Summary: Seniors face much greater financial barriers to medical care in the US than in other wealthy countries. Why? Because we’re handing Medicare over to business interests, which prioritizes profits over medical care and health.
When Costs Are a Barrier to Getting Health Care: Reports from Older Adults in the United States and Other High-Income Countries, The Commonwealth Fund, October 1, 2021
Toplines: Older Americans pay more for health care and are more likely to postpone or skip care because of the cost than people in other high-income countries.
Despite the financial protection Medicare offers, the program’s significant cost-sharing requirements leave many older adults exposed to high health care costs.
Policy Implications: Overall, our analysis shows that the affordability of health care remains a concern for older adults and is leading American seniors to forgo care. Survey data show that older Americans pay more for health care and are more likely to postpone or skip care because of the cost than people in other high-income countries. Countries where more comprehensive coverage is available have fewer people skipping or missing care. Dental care illustrates the key role coverage plays in access to care: in those countries that carve out dental care from medical coverage, or fail to cover it at all, many people avoid getting their oral health needs addressed.
Care that is postponed or never received could have cost implications for Medicare. Evidence shows that forgoing health care is associated with poor health outcomes and increased risk of hospitalization.
Congress is currently considering legislation that would add dental, vision, and hearing coverage to traditional Medicare. This change could lead to an increase in U.S. older adults visiting the dentist.
By Don McCanne, M.D.
In spite of the popularity of the concept of Medicare for All, what gains have we actually made in expanding Medicare to provide more financial protection for seniors, much less expanding Medicare to cover more individuals than those over 65 (except for people with disabilities)? This Commonwealth Fund study indicates that, compared to other countries, Medicare is falling short of providing adequate financial protection to seniors with health care needs.
Although there has been considerable discussion about using proposed reconciliation legislation to expand Medicare coverage by adding dental, vision, and hearing services, insider information from Congress reveals that it has already been decided that these services will not be included as efforts are being made to compromise on the cost of the legislation.
Actually, it is worse than that. As we continue to advocate for Medicare for All, a greater percentage of Medicare beneficiaries have moved into the privatized Medicare Advantage plans, and, even worse, there is considerable momentum to involuntarily shift even more of the traditional Medicare beneficiaries into privatized plans through the deceptive direct contracting entities (DCE). Those who are trying to escape into the Medigap policies are finding that they may not be available to them if they did not sign up when they first became eligible for Medicare.
So not only is Medicare coverage not nearly as generous as many of us need, the private insurance industry is operating behind the scenes to even further reduce the coverage provided while using celebrities to promote sales through false images of expanded coverage when actually they are taking away coverage and diverting profits though restricted provider lists, prior authorization barriers, illegitimate risk-adjustment upcoding, and other private insurer deceptions.
For decades now, we’ve been sitting in the aisles, supporting “Medicare for All,” while the various administrations have been moving in the direction of turning health care over to the business interests. Those physicians who were in practice, like me, before Medicare and Medicaid were enacted – just think back about how the programs were when they began and how they have been transformed over the decades, right under our supposed supervision, giving ever more power to the MBAs. Now look at where we are with the pending involuntary privatization of the traditional Medicare program, with structural changes being made to take good care of the business interests while neglecting the needs of patients. Think of the various policies that have been and will be put in place, and you will see that they are based on what is taught in business schools and not on what is taught in medical, nursing, and other health professional schools. There we are taught how to take care of patients.
Do we really want to continue to promote Medicare for All when Medicare itself is transforming into an industry that primarily serves the financial interests of insurers to the detriment of the health care interests of patients? Are we going to end up with Medicare Advantage for All? That’s a label that might assist the private insurers with their marketing, but it can only compound the deficiencies hinted at in this Commonwealth Fund report on current health cost barriers for our seniors on Medicare.
Maybe we’d better reset our public education campaign and go back to promoting SINGLE PAYER – Health Care for All.