Adventures In Medicare
We warn against the horrors of the privatization of Social Security and Medicare. Shit I did not know: Medicare is already more than half privatized, if you go by spending, in the form of the Medicare Advantage plans. These are plans offered by private insurance companies that are funded by the Medicare program. It is well documented that they rip off Medicare by screening for beneficiaries who are in better health and who will consequently, on average, cost less than those in public Medicare.
As a Medicare beneficiary, I’ve tried to evalute whether any Medicare Advantage plans would save me money. It’s a hopeless task. You might as well wear a target on your back and invite financial disaster if you incur a serious medical problem. It’s much simpler for me to pay a ton for my Blue Cross, on top of Medicare, and be assured of zero out-of-pocket medical expenses. As one of my doctors advised me, at your age (and in my condition, he didn’t say but didn’t need to), buy as much insurance as you can.
People babble about Medicare For All. It’s an empty box. Thing is, Medicare is not insurance. It pays 80 percent of doctor costs (more for hospitalization), and 20 percent of a catastrophic expense is still a catastrophic expense for most people.
When my wife was in the hospital, we discovered that Medicare only covered a limited number of days after she would be released (but still saddled with cancer). I made sure to get into long-term care insurance for myself while employed by the Feds. Without Federal group coverage, I would not have been able to buy my own. That’s why the Harris proposal for Federal support for people who need skilled nursing care at home would have been huge.
In the book I reviewed the other day, Einav and Finkelstein claim all doctors are required to take Medicare patients. Ha! When I moved to Virginia, I was pleased to see a doctors’ office five minutes from my new house. Alas, they will not take people on Medicare, even if they have heavy supplementary health insurance, as I do, thanks to my service for the Feds.
The current public system — Medicare and Medicaid — is easy to depict as a huge mess. As such, it is a ripe target for those who would convert Medicaid into a block grant and public Medicare into nothing but Medicare Advantage. Einav and Finkelstein’s book embodies the political strategy underlying the potential dismemberment of M&M.
The block grant gambit is well-established, starting with the Reagan Administration in the 1980s. Block grants “simplify” and reduce government bureaucracy, we will be told. There might even be a sweetener of a bit more money up front, to quiet down nervous state government politicians who won’t be around as the grants become increasingly inadequate. The inadequacy will be by design, as long as health care costs rise faster than inflation. When that a-hole Bill Clinton block-granted Aid to Families with Dependent Children, he didn’t even include an inflation adjustment.
Both Medicaid and public Medicare spending have been open-ended and growing rapidly. Hence both are top targets of deficit hawks and general opponents of the welfare state.
Just another thing to brace for.
Little-known (in my experience) fact about traditional Medicare vs. Medicare Advantage:
About four years ago, I was induced to switch from traditional Medicare + Supplement (Parts A, B and D)to a Medicare Advantage Plan (Part C). It saved me some money on one medication. I had no real problem with it but I began to hear horror stories from others about this procedure or that not being covered of this or that practice not accepting MA. I decided I needed to switch back.
I tried.
No such luck. I chose a plan with a supplement from Mutual of Omaha. Highly rated.
I was rejected. Why? Seems I had “degenerative bone disease”, something I was not aware I had. Me, who was cycling over 75 miles a week on a traditional bicycle, not an E-Bike. I called to complain. What the hell is “degenerative bone disease”?
It turns out that DBD is a fancy name for “arthritis”, something that, what, 98% of those of Medicare age (I’m guessing) have somewhere in their medical records. Mine was not severe in the least, something that some doc at some time just wrote in my chart before Medicare Advantage existed, probably.
I called Mutual of Omaha to complain and was directed to some broker. She said she thought she could find me a decent plan but it wouldn’t be easy. You see, here is the thing not many people know: the decision to take Medicare Advantage is practically irreversible. When you first go on Medicare they can’t reject you for any preexisting condition. You have what they call “right of issue”, the right to be issued a policy, no questions asked. Once you take MA, you no longer have this right and preexisting conditions can be and are considered.
I can’t tell you how many people I’ve spoken to who do not realize this.
However, I was in luck. This broker knew her stuff. I casually mentioned that I’d just moved from Illinois to Arizona, and a light went on in her head. This light did not go on in the head of the consultant who worked for my previous employer who I had previously spoken with. There is an exception to the above right of issue rule.
IF you happen to move to a different state, then right of issue is back in force and they have to take you! And so Mutual of Omaha, once informed of my move, gave me the policy they had previously rejected me for.
I had no idea of any of this when I moved. But anyone in greater need than I of getting back to Traditional Medicare might seriously consider such a move if feasible.
After a few surgeries and various procedures (stress tests, heart catherization, colonoscopy, etc.)—nothing catastrophic—Medicare has served me well. Medicare limits what doctors and hospitals can charge, so the 80% payment figure isn’t quite accurate (which is why some doctors won’t accept Medicare). Many bills are already reduced perhaps 25 to 30% by Medicare, so patients pay about 20% of an already reduced medical bill.
I used United Healthcare for a time to cover prescription drugs, but realized there were no savings for drugs because of the high premiums. Instead, I joined a prescription club at Walgreens that gives me almost the same reduction in price as United for only $25 a year rather than $100 a month premium. (Medicare itself last time I looked cost me $115 a month, taken directly from Social Security.)
So, my experience with Medicare has been positive, and Medicare for all as a step toward universal healthcare seems sensible. Besides the premiums, the biggest difference between Medicare and private insurance is that Medicare limits what patients can be charged and private insurance limits what it will pay (if anything). Of course, Medicare won’t pay for everything, but it does for much more than standard insurance plans.