By Lambert Strether of Corrente.
For most of my working life — which roughly coincides with the flattening of real wages and slow, deliberate destruction of the public sector that began in the mid-70s and has continued until the present day — I’ve comforted myself with twin ideas or visions or illusions that FDR’s Social Security would provide me with a baseline of dignity when or if I retired, and that no matter the insanity of the health care system for those younger than 65, everything would change, and for the better, when I could enroll in Medicare, a single payer system; out of the stormy seas into the safe harbor, as it were. (Never mind the conondrum that the best way to stretch my Social Security dollars is to leave the country, in which case Medicare won’t cover local care; it’s like they don’t want me to escape, or sumpin.)
Anyhow, I’ve been corresponding with an actual Medicare user, and it seems that, sadly, I haven’t been cynical enough; the safe harbor I had imagined may turn out to be just that: Imaginary. Anonymizing medical and location details, I’m going to excerpt some of this correspondence below, and then comment on each excerpt. (Any misinterpretations are solely my responsibility.) This will not be a systematic treatment or a 30,000-foot view, because I’m not ready to do that, yet; what I’m really looking for from you, readers, is confirmation or disconfirmation of my initial reactions, as well as your own, real-life experiences with the Medicare system.
Medicare Advantage and Supplemental Plans
The Medicare Site describes Medicare Advantage as follows:
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Which, to my ObamaCare-jaundiced eye, looks like a neo-liberal privatization scam, with the hallmark of all such scams, the rent-extracting intermediary that add no value. Readers, can any of you speak from experience in comparing the two?
AARP describes its supplemental plan:
Medicare has several gaps and doesn’t pay for all of the health care services you may need. If you are in the Original Medicare Plan, you may want to buy Medicare supplemental insurance, also called Medigap insurance. This is health insurance that helps pay for some of your costs in the Original Medicare program and for some care it doesn’t cover.
Medigap insurance is sold by private insurance companies. By law, companies can only offer standard Medigap insurance plans. There are 11 standard plans labeled A-N. Each plan, offers a different set of benefits, fills different “gaps” in Medicare coverage, and varies in price.
study all the Medigap plans before deciding which is best for you.
Which, still with the same jaundiced eye, reinforces the possibility of a neo-liberal infestation: Like ObamaCare, we have the artificial creation of a phony “market”; after all, the gaps are there because coverage was not legislated, and that’s what created the market; like ObamaCare, we have the standardized plans (with no way to determine the actuarial value of each plan beyond the vendor’s brochure); like ObamaCare, we have the proliferation of plans; and like ObamaCare, we have the tax on time of “shopping.” (“You will want to” is an especially nice touch, since it means “You had better, if you want the slightest hope of decent coverage without being ripped off.”) It’s almost starting to look like Medicare has been the testing ground for “what level of badness can we get people to accept” under ObamaCare. Readers, has this been your experience?
And here is what my correspondent had to say about Medicare Advantage and Medicare Supplemental:
[CORRESPONDENT:] As for the impact on me without either Medicare Advantage or the AARP Supplemental Plan:
I would have had to pay the 20% not covered by Medicare out of my own pocket. Considering my surgery and meds, just a wild ass guess without digging out the records: $30-$40K in 2013, another $15K last year. Plus the tax penalty for early withdrawal from my IRA, because that’s where the money would have come from.
I frankly don’t see how anyone can survive without an Advantage or Supplemental plan. And with the way they keep cutting things, the day will come when many folks won’t be able to survive even with one of those plans. Like Alan Grayson said, “Don’t get sick, and if you do, die soon.”
Yikes. Where ObamaCare forces people into market through the mandate, Medicare forces people into the market by making the public coverage “gappy” and lousy (a standard play in the neo-liberal playbook). Readers, am I being too cynical?
Random Variations in Coverage By Jurisdiction
My correspondent advises me:
[CORRESPONDENT:] What you should try to do is find someone on Medicare in you area who will lend you their plan information booklet so that you can review the plan options in your region. That will give you an idea of the limitations on service/access/choice of providers that you will face come 65. (Assuming, of course, that things don’t get even worse by that time.)
Huh? One of the most unfair features of ObamaCare is random variations in coverage by jurisdiction (see here, here, here, here, here, and here). Is this guy telling me the same is true of Medicare, supposedly a national program? Readers?
And my correspondent goes on:
[CORRESPONDENT:] And BTW, with regional plans, if something happens to you while you’re out of the region visiting the grandkids, taking a vacation, even traveling for work if you’re still employed, guess what? You’re generally automatically OUT-OF-NETWORK, except possibly — depending on the plan — for your Part D medications. The AARP Supplemental plan is not only national, but the one I selected also covers a significant portion of costs if you fall ill outside the country.
Huh? Narrow networks and narrow formularies are one way the insurance companies game ObamaCare, through, as it were, “pre-rescission” (see here, here, here, and here). Is my correspondent telling me the same happens with Medicare?
Why yes. Yes. Apparently they are:
[CORRESPONDENT:] It’s official; for 2015 there is not a single Medicare Advantage PPO plan available in [my] county. Even Aetna’s Medicare Select Plus NATIONAL PPO plan is not available.
HMOs ACOs are the wave of the future, anyhow! But that’s some variation. Have other readers had similar experiences?
