BILL CLINTON TEACHES US HOW TO
CUT MEDICARE COSTS – AND
COVER MORE OF THE UNINSURED
AND UNDER INSURED
I am now 74, but back when I was a mere child of 55, I went to my primary care physician for my annual physical examination. After performing all the usual tests, he reported back to me that a microscopic trace of blood had been found in my urinalysis. Based upon my age and history, he said, “Mr. Hollenberg [they used to call me “Mr. Hollenberg” in those days], ordinarily we would ascribe this to a minor infection that is sure to pass. However, I think it is time we had a radiologist take some pictures.” At the time, I was still Senior Attorney with a major law firm, so I had very complete health coverage.
After gauging my billable hours, I chose a Friday afternoon for the sonogram. The technician at the facility seemed to me to be doing an ultra-thorough exam. When he was finished, he mumbled something about this being a teaching facility and the need to consult with his supervisor. The radiologist entered upon the scene and performed the exact same procedure as the technician. Since I thought the technician to be thorough and professional, I was puzzled at the duplication of effort.
Then the radiologist dropped the bomb. He said that he thought they had seen something on one of my kidneys. Since patients often dropped out of appointments on a Friday afternoon, he said that there was time available on the CAT-SCAN machine, and that I could postpone further testing, but he recommended we do it, at once. I complied, but when the test was over, he said he could not give me the results: he would send the results to the referring physician on Monday and I could speak to the latter then. Talk about your lost weekends!
On Monday, my primary care physician called me and said they had found something on my kidney; he had asked that the test results be delivered to a recommended urologist, with whom I should seek an appointment shortly. The urologist examined me and we studied the pictures, together. He pointed to the offending items and said he and the test results strongly indicated that I had cancer. He said the kidney needed to be removed, as soon as possible. With no little embarrassment, because I was talking to one of the world’s leading urologists, I brought up the question of a “second opinion.” Luckily, the urologist had not watched much television or visited clubs, so he refrained from simply adding, “You want a second opinion? You’re ugly, too!”
He gave me the name of the other of the two leading urologists, a Professor at a “rival” teaching hospital. The second doctor saw me quickly. He and his own radiologists reviewed the pictures. He then asked for additional information based upon my history. Luckily, the priest-administrator at the mid-western hospital I had once gone for tests, who had access to the information dating back 15 years, was able to FAX the results to the “second-opinion” doctor. The second specialist not only confirmed the diagnosis, he also –perhaps to bolster my confidence, and in light of my generous insurance plan – offered to perform the surgery, himself. Indicating the first urologist, he told me they were the best in their field and that I could trust either of them.
I chose the first specialist. I’ve always wondered why anyone would choose not to have all the information possibly available, in a situation such as that. We went over every detail of my condition; the nature of the procedure; the risks; the potential benefits, and the course of recovery. “If we get all of the cancer, the chances are you will make a full recovery and you will not need radiation or chemotherapy.” He added, to be thorough, “just as you can live with one kidney, you can live with one of the two adrenal glands that sits atop each kidney, so I propose to remove both the kidney and the adrenal gland -- the whole thing.”
I said, honestly, “I have heard that adrenalin is the only true aphrodisiac, and at my age, I need all the help I can get. Could you please leave in the adrenal gland?” He said he could make no promises, but that he would try to cut out only the cancerous kidney.
Several days later, I underwent the surgery at St. Luke’s-Roosevelt Hospital, where the care I received could not have been improved upon had I been the Shah of Iran. Indeed, it was much better, because I was the one that survived. Best of all, not only was the operation a success, with residents, nurses, and interns surrounding him, laughing with restrained but obvious jollity, the urologist-surgeon informed me that he had not only removed the offending organ, he had also managed to save my precious adrenal gland – and that HAS made all the difference!
The care that a person receives between ages 55 and 65 may well be the most crucial care of a lifetime. I think you are all sophisticated enough to realize what, if anything, would have lain ahead of me had the cancer on my kidney not been diagnosed and removed when it was, because I lacked the very insurance that probably saved my life.
So with thousands of similar cases in mind, when Obamacare legislation was being drafted, along with a “public option,” proponents were suggesting that persons between the ages of 55 and 65 be allowed to buy into Medicare, at higher but affordable premiums. The idea was all set to fly when the sanctimonious but exquisitely venal Senator Joseph Lieberman (I.-Conn.), sometimes referred to as “the Senator from Aetna,” withdrew support from that very proposal, he, himself, had made. His masters had reminded him that the Medicare buy-in would intrude upon anticipated Obamacare windfall profits expected by the health insurance oligopoly to which Lieberman owed his political existence.
It gets better. Or at least more interesting. The Medicare buy-in was not a liberal-progressive idea, at all. In the days when Bill Clinton was still accounted a conservative, "New Democrat," the Medicare buy-in was seen as a way to garner an enormous infusion of money into the Medicare system. More important, the Medicare buy-in would create the single greatest PREVENTIVE health care initiative in history!
