If Not For Medicare, How Would Seniors Get Health Care?

Great Debates
1

I was thinking about Starving Artist’s comment about how we are essentially addicted to Medicare, by force of law, and as such will never be able to get off it. And he’s right, knowing that there will be Medicare alters people’s retirement planning now, which means they will need to have Medicare in 30-50 years.

It made me wonder: given everything you know (or think you know) about health care in the US, what would seniors do for health care if Medicare didn’t exist.

I think for sake of argument, we should also assume Medicaid does not exist, because that would be too easy an answer, “all seniors will have to declare bankruptcy and go on Medicaid.”

There are three very large obstacles I see as to why we need Medicare: 1.) after retirement you lose your company group health plan, 2.) by 65 you are pretty much guaranteed to have at least one pre-existing condition, and 3.) as you get older, you are more “risky” to the insurer.

I don’t mean to inject personal anecdotes, but my opinion of this particular subject is formed from knowing people aged 55-65 who had planned to retire before 65, but when they got to 55 found out that there was no way in hell they’d be able to get health insurance. So they continue to work until 65 so that they can qualify for Medicare. And these aren’t a group of people that were basing their retirement on having Medicare. They saved extra and included a cost of private insurance into the plan. But then a heart attack at 54, or Type II diabetes at 61, or breast cancer at 45 meant private insurance was inaccessible–at any income.

The only people I know that were able to retire early were those with some form of union retirement plan, or a special buy-out package as part of early retirement that included some form of health insurance until 65.

So what do you think? Without the Medicare/Medicaid system would seniors be able to get insurance? Or do you have to force the insurance companies to take them, at a reduced rate?

I would personally love to have a +55 Doper give us a quote for private health insurance, but that would probably muddy the water with facts and stuff.

2

My mother (age 83) still has her company’s health insurance, even though she retired quite some time ago.

3

When Medicare was passed , it was because of a crying need. Our system provides health care for those who are working. When they are no longer useful to the company, they no longer get it. It just happens to be when they are no longer covered, they are at an age where they are beginning to suffer the ravages of age. Insurance does not want to cover those who actually need it. They want to cover the healthy. So the old were abandoned. They died miserably in their homes or were taken to a hospital too late. Of course there are exceptions. Those who worked where there were unions, got contracts that covered them in their late years. Now unions are under 7 percent of the work force. that makes it obvious that many will go into old age with nothing, if Medicare is killed.

4

Without getting personal, does she have to worry about that company going bankrupt and ending the policy? What would she do under that scenario?

As a conservative, do you see that as a solution? To me it seems like a massive burden on the company. As Ford, Chrysler, and GM were going bankrupt analysts kept bringing up the fact that these companies were paying for three-four generations of employees, the result was that they couldn’t possibly compete with a younger company.

As an investor, I don’t like the thought that as employees age, the liability on a company grows.

5

It almost seems ironic that the conservative answer to health care is, “get rid of Medicare, and replace it with unions.”

6

My neighbor was a manager at GM, and they just cut his healthcare, which they couldn’t do for those in the union. (Yet.) I don’t think very many companies are going to be covering retiree health care going forward.

7

I’m in that category, but I have a pre-existing condition, so I probably couldn’t even get any. Luckily I’m still employed, so I don’t have to worry. I’m definitely going to hang on to 65 for the very reason you mention, unless we get some sort of decent health care plan. So, I’m keeping a job which could go to a younger person.

If there was no Medicare, I suspect there would be a lot of high deductible private insurance sold, so more seniors would become impoverished, and more would die. But conservatives no doubt will see the silver lining of that - it would help the Social Security problem.

I wonder if private insurance for seniors would involve death panels.

8

And for how many people in the retired age category is this true, or expected to be true in the future, and under what conditions, and how stable is that situation expected to be?

I mean, surely you can see that your anecdote doesn’t really answer the question.

9

I don’t know.

I know that my dad, before he died, paid attention to what my mom’s coverage options would be, and planned her coverage on the assumption that Medicare wouldn’t exist.

So I guess I would start by asking in return, “How many people in the retired age category did that?”

10

So ask that, and address the OP’s questions, rather than offer one personal anecdote that appears to be designed to say “that doesn’t fit my experience, so your questions and comments can be ignored.”

eta: Sorry, that sounds more snarky than I intended. I just meant that offering a personal anecdote that addresses one instance in which one of the OPs statements was not true really doesn’t help.

