Medicare Generational Split?
Wednesday, 30 April 2008
[EDITORIAL NOTE: There are just two more days - today and tomorrow - to take The TGB Elderblogger Survey. If you haven't done so yet, you know what to do with this link.]
Not infrequently, I run across young workers, on their blogs, complaining about the 1.45 percent payroll deduction for Medicare. The complaints generally run to something like, “Why should I have to pay for those old farts’ healthcare.”
With global resources shrinking and the beginning of a recession that probably won’t end any time soon, there is already the prospect of a generational divide. Now, Health and Human Services Secretary Michael O. Leavitt, who oversees Medicare, is fanning the flames.
“’I suspect that’s one of the things that worries me most about the Medicare situation, which is that it is destined to divide our nation along generational lines. Right now, there are four earners for every Medicare beneficiary. I think it’s 2028 when there are only two,’ he said…“And I’ve had this conversation with my sons, and of course at their age, they say, ‘Well, we ought to reduce the benefits. They don’t need unlimited care. They ought to be sharing part of the burden,’ he continued.
“But if you are 65, what you say is, ‘Well, look, I paid for it. I did my time, now they need to do theirs.’ So you’ve got this generational conflict happening,’ he continued.
- The Washington Times, 25 April 2008
Before I get to what I came here to say today, I want to point out the head of HHS, who is responsible for the government’s role in the health of all Americans, correctly states that Medicare faces huge fiscal problems. But he then signals that the Medicare deduction is unfair to young people. Nowhere in the report of this interview with the secretary is there a mention that he might have an idea about a solution to the looming Medicare deficit. We can only assume he doesn’t have one.
In response to Secretary Leavitt’s points:
Elders Sharing the Cost
Medicare was established in 1965, during Lyndon Johnson’s presidency to provide older Americans with comprehensive healthcare at a reasonable cost, something that previously had not existed, leading to what was generally agreed to be a healthcare crisis among older Americans.
That first year, the premium for Part B (outpatient medical care), which beneficiaries pay, was set at $3.00 per month. In 2000, it was $45.40. This year, it is $96.40. In addition, most elders purchase supplemental policies to help cover the gaps in Medicare. And many also buy prescription drug coverage – Part D. Premiums for Parts B and Part D vary wildly depending on deductibles and other choices from the private insurers which offer it.
With careful investigation into the varieties of coverage, I’ve kept my monthly cost for healthcare premiums to $265.10. Other elders may pay more, but I doubt many pay less, and with average, monthly, Social Security benefits currently at $989.80, that’s is undoubtedly a hardship for some elders. But we do share the burden of the cost. Medicare is not free.
The Cost to the Young
Every elder who benefits from Medicare today spent decades paying their 1.45 percent salary deduction. It was and is not a savings account. Nor an insurance premium. The money goes into the Medicare pool to benefit current elders and, by the way, the disabled of all ages.
What I find shocking about the young people’s blogs I read and Secretary Leavitt’s apparent agreement with his sons is how stingy they are. In all the years, decades, I’ve spent discussing the high cost of goods with friends along with our complaints of how much the government took from of our paychecks (“I’d rather have the government’s portion of my salary,” we used to say, exaggerating only slightly), no one ever, not once, begrudged the deduction for Medicare.
If we thought about it at all, I think we believed it was for the common good, that it is everyone’s responsibility to help where it is needed and the Medicare deduction was small enough for the great good it accomplishes. For if there were no Medicare, only wealthy elders could afford any healthcare at all because there is no affordable insurance after about age 60.
The Medicare Crisis
Secretary Leavitt is correct and I would state it even more emphatically: Medicare is a looming catastrophe thanks to all those damned baby boomers who have the effrontery to get old and didn’t have the foresight to have enough children to pay for Medicare. Shame on them.
Actually, the Department of Health and Human Services, through many administrations and secretaries, knew this demographic shift was coming. It has been warned of and discussed by actuarial experts for decades, but was irresponsibly ignored by our representatives in Washington. Now there is a real crisis.
The Solution
But there is a solution – for you, me, the baby boomers and the kids who resent that paycheck Medicare deduction: universal healthcare, single-payer system, national health, whatever you want to call it. Nitpickers will tell you there are differences among those names, but the idea in each is to make healthcare available to everyone.
Medicare should be folded into it, everyone pays into the system and everyone takes out as needed. It works in Canada, Great Britain, France, Germany and every western democracy except ours, and there is no reason it cannot work here.
But it must be universal to succeed. Neither Democratic presidential candidate has a true universal healthcare proposal and Senator McCain's plan, released yesterday, will cost families even more than they pay now. All the plans continue the grab bag of private and government coverage that continues giving private insurers huge profits and still doesn’t cover everyone - undoubtedly because the giant pharmaceutical companies and the healthcare industry donate big bucks to their campaigns.