So, in light of the intense media preoccupation with the callow, yes, even childish, unarithmetic proposals of infantile social Darwinians like House Budget Committee Chairman, Paul Ryan (R.-Wis.), it seems to me more than apt to present for your perusal and delectation Bill Clinton's original, superb proposal of Medicare-buy-ins by those aged 55-65, without touching the benefits or age eligibility of those over 65.
PRESIDENT’S PLAN TO STRENGTHEN AND MODERNIZE MEDICARE FOR THE 21st CENTURY
Medicare Buy-In for Certain People Ages 55-65
Overview. Americans ages 55 to 65 are one of the most difficult populations to insure: they have less access to and a greater risk of losing employer-based health insurance; and they are twice as likely as people ages 45 to 55 to have health problems. Some lose their employer-based health insurance when their spouse (frequently the husband) becomes eligible for Medicare. Many lose their coverage because they lose their jobs due to company downsizing or plant closings. Still others lose insurance when their retiree health coverage is dropped unexpectedly. As a result, this is the fastest growing group of uninsured.
To address this problem, the President included in his FY1999 and 2000 budget submissions a targeted, paid-for proposal to give Americans nearing age 65 new options to obtain health care coverage. There are three parts to this proposal: The centerpiece of this proposal is a Medicare "buy-in", which allows eligible people to purchase Medicare coverage at a fair price. This is comparable to the Social Security option to allow people to begin to receive benefits at the age of 62, paid for by reducing the amount that they receive over the course of their retirement. It also assists displaced workers ages 55 and older by offering those who have involuntarily lost their jobs and their health care coverage a similar Medicare buy-in option. Thirdly, it providers Americans ages 55 and older whose companies reneged on their commitment to provide retiree health benefits a new health option by extending "COBRA" continuation coverage until age 65.
All three proposals are designed to be paid for by the people who benefit. People ages 62 to 64 who buy into Medicare will, over time, repay the amount that Medicare "loans" them when they are buying in. Displaced workers will pay a premium that takes into account participants’ costs. And, the COBRA buy-in policy has no Federal budget impact whatsoever. The short-term Medicare "loan" to buy-in participants, plus the costs of the displaced workers’ buy-in, will cost approximately $1.4 billion over 5 years. These costs will be financed by a series of offsets in the President’s budget; as such, its costs are not included in the summary table for this plan. The initiative should help 300,000 to 400,000 people.
a. Medicare buy-in for people ages 62-64
Policy: People ages 62 through 64 (without access to employer-sponsored insurance) would be able to buy into Medicare early. They would pay for this coverage through a two-part premium "payment plan." First, participants would pay a base premium of about $300 per month – the average cost of insuring Americans in this age range. Second, participants would pay an additional monthly payment, estimated at $10 to $20, for each year that they buy into the Medicare program. This premium, to be paid once participants enter Medicare at age 65, would cover the extra costs of sicker participants. This two part "payment plan" enables these older Americans to buy into Medicare at a more affordable premium, while ensuring that the buy-in option is self-financing in the long run.
Background/rationale: People ages 62 to 64 are simultaneously the most likely to develop health problems and the least likely to have access to employer based health insurance. This forces them to turn to the individual insurance market, which can be expensive or denied altogether in most states. The Social Security program recognizes that some people in their early 60s may need access to benefits, and allows them to receive partial benefits. No such option is available in Medicare.
b. Medicare buy-in for displaced workers ages 55-62
Policy: The plan would also offer those who have involuntarily lost their jobs and their health care coverage a similar Medicare buy-in option. Individuals choosing this option will pay the entire premium at the time they receive the benefit without any Medicare "loan," in order to ensure that Medicare does not pay excessive up-front costs and participants do not have to make large payments after they turn 65 (although some Federal costs are expected due to adverse selection).
Background/rationale: This policy responds to the increased vulnerability of older Americans to work transitions and company layoffs. Such workers have a harder time finding new jobs: only 52 percent are reemployed compared to over 70 percent of younger workers. Nearly half of these unemployed, displaced workers who had health insurance remain uninsured.
c. Access to health insurance for retirees whose employers renege on coverage
Policy: This proposal allows retirees whose companies reneged on their commitment to provide retiree health benefits to buy into their former employers’ health plan through age 65 by extending the availability of COBRA coverage to these families. This policy provides much needed access to affordable health care for these retirees and their dependents whose health care coverage is eliminated after they have retired. Retirees will pay a premium similar to that of other COBRA participants.
Background/rationale: In recent years, the number of companies offering retiree benefits has declined: in 1993, only about half of full-time workers in medium to large firms had access to retiree health insurance, compared to 75 percent in 1985. Some companies have ended coverage only for future retirees, but others have dropped coverage for individuals who have already retired. It is often difficult to impossible for retirees to find affordable, alternative sources of health insurance.
Harvard Hollenberg is a writer and an appellate attorney in New York City.
© Copyright Harvard Hollenberg 2013. All rights reserved.