If enacted, Clinton's 'Medicare for some' proposal may help hospitals

I'm not sure what to make of 86-year-old William Hager, who almost certainly will spend what remains of his days behind bars for shooting and killing his 78-year-old wife. He claimed the couple could no longer afford her medications. I'm not certain what say Carolyn Hager had in the matter, and even if she fully assented to this demise, her husband still murdered her.

These so-called "mercy killings" crop up from time to time, and it does show a lot of Americans are under enormous pressure to foot part or even all of their healthcare costs, even decades after they have stopped working and shouldn't have these worries any longer.

The Hagers declared bankruptcy five years ago, according to The New York Times, and he apparently took a job at Sears to cover her medical bills. Is there anything more profoundly depressing than working in your 80s in a declining retail chain store in Florida in order to get medicine for your spouse? No doubt the business practices of Turing and Valeant Pharmaceuticals have been little help here.

This is among the reasons single-payer healthcare is no longer being maligned in this country as a serious policy proposal. The right has been slamming the Affordable Care Act (ACA) since it was enacted six years ago, but it has become patently obvious repeal isn't going to happen. The replacement(s) touted by Republican lawmakers--mostly allowing insurance sales across state lines--are so feeble they're being ignored. Bernie Sanders' calls for "Medicare for All" would have made him a laughingstock just a few years ago. But now that it's on the table--and healthcare costs continue to rise--it is likely going to stay there.

One of the reasons for that is painfully obvious: Mortality rates for white middle-aged Americans--particularly those without college degrees--have been skyrocketing upward since the late 1990s. Suicides explain some of this rise, but much of it can be blamed on healthcare problems like liver disease, opioid addiction and sparse access to care.

This demographic typically votes for Republicans, but the utter turmoil in this year's presidential campaign on the right strongly suggest they if there's going to be an oar lowered into the water, it better be used to help them rather than beat someone else. An indication of this is the fact Donald Trump actually has a healthcare policy that parrots the GOP party line. Yet he talks about it on the campaign trail about as often as he releases his tax returns.

The most workable proposal recently came from the middle. That's where Hillary Clinton resides, but Sanders' relentless leftward yanking finally forced her hand on healthcare. Clinton's proposal is pretty simple: Lower Medicare eligibility to as low as age 50, and allow those up to the age of 64 to "buy in" to the program, likely through policies available on the state exchanges.

This is a modified extension of the so-called "public option" that died a bitter death as the ACA was being hammered out in 2009 and 2010.

In short, it is less a pale nod to single-payer than a relatively small tweak to the ACA. But it could provide enormous benefits. There are some 13 million people between the ages of 50 or 64 who are either uninsured or buy coverage on the exchanges. Many of them struggle with costs; my family's premium rose about 40 percent this year under the ACA's community ratings rules after my wife turned 50. I expect them to go up again significantly in 2017 as I hit the half-century mark. Something to look forward to, I suppose.

But given Medicare pays providers far less than commercial insurers, I would expect its premiums to be significantly lower (no doubt why the public option was killed before the ACA was enacted). And statistically speaking, the 50-64 age group is much healthier than the 65 and above crowd. So, out-of-pocket costs could be significantly lower as well.

Add to that the enormous political popularity of Medicare--and the demographic ills of many middle-aged Americans --and there likely would be broad support for such a proposal.

Hospitals don't love Medicare, which as I said pays significantly below commercial rates and insists on introducing those pesky value-based programs to keep costs in check. But over the long run it's probably cheaper for hospitals to have more insured middle-aged patients and work with a highly reliable payer than have to spend tons of money dunning for four and even five-figure co-payments.

The next few months and several years will show which course the country has decided to take. But for now, I could definitely do without more stories like the Hagers.--Ron (@FierceHealth)