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To Save Medicare, Think
Like the Patients Who Use It
By Ron Wyden, The Atlantic
May 21, 2012
Tyler
Olson/Shutterstock
"Medicare"
means different things to different people. Some say
it's the best argument for a national single-payer
health insurance system. Others will tell you that
it's the federal budget's biggest villain, while
election strategists call it a campaign defining
issue. However, for the nation's 50 million Medicare
beneficiaries, Medicare is neither an ideological
argument nor a political talking point. For them,
Medicare is their health insurance plan.
Of course, it's more than just a health insurance
plan. It is a lifeline for millions of our senior
citizens. Before Congress created Medicare, in 1965,
more than 50 percent of American seniors didn't have
health insurance, mostly because the increased health
risks associated with aging made health insurance
unaffordable. At the time, it was not uncommon for the
sick elderly to be treated like second-class citizens,
and many aging Americans ended up destitute without
necessary health care.
Medicare changed that. As a rock-solid guarantee of
essential health services for every American over the
age of 65, Medicare has been our country's most
important social safety net. But as a health insurance
plan, Medicare has never been perfect.
From its outset, Medicare only covered essential
inpatient (Part A) and outpatient (Part B) services,
which has long meant that seniors had to purchase
supplemental private insurance to cover what Medicare
does not. One of the reasons I ran for Congress in the
early 1980s was to help regulate the market for
supplemental Medicare insurance plans, because
unscrupulous agents were exploiting holes in the
Medicare law to sell seniors worthless policies. (In
1990, former Senator Tom Daschle and I passed the
"Medigap" law to regulate the market for supplemental
Medicare insurance.)
In 1997, Congress passed Medicare Part C to give
Medicare beneficiaries the choice to receive their
Medicare benefits through a private health insurance
plan. This reform has become a lifeline for seniors in
states like Oregon, where Medicare's low reimbursement
rates have made it increasingly hard for seniors to
find a doctor. Right now, 41 percent of Oregon's
Medicare beneficiaries get their Medicare from a
private insurance company.
In 2003, Congress added Medicare Part D to give
seniors a prescription drug benefit that had not
previously been available through Medicare. And the
Affordable Care Act (ACA), passed in 2010, included a
number of provisions to enhance Medicare's
preventative care services, while ensuring that more
seniors have high-quality private sector options in
addition to traditional Medicare.
Yet some seniors still find that Medicare fails to
meet all of their health care needs. While the ACA
included an annual out-of-pocket cap and removed
lifetime limits for insured Americans under the age of
65, there remains no catastrophic benefit in the
Medicare program, and Medicare continues to enforce a
lifetime limit on the number of days Medicare
beneficiaries can spend in the hospital.
Medicare's copays and deductibles are also not
insignificant for American seniors, 62 percent of whom
currently live on a fixed-income of less than $30,000
a year. For example, while Americans under the age of
65 pay an average of 3 percent of their total income
on health care, Americans over the age of 65 are
currently spending 16 percent of their total income on
their health needs.
As a fee-for-service health insurance plan, Medicare,
like much of our health care system, promotes quantity
over quality, by reimbursing providers for the number
of services they perform versus the quality of their
care. States that have found ways to lower Medicare
costs, like Oregon, continue to be punished with lower
reimbursement rates for providers, for the very reason
that they have established lower annual costs.
Meanwhile, Congress's inability to come up with a
long-term solution for Medicare's provider
reimbursement problems means that more and more
doctors are limiting the number of Medicare
beneficiaries they are willing to treat--just at the
time when, as of the beginning of this year, 10,000
Americans turn 65 every day, a rate that will continue
for the next 20 years. The Congressional Budget Office
projects that the Medicare Hospital Trust Fund will
run out of money in ten years. If Congress does
nothing before that time, we will be reneging on the
promise of Medicare to millions of American seniors.
Yes, Medicare means many things to many people. But
upholding the guarantees of Medicare requires each of
us to start thinking like the 50 million Americans who
rely on it for their health benefits. Those 50 million
Americans don't care about talking points or
ideological battles nearly as much as they care about
being able to find a doctor and get the care they need
when they need it. Unless Congress starts looking for
meaningful solutions to ensure that every Medicare
beneficiary will be able to find a doctor and get
needed care, seniors are going to be the ones forced
to endure increasingly higher premiums and arbitrary
cuts to benefits--until Medicare doesn't guarantee
much of anything.
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