Mitt meets Medicare

Dean Clancy Partner, Adams Auld LLC
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Mitt Romney turned 65 this week, but, according to reports, he won’t be enrolling in Medicare.

Instead, an aide explained, the Republican presidential front-runner “will keep his private insurance and forgo the social safety net.”

Talk about a way to remind everyone of just how wealthy you are. But the former Massachusetts governor’s statement isn’t a gaffe just for that reason. It also reveals an ignorance of how Medicare works — and a disturbing out-of-touchness on the politically charged entitlement program. There are four reasons why Mitt may have muffed here:

First, enrollment in Medicare Part A, which helps with hospital costs, occurs automatically when a senior first reaches retirement age and applies for monthly Social Security checks. Thus, Medicare is, as a federal judge recently put it, a unique “mandatory” entitlement. Romney needn’t “enroll”; Medicare will just happen to him, like puberty. Next time he checks into a hospital, they’ll ask for his Social Security number and start sending the bills to Medicare.

Second, the other half of Medicare, the “voluntary” Part B benefit, which helps pay for doctor costs, is only voluntary in the sense that, if you fail to enroll right at 65, and later change your mind, they charge you a huge late fee. (As a result of this, only 2 percent of seniors decline Part B.)

Third, if Romney should actively try to dis-enroll from Medicare, under current rules the only way for him to do it would be to forfeit his monthly Social Security checks and pay back any money he has already received. Thus, Medicare features its own, Obamacare-like “individual mandate” for seniors — enforced by a financial penalty far heavier than the ones in either Obamacare or Romneycare.

Finally, there’s the governor’s assumption that he’ll just “keep his private insurance.” If only it worked that way. Federal rules effectively eliminate private health insurance options for people over 65, except for benefits that supplement, wrap around, or coordinate with Medicare’s. Assuming his private coverage is employer-provided, he can keep it; but thanks to Medicare’s “coordination” rules, unless he actually dis-enrolls from Medicare he won’t be able to avoid the program paying some or all of his medical bills, whether he likes it or not.

What happens if he ever loses or drops his private coverage? He’ll find he’s still on Medicare, for the reasons I’ve just given. Alternatively, if he ever decides to dis-enroll from Medicare, he’ll find that it’s a harsh world out there. Thanks to the program’s effective monopoly status, anti-competitive rules, and aggressive price controls, uninsured seniors today have very few affordable insurance options and very few doctors willing and able to treat them for cash. Which might be fine for someone as fabulously wealthy as Mitt Romney. But for Americans of ordinary means, it’s not.

Does Mr. Romney know any of this? Perhaps. But it’s fun to imagine his first visit to his local Social Security office:

SSA Employee: Next!

Gov. Romney: Hi, my name’s Romney. Mitt Romney. Applying for my Social Security. Here’s my card.

SSA: Thank you, Mr. Romney. Say, have I seen you before?

Mitt: Oh, maybe. (Laughs.) I used to be the governor.

SSA: (Smiles.) Oh, that’s right! We used to have your picture over there on the wall, right next to Franklin Roosevelt.

Mitt: (Laughs.) Thanks. Um, when will I get my first check?

SSA: In about a month. Are you 65?

Mitt: Yep. Just turned. (Laughs nervously.)

SSA: (Types on computer for a minute.) Congratulations, sir. You are all set.

Mitt: That was easy!

SSA: We’ll send your Medicare card in the mail.

Mitt: Medicare? Um, no, uh, hold the Medicare.

SSA: (Puzzled.)

Mitt: I just want my Social Security. I’ll forgo the social safety net, if it’s all the same.

SSA: Really? You don’t want your Medicare? Are you sure? Well, my goodness, we don’t get that request very often! Let me talk to my supervisor.

(A few minutes later.)

SSA: Thank you for waiting, sir. I’m sorry, but you’ll have to take your Medicare.

Mitt: Have to?

SSA: Or forfeit your Social Security.

Mitt: Wait. You mean I won’t get my checks? The ones I paid for, during my entire working life?

SSA: That’s right. If you drop one program, you have to drop both.

Mitt: Now, wait a minute. This is a free country, right? You know, America the Beautiful? Amber waves of grain? I’d really prefer just to keep my own insurance.

SSA: (Puzzled.)

Mitt: (Thinking aloud.) So either way, I create an unintended headline: “Mitt Skips Social Security,” or else “Mitt Flips on Medicare.” Gosh. How will that play in Florida. You sure I don’t have a choice?

SSA: No, sir.

Mitt: Am I on “Candid Camera”? (Looks around.) I see. Well. (Pause.) I am financially blessed.

SSA: (Laughs.) It’s up to you, sir. Do you want your Social Security, or not? (Pause.) And, um, there are people in line, waiting.

Mitt: Oh, right. (Looks at watch, clinches jaw.) All right. Okay. Give me the Medicare.

SSA: (Smiles.) It’s already taken care of. Next!

A question for Gov. Romney, and all GOP candidates: You have vowed, if elected, to repeal Obamacare’s individual mandate. Will you also repeal Medicare’s?

Dean Clancy is legislative counsel and vice president, health care policy, at FreedomWorks.

Note: This article has been updated.