Healthcare is not optional; it is a human right. It is disgraceful that the United States leaves millions of people without access to care and allows millions more to be under-insured.
We must demand from this year’s candidates for Congress that universal coverage be among their top two or three priorities when they take office in January. Without it, not just Medicare, but the entire healthcare system is in danger of collapse. There is much public discussion that should be had regarding healthcare and the Secretary of Health and Human Services should be leading it - not supporting divisions among age groups. [See also Universal Healthcare and the 2008 Election.]
[At The Elder Storytelling Place today, a message.]
I would think that a simple way to get universal coverage would be to just start lowering the age at which people are eligble for Medicare. As you say, there is no affordable coverage once you hit 60. As two self employed people we are having a hard enough time with a very high deductible policy that I dread what is coming. We are healthy and are just going to have to stay healthy. But I am afraid we will be going without coverage at all at some time in the future.
Posted by: Zuleme | Wednesday, 30 April 2008 at 04:08 AM
I think you've said it well, Ronni!!!
Posted by: Kay Dennison | Wednesday, 30 April 2008 at 05:29 AM
A sense of mortality comes after adolescence (i.e. around thirty something) Until then we all think we'll live forever and never suffer debilitating illnesses.
Compassion is not
universal among the young.
A single payer system is still the only soloution but I'm afraid we'll get it around the time we discover glaciers in Hades.
We are indeed living in a fool's paradise.
Posted by: mythster | Wednesday, 30 April 2008 at 07:25 AM
As you know, Ronni, I do not agree that healthcare is a "right". I do, however, believe that a single payer healthcare plan is desirable and practical. Healthcare has become a tangled web rivaled only by our taxing systems. Unfortunately, both are the way they are due to greed (read: special interests).
Posted by: Cop Car | Wednesday, 30 April 2008 at 07:27 AM
Although I am a supporter of a free-market economy, there are times when the free-market does not adequately provide for everyone. Healthcare is one of these situations.
I have written to several Congressmen and Congresswomen regarding a healthcare proposal I believe is workable. I believe it provides a framework that can be used as a starting point.
My proposal starts by eliminating all of the competing health plans, i.e., Medicare, Medicaid, SCHIP, Veterans Affairs, etc. In its place would be a universal heatlh plan that every citizen would qualify to receive the moment they are born. The plan would be basic, but would provide coverage for emergency care. Coverage would be set and manadated by Congress. It should be created in a manner that would make it difficult to change. It would not provide extreme, life extending care. The plan would be paid for through a similar tax such as the 1.45% withheld for Medicare. Here is where the free-market steps in. The country would be regionalized and bids would be accepted to administer the program. The government is not in the insurance business, it is in the business of protecting its citizens. The government needs to leverage the expertise that exists within the country to make the plan work.
Anyone or any employer wanting to supplement the government health plan with private insurance is free to purchase it from any insurer that wants to offer a plan.
Under this framework, everyone has insurance and is provided access to a physician. The administrator would geographically assign physicians. People would be free to change their physician as long as the new physician accepts the assignment.
It has its shortcomings, but every plan will. No plan will address every need of every person. Since everyone is talking but no one is doing, here is something to chew on.
Posted by: Jeff Gunnet | Wednesday, 30 April 2008 at 08:43 AM
I agree that we do need a single-payer universal coverage system. Some might find it strange that I think we need it for both employers and employees. Business/industry groups are quite right that American business and industry is at a disadvantage with respect to its foreign competition when it is saddled with the costs of providing coverage for employees. The business argument ends there. However, most of that competition doesn't pay directly for employees' health coverage because governments pay and then tax both individuals and companies to get the funds. American business wants out from under health insurance costs. But most of the plans simply make the individual solely responsible for those costs. That saddles all American workers with costs foreign workers don't have. If we truly wanted to level the playing field we would cover all Americans for basic preventative care (including dental and vision) and necessary surgery. Those who want and can afford insurance for elective surgery can buy insurance for that. Unfortunately, most of our politicians seem to believe that the health of the medical insurance industry is more important than the health of American workers and they are willing to secure the former by sacrificing the latter.
Posted by: Mary Walker | Wednesday, 30 April 2008 at 09:09 AM
Well, when those younger workers have watched their mom's last hospitalization costs run to $350,000, thankfully paid by medicare and insurance, leaving enough in the estate to take care of their disabled sister and nephew, pay off their brother's house and let them enjoy life instead of worrying about money for awhile, maybe they'll begin to appreciate it.
I know I do.
