The Reality of Medicare: Letting our seniors down- (An Independent Voice Piece)

Grandpa and I at my college graduation

By A. Zych

I have pondered on how this could happen to our beloved seniors the mere fact that the rationing of their care has cost them much more than services, their quality of life. With the recent passing of my grandfather and the events that lead up to his death our family has witness the dismantling of Medicare. We have seen first hand what rationing can do to a love one that has served his country in every possible way: World War II, a hard worker as a crane operator for a well-known company and supportive community member paying his taxes because it was the patriot thing to do. He worked all his life and put into the system to only to receive inadequate health care. So I ask you, my readers why in a country where we are known to have the best health care available in the world but what good is it when its’ citizens are unable to access it?

To be fair I will explain that not only did my grandfather had a stroke he had other issues like emphysema so his time may have been closer than we realized however the end of his life care should have been much better than it was. To further explain what happen to my beloved grandfather, the last 6 months have been an uphill battle with one hospitalization after another for illnesses like pneumonia to breaking his hip that all required rehabilitation in a long-term nursing home.

The care in the hospital was wonderful he received the top-notch care for his cardiovascular issues as well as the general care while he was recouping from his illnesses. However when it came time to be transferred to a rehabilitation facility it all changed and not for the better. First, incident when he was kicked off of Medicare for his lack of progress in less than 30 days after his hip replacement. Furthermore when we tried to appeal the decision with an explanation that he was on pain medication during the rehab sessions it’s no wonder he was not responding to therapy however we were denied.

This is when I got disgusted so I asked my grandfather’s therapist what is going on? Ironically, the therapist said in the past two years so  there has been cut to services for Medicare recipients in fact in all of his twenty plus years in the industry it has been getting much worse with the normal 180 days of service being cut to as low as 30 to 90 days of services like rehabilitation.

So let’s get to the facts, according to Leading Age Washington, “ Increasing numbers of Medicare beneficiaries are finding out that Medicare will not cover their post-acute skilled nursing facility stays because they were kept in the hospital for observation rather than being admitted as in patients.”(1.) Furthermore, in some cases this is happening when recipients are in the hospital for more than the three days to meet the requirement for Medicare benefits in relation to long-term care again they were denied services.

Now let’s get to the real issue of Medicare and its future! Unfortunately, it is all politics when it comes to discussion of entitlements like Medicare. The Republicans say we need to repeal and replace the infamous Obama care which cuts 716 billion from Medicare providers. (4)In contrast Democrats say we need to keep the law because it will provide health care insurance to millions of Americans who are uninsured by expanding the Medicaid program. (2.) But how are we going to fund this expansion?

That’s the million dollar question these days with both parties claiming they both have a solution. First, how does the Affordable Care Act remedy the funding issue when it comes to Medicare? According to the Congressional Budget Office, “CBO expects that Medicare spending under the bill would increase at an average annual rate of roughly 6 percent during the next two decades well below the roughly 8 percent annual growth rate of the past two decades, despite a growing number of Medicare beneficiaries as the baby-boom generation retires.”Furthermore, I must admit that I am unfamiliar with economics but one would think that we need a higher GDP to accommodate these costs, revenue coming from those individuals to help pay for these entitlement programs; and/or somehow we need to cut spending in other areas of the government. (3.) This issue is that we need more revenue to cover these entitlements and without a healthy economy how are we going to achieve this feat? ( Save this topic, economy for another discussion on another day!)

In reality, one could say that Obama care does not address the issue of Medicare and a possible reform. It may be a good assumption to believe that to cover the costs that our leaders in Washington will have to cut more Medicare spending to afford the expansion of Medicaid and other subsidies in the Affordable Healthcare Act? It has been happening in the past, present and one could say in the future. In fact in 2009, there was some legislation to cut more Medicare spending and currently some advocates of seniors are trying to pass a bill to prevent this from happening and an attempt to be made to reinstate some of these vital services.

On the other hand lets look at the Republican plan, which happens to be described a budget resolution, Path to Prosperity co-authored by GOP Vice Presidential Candidate Paul Ryan . The propose plan offers up an insurance exchange or some Democrats like to call it a voucher system with the intention of saving Medicare for the future generations yet not disrupting those in retirement or near retirement. (5. P. 45) To sum it up the plan would have a traditional fee for service option, a benchmark plan in which then will the beneficiary be able to choose from other marketplace options and if the beneficiary chooses a more expensive plan then they would be personally responsible for the remainder of the cost of the policy. (5.P.52) What about those who fall under the low-income category? The plan addresses this too, by adding that some beneficiaries’ will qualify as dual and will receive both Medicare and Medicaid. Sounds good in theory, right?

There are some positives in this plan concerning the deficit reduction however this plan affects the quality and access of care to the seniors. According to the Congressional Budget Office, “Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system.” (6.P.6 )

Therefore this could affect the ability to gain access to health care as well as hitting the pocket-book of seniors making it difficult to pay for other living expenses. In addition to the fact that the states will be in control of Medicaid while making the delivery unpredictable and as a result there could be greater efficiencies such as denial to the elderly for program benefits.

In the end neither plan addresses the variables concerning Medicare’s future sustainability such as the economy and tax revenue especially since we are still in a recovery with a great chance of a downturn as some economists have predicted.

Looking at the bigger picture how are the future generations going to prepare for the uncertain future of Medicare and other entitlements? Also, could it be that we need to take a look at insurance companies and their handling of passing off costs to consumers? Or is the providers like hospitals who are to blame for the out of control cost of simple things like a dose of Tylenol?

This is not a problem that we can simply sweep under the rug we must act now by involving ourselves as advocates for our grandparents and generations to come. As citizens our civic duty to vote for leaders who are serious about reforming and/or legislating new laws to tackle the insurance companies and other health care entities. Please join in this debate ideas are welcome!

Resource Links:
1.Leading Age Washington

2.Health and Human Services

3.Congressional Budget Office


5.The Path to Prosperity: A Blueprint for American Renewal

6.Congressional Budget Office

Other websites to research

Affordable Care Act

Senior Corps


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