By George Bohmfalk, M.D.
Aspen (Colo.) Daily News, July 31, 2021
On July 30, 1965, President Johnson signed Medicare into law. Less than a year later, the vast majority of Americans over 65 were enrolled. Today Medicare is our most popular and efficient health insurance program.
Medicare has substantially improved older Americans’ health and decreased their rate of poverty, but it has several shortcomings that could be addressed in the huge budget reconciliation bill being formulated in Congress. While a full-on transition to Medicare for All would be the preferred solution, we should incorporate these incremental improvements as soon as possible.
Medicare doesn’t cover vision, hearing or dental care, each of which substantially affects other health issues, like arthritis and heart disease. Many Medicare enrollees who need hearing aids can’t afford them. In a recent year, most who had difficulty eating because their teeth hadn’t seen a dentist, and nearly half with vision problems hadn’t had an eye exam. To improve overall health and quality of life, Medicare should include vision, hearing and dental care.
Traditional Medicare pays only 80% of many charges and has no limit on out-of-pocket expenses. This is a huge economic burden for over half of Medicare enrollees, who live on less than $30,000 a year. With the average enrollee annually spending nearly $6,000 on out-of-pocket costs, medical debt and bankruptcy are ever-constant threats. Congress should place a reasonable cap on annual out-of-pocket costs.
Medicare is now available only to people over 65 and some with disabilities. A recent Stanford University study showed that, of people with cancer, those over 65 did better than patients in their early 60s. One might expect the younger group would fare better, but the factor benefitting the older group was having better access to health care, through Medicare. Lowering the eligibility age to 60 would extend the reliability and better outcomes of Medicare coverage to 23 million more Americans. Given the bipartisan support for doing so, Congress should lower the Medicare eligibility age to 60.
On average, Americans pay over twice as much for medications as do people in other countries. Medicare could save hundreds of billions of dollars by negotiating drug prices, which a previous Congress banned it from doing. As these savings could be used to pay for the other improvements, Congress should allow Medicare to negotiate drug prices.
The above improvements would extend beyond individual beneficiaries. The COVID-19 pandemic has both illuminated and aggravated unconscionable racial and ethnic health care inequities affecting millions of Americans. These improvements to Medicare would not erase any inequities, but they would substantially mitigate many of them. Businesses would also benefit, as they would no longer bear as large a burden of their employees’ health care costs.
Over 150 members of Congress signed a letter to President Biden requesting that the American Families Plan include these improvements to Medicare. If your representative is among them, please thank them. If not, ask them and your senators to support these improvements as a bill is developed.
Happy and healthy 56th birthday, Medicare! Short of expanding Medicare to cover everyone, there is no better way to celebrate it than to enhance the physical, emotional and financial health of older Americans by improving and expanding Medicare coverage.
Dr. Bohmfalk is a retired neurosurgeon in Carbondale and a member of Physicians for a National Health Program.