Posted by: donna | Wednesday, 30 April 2008 at 10:47 AM
I'm in agreement with Cop Car - Healthcare is NOT a right. It is a commodity, and it is likely to stay a commodity. Those of us who can pay for 'extras' will always be able to get them. There will be no limitation on healthcare for those of us that have made life choices that enable us to pay for it.
There was a time when every Quack with an M.D., didn't have their picture pasted on bus benches and billboards lining the highways offering everything from vasectomy reversal to bariatric surgery to botox treatments.
But this young vs old thing is brought about by two separate set of circumstances. The first is grievance mongering. While it used to be the purview of the left, it has now infiltrated EVERY part of politics. Divide and conquer. Consolidate your voting base. Create an 'us' and 'them', where 'them' are taking from 'us'.
And modern parenting. So now it is time for the kids to feel their parents (and grandparents) are burdens, because they are continuously told it is true. Well folks, we reap what we sow. I never felt that way about my Mom and Dad, and I bet most of the people that contribute to this blog don't feel that way. BUT WE RAISED KIDS WHO DO! We made them the center of the universe and Lo! Now we are surprised that they think they ARE the center of the universe!. (I use the collective 'we', I don't have any and never wanted them.)
Most kids younger than 30 grew up either with parents who don't care at all, or with a Soccer Mom. Crack house kids are probably worse off than the kids in my neighborhood who had drunks for parents, but not a lot worse off... They have every right in the world to hate their parents and their lives. People who dedicated their lives to their kids are amazed at their kids that have grown up with a 'me me' attitude.
Was it true of Baby Boomers? I don't think so. I was in a few school plays, played on an intramural hockey league and played competitive tennis, and so did a lot of kids I knew. Did our parents break their schedule so that they could 'attend' our events? Nope. They had a limited amount of free time and they spent it in adult pursuits. They spent time visiting their friends, and going places they wanted to go, taking me too, but it was their choice where, being on a bowling league having friends over of a Friday night for a card game. Do I think I was a deprived kid? Never in life! I had a great childhood and a really fine, loving relationship with my parents over these years. I was important to my parents and I never doubted their love for me, but I was decidedly NOT the center of the known universe.
I am off track here, and this solves nothing. There is no way to go back and 'fix' that problem. But every time a politician yammers about 'Social Security going away!!!!!' or Medicare is 'TOO EXPENSIVE!!!!!' or any other pat divisive rhetoric built to consolidate a voting base, and propose no (real) solutions, it gives me the shivers.
There was a pretty good science fiction story written in the 70's about the future where the old had to barricade themselves behind walls, else the young would prey upon them. They old had lost their legal right to protection - another commodity. The only way the 'old' could protect themselves was with high walls, big locks, and money.
Art predicting life.
Posted by: Cap'n Jan | Wednesday, 30 April 2008 at 11:39 AM
Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.
Posted by: matt | Wednesday, 30 April 2008 at 02:26 PM
I admire you presenting this issue and found the comments fascinating. No anyone is wrong or right. Isn't that amazing? and a political dilemma? It is a very tangled web we have woven.
Forgive me my apparent divergence from the issue at hand but perhaps it isn't so far off if you care to read on.
My additional worry is that the special interests of the medical field and the drug companies (grrr!) doing everything possible to put down alternative and often more successful means of treatments. There is an article in the Washington Post on the 29th that tries to undermine the validity of supplements in order to regulate them or remove them for the marketplace. Only because they take $$$ away from the drug companies and the medicos. A healthy populace means a lot less money spent on hospitals, surgery and drugs. In other words, place supplements under the direction of the FDA - they are so successful at protecting us - don't you feel safer already? She says sarcastically...Then the drug companies can genetically alter and thereby patent supplements! Our health "care" has truly been taken away from us as we are not given solutions to maintain good health - but only drastic barbaric solutions to cut and remove the offending organ or body part. Doesn't that seem barbaric - this allopathic idea? In eastern medicine - the practitioners were paid to KEEP THEIR PATIENTS HEALTHY!!! and WERE NOT PAID WHEN THEIR PATIENTS FELL SICK. Sounds fair to me!!!!
This issue is of choice about how we maintain our health and thereby become dependent on this system in dire trouble is an underlying and root cause in my opinion. We are the most unhealthy populace on Earth! There is the problem as we are not looking in the right direction! Our lack of truthful information because it is suppressed by special interests is a huge problem.
"Thanks for listening" and for the opportunity as always Ronni.
Posted by: Mary | Wednesday, 30 April 2008 at 03:05 PM
In reply to Matt and everyone who mentioned that 'survey'.
The survey means nothing if you can't see the questions asked: I never saw what the questions were, and I have looked!
If you have a list of the questions asked of these docs, I would sure like you to post it.
Here is an example of the way questions could be worded producing positive replies.
"Would you be in favour of national health if your income were not reduced, but your hours were?"