Here my correspondent describes what what I can only believe is a sequence of normal, everyday interactions with Medicare:
[CORRESPONDENT:] Therefore, you present only your Advantage card (from Blue Crucifix, United, Aetna, whatever) and your doctor bills that insurer, but never has to bother with billing Medicare itself. You get a statement from the insurer showing what they paid, what (if anything) you owe for co-pays, deductibles, out-of-network charges, etc., and what was disallowed as above Regular and Customary (R&C) pricing for your region and your procedure/treatment.
So you have one card. It’s just that everybody doesn’t have the same card (unlike Canada). And here we go:
[CORRESPONDENT:] At some point your provider bills you. Sometimes it’s just for any unpaid portion not covered by the policy. Other times you get a bill for the whole thing, then a month or so later you get a bill showing the total less insurance payments and the net amount due. This is a hassle. You have to collate the statement from the insurer with the invoice(s) from the provider in order to pay the correct amount and not overpay. Sometimes you can end up having to mail off a payment for a balance due of as little as $5.
Fortunately, elders, especially sick ones, enjoy collating invoices, and anyhow, if they don’t, they can always have their personal assistants do the work. Am I right, readers, or am I right?
[CORRESPONDENT:] With the AARP/United Health care Supplemental (but not Advantage) plan I have to present both my Medicare card and my AARP card and the provider has to bill both.
Oh, wait. Now there are two cards. More useless complexity of benefit only to rent-seekers. We continue:
[CORRESPONDENT:] So far this year I’ve had several doctor’s visits… and have yet to pay an on-site co-pay. I also have not yet received any billing statements, so I have no idea if this new AARP United Health system is going to be better, worse, or the same as my old Blue Crucifix coverage.
And finding out is going to be something to look forward to!
[CORRESPONDENT:] As for you being safe when you hit 65: Hate to be the bearer of bad tidings but, NOT. A. CHANCE. Costs keep going up, coverage keeps getting worse or more limited, co-pays and deductibles keep rising, etc. That’s why I’ve written several comments on NC about how Medicare-for-All is not the answer because it does not really cover the true costs of care.
But wait! [pause] I checked the Medicare website. I did. My plan here, readers, was compare and contrast what Medicare claims to do with what we find that it actually does (“But wait! The Medicare site says….”). And I spent maybe ten minutes clicking around for something like a mission statement, and couldn’t find anything; not the About page, not the FAQ; I even looked up Medicare in the Glossary, but nothing. I even tried “Get Started with Medicare,” because I dimly recall that the first button on the left of the top menu is the hottest spot for clicks… And I can’t find what Medicare is or does! To be fair, you can’t say “Medicare is a program that provides universal health care for U.S. citizens over 65″ if you can’t say “Medicare is…”  So there’s that. Moving on:
[CORRESPONDENT:] For example, in June of 2013 I suffered a back problem which eventually required surgery (in-network). I also have an annual exam and a tri-annual cancer check-up. (Father died of this form of cancer.) Between the deductibles, co-pays, Medicare insurance premium surcharges, and the $134 a month ($1,608 a year) deducted from my SS check for the basic Medicare premium that everyone on Medicare is assessed, my 2013 out-of-pocket medical costs came to…
With all the post-back op pain meds, doctor’s visits, some dental work, and so forth, this past year, 2014, my total out-of-pocket was $8,605. (BTW, in many plans dental care is an additional premium, as is vision care. And my dentist does not take any Medicare patients, even Medicare Advantage.)
Of course, these expenses were partly because I selected the BC plan which was the only PPO in my region. I could possibly have spent far less by choosing one of the various HMO policies, trading choice of doctors and physical location convenience of facilities for lower costs. I might also have saved more by opting for the AARP United Health Supplemental-but-not-Advantage plan, had I known about it at the time. (Those plans are NOT included in the annual booklet sent to all Medicare beneficiaries.)
Ya know, I think my correspondent is telling me (a) I could go belly up, financially, even with Medicare and that (b) this depends, among other things, on random coverage variations by jurisdictions. Can this possibly be true? Readers?
I don’t have a lot to conclude, here — readers, you’ve seen my questions — except that Medicare has all the signs and symptoms of being infested by neo-liberal rent-seekers in the same way that ObamaCare has, except targeting a far more vulnerable population.
However, one thing that you could do is send me especially egregious documentation — PDFs, scans — of useless complexity; stupid insurance company brochures, stupid invoices, stupid policies, and so forth. You can use the same contact information that people use to send me images of plants, down at the bottom of Water Cooler. Thank you!
 Personally, I believe that shuffleboard is a death sentence, so I would prefer to work ’til I drop.
 Does anybody know any elders who’ve put “Decoding deliberately obfuscated insurance company policies” on their bucket lists? No?
 To be fair, it’s good news that AARP Supplemental might help enable my plan to die in a ditch in the tropics rather than be hooked up to a machine in a “nursing home.” Of course, there ought to be a way that I get health care by virtue of being an American citizen; but there’s no business model for that, so it’s a non-starter under today’s neo-liberal regime.
 Hilariously, the top question for the FAQ is: What if I decide to cancel my MyMedicare.gov account? Mission accomplished?
 UPDATE After another ten minutes poking around on an unrelated topic, I found what I was looking for like three levels deep in the sign-up material, under “What is Medicare?” In other words, you only see what you’re signing up for after you start the enrollment process.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
I like my version better. But heaven forfend that the program’s purpose be on the front page!
The political aspect here is the frame “Medicare for All.” When single payer advocates use that phrase, it looks like what they really mean is “Medicare before the neo-liberal infestation,” or rather, “Canadian-style Medicare.”