HEALTH CARE/Joan Retsinas

A Medicare Primer

This September, when a lot of Americans are heading back to school, a swathe of the electorate should follow their lead and take Medicare 101. Given the hysteria over “Obamacare,” coupled with the frenzy over Big Government stepping into the Private Sector, this primer is overdue.

Here is the sneak-preview final exam.

1. Medicare excludes people

a) who have a history of substance abuse

b) who have cancer

c) who have schizophrenia

d) all of the above

e) none of the above.

Correct answer: e) Medicare accepts every American over age 65 (as well as Americans who are disabled and who have end-stage renal disease). No matter how sick a would-be enrollee, Medicare will accept him. Private insurers, on the other hand, may reject an applicant for any of the above conditions — or, under the rubric of “pre-existing conditions,” may refuse to pay for treatment of that malady. Indeed, one hallmark of the recently passed health reform legislation is that it will force private insurers to do away with “pre-existing conditions.”

2) Every insurer spends some money on non-health care expenses.

Medicare spends

a) less than 5%

b) 10%

c) 20%

d) 30%

Correct answer: a) Disregard the rhetoric about bloated government. Medicare pays out most of what it collects to the people who provide care — doctors, hospitals, laboratories, therapists. “Administration” consumes a sliver of revenue. In contrast, private insurers pay mega-salaries to executives (the head of Medicare earns less than $200,000 a year; a honcho of a major private insurer earns as much as $1,000,000 a year); and they pay dividends to shareholders.

3.True or False. Medicare is costly: high premiums, co-payments, deductibles. Poor people who can’t afford the Medicare premiums don’t get Medicare.

Correct answer: True and False. True: Medicare does charge monthly premiums and does demand deductibles and co-payments. Those fees can run to several thousand dollars a years. But Medicare doesn’t exclude people who cannot pay. People with very low incomes will be eligible for Medicaid, which will pick up the premiums, the co-payments, and the deductibles. For other enrollees with low incomes, Uncle Sam will defray the premiums and co-payments. Private insurers also have high premiums, co-payments and deductibles, but will drop people who cannot pay.

4. True or False. Deny, deny, deny is the operating mantra of Medicare.

Correct answer: False. Deny, deny, deny is the operating mantra of too many private insurers. Even though the private market enrollees who are denied service can appeal to their insurer’s review panel, and even though most appeals meet with success, the process is daunting, especially for a sick patient and a distraught family. Medicare, in contrast, will treat even when treatments are almost surely futile. Medicare has an option for patients to enroll in hospice, but, notwithstanding the hysteria over “death panels,” enrollment in hospice is completely voluntarily. So long as a patient wants treatment, and a physician prescribes it, Medicare will pay.

5. The percent of people who opt out of Medicare after a year, seeking to join a private insurer, is:

a) 50%

b) 30%

c) 10%

d) 5%

e) unknown.

Correct answer: e) The conservatives who abhor Medicare should try to tabulate this statistic. There may be somebody who has dropped Medicare to enroll as a non-group member in a private policy (assuming s/he can find a policy that will enroll him/her), but I doubt that among the elderly disgruntled voters, griping about Big Government, you’ll find anybody so disgruntled as to drop Medicare.

6. The newly passed health reform legislation will

a) extend Medicare to cover all Americans

b) nudge the private insurance industry to cover most Americans

Correct answer: b). Rhetoric aside, most people will still be covered by a private insurer, but the government will have enacted regulations to make that insurance more equitable, and subsidies to make it cover more people.

I urge the people waving I-Hate-Government placards at Tea Party rallies to take Medicare 101.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, September 15, 2010