March 18, 2013
My first wife, Karen was on Medicare and for two brief periods she was a Medicaid recipient. It’s strange how things in life turn out. Lyndon Johnson, The President who brought Medicare and Medicaid into existence is the one I waved to on the streets of Inez when I was about nine years old.
After fighting multiple sclerosis for about three years she knew her school teaching days were over. She applied for disabled Social Security benefits. The application and wait time for approval was about 18 months. Her monthly check from Social Security was $550. She also received her Medicare card. Previously she had lost her medical coverage. After she left her teaching position we bought into COBRA for several months but lost that because the insurance company was going through bankruptcy. The company folded and reorganized under a new name. In the process they dropped people like Karen who were going to be expensive to cover.
Losing health care insurance on the one person in the family who needed it was painful. My two sons and I could scrape the money together to buy health care insurance, but no insurance company would cover Karen due to her debilitating multiple sclerosis.
In many ways, Medicare was a lifesaver but most of the MS drugs weren’t covered. In 1994 one of her drugs cost us over $1,000 a month. Another drug cost over $1,200 a month. At the time my total salary as a pastor was about $36,000 a year. This included all benefits and perks. Saying we were stretched financially would be an understatement.
After battling the progressive disease for eight years Karen’s health had deteriorated to the point where she could not do anything. She could not feed herself. Her hands and head became very shaky. She could not walk. She couldn’t do anything. After a brief hospital stay she ended up in a nursing home for six months. That was six tough months as written about in my book, Nursing Home Nightmares, America’s Disgrace.
Medicare only covers a limited number of days in a nursing home. At the outset we did not know how long she would be in the nursing home. We applied for Medicaid. I didn’t know anything about it but I was encouraged by the nursing home staff to get Medicaid. I went to our local county social services office. This was the same office where people applied for food stamps and other forms of public assistance. Sitting in that office waiting my turn was not a great feeling. I had never asked for anything like this from the government before. The woman who worked with me was very helpful. Basically Karen would be the one going on Medicaid. We were paying on a house and making a car payment. We didn’t have any money stashed away, but we had lots of debt and now a $4,500 a month nursing home bill. This made us approvable for Medicaid.
After finally getting out of the nursing home, Karen went off Medicaid since we were no longer entitled to it. About 14 months later she would have to go back into a different nursing home for about the last 10 weeks of her life. I would once again go through the same paperwork application and interviews once again because Medicaid was our only hope of paying for her nursing home bills.
It was such a painful time for my sons and for me. However, millions of Americans have been there and done that or are doing it now.
The numbers are always changing but currently there are 44 million people on Medicare and another 40 million on Medicaid.
Medicaid is for the down and out. People on Medicaid are the disabled or the very financially poor of society. I don’t think the majority of Medicaid recipients are pleased with their situations in life. I believe they want to get off Medicaid if they can. In cases of disabling illness they cannot get by without Medicaid and our society should help them. There are situations where people become dependent on the system and will not try to improve their lives to move beyond the system. This latter group represents millions. The drain on the federal budget is in the billions.
Too many doctors are extremely lenient in signing the papers needed to achieve disability status. Too many people have become accustomed to poverty and surviving on very little. If you are financially needy enough, as determined by state guidelines, then you can qualify for Medicaid.
Local offices are overworked and understaffed and so it’s difficult in most cases for any recipients to have anyone working to help them get off Medicaid.
I am in favor of Medicare and Medicaid.
We have to repair the system or there will be nothing for our children and their children.
I don’t think anyone should be forced to use Medicare. If someone wants to opt out of Medicare at a younger age then I believe that should be his or her prerogative. The reality is that most people at retirement age need Medicare. Health care insurance has become unaffordable for the average person and the premiums are climbing every year. The co-pay insurance plans that people are buying now to supplement their Medicare is becoming unaffordable for many.
One of the biggest problems with Medicare is the medical cost. Recently, a doctor was going to perform a medical procedure on me. He informed me he would have to submit a bill to my insurance company three times the amount he really needed in order to get what he wanted for the procedure. That’s crazy and is part of the big problem. Not all but certainly some doctors and hospitals are grossly abusing the system.
I heard about one nursing home owner who went to prison because his nursing home unjustifiably billed Medicare and Medicaid for hundreds of thousands of dollars. He was billing for services that were never rendered.
If we can eliminate the fraud and the abuse by the medical society we would save billions of dollars each year.
Long-term health care insurance must be made competitive across the country. Insurance companies should be able to sell from state to state. Citizens should be able to buy from any state in the country. Competition would be great for the business, the people and the economy.
Second, insurance companies must develop term health care insurance much like term life insurance. Someone buys a 20-year term policy and it covers your health care insurance for a cheaper rate because you’ve bought it for 20 years. Someone could buy a policy at 50 designed to provide coverage to age 70. If we could get people off Medicare until they are 70 it would save the nation billions. Many seniors are living very productive lives well into their 70s. If a senior could buy a term health care plan that would cover him or her to 70 before switching to Medicare that would be huge in solving part of the system’s crisis.
Glenn Mollette is the author of “American Issues: Every American Has an Opinion” and nine other books. He grew up in Martin County, and in 1964 was a child when President Lyndon B. Johnson visited the county seat of Inez to begin his campaign on poverty. You can hear him each Sunday night on XM Radio on channel 131 at 8 p.m. Find him on Facebook. Email firstname.lastname@example.org