The future of Medicare – what’s on the line for millions of Americans

imageThe future of Medicare is at the center of a tense national political debate that touches on values, priorities and the entire U.S. economy. It's also the key battleground for the broader issue of building a viable, affordable health care delivery system for an aging and economically diverse society.

The above serves to introduce an essay by my colleague, Ian Morrison, in todays’ Hospitals and and Health Networks on-line Daily.  Mr. Morrison’s essays are not only succinct and full of wisdom.  They are also injected with a smattering of his well-placed humor. 

Everyone agrees that Medicare is a cause of projected federal-budget deficits. But it is also a key symbol of what's wrong with America according to the political right (a generous federal government entitlement program) and what's right with America according to the political left (a tax-based, universal health-insurance program for the elderly).

Before I cut to the summary of Ian’s essay (and the importance of information technology in the solution mix), I thought I would share a few of my own observations about what is at stake in this national debate and how important it is to every American.  To protect the privacy of my friends and associates whose stories I will be using to illustrate my points, I must be a bit vague on some of the specific of what I’m about to share while maintaining the essence of their true stories.

imageThe first comes from a long-time friend who recently retired from the transportation service industry.  His line of work required him to retire at age 60.  His company (by union contract) continued to provide the family health insurance coverage he has always enjoyed, that is until he turned 65 and became eligible for Medicare.  While his family still has private health insurance coverage, he has discovered that he’s now a second-class citizen.  Hospitals, clinics and clinicians that used to embrace him with open arms, are suddenly not so interested in seeing him.  During a recent bout with asthma and pneumonia, he really struggled to find the care he needed because the doctors he’d seen previously more or less rejected him now that Medicare is his payer.

imageAnother colleague is struggling with a serious chronic disease.  Her husband lost his job 18 months ago.  Until that happened, they had had excellent health insurance.  Cobra covered husband and wife until it expired.  Fortunately, the husband is a Veteran.  Although he hasn’t turned 65, he can get care through the VA.  His wife however, the person with the serious health issues, doesn’t have that benefit.  She is still 4 years away from Medicare eligibility.  With Cobra coverage ending, she has had to find private individual insurance.  She was able to continue coverage with the same organization that had been providing services under Cobra, but now she must do so as an individual subscriber.  The best plan available costs more than $700 a month, has a $1750 deductible, and a $6000 cap on co-pay.  Her drugs are only covered at 40 percent with no upper limit on the co-pay.  The way I see it, her yearly out of pocket costs for healthcare will be at least $25,000 – a rather onerous sum when you are involuntarily “retired”.  I call that being between a rock and a hard place.

imageIf I were to leave my current employment, my wife and I would face a similar fate until we became eligible for Medicare.  But neither one of us is a Veteran and my company offers no group insurance when employment ends.  Once Cobra ran its course, I’d be looking at possible healthcare expenditures for me and my wife approaching $50,000 a year.  Is that affordable as one eases into retirement.  Not very!  If you are a young person working for an employer that provides group health insurance of any kind, do not underestimate the value of that benefit.  Only when you try to replace it on your own will you fully appreciate what having health insurance is really worth to your family.

That is the dilemma faced to far too many Americans these days, and those are the fortunate among us who’ve had good jobs and private health insurance up until now.  So what is the answer to fixing Medicare?  Well, it sure isn’t our elected officials kicking the can down the road for a few more years, nor is it cutting provider fees until it becomes so painful that no one wants to practice medicine in America.

Here is what Ian Morrison surmises, and you’ll need to read his full essay to really understand how he gets to this point -

……..we should build organizations and partnerships that embrace risk for the care of the elderly population. These sophisticated service businesses must combine cutting-edge information technologies, evidence-based medicine, and patient- and family-centered support systems to keep costs low and to keep us patients functioning at the highest possible level into our dotage. At least that is what I am hoping for: You had all better come through.

That’s what I’m hoping for too, Ian, and millions and millions of others just like us.  And yes, cutting edge information technologies must be a part of the solution.

Bill Crounse, MD                          Senior Director, Worldwide Health               Microsoft

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