

Opinion Exchange is produced by the Editorial Department, which is dedicated to hosting the discussion on a range of issues of interest to Star Tribune readers online and in print. In its new format, it's our hope that Opinion Exhange will create a more dynamic dialogue between Star Tribune readers and the Editorial Board. Many individual posts will be written and signed by members of the Editorial Board and will reflect their own opinions. Daily editorials will continue to represent the institutional voice of the newspaper and be researched and written by the Editorial Department, which is independent of the newsroom.

Subscribe to RSS|Learn more about RSS