I am old enough to remember the time before Medicare. Although my paternal grandmother lived with her daughter’s family (my dad’s half-sister) in Ohio, my father bought a catastrophic insurance policy for her. You see back then pretty much most people could afford to go to a general practitioner. Office visits, which included blood work or other tests when necessary, cost about $20 or $25. Insurance provided by employers only covered catastrophic (hospitalization) costs. I don’t remember a lot of specialists in my childhood. There was the family doctor, the surgeon and the dentist……and the veterinarian. There was no Medicare.
When my mother retired she was on Medicare and the insurance plan from her employer continued, with a monthly premium of $77.36. The premium amount never changed during the nearly 20 years of her retirement. There were no insurance industry supplemental plans at that time. The employer insurance paid 80% of the amount not paid by Medicare. After retirement my mother was hospitalized three times. Our share of the remaining costs was minimal. Of course, even hospital costs were much, much lower in the 1980s and 1990s than they are now. My 23 days in the hospital at the end of 2010 was nearly $250,000.00. I paid nothing because my deductible of $1000 had been paid when I had a hospital stay earlier that same year.
My employer pays 80% of my medical insurance premium each month. In the nearly 20 years I’ve worked at this job my monthly insurance premiums have gone up about 600%. That’s due to increasing cost of insurance premiums and my increased age. When I turned 60 my premium doubled (100% increase) from the previous year. I am 62 now and will be going on Medicare in just a few years.
My next door neighbor, Anne, will be 91 later this month. She has Humana for her medical insurance. She is relatively healthy, having been in the hospital twice for pneumonia in the 30 some years we’ve been neighbors. Her medications are daily blood pressure meds. She recently had to have radiation treatments for skin cancer. All in all, she is miraculously healthy. I, on the other hand, take two handfuls of meds each day, for high blood pressure, high cholesterol and diabetes.
My neighbor signed up for Humana when a nice young man came to her door and sold her the plan. Frankly, she wasn’t capable of understanding just what she needed or what she was getting. Once she changed to this supplemental plan she had to change her regular doctor. He didn’t accept Humana. Her salesman didn’t ask her what doctor(s) she used and, obviously, didn’t check to see if Dr. Moore was a participating physician in the plan. If he had, then he would have probably lost a sale.
I drove Anne to her first appointment with her new doctor. Although we had an appointment, we sat in the waiting room for about 2 hours before we were able to see the doctor. Now she has a patient woman from her church who takes her to her doctor appointments. That is because Anne doesn’t drive any longer. Either due to some mini-strokes or the onset of dementia, she would get lost or forget where she was going when she got in her car to go to church or the grocery store. Another neighbor feeds her cats for her every day because Anne can’t remember to feed them or whether or not she has already fed them. She’s been known to feed them cereal, bread and bird seed instead of cat food. I take her to the grocery store and the pet store every week or two, as needed. Her only relative is her nephew who lives in Colorado and has only visited her twice in all the time I’ve lived here.
Due to my personal experience, I have a problem with Paul Ryan’s plan to turn Medicare into a voucher system. As it is, it’s already confusing and difficult for seniors to evaluate and choose a supplemental insurance plan. As long as the insurance companies have few, if any, restrictions on how much they can increase premiums year after year after year, either the vouchers will cover a smaller and smaller percentage each year or the steadily increasing amount for the vouchers will cost the government more and more each year. The vast majority of seniors are already struggling to survive on their meager Social Security benefits so an extra monthly expense for health insurance will add an additional financial burden. If they can afford insurance, with vouchers they will have to shop around for the most affordable plan, as opposed to the most effective one that provides the type of coverage their health conditions require. This will be at a time of their life when many will be less able to navigate the confusing world of insurance coverage. Not all of them will have children, family or a spouse with whom to consult before making a decision. It is tough enough during the years we are in the work force to compare and contrast the insurance plans available to us. As we age, most of us face physical and mental impairments that affect our ability to make difficult choices. Many of us have reached a point when we simply want fewer choices and fewer decisions to make. We have become more set in our ways and prefer the routines we have established. We don’t have the resources to consult that we once had. Simply knowing that once you retire you will receive your Social Security check on the 3rd of the month and that you have Medicare provides, at least, some sense of security.
The final point, for me, is that insurance companies exist to make a profit for their shareholders. Insuring elderly people, who are more likely to have increased health problems, is less likely to return a profit than insuring younger, healthier people. I fear choices will be limited, coverage will be minimal and premiums will increase each year, with even greater increases when you live into another decade. The younger you die, the better chance of a profit for the insurance company. Will they really want us to live to be 80, 90 or 100? I doubt it. Basically, privatizing Medicare is a losing proposition. If there is little or no profit in providing insurance to the elderly, why even enter the market in the first place. The providers who exist today are in it because they have a guaranteed payment………….from government administered Medicare. Once that’s gone, will most of those insurance companies disappear from the elder care marketplace as well? I’m betting the answer to that is a resounding YES.