Don't weaken Medicare

By Ed Weisbart, M.D.
St. Louis Beacon, Dec. 21, 2012

As I sit in the waiting room for my 83-year-old mother-in-law’s cardiac MRI, I realize I’m not a good health-care consumer. I didn’t try to find the best deal; I didn’t ask any prices; I didn’t check to see if this were “in network.”

I did the only thing I wanted to do – I found the doctors we wanted and flew her to St. Louis from Daytona, Fla. I am incredibly grateful to have found these terrific physicians.

But I’m also incredibly grateful that my mother-in-law has Medicare. She lives on her meager Social Security check; and without Medicare, the cost of dealing with her heart problem would otherwise bankrupt her.

She’d have had to sell her condo in Florida and move in with us in St. Louis, moving away from all of her friends and into our colder winters. We’d love to have her with us, but not because she’s forced to be with us.

Thankfully, she does have Medicare. She’s “entitled” to it, having paid into it for 40 years, working full-time to earn that and her Social Security check.

Medicare gives her control over her own health-care decisions. Unlike my own “private” health insurance, Medicare lets her pick from virtually every doctor and hospital in the country. That’s the kind of choice she wants.

Frankly, it’s the kind of choice we all want. We’re not so interested in selecting one insurer’s restrictive network over another’s. We want and need access to quality health care, period.

We all want the fire engines to come when our house is on fire. When we all want the same thing, it just makes sense to provide it for everybody.

That’s exactly why we should just fix the problems with Medicare (end the deductibles and co-pays; correct the inadequate physician reimbursement, etc.) and provide it to all Americans, regardless of their age. That’s essentially what every other modern nation does, typically at half the cost and with far better health outcomes.

Instead, our precious Medicare is under attack.

Some propose increasing the eligibility age from 65 to 67. Because life expectancy has increased since Medicare was passed, they believe the age of eligibility should go up, too.

They ignore the fact that life expectancy hasn’t gone up the same for all of us. While the wealthiest have added five years to their life expectancy since 1977, the bottom half of us saw an average increase of barely one year. A significant number of people would get less, not more, years of Medicare since the bill was passed. Aside from the fundamental lack of fairness, more of us would die early preventable deaths.

Our 65- and 66-year-olds would either have to keep working or use the Affordable Care Act’s new insurance exchanges. They would choose from several insurance options, each with different premiums, deductibles, copays, networks of physicians and hospitals, etc. Thanks to the ACA, insurance companies will not be able to refuse to offer a policy, but few if any of the choices would be as affordable and robust as Medicare.

Second, some lawmakers have proposed to “means test” Medicare, creating an administratively complex system that would test the fortitude of patients, providers and even the IRS. Making wealthier patients pay more for Medicare will only motivate them to look for private insurance elsewhere, undermining the original program.

Others in Congress suggest turning Medicare into a voucher toward the purchase of private insurance. Healthier seniors would start picking the cheapest, but least robust, health plans and end up in dire financial trouble if they became seriously ill.

Each of these strategies undermines Medicare’s social contract, the message that “we’re all in this together.”

Now just imagine if we had an “improved Medicare for all.” By replacing our wasteful, profit-seeking private insurance industry with a streamlined single-payer system, we could save more than $400 billion in administrative costs – enough to provide high-quality care to everyone, mothers-in-law included.

Don’t throw our mothers-in-law over the fiscal cliff. Don’t cut Medicare – protect it, improve it, and expand it to cover everyone!

Dr. Ed Weisbart is the chair and a founding member of the St. Louis chapter of Physicians for a National Health Program.!/content/28562/voices_weisbart_medicare_122012?coverpage=2395