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GRAY MATTERS: Medicare Anniversary

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

It’s not too late to observe and celebrate the 45th anniversary of Medicare, for it’s a good occasion to wonder, in this time of economic distress, what life would have been like without it for the 45 million of us who are eligible because we are disabled or over 65.

One reason I ask is I suspect those deficit crazies have not thought about the consequences for Medicare if, as Republicans suggest, the Social Security retirement age is raised from 66 to 70 on the grounds that we’re all living longer.

It does not occur to these loonies that Social Security and Medicare are among the reasons for the increase in longevity. But then members of Congress will always have all the coverage they need for themselves and their families, subsidized by your taxes and mine.

Nevertheless, by putting aside the human issues for a phony bottom line and a deficit that matters little to most of us, it would not be long before these lawmakers on Barack Obama’s deficit commission would raise the Medicare age eligibility. That, of course, would sharply increase, by at least a few million, the nearly 50 million Americans under 65, including 10 million children and babies, who are without adequate health coverage and are dependent on emergency rooms or free clinics.

If I may get personal, let me tell you what Medicare has meant for me, for my experience has not been unusual, although I’m lucky to have supplementary coverage through my wife’s former employer, which used to be free but now costs a bundle. Most other Medicare beneficiaries have similar secondary coverage through former employers or one of several Medigap policies sold by several insurers to cover some or all of the costs not covered by Medicare.

I don’t mean to get too basic, but Medicare Part A, which pays for hospitalization, has rather high deductibles; Medicare Part B covers 80 percent of the cost of physician and lab services. Secondary insurance covers those Medicare gaps, and some may provide drug coverage.

Anyway, in 2003, I had a serious stroke, which partly paralyzed my right side and necessitated hundreds of hours of inpatient and outpatient rehabilitation at several of the nation’s finest facilities. The stroke was caused by a heart malfunction which was cured with minor surgery.

In 2005, after too many years as a smoker (I had quit in 1976), I was diagnosed with cancer of the esophagus, which is usually fatal. But chemotherapy, radiation and radical surgery at Johns Hopkins in Baltimore saved my life.

For all this, plus frequent checkups, CT scans, routine doctor visits and a recent prostate procedure, I have paid nothing aside from the reasonable Medicare Part B premiums and the cost of secondary coverage. In short, I can say what millions of Medicare beneficiaries say: without Medicare, I’d be broke, bankrupt or dead.

But that, alas, has been the experience of the millions who, because they are too young, have been denied Medicare. Nor do they yet have decent, dependable and affordable health care because a compromising president and a spineless Congress, mostly Republicans and conservative Democrats, have declined to give the rest of the nation what they and the rest of the world have, universal health coverage like Medicare.

The anniversary of Medicare’s adoption, by a liberal Democratic Congress and president (Lyndon B. Johnson), has give advocates an opportunity to list its lesser known accomplishments. While most of the new health reforms won’t become effective until 2014 (the Part D doughnut hole won’t close until six years later), Medicare was serving 19 million Americans a year after passage.

LBJ Signs Medicare Bill

In a paper written by June Eichner and Medicare’s first director, Bruce Vladek, they point out that beginning in 1966, as the nation’s largest purchaser of health care, Medicare desegregated most hospitals as a condition for receiving Medicare reimbursement. Since then, they wrote, Medicare has contributed not only to the improvements to the lives and health of the disabled and older populations, but has gone far in erasing disparities between blacks and whites. More than 25 percent of Medicare beneficiaries were living in poverty in 1965.

The passage of Medicare came just after the Civil Rights Act of 1964. Which is why southern Democrats joined Republicans in resisting Medicare. But because of those two landmark pieces of legislation, the National Bureau of Economic Research found that

“the gains in black access to hospitals (in Mississippi) coincide with a striking reduction in black post-neonatal deaths for causes considered preventable.”

The cost for these improvement were borne by Medicaid, passed along with Medicare to provide care for the very poor.

Another study noted that Medicare played a significant role in the education of today’s physicians. According to an April Wall Street Journal story, there are about 110,000 resident positions in teaching hospitals that rely heavily on Medicare funding.

Medicare pays $9.1 billion a year to teaching hospitals which pays residents’ salaries as well as the higher operating costs associated with teaching hospitals which tend to see the sickest, most costly and uninsured patients. Unfortunately conservative diehards kept out of the health reforms any increase in the number of funded residencies.

There are, too, a few glitches that have shown up lately in Medicare that need fixing. Under current law, persons over 65 who end their employment and employer health coverage must apply for Medicare during a “special enrollment period” up to eight month after that coverage ceases.

