To Save Medicare, Think Like the Patients Who Use It

Fast facts about the health insurance guarantee 50 million Americans rely on.

"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.

Solving the nation's most entrenched problems See full coverage

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.

This article available online at:

http://www.theatlantic.com/health/archive/2012/05/to-save-medicare-think-like-the-patients-who-use-it/257299/