Happy birthday, Medicare

By Ed Weisbart, MD
St. Louis Post-Dispatch, July 30, 2014

Medicare is today entering its 50th year, and the need to expand it to all Americans has never been greater.

Private health insurers are putting more and more restrictions on which doctors and hospitals can take care of which patients. Premiums, co-pays, co-insurance and deductibles are rising, often sharply. And states like ours are picking and choosing which low-income people to save and which to let die.

We insist on clinging to the uniquely American model of private health insurance despite the fact that it costs us double what every other modern nation spends per person on care, that our life expectancy lags those nations’ by several years, and that it places each of us just one disease away from bankruptcy.

Why do we cling to it so feverishly?

Rabbi Susan Talve recently reminded me of a biblical story in which the slaves leaving Egypt tried 10 times to return home to slavery, to nearly nothing, instead of continuing on to the promised land. Why would they have done that?

Both answers are the same. No matter how rotten something may be, it’s human nature to resist giving it up for something new and tempting. Sometimes, that part of our nature does us great harm.

But here’s an important difference: Medicare is a nonprofit, social insurance program we have come to know very well. And as any senior or member of their family will tell you, they like it very much.

Medicare was enacted in 1965 because older Americans were dying needless, preventable deaths from not being able to afford health care. When they got sick, they would sell their homes and declare bankruptcy in a last-ditch effort for care. They were dying paupers after long lives of working hard toward the American dream.

Sound familiar? That’s exactly what’s happening today to Americans who have not yet reached Medicare age, despite the significant progress of the Affordable Care Act.

A 60-year-old husband and wife in Missouri with a combined household income of $62,200 today would pay a premium of $13,761 for a high-end Silver plan and still be faced with $12,700 out-of-pocket expenses, potentially consuming 42 percent of their household income on medical expenses.

And that doesn’t include anything more they might have to spend if they need to see a physician or go to a hospital that’s not in their plan’s network.

So despite the great news that millions more of us have insurance, medical bankruptcies will continue. More than 60 percent of those bankruptcies happen to people with insurance! We could end that problem if we improved Medicare and gave it to everyone.

Putting aside the fundamental issue of fairness, providing every American with improved Medicare is a wise investment for our nation.

Every one of the thousands of health insurance companies in this country uses legions of people who operate computer systems, analysts, sales people, and more, all dedicated to collecting premiums and minimizing payouts for claims — i.e. to fatten the company’s bottom line.

This paper-pushing and dollar-chasing affliction is everywhere. The average hospital in the U.S. employs more people in billing-associated jobs than it has hospital beds.

This level of bureaucratic waste diverts our nation’s resources and drives up the cost of doing business here. We would be wise to retrain those hardworking folks into positions that actually improve health.

Improving Medicare and providing it to all Americans would cost us less than what preserving our current system costs, and would give us powerful tools to control costs.

Today, Medicare’s 49th anniversary, let us stop clinging to the failed private insurance experiment and recommit ourselves to Medicare for All, the most fair and prudent solution.

Dr. Ed Weisbart is chairman for Physicians for a National Health Program-Missouri Chapter.