Medicare: a personal story

In the early morning hours of a day last October, my theories of optimal medical insurance began to be put to the harsh tests of reality.

My wife had gone to bed early, saying that she had a sore throat. At about 5 A.M she woke me and said that she couldn’t breathe. An ambulance took her to the local hospital, where she was sedated and intubated. She was unconscious. By about 11 o’clock her blood pressure began to drop, and my daughters and I were told that she would be transferred to cardiac intensive care at Massachusetts General Hospital because the doctors feared that she was having a heart attack. We followed her to MGH and began a three month vigil.

Massachusetts General Hospital is probably one of the best hospitals in the world. It is also probably one of the most expensive. My wife, Carol, was in an intensive care unit for about three weeks, during which we learned that the basic problem was not her heart but a bacterial infection. Mass General prides itself on its treatment of infections, and that problem was soon on its way to solution. However, Carol remained unconscious; an MRI showed bleeding in many parts of her brain, probably brought on by the infection. She was in a medical unit at MGH for another week, where she was fitted with breathing and feeding tubes, and then she was transferred to what I am told is the region’s finest rehabilitation
hospital. We had no assurance that she would ever regain consciousness and if she did, what her mental condition would be.

About two weeks into this process, when Carol’s condition was stabilized, the thought crossed my mind that this world-class care probably had a world-class price tag. Suddenly I was faced with the reality that thousands of insured Americans go bankrupt each year because of medical expenses. In addition to Carol’s physical condition and our deep anxiety, there was the possibility of financial disaster after years of hard work and careful saving. I gathered the books on medical insurance issued by my various insurance carriers and began to read carefully what the various plans covered and how they were coordinated. After an hour or so the conclusion was clear: we were unlikely to have any more than quite minor costs for which we would be liable. For the first time in what seemed ages, I had an enormous sense of relief. We could concentrate on Carol getting better,and in the middle of December, she began to recover consciousness. At the end of January she came home and today is her old self, except that she has trouble balancing the checkbook!

Is this a tribute to the insurance companies of America? Far from it! You see, like most elderly people, we are covered by Medicare Parts A and B and a supplement that is private but government-standardized. As I followed the claims process, it was seamless and required no intervention on my part. The claim went directly to Medicare and then to the private carrier. Presumably, if there had then been a balance, I would have been billed. In fact, with this catastrophic illness, I received one bill for $235. I probably could have contested it if my emotional state had been better, but it was easier to write the check.

Why am I troubling you with this intensely personal story? First, to point out that, for part of our population, we already have a well-functioning government health insurance system, and in my experience it does not interfere in any way with superb medical treatment and does not involve bureaucratic red tape. It is Medicare, and unfortunately it covers mostly us old folks. After my own relief at our coverage, my next thought was, why doesn’t everybody in this country have the same assurance of good treatment
without anxiety over costs? The short answer is that medical insurance in this country is in the hands of companies that have a vested interest in denying claims and hassling people who are already having a hard time. President Obama and the corporate Democrats left health insurance for most people in the hands of these companies when the Affordable Care Act was passed in 2010 (when the Democrats controlled Congress). They had before them a workable and working example in Medicare, and they ignored it.

At the same time that my family and I were going through this terrible experience, the implementation of “Obamacare” began. It is composed of many moving parts, like some ramshackle Rube Goldberg machine, and some of those parts, like the expansion of Medicaid in the states,are in the hands of politicians deeply opposed to the whole idea. The finest administrator would have had difficulty with its implementation, and there is no evidence that Barack Obama has an abundance of administrative skill. We have before us an example of how to make health insurance work. Medicare for All!

2 thoughts on “Medicare: a personal story

  1. 1. I am happy to hear about the good outcome for your wife
    2. Everyone that lives near Mass General has “the same assurance of good treatment.” As your story points out, no one ever asked you about health insurance and you only even thought about it after the crisis passed. Access to great treatment has nothing to do with insurance particularly in Massachusetts.
    3. I hate to tell you this but your insurance is also totally handled by a “Rube Goldberg machine” of private insurance companies, many of whom are for-profit companies. In Massachusetts,
    — A and B are administered by the for-profit Wellpoint insurance company of Indiana
    — your supplement (given other things you mentioned) is probably a special Massachusetts Medigap deluxe plan (such as Medex Bronze from the non-profit Massachusetts Blue Cross; but we in Massachusetts do not get the same Medigap choices as the rest of the country)
    — you did not mention it but you probably have a Part D plan from a for-profit private insurance company (or drug insurance from an former employer who bought such insurance for you)
    — even with this “Rube Goldberg machine” called Medicare, you are responsible for your own vision, dental, and hearing medical expenses and you do not even get coverage of an annual physical exam
    — on average nationwide, people with your type of plan (again, Massachusetts is different so apples to apples not possible) pay more than half of their medical expenses (including their premiums–see final point) out of their own pocket. On the Obamacare bronze/silver/gold/platinum scale, Medicare itself is a Cardboard plan with neither catastrophic coverage or an annual out of pocket spend limit (if your wife had required a few more days at Spaulding, the bills would have started rolling in as you reached the rehab limit; if the event had been sadly enduring, your coverage would have run out in a year)
    4. Oh you didn’t mention the cost. If you are between 65 and 70, you (and most likely your wife) prepaid for A and B via payroll and income taxes for 50 years (almost $200,000 on average for the couple) and you now pay about $600 a month for your and your wife’s B, D and supplemental coverage ($7200 a year) plus possible surtaxes and more Medicare taxes if like most of us you keep working past 65 (because the Social Security full retirement age is not 65 but 66 and going up)
    5. Again, it’s great that everything is fine. I would say it was money well spent but do not pretend that it is not a Rube Goldberg machine or that it is run by the government

  2. I appreciate the additional information, including the points about Medicare’s shortcomings. Of course, I experienced Medicare from the family’s point of view and what I saw, I truthfully presented in the piece and did not “pretend” about anything. Perhaps from your obviously expert point of view, Medicare is also a Rube Goldberg
    machine; I guess Rube had some machines that worked better than others because Medicare clearly works better than Obamacare. Obviously Medicare has some shortcomings (lack of visual, dental, etc.) and these should be remedied. Perhaps you will help by writing some pieces on health insurance in Socialist Currents.

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