It’s no secret that I’ve been a big-bandwagon supporter of single-payer healthcare in the US for more than 30 years—long before I was diagnosed with end-stage renal disease. As a small business owner I know very well the outrageous costs associated with health insurance and healthcare. Even when I was working at Utne Reader, I paid 100% of my health insurance—more than US$1,000 per month. Since mid-2006 my wife and I have been covered by one of the University of Minnesota’s group plans. For that I feel entirely grateful. US$112 every two weeks is a hell of a lot more affordable.
Like many in my generation, I’ve known I’ll probably have to continue working my entire life for at least 20 years. The knowledge of no retirement for you is mildly disturbing, but we’ve had decades to adjust. What’s really shocking, though, is the cost of our healthcare insurance when we reach age 65. If I can manage to keep from getting fired or laid off from the University for another 18 months or so, I can qualify for the institution’s group retirement plans. Group plans—especially really big ones like the University’s—are much cheaper than individual plans. So, best case, in a year-and-a-half or so I could hypothetically retire from my position at the University and continue to freelance or even go to work for someone else. Or, of course, continue working at the University’s College of Design.
Before I turn age 65, I’d be eligible for the same health insurance plan we have now, only I’d have to pay the full, non-subsidized rate of US$1,125.60 per month for coverage for my wife and myself. After my wife and I both turn age 65—five years for her; ten for me—we’d be eligible for Medicare and the University’s medigap (supplemental) insurance. That’s US$192.80 for Medicare Part B + US$520 for the University’s supplemental insurance—for a total of US$712.80 each month (plus co-pays and deductibles).
That’s best case scenario and last year’s rates. Health insurance rates have been doubling every seven years. It’s a sure bet I’ll be paying two or three times as much for health insurance in my “retirement” years than my mortgage. Because I’m an end-stage renal disease patient on dialysis, Medicare is closer than it may appear—I automatically qualified for Medicare (.pdf; 737KB) 18 months after I started dialysis.
Who could have planned for this?
Medicare Part A covers 100% of hospitalization minus annual deductible (US$1,068) unless you’re hospitalized for more than 60 days, then you pay US$267 per day until day 91; then you pay US$534 per day and everything—100%—for anything beyond 150 days. That’s not so bad (except for the deductible), because hospitalizations rarely last longer than a week or two. Medicare Part B covers 80% of most non-hospitalization “allowed” medical professional services minus a US$135 annual deductible. So long as your doctor agrees to “accept assignment” of Medicare’s allowed rate. If not, his or her fee is limited to 115% of the Medicare reimbursement, but you’re on the hook for the 15% overage + the 20% that Medicare doesn’t cover.
The problem is the 20% that Medicare doesn’t cover. It’s much larger than it seems.
The health insurance my wife and I had when I was diagnosed with end-stage renal disease in 2000 cost roughly US$800 per month with a 20% co-pay, a US$1,000 deductible, and an alleged US$3,000 out-of-pocket cap. If you’re a reasonable person, you’d think that in addition to the cost of the premiums, the most I’d have to pay in any year for healthcare is US$3,000, right? Well, that’s not the way it worked. By January 2003 we were personally bankrupt solely because of my medical bills.
What needs to happen is simple. Medicare needs to be improved to pay 100% of all healthcare, with reasonable premiums—say US$200 per individual per month—and reasonable co-pays and deductibles for hospitalization and professional treatment and care. Overutilization is addressed with reasonable co-pays and a real, reasonable annual out-of-pocket cap of, say, US$3,000. And it gets extended to every citizen in the US. Call it Medicare Plus for all. Work for a health insurer? Find work elsewhere; at least you’ll be able to afford your healthcare.
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