11

I’m 31. The bulk of my professional experience comes from working for a fortune 50 financial services company. It is absolutely inconceivable to me that my employer will be able to offer me anything whatsoever when I retire. I have already observed contraction of my health benefits, conversion to a weaker retirement savings program, and a decrease in long term incentive awards, and a general weakening in the long term benefits offered by my employer.

I could go to another employer, but the song would remain the same. If I get the academic job I want, I will never have to retire. But if I stay in the private sector, honestly, I have no idea how I would ever retire.

12

Not a hijack–just a tangent

Now transpose this same logic to turning the entire country’s health insurance coverage over to a government-sponsored system and you’ll begin to understand the weakness most conservatives see in such a proposal.

Okay. Back to the original discussion.

13
  1. There shouldn’t be “company insurance”. People should purchase health care insurance on their own and pay for it each month directly.
  2. No one should be able to be uninsured. If they aren’t officially registered with a company, when they go into the hospital they can be assigned one randomly or pick one themselves right there. Either way, the insurance company has no ability to say no, so long as they are a legal citizen.
  3. The amount that insurance pays should be based on your age and the total amount that you have payed in to-date. I.e. the amount you paid while you were still employed continues to affect the level of care you receive after you retire.
  4. You can switch insurers periodically (once a year, for example) and all money that you have payed in to health insurance should automatically transfer over with you to the new company.
  5. If you have never paid any money in, there is some minimum percentage of any doctor’s bill which the insurer will still have to cover. This percentage will be increased or decreased by the government as need be until a value is found at which enough people pay monthly insurance bills sufficient to cover the cost of care of those who have never paid anything.
14

Do you like this as an alternative to Medicare?

That’s a good question, how do we find that number?

And while we’re looking, I’d like to know two other things: 1.) How long do you have to work for a company before that sort of policy would kick in (I’m pretty sure there would be a vesting period). And 2.) how many people lose their coverage each year because the company goes bankrupt?

Perhaps it’s a generational thing, but I wouldn’t expect any company around today, to still be around in 30-40 years, and to still honour a lifetime insurance policy. And that doesn’t mean the name won’t still exist, but like Ford or GM, after a month in bankruptcy court to me isn’t the same company. I don’t trust pensions either in the same way.

15

Do you distinguish between those not paying because they are gaming the system and those not paying because they cannot afford to?

If a person pays some reasonable percentage of his income for insurance, and has an illness that costs far more, what then? Do insurers make a bundle by limiting payout by your method while taking money from those whose payments exceed any treatment?

All insurance involves some people getting more out than they put in and some people less. Is this a problem for you?

16

Insurance is based on risk, otherwise it is universal health care and not insurance.

I’m not against UHC but I’m against calling it insurance. If insurers can’t turn people down, then it’s not insurance. Car insurance is based on age, statistics, location of insured and other risks.

This is why you need to make the distinction between Health Insurance and Health Care Coverage

17

No. Though somebody who is gaming the system will simply never pay. Someone who is basically honest will probably pay in something at some point, even if he can’t afford it now, which helps his situation.

If you pay more, you get more. If you have an illness that costs more than your plan provides for your agegroup, then you die or hope that a charity does something for you.

Requiring a minimum level of care is a different thing from giving everyone the best care–which is just impossible. You’ve got to ration care, and you can either do that based on need or based on how valuable the person is to society. The loss of a guy who begs on the street for money to go get high with just isn’t as worth saving as a doctor or a guy who designs microprocessors, or a lady who keeps a company that employs 10,000 people running. The value of a person’s life varies by who they are. The cost to keep them kicking and helping the world out varies by person. Getting those two to match is a pretty good deal. Getting it reversed is rather silly.

But note that even in a system where it rations based on value, within each bracket, it goes to the most needful. There’s a pool of money that gets doled out based on who needs it most, up to the point where it would break the bank.

18

Similarly, many conservatives want to get rid of labor unions because the government has supposedly rendered them unnecessary. If you’re just “anti-” you can be anti-everything.

19

Without Medicare, catastrophic illnesses will bankrupt many older citizens. It bankrupts younger people too. Health costs are the leading component in bankruptcies. It is almost impossible to pay for a serious illness. Cancer is a 300,000 dollar and up diagnosis. Some cost a million dollars and more. But I guess many say you should think and plan ahead. Plan on not getting sick then. Plan on not getting in an accident.

20

Never mind that if this was required by law, companies would only use contract employees.