Part 1 of a two-part podcast on Medicare – it’s history, value and gaps – featuring Jodi Reid, executive director of the California Alliance for Retired Americans.
Making Medicare Even Better?
The Promise of Improved Medicare for All
—– TRANSCRIPT —–
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for all could help. I’m your host, Brenda Gazzar.
How do retired Americans feel about Medicare? What concerns do some seniors have today about improved Medicare for All — and are they valid? To find out, we spoke to Jodi Reid, the executive director of the California Alliance of Retired Americans, a grassroots senior advocacy organization. She has forty years of organizing experience, mostly with community-based and senior-based organizations on issues ranging from health care to housing.
Welcome to Code WACK! Jodi –
Q: Tell us what healthcare was like for American seniors before Medicare was established in 1965.
Reid: I don’t know this from experience, so this is all anecdotal, but I do know that so many seniors were either left in poverty because of the high cost of medical care, and had to spend every penny that they may have amassed when they were working either through savings, or through pensions or Social Security, to pay for what continually are more expensive procedures and many wound up with losing their housing, many more in shelters I think are what we call them now because they lost everything in order to be able to pay for their health care and left many, many, many, many seniors in poverty because of the high cost of care, and the inability to have any kind of coverage for that care.
So, our Medicaid system was also not developed at that time either, so there wasn’t really a safety net for anyone so you either paid out of pocket if you needed the care or wanted to get it or you were dying much earlier because you chose not to mostly because you couldn’t, because you couldn’t afford to pay for the care so the situation was really dire, and that’s what brought us to finally the passage of Medicare and Medicaid together. They were passed as a package in 1965 with the hope and the promise that we would start with this population that is so severely impacted and doesn’t have access to any other kind of coverage — the older folks — but that it would eventually be expanded to cover everybody. That was the vision of the program when it was signed into law and in fact, seniors are the hardest to cover, the most expensive population to cover because they often have chronic diseases that need to be managed.
Q: Right. How do retired Americans feel about Medicare today, both the good and the bad?
Reid: In general I think people are very grateful for the program, that it has kept people out of poverty, it has provided basic care, especially hospital care, which is the most expensive. It has covered those benefits, and that people are grateful that they have access to care at this age, especially as they’re maybe dealing with the mechanics of their body getting older and not working as well as it used to, as well as, you know, diseases that may have preceded them becoming Medicare-eligible but they have to manage to the rest of their life.
I would also say that, you know, in terms of the second part of the question, you know, what are some of the downsides as Medicare has aged, since its original Inception when it was a fee-for-service program where Medicare paid 80% of what covered benefits, and the consumer paid 20%, more and more of the services that people need to be fully covered for all of their health care needs are being paid through private insurance companies so Medicare covers hospitalization and some outpatient expenses, but people are forced now as Medicare has become more privatized to find supplemental coverage to cover the rest of their care and that has become more and more the way of Medicare over the years and has caused more and more trouble because it gets more expensive with less things covered, and it’s a struggle to figure out how to get a full benefit package that covers all of your healthcare needs.
Q: Do you have an anecdote or story you can share that kind of illustrates some of that?
Reid: The most obvious one that comes to mind, and it’s fairly recent is neither Medicare nor most of the supplemental coverages cover dental, and for people who have chronic illnesses, especially heart disease, oral health is essential in maintaining your whole body health, and a very close friend of mine actually, who’s a senior had just become Medicare-eligible was diabetic and had some heart issues, and he did not have dental coverage after he no longer worked. He used to have it, then he lost it because Medicare doesn’t cover it, and he had a series of dental problems that turned into an abscess and infection. It was so bad he was having trouble breathing. He checked himself into the hospital, and the next day he died because the infection went to his heart. Had he had dental coverage, and had been able to have his infection and an abscess dealt with, which he would have had when he had his dental coverage but could no longer afford, that never would have happened.
Q: Hmmm. I’m so sorry to hear that. Wow.
Reid: But there’s tons of stories like that of people who, you know, because you have to pay out of pocket costs for some of the supplemental coverage, many people don’t have the resources to do that and so they either wait too long until the problem becomes more severe, and then it gets even more expensive, or they wind up in the hospital and then Medicare picks up the hospital charges but the person’s health has so deteriorated, because they waited too long to seek care because they couldn’t afford the, you know, the deductibles and the outpatient costs.
Q: So why does your organization, the California Alliance for Retired Americans, support Medicare for all, when many of your members are seniors who already have access to Medicare?
Reid: So I would say first of all I think that people, like I said, are grateful for Medicare and having hospitalization, at the very least covered, but we talk about it as improved Medicare for All. So, standard Medicare now is not enough. And even though the campaign mantra is Medicare for All, we are constantly trying to change that language, because if you talk to people who are on Medicare, Medicare has a lot of really great things, and the fact that we’re able to cover this very hard, very expensive population by pooling our resources, shows that this kind of a single-payer system can really work, save money, reduce administrative overhead, so that everybody who’s Medicare eligible has access to some basic coverage, but until we take the private part of Medicare Supplements, as well as this latest version of Medicare, which is the Medicare Advantage Program, which takes capitated money but may be denying care just like additional insurance does, we need to improve the Medicare system. It needs to cover more benefits, cover all parts of our body right now, dental, vision, eye, podiatry, some medical devices, long term care which is a huge growing need for older folks so that they can get some assistance to stay living independently. None of that is covered, not by Medicare, or most cases not by Supplemental.
And so, Medicare, the basic concept of Medicare where we’re all in it together and we all pool our resources, is the model that we know works, and now we need to create it for everyone, which will make it much more robust because younger people who use healthcare services less than older folks will be paying the same into the system, creating a much better funded system, but we need to do that by looking at expanding the benefit package and eliminating the need for any kind of supplemental private insurance, so people love their Medicare, but we’re not fighting for the Medicare we have now, we’re fighting for an improved and expanded Medicare for everyone.
Q: What concerns do some seniors have about Medicare for All?
Reid: I think any change is scary and for people who are managing chronic diseases especially but just as we get older and know that the equipment starts getting a little older and needs to be managed more frequently. Folks have put together their care team, so you know many seniors had not only a general practitioner but some might have, you know, cardiologists or diabetes management or there’s a whole host of physicians and providers that people have come to know and care about and depend upon to manage their health care.
And I think that there’s a fear that somehow, with any change, that they are going to lose access to their care team. It may not be perfect, but it’s you know, the devil you know is better than the devil you don’t and just the fear of any change, and their health care, day to day oversight, being shaken up, is very, very scary to folk. As we are able to talk to folks and talk about “but what if you could get more covered at less cost to you even as a Medicare recipient and still choose the same providers that you have now?” I think as we talk about that being our vision for what a guaranteed health plan would be, I think people become less, less nervous about it but change is hard, and especially when you are dependent on the coverage that you now have, the thought of changing anything is very scary.
Thank you, Jodi Reid.
Stay tuned for part 2 when Jodi talks about California’s fight
to win Improved Medicare for All.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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