The past year’s health discussion has been remarkable for the narrow range of ideas and opinions that have floated down to the man on the street. Journalists have sought out the same organizations and sources for their stories, offering up what has become the conventional wisdom for reform. To bring more voices into the conversation, our series, Excluded Voices, will intermittently feature health care experts who aren’t on the media’s A-list of sources. (The entire series is archived here.) We want to offer journalists more options for their stories and encourage a deeper conversation. To that end, we’ve asked the experts featured in each post to respond to questions from Campaign Desk readers.
Too hot to touch during the campaign, too complicated to explain in space-limited news stories, Medicare has long been a verboten subject among the pols and press. When budget director Peter Orszag told The Washington Post that “Health care reform is entitlement reform,” Medicare suddenly got a bit more respect—but only in the context of stories about Medicare Advantage plans, those controversial policies whose sellers receive excess payments from the government.
Yet there are many stories that touch the more than forty million Americans now on Medicare, and the millions more who will join the program in the next few years. Increasing medical costs threaten the program’s long-range solvency, and seniors themselves are being asked to bear more of their health care expenses. In its annual survey of retiree costs, Fidelity Investments found that medical costs for this group have risen 50 percent in the past seven years. Medicare now pays for just a little more than half of the medical expenses for beneficiaries.
Campaign Desk talked to Medicare expert Marilyn Moon, vice president of the American Institutes for Research, and a former trustee of the Medicare system, to help journalists and the public understand the short-term and long-term issues facing the program—and some of the proposed fixes.
Trudy Lieberman: What’s the biggest problem facing Medicare?
Marilyn Moon: It’s the misconception that Medicare is too generous for its beneficiaries. People who say Medicare is not sustainable and must be part of entitlement reform implicitly accept the argument that there is excess coverage there. It means that anyone who wants to talk about improving Medicare is instantly on the defensive.
TL: What is the biggest risk faced by people now on Medicare?
MM: The gaps in Medicare’s benefit package mean that anyone who can afford to will seek supplemental coverage. That coverage is expensive and often not a very good deal. When people buy what’s called “Medigap” insurance, on average they may be getting back only seventy-five cents worth of health care for every dollar they spend. Administrative costs are also high. But going without such coverage is risky since the basic Medicare package has no catastrophic protection for those with very high expenses.
TL: What is the biggest risk faced by people who will be on the program in the next several years?
MM: In addition to the high costs of supplemental coverage for those who must buy it on their own, more employers have stopped providing the retiree insurance that is now available to about one-third of all Medicare beneficiaries. Also, the costs of health care continue to grow faster than retiree incomes. This affects the costs of Medicare and puts extra burdens on people who must pay more for their Medicare benefits and supplemental coverage.
TL: How much do individual beneficiaries typically spend out of pocket?
MM: The average is about $3,000 a year, but it can be much higher.
TL: What improvements would help?
MM: I’d give beneficiaries protection against huge out-of-pocket costs which keep increasing. If Medicare is an insurance plan, then it must cap the amount that people spend on their own, just as there is a limit on out-of-pocket spending offered by most good commercial insurance policies.
TL: Medicare is so complicated. How should it be simplified?
MM: Deductibles should be combined. People pay a separate deductible for physician and outpatient care and a very high deductible for hospital services, now over $1,000 a year. Coinsurance amounts are confusing and vary by type of service. Until you simplify the basic structure so that people don’t feel it’s necessary to buy supplemental coverage, Medicare will continue to place a financial burden on beneficiaries and their families.
TL: How will that make the system more understandable?
MM: If people know that they have one deductible, say $350, and modest coinsurance up to a limit of perhaps $4000 they would pay out of pocket, then they can decide whether they want supplemental coverage. That would help them decide how much added protection they need, and at what cost.
TL: Is anyone talking about those kinds of reforms?