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People, What’s Wrong with a Medicare Buy-In?

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Will the obstacles never go away? Now people are fighting the Medicare buy-in for uninsured people 55-64. Leave aside for the moment that, as currently structured, buying into Medicare might be too expensive for most of the uninsured, who are also the unemployed.

Let’s presume for the moment they can all afford it. It that’s true and they buy in early, this SHOULD result in an overall health care cost saving for the entire American population. Why?

Because, as my friend Merrill Goozner, who by the way is also an awesome health blogger, points out,

The decade before people enter Medicare (55 to 64) is the time of life when many people develop the chronic diseases that will make them the most expensive patients in Medicare once they get there. Diabetes, heart disease and many cancers often emerge in late middle-age. Intervening when the warning signals of these diseases first appear can moderate or even eliminate many of these costly conditions.

So wouldn’t it be great for Medicare if someone like me could have been treated earlier for my hip problem, rather than waiting until Medicare when I required a replacement? Maybe an earlier intervention could have meant a re-surfacing at a much lower cost than a THA (total hip arthroplasty).

But from 55-64 I was essentially self-insured, and did nothing beyond routine physicals, Pap smears, and mammograms. And I wouldn’t have even done those if I weren’t knowledgeable in prevention issues. What about people who have never had their blood pressure checked, or their cholesterol measured?

The one thing people who oppose health care reform don’t understand is that uncovered illnesses and conditions are a tax on everybody, because we don’t turn people away from County Hospitals and emergency rooms. And once they get there, they are catastrophically costly to treat.

A friend of mine is a nurse in the ICU of Maricopa Integrated Health Services, the county hospital for Arizona. Every day she keeps people alive who are the product of decades of neglect, whether because of poverty, addiction, abuse, or chronic illness.

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Wonderful post, and right on target. I too have been frustrated by the twists and turns that health care reform has taken. The very thing that made me believe we had to reform it -- the number of uninsured people -- seems to have fallen by the wayside in some ways.

But it does seem like there will be a reform bill passed, and I've decided we just have to look at it as a first step. We can't get things perfect on the first go, and so we've just got to do the best we can and then try to tinker and tweak it to make it better.

Whenever politics intersects with real life, this seems to be the way it goes. But if some big steps can be taken now, maybe the giant strides can be next.

Thanks so much for writing.

December 17, 2009 - 8:27am
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