Maybe it’s because I write a lot of columns about Medicare, or maybe it’s just the fact that many folks feel an overwhelming need to express their frustration about Medicare (and health insurance in general) to somebody who doesn’t have “Do Not Reply” conspicuously attached to their email. But over time, a rather considerable number of you have expressed various and sundry opinions on the matter of Medicare, with a few miscellaneous questions thrown in about the state and the origin of same. The phrase “conspiracy theory” pathetically understates the gist of most submissions.
Nonetheless, being the true-blue journalist I am, I feel compelled to share a distillation of these observations, courageously dismissing fact, history and even political persuasion, in my usual swashbuckling style.
Near as I can tell, the civilian view of Medicare (which flies in the face of conventional political wisdom, a phrase that defines “oxymoron”) goes something like this:
In the early days of our national odyssey toward confusing the term “health care” with “health insurance,” people who made decisions for people who were considered incapable of making decisions noted two distinct facts:
1. There were getting to be a lot of old, and relatively poor, people.
2. There appeared to be an entrepreneurial niche in which to develop a lucrative industry that accomplished virtually nothing, except to add dollars to pockets that already were chock-full of dollars. (Dismiss “value-added” and think, “opportunity”!)
Thus was born “health insurance” — and, in there somewhere (because we are steadfastly avoiding being confused by facts), Medicare.
The approach is elegant in its simplicity:
If health care costs continued to escalate to the level of being unaffordable, people could probably be convinced that it made sense to send money to people who would, ostensibly, then send money to people who were providing health care, because the people who needed the health care didn’t have enough money to pay the people who provided it.
And if, again, the costs of health care could be driven into the stratosphere, people could probably be convinced that it made sense to pay some money out-of-pocket before the people you sent money to would send money to the people who provided you with health care. Or — better yet! — the costs of this thing called health insurance could be driven upward to the point where people were afraid to use it, because using it would increase the cost of their health insurance, so they would die without using health care! Thus, the money they paid for health insurance would stay squarely where it belonged, which was in the pockets of the people they sent money to; so they would have paid that money for something that, as it turns out, they were afraid to use.
But that’s not all, because here’s the most conspiratorial piece of the theory: As a subset (or “fringe benefit”) of the above, if this health insurance/Medicare thing could adequately confuse, frustrate and intimidate non-rich old people to the point of medical capitulation, they would likely die sooner, providing the ever-elusive answer to reducing the number of poor people — which is why Medicare has never paid for “long-term care.”
The latter could be most effectively achieved by inventing concepts like “deductible,” “co-pay,” “benefit limits,” “managed care,” “benefits coordination,” et cetera, ad infinitum — which would eventually replace the cliché “It’s not rocket science” with “Well, it isn’t health insurance!”
OK, maybe not.
But it does make you stop and think. And, as is often the case on this fascinating planet where God is considered to have no sense of humor, there is an unintended, and somewhat contradictory, side effect to all of this.
As our national life expectancy has continued to increase in spite of health insurance, various forms of dementia (including Alzheimer’s) have emerged as a leading means of retiring retirees. Now, how does one attempt to prevent dementia? By, among other things, developing new neuronal pathways.
And how does one develop new neuronal pathways? By learning new things and attempting to master the hitherto unmasterable.
And what is the most unmasterable thing you can imagine? Medicare!
So, belay the Sudoku, cancel the crossword, relegate the quantum physics text to the status of “doorstop” and simply perseverate on your Medicare “Explanation of Benefits.”
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Mark Harvey is the director of information and assistance for the Olympic Area Agency on Aging. He can be reached by email at firstname.lastname@example.org; by phone at 360-532-0520 in Aberdeen, 360-942-2177 in Raymond, or 360-642-3634; or through Facebook at Olympic Area Agency on Aging-Information & Assistance.