Medicare, the government’s insurance program
for people 65 years old and older, as well as younger people with disabilities,
sets the standards for virtually all private insurance, but there are several big
challenges within the system.
With some 50 million people on Medicare, a system they paid
into when they worked, it’s a huge ($200 billion-plus) program. But it is far
from perfect.
First, it doesn’t cover all medical costs. It generally
covers 80 percent of allowed charges, though discounts often reduce the billed
amount to less than that. Some things, like dental, are not covered. Prescriptions
require a separate drug plan (Plan D), which is an additional monthly cost. Perhaps most importantly,
there is no limit on out-of-pocket costs, so someone in the hospital for weeks,
say, could easily have to pay $20,000 on a $100,000 hospital bill . . . and up
and up. Most private insurance caps out-of-pocket costs yearly, often at around
$5,000.
Also, each state has a supplemental insurance lrigram, which is
designed to cover (in varying amounts depending on the plan selected) that gap
between what Medicare pays and what an individual pays out of pocket. Unfortunately, each
state has different companies offering the supplemental insurance and
different requirements,, though the plans (Plans G, N F, etc.) are virtual the
same (that’s mandated). In general, when one first goes on to Medicare, he or
she can sign up for supplemental insurance and not be denied that coverage
(usually offered by several companies all of whom offer the same overall
coverage benefits). However, if one doesn’t add the supplemental coverage right
away, then each state has a different set of rules and qualifications for the
added insurance, so the rules change.
Some states allow all people to buy supplemental insurance,
some require an underwriting approval (which generally eliminates anyone with
health issues), and some offer a combination of both. New Hampshire only has
one company offering supplemental insurance without an underwriting hurdle.
It’s expensive for those of us under age 65, but drops to half the monthly cost
on the most complete plan after age 65. As with many of these programs, many
companies (AARP/United Healthcare for instance), is not offered. As someone who
is under 65 and disabled following an amputation (which is why I qualified for
Medicare), it’s virtually impossible to make it through the underwriting
process.
A national program would eliminate these
state-to-state-differences, which would be a good thing for many reasons. First,
it would offer the widest selection of supplemental insurance to the widest
number of people and eliminate states that waffle on trying to legislate health
care options within their borders. It would also prevent insurance companies
from cherry picking from the 50 states and ignoring some states. So a national
program would level the playing field.
If everyone was offered the same supplemental insurance
programs no matter where they lived, it would level costs and slow increases.
Medicare for all?
Talk of a national health insurance program, often referred
to as “Medicare for all” is clearly where we are headed, and it is, with
slightly different approaches, where the rest of the world is as well. While we
have the world’s most expensive health care system, our overall care falls
somewhere in the middle of the pack.
National health care coverage without a state by state process
would eliminate companies from cherry picking some states and ignoring others. (New
Hampshire has stumbled since the beginning, initially launching a state
insurance exchange with just one company, trying to move Medicaid to private
companies and then killing that system before it got off the ground but well
after people had signed up.) Make supplemental insurance options with coverage
similar to what it is now. Some people might not need the supplemental
insurance, for instance higher-income people who can afford the 20 percent
uncovered by standard Medicare.
Add supplemental . . . add foreign coverage . . . add maybe
long term care . . . limit of say $1 million and can add to increase
that. Add dental . . . All can be “supplemental-type” add-ons to
any national coverage . . . That’s much the way people buy private insurance
now and very much like the way corporate insurance and benefit programs are
presented to employees.
That way people get basic coverage but can add what they
want and need and can afford.
Some type of national program is coming . . . It’s
inevitable because the piecemeal system we have now allows to too many care and
cost variations and leaves too many people uninsured, which means they often
enter the system through the emergency room, the most expensive door for
“regular” care.
We’ll see more merger in the health care industry as
corporations jockey for dominant positions in their fields . . . hospitals,
pharmacies, and doctors . . . but don’t buy into talk about corporations
suffering through ll of this. They won’t. That talk is like a coach talking to
officials about a player on the other team . . . he’s just trying to set up the
game to lean towards his team a bit.
By giving people more control over their health care and
leveling the field nationally, all the while mandating coverage and acceptance
of pre-existing conditions (one of the most important features of the
Affordable Care Act) we can all rest a bit easier that we can pay for the
health care we need and that paying for it won’t bankrupt us.
No comments:
Post a Comment