Slouching Toward Medicare

For me the odometer rolls over in December. I’ll turn 65 then. I’ve been fortunate all my life where health care is concerned. As a kid, in my parents’ home, I was unconscious of how the medical bills got paid. Those were simpler times, before the corporations ran rough-shod over public and private life, before our national leaders had devolved to a gang of thugs in the pay of corporate masters, before a privileged upper middle-class dominated policy development at the behest of these same corporations. When I was a child the perpetual proletariat of today, informed by propagandists aping the exercise of free speech, had not yet come to dominate political discussion, to drown out informed debate. When I was a child the vicious forces of rapacious greed were hidden in an emerging consumer society, their presence only hinted at by the chimera of a communist menace invoked by heroes and fools alike. From Winston Churchill to Joseph McCarthy there was a unity of opinion regarding our freedom, our way of life, and the challenges and dangers that a nebulous “other,” the red menace, posed to peace and prosperity.

When I was a student, the University provided health care (for which I was grateful once when I needed spackling and repair following a motorcycle accident).

Those first twenty years or so of my life were, I guess, the good old days.

When I found work in Northern California, I became a member of the Kaiser Permanente HMO, where I remained for twenty years. Mostly, I never saw the money that Kaiser cost me as anything more than a modest deduction noted on a pay stub. Health care was easy, inexpensive, and more than adequate. My twin sons were born prematurely at Kaiser Hospital in San Francisco. The week or more they spent in the premie intensive care nursery cost no more than if their mom had delivered normally and gone home with them the next day. I was certainly grateful for that.

Those next twenty or twenty-five years of my life were, I guess, the good old days too.

For the last twenty years Beth and I have had great health insurance coverage. We had the luxury of choosing which of our employer paid plans would benefit us more. Then, when I started my own business, I had coverage under Beth’s plan, nicely avoiding the health care overhead that so many sole proprietors face.

These may still be the good old days.

But Medicare has appeared on my personal horizon just as the country is engaged in the great Health Care Reform debate and it is held up as a model of health cost coverage. Medicare may be the lowest common denominator for Health Care Reform legislation. It may be the model for our new system.

This may not be a good thing and here’s why.

First, about $1,200 will be withheld from my retirement checks in 2024 to pay for Medicare Part B coverage. Second, if I’m hospitalized, I have to pay a $1068 deductible before Medicare kicks in. Third, the Part B coverage that’s costing me $1200 only covers 80% of medical expenses.

But there’s a solution waiting in the wings! First, I’m still covered by Beth’s group policy until she retires. Then, when she’s retired too, we can choose to pay $1200 or so a year (each) for continued coverage on her group plan, coverage which will fill in the awkward gaps left by the Medicare Part A and Part B deductibles and 80% payment limitations and so forth.

Medicare Part A and B provide enough coverage to help you avoid bankruptcy if you are hospitalized with a serious condition. Sure, you’ll be forced to live a penurious existence after that. Your home will be sold to pay the deductibles, you’ll move into a public housing project and be forced to eat government cheese, but the fixed income from your pittance of a retirement annuity won’t be attached by the hospital to help pay for your cardiologist’s fifty foot sailboat.

Mindful of this, congress added a few more bureaucratic hoops: Medicare Part C, and Medicare Part D. Part C covers the deductible gap and Part D helps you manage the outrageous prescription prices the pharmaceutical industry has foisted off on us. The extension of Beth’s group coverage, while not precisely a “Medicare part C” product functions nicely to fill in the gaps that other private insurers cover with Part C and Part D plans. These plans have different names, like “Medicare Advantage” and “Medicare Select,” but, hey! Branding is part of competition and competition is what keeps this great wheel of commerce turning, right?

The State of Wisconsin Commissioner of Insurance says,

Finding the right coverage at an affordable price may be difficult as no one policy is right for everyone. Coverage options include:

• Group Insurance, including Employer group plans and Association group plans
• Individual Medicare supplement policies
• Individual Medicare cost-sharing policies
• Individual managed care Medicare supplement policies, including: Medicare select policies and Medicare cost policies
• Medicare Advantage (formerly called Medicare+Choice plans)

A person could get downright confused. Fortunately, I have until December to get it all sorted out. Unfortunately, it seems likely–after we are both retired–that in order to get complete health care coverage, we’re going to have to spend four or five hundred dollars a month (including $200 that goes straight back to the government). Oh, well. I’m one of the fortunate ones. I’ll have coverage and I can just about afford it. But I wonder if the insurance industry and the government will get together on a “public option” for the forty or fifty million uninsured Americans, a “public option” that includes squeezing them for $5,000 a year that they just don’t have.