But if the workers chooses to get COBRA coverage, which usually lasts 18 months, they may not realize that they will be disqualified from the special enrollment period and will have to wait until the regular open enrollment period, from January through March 31. In that case, their Medicare coverage won’t begin until July 1. This rule is 24 years old but because it’s happening frequently, legislation is pending to permit signing up for Medicare when COBRA runs out.

Here’s another glitch, discovered by Bloomberg News. Under current law, a person (who suffered a stroke or was injured) is entitled to skilled nursing care and rehabilitation after three days in a hospital. But lately some hospitals, to save money, are keeping patients “under observation” and not admitting them, thus depriving them of the rehabilitation they need. Medicare auditors are challenging this practice, which should be reported as fraud to Medicare.

Finally, the biggest necessary fix is the one Obama said he was for before he became president; Medicare For All. It is the subject of a new appeal to the Congress by Representatives Dennis Kucinich (D, Ohio), John Conyers (D, Mich.), and Independent Senator Bernie Sanders of Vermont.

If Congress won’t pass it, they asked that states be permitted to adopt it. It would be better, of course, if Medicare for All was federal law. If Obama led the way, he could be in the same leagues as LBJ. But our president for change, who has yet to speak forcefully against cutting or tampering with Social Security benefits, is too busy to listen. Maybe it’s possible in a second term, if he gets one.

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Very good summary. I don't necessarily agree that people of Medicare age should be allowed to use up their COBRA, but I know that some don't get the right information.

Thank you.

It is, unfortunately, a fact of life that many Seniors can state a similar story of Medicare charges late in life. It is a problem that must be
either be accepted as routine and planned for with adequate funding or routine and funded differently so as not to "break the Taxpayer's Bank".
I heard Senator Kent Conrad of North Dakota say at the Joint Congressional Meeting On the New Health Care Law with President Obama prior to its passing that one fact which surprised him about Medicare costs was to learn that approximately 40% of all Medicare money is spent during the last few years of a Senior's life: the attempt by hospitals and Staff to prolong life as long as possible. In my case, it was over $50,000 for a heart by-pass and over
$100,000 for a Cardiac Arrest--no questions asked. Just paid. Was I worth it; I doubt it. However, I've often wondered if the medical system
doesn't love these cases because they get a huge amount of money in one fell swoop. Would I rather the Country spends its tax money on Senior Medical care than on wars in Iraq and Afgahnistan? You bet! And this comes from a Father whose US Army Son puts his life on the line every day flying Boeing Chinook Helicopters and has spent two one year tours in Iraq and one in Taliban territory. (Both those wars would be over in 30 days, in my opinion, if the wealthy and the elite had their Children on the firing line. For them, no draft no worry.
Actually, there is no doubt in my mind that if Bush the Son or Draft Dodger Cheney had ever fought in combat, the Iraq war would never had started. Speaking of costs: Remember when Iraq oil was going to pay all the costs of that war!) Why this Country doesn't require that the Medicare tax be paid on ALL earned Income is beyond me. And considering our Country's debt situation, if the Democrats allow the Republicans to politically coerce them into continuing the Bush tax cuts for the top 2% in our Country, they ought to be ashamed of themselves. Never forget, recalling what some call "Our Greatest Generation" and World War II, the top tax rate then was 91% and that rate was not repealed until during the Eisenhower Administration. By the way, I am an Independent; I'll listen to both camps and, then, make my own decision.

The States, unfortunately, won't consider adopting Medicare for All. Some states are suing the Federal Government now over the requirements they have to meet in the new Medical Reform Act. Obviously, there will be no reform coming from cash strapped States.

Until this country joins the other industrialized nations with a single payer system we will always have an expensive and ineffective medical system.

I fear the conservatives are already trying to chip away at the reforms and it will get worse before it gets better.

On a personal level, I, too, would be destitute or dead without Medicare. Probably dead.

I do think that the horrendous cost of keeping an elder alive a few weeks or months more should be reconsidered. I, for one, do not want Medicare to spend $100,000 + keeping me hooked up to machines extending my life a little longer. When it is my time I want to go according to nature's plan. There should be a way to deny that kind of coverage to a patient unwilling to 'let go.'

My husband and I also would be dead or destitute without Medicare. Most people's life savings are nothing compared to the cost of treating cancer. Why should anybody's life depend on whether or not they are millionaires? We do have medigap insurance, which is not cheap.

When my time comes, I'd gladly choose hospice care over ridiculous treatments that only keep you alive a few more months in misery.

At the risk of feeling conned later, I think that I should point out that the same morning Saul's post went online, President Obama did speak strongly against privatizing Social Security. Now we have to hold him and the rest of the Democrats to this (including further raising the retirement age!)

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