"Would you be in favour of national health if your office staff could be reduced because paperwork would be reduced AND your income would not go down?"
"Would you be in favor of national health if you were guaranteed payment for every individual you billed for, and the billing amounts would be set by the AMA?"
See what I mean?
That's the trouble with unpublished surveys. It is also the trouble with surveys in general.
I looked all over the place for bias in the survey that Ronni came up with for us, but it was pretty amazingly unbiased! Nice job!
The Captain
Posted by: Cap'n Jan | Wednesday, 30 April 2008 at 03:24 PM
It is not only the over 60's that need medical benefits. I've worked out that in the last 20 years the social medical system has paid for everything from a three-month sick leave (I had to stay in bed for the last three months of my pregnancy with my daughter), six operations, extensive rehab treatment, mouth surgery (my son), two sets of braces (my two children), numerous visits to the emergency ward (children), various visits to specialists, and on and on, right up to the acupuncture treatments for back pains. My children and I were the recipients of excellent "free" medical procedures all through my thirties and their early years. Now, in my 50s, I am, thankfully, more or less just practicing preventative medicine. For all of this treatment and sense of security, I pay about 12% of my monthly salary and my employer pays an equal amount into my policy. Each person pays according to their earnings. If you earn little, you still are able to receive full advantages of the system. If you earn a lot than you don't have to participate in the social medical plan, but can insure yourself privately. The system is flexible, and consistent, and, I believe costs only a fraction of what your system costs.
Posted by: lilalia | Thursday, 01 May 2008 at 12:01 AM
I think it's appalling the Sec'y of Health & Human Services contributes to such devisiveness so pervasive in our country, especially the past eight years. He's following that destructive herd that has exploited the technique for personal political gain. So many voters keep falling for it. Surely not again!
Of course, if he's part of the cadre' in government determined to destroy Medicare, or those who give only lip service to health care for everybody, we should know he has no incentive to aid in resolving the problems -- people such as him seem to be the ones who have been appointed to responsible administrative positions during these years.
I can support a national health care system designed with certain basic guarantees, including:
1. specific clarification of what are condidered emergency life-threatening conditions (more than just general language i.e. some medical problems are not in and of themselves life-threatening, but if left untreated, or inadequately treated will become life-threatening. I don't want care to be delayed to that point.)
2. a certainty there will be timely delivery of services.
I remain unconvinced any plans proposed by the current candidates are adequate as universal health care.
What I do want to see is an elimination of the basically usury rate of medication costs to citizens incurred from the current way in which the pharmaceutical companies distribute their products in the USA. Ways to resolve that issue have been spelled out here in earlier TGB posts. That alone would be a beginning meaningful step toward one aspect of reforming this health care debacle.
I have long been a skeptic of most survey and research statistics since they are all too often not very valid or reliable, much less realistic. I have found most of what is presented on this blog or devised for this blog to be reliable and credible.
Posted by: joared | Thursday, 01 May 2008 at 03:37 AM
So how well really does universal health care work in other countries? I know Americans living in Sweden, England and Japan who return home for their healthcare. Some of that is because of the incredible wait times for regular checkups - plan a year in advance; if you are sick you can get in, but there are SO many people. I wonder if that is because folks come in for every little thing since it's free. A Japanese doctor, his waiting room filled with happily chatting older ladies, was wistful of his American counterparts who didn't have social clubs in their offices. France is having problems paying for all its "free" services and of course once you give it you can't reduce it as the govt discovered, Japan is very worried. When you talk universal healthcare here, how many people want to see their taxes go way up to pay for that? I suspect totally "free" is not the way to go. There's got to be a happy medium.
Posted by: Linda | Thursday, 01 May 2008 at 10:01 PM
I went without health care insurance for 10+ years because I was working part-time and paid my own way through college. I am from labor class and my parents did not pay for me to go to college. When I was in my mid-20's, I got tired of getting sick every year (since childhood) with 4+ days of severe abdominal pain and went to the hospital to find out what it was. $30,000 later, I ended up having to bankrupt. At that time (maybe even now), no help was available for a childless, single, self-sufficient woman. Luckily, my condition is physical and controllable with good diet and exercise; however, I learned to avoid going to the doctor. Even now, with good health care insurance (required by employer otherwise I consider it a waste of my $$$), I refuse to go to the doctor for myself because I've been well trained by this society to realize I am not worth health care. As long as this nation's only catastrophic health care coverage is Bankruptcy, I shall not go to the doctor for myself.
Thank you my dear society for training me this way. But, I totally understand the selfishness of this entire society regardless of generation, and, unless you've gone through this personally, it doesn't really matter if everyone has health care does it?
Posted by: AVI | Saturday, 03 May 2008 at 11:58 AM