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Medicare -- still there when insurers need it

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WASHINGTON -- Nearly two years after she died of infection and exhaustion in New York City at the age of 86, my mother received a medicare summary notice from the Centers for Medicare and Medicaid Services informing her the U.S. federal government had reimbursed only a portion of her final ambulance, hospital, psychiatric, gynecological, radiological, gastrointestinal and anesthesiological charges -- not to mention CT scans of her abdomen, pelvis, and thorax -- and she would be held responsible for paying the rest of the bill.

Some of the amounts in question were trivial: $2.01 to a Dr. Dimitriy Katkovskiy for a chest X-ray; $1.37 for ground mileage to the ambulance service that took her to the bed where, to use a word that always made her giggle, she "expired" one minute after I had to leave the room to go to work.

Other sums were more significant: for example, $1,360 for an ominously named "Anesth vaginal procedure." And some bills were wiped out altogether with the cheery notation that, "It appears that you did not know that we would not pay for this service, so you are not liable."

"If you have not received your flu shot, it is not too late," the letter helpfully concluded.

Two years later, wondering if my heirs will be stuck with a similar invoice long after my own expiration, I pop into a session at the American Enterprise Institute titled The Future of Medicare: A Reality Check just in time to hear a brace of Republican senators predict that, should I linger another five years or more, there won't be any more Medicare at all to dun my kin post mortem.

"We have to be honest with seniors," Sen. Tom Coburn, an Oklahoma gynecologist who just turned 64, is saying. "It is my personal belief that, within two to five years, we are going to have a catastrophe."

"America cannot go forward with things being free," adds Richard Burr, a former North Carolina lawn equipment salesman, age 56. "There has to be skin in the game."

What they are talking about, of course, is not the future of the Obamacare legislation that resides in the Supreme Court at the moment, but of Medicare, the universal, single-payer, Canadian-like system of insurance for Americans age 65 and older that has been in existence since 1965. (A paradox of the rise of the Tea Party movement has been its vehement opposition to both a "government takeover of health care" and any reduction in benefits from the government health-care program that geriatrics already enjoy.)

"We have a moral obligation to our children and, were my parents living, to my parents," Sen. Burr says. He proposes to "offer every senior a cap on what they have available to spend for any disease." After that, you're on your own.

"What's it gonna take to get this through Congress?" the Carolinian muses. "Spinal implants."

"The average person comes into Medicare with five chronic diseases," notes Dr. Coburn, himself a survivor of melanoma, prostate, and colon cancer. "Do you think that Medicare pays me to sit with him and talk about his diabetes and his hypertension and his obesity and his coronary artery disease? The average office visit lasts less than 10 minutes. They give me $36, and that won't pay the nurses."

Both men predict a pillar of Barack Obama's re-election rhetoric will be the accusation the Republicans intend to "end Medicare as we know it."

"You can't say we're never gonna touch your Medicare," Tom Coburn exclaims. "We need to call him out on it. Anybody who says we don't have to fix Medicare is lying. It's an outright lie. Medicare is ending as we know it, whether we want it or not."

The solons' diatribe is followed by a corroborative presentation by a man named Richard S. Foster, who is the chief actuary for the Centers for Medicare and Medicaid Services, the very body that keeps sending bills to my late parent.

Foster's graphs and charts extend out to the year 2090, when I will be 140 years old. They show a widening and unbridgeable chasm between the funds available from government revenues and the amounts that will be needed to keep baby boomers such as me upright and shuffleboarding.

"The reality could be worse than this, and in fact is likely to be much worse," the actuary prophesies. He follows this ray of sunshine by predicting a future in which most hospitals refuse to treat any Medicare patients at all.

As it was, the system still was solvent enough in 2010 to try to ease, if not forestall, my mother's final hours. Two years later, I call the offices of Dr. Dimitriy Katkovskiy in Manhattan to ask what to do about her outstanding Medicare balance of $2.01. A very cheerful woman answers the phone.

"My mother just got a bill from Dr. Katkovskiy," I inform her. "Also, my mother is dead."

"Send it right back to Medicare!" the woman advises, "You can tell them that the patient has expired."


Allen Abel is a Brooklyn-born Canadian Journalist based in Washington, D.C.

Republished from the Winnipeg Free Press print edition May 5, 2012 J11

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