Now that the Democrats got skunked on their plan to take down Trump with Russia they have pivoted along with their teammates on cable news to health care.
The people who work on governmental health policy quite often have not experienced having the insurance they regulate. Recently single-payer insurance (i.e. government operated and controlled medical insurance) has been recast with the cutesy name “Medicare for All.” As someone who recently became a Medicare-covered individual along with the Beautiful Wife (BW), let’s talk about reality.
As you know, Medicare is a program begun in 1966 to cover people 65 years of age and older. The program is to be paid through lifelong payroll tax payments akin to social security. Unlike social security, the benefits are not related to how much you have paid into the program. An important point to understand is (for most people) the vast majority of medical expenses are incurred near the end of one’s life. When the program was established, it was not anticipated that people would be living as long as they do. This has also driven up costs; i.e., keeping older people alive.
As an aside, Medicare covers for pre-existing conditions. 180 million people who are covered by corporation health insurance also are covered for pre-existing conditions as well as those covered by Medicaid. That is over 90% of Americans, so we can dispense with that canard. Some politicians want you to believe people are threatening to take away coverage for pre-existing conditions when that is just not true.
One thing you need to know is who must go on Medicare. If you have personal insurance or are covered by group insurance where the group is 20 or fewer people, you must go on Medicare. If you have coverage by a company and there are more than 20 people on the plan, you can opt out. More seniors are working past 65 years old and are opting out of portions of Medicare to remain covered by their employers. One reason is Obamacare outlawed reimbursement to the employees of any insurance paid by employees.
When you are young – except possibly those caring for an elderly parent - you probably don’t know how Medicare works. You think that if you have Medicare that covers you because you have been making payments into the program for 40 or more years, but nothing could be further from the truth. What you need to know is your “alphabet” to understand the different components.
There are four main elements to consider:
Part A – This is the free element. It covers your medically-necessary hospitalization. That is the only thing you get at no cost, somewhat. This has a co-pay of up to $1,364 annually in 2019.
Part B – This covers doctor fees and some outpatient services. This you pay for to Medicare. If you receive Social Security, the government deducts your insurance premiums from your monthly social security payments. Also, Part B benefits are income tested. That is why 12.4% of people opt out of this benefit and remain covered by their employers. The more money you make the higher your premiums, which start at $135.50 per month currently. Monthly premiums can go as high as $460.50. Part B has a co-pay of up to $185 annually in 2019.
Part D – This is for medications and the cost is all over the place. This insurance is paid for by you, not the government.
You get this insurance by going on a Medicare website, putting in your prescriptions and whether or not they are generics. The site generates for you a few options with monthly premiums and annual co-pays. Interestingly, the premiums for the BW were more than for me despite the fact she takes fewer regular prescriptions. That is because the BW takes hormone replacement, a common medication for women over a certain age. Thus, it appears Medicare discriminates against women by charging higher premiums because they don’t want to cover a vital medication for older women.
Plan F – This is a comprehensive supplement to Medicare which covers other things not covered by A and B and the co-pays for A and B. Ear cleanings and flu shots are two examples of what Part F covers. This supplemental policy is paid for directly by you.
Here are a few of our experiences so far. Yes, there is less paperwork. There are more cards to carry around – three since one covers both A and B. There is less cost as our insurance has gone down about $400 per month per person and our annual co-pays have been eliminated which were about $4,000 each. That is supposedly a savings of about $17,500 per year if we maxed our deductibles under our private plan. But that savings comes with 50 years of paying into a fund and we are still paying in because we are still working. Otherwise, if you remain working, payroll taxes are still collected and you are charged more for your Part B insurance.
The point is Medicare is far from free. Less paperwork and figuring out what is or isn’t covered notwithstanding, decisions still have to be made under Medicare unlike what has been stated by some politicians.
Our first occurrence with Medicare came with a shoulder surgery needed by the BW. Both shoulders needed fixing but only one could be done prior to her 65th birthday so the second was scheduled for after. The surgery was planned when we found out her friendly surgeon did not take Medicare. He would perform the surgery we presumed, but we would have to pay his fee out-of-pocket. California has a lot lower acceptance rate for doctors of Medicare.
We called our doctor referral source who is a non-practicing orthopedic surgeon. He knows almost every doctor in the area because he developed surgery centers and had a lot of docs as investors. He told me he stopped accepting Medicare years ago because the reimbursement rate did not warrant the financial and insurance risks of performing the surgery. He recommended two top flight doctors and we proceeded with one.
The BW went ahead with the surgery. The new doctor recommended a specialized procedure which would not be covered by Medicare, but for which we could pay out of pocket to the tune of $7,200. We decided with -- proper medical consultation -- that in her case it was not necessary. We had to go through that analysis and make sure we were not risking her health because we did not opt for that portion and whether we were just being frugal because Medicare did not cover for the procedure. For most that amount is not an option -- $7,200 is a lot of dough.
From our experience we can deduce some things. Medicare for All is a nice saying, but very misleading. First, Medicare comes with a cost for all and that would have to be factored in - it is not free for anyone despite all you paid into the fund. Second, it does not cover everything as some politicians lead you to believe. Third, if you want to keep your doctor, you may not be able to do so.
The truth is Medicare for All is just a ploy to further move us to government controlled and administered health care. I have been writing this point for years and wrote that Obamacare was just a step along the way. The Left continues making private insurance more and more difficult to administer and then belittles the insurance companies for their operations. There is one goal here: to have complete control over the health care system and then we will be at the lowest common denominator for the health care we receive.
As you have been told before, just look at the health care administered by the VA. The Trump administration has finally freed our veterans to see private care practitioners. Thank God. Please don’t make the rest of us suffer the fate of our veterans being covered by government-run insurance.