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The Joys of Socialized Medicine

Oddly, it was only after President Obama’s speech to the joint session of Congress that it dawned on me for the very first time that without Medicare these past years, I would by now be either bankrupt or dead.

There are two reasons I’d never before thought of that. The lesser of the two is that when it comes to my personal health, I am terrific at denial. I do seek treatment for my illnesses and conditions as they occur, but I then very promptly forget about them. I find it somewhat staggering to go through the list of ailments for which I have been treated and for which Medicare has paid; after all, aches and pains aside, I consider myself a reasonably healthy specimen.

But on my desk is the printed record of the many tens of thousands of dollars I’ve cost the system, and the record suggests that I not only deny, but also distort. It provides not merely a catalogue but also a judgment: “Healthy?” it incredulously seems to ask. “You lie,” it (silently) answers. No South Carolina-type heckling, just a straightforward and apparently objective assessment.

But of course, there’s the rub. Between my ailments and my healthiness there stands Medicare and all that it makes possible. I have never had to consider whether going to the doctor might wreak havoc with my budget. I have never had to ration my own medical care. No specialist has turned me away, nor has my primary-care physician ever rushed me through. I have been treated respectfully, diligently and effectively every time, and Medicare has enabled all that. Medicare, as it were, enables both my health and my pattern of denial.

The more important reason I’d never thought about all that before is that one slips into the Medicare system quite seamlessly. One morning you wake up and you have a really good and comprehensive medical insurance program, all already paid for, and you’ve done nothing save had a 65th birthday. Now you can change employers without any health insurance hassle, because Medicare is not employment-based; it is yours as a matter of right and as a matter of law. Prior condition? Not relevant. Frequency and complexity of treatment? Not relevant.

And if you can afford to spring for the moderately priced Medicare supplement, offered by private insurance companies, then no deductibles, no co-payments; not relevant. (Sadly, it is necessary to point out that Medicare Part D, the prescription drug benefit, is anything but straightforward and that the cost of prescription drugs can be a serious burden. But there seems to be general agreement that if health care reform survives, Part D will be among its reforms.)

The much-discussed growth in the cost of Medicare services and the consequent unsustainability of Medicare is in no small measure a function of Medicare’s age restriction. It covers beneficiaries who need more frequent and more intensive services. But were Medicare to cover everyone, the per-person cost would be quite dramatically reduced; younger people require less costly medical services than older people. Moreover, the total cost of health care would be dramatically reduced because the administrative costs of Medicare are very substantially less than the administrative costs of private health insurance. And with more care being delivered, health outcomes would improve.

One recent study, for example, shows that with regard to diabetes and cardiovascular disease, the 55-64 age cohort is in worse shape that the 65-plus cohort. That’s not because those conditions improve with age; it’s because the older cohort is on Medicare and is therefore more likely to get better treatment.

People who believe that a public program inevitably means regimentation should talk to their friends and relatives covered by Medicare; they will learn that Medicare fully preserves our right to choose our own doctor.

Shockingly, very many Americans are simply not aware, even now, that Medicare is a government program. Nowhere on the statement I periodically receive informing me of the medical care I’ve used and what Medicare paid for that care is there any indication that Medicare is a government program. Suddenly, inexplicably, our government, though entitled to boast, has turned shy.

President Obama is determined, he says, to be the last American president to wrestle with the health care system. He won’t be. The proposed Obama reforms will help, but they will leave considerable room for improvement by his successors.

One may hope, on this eve of a new year — may yours be sweet and healthy — that Obama’s concluding peroration on social justice and the role of government will oft be repeated and long be remembered. If it is, then I am reasonably confident that we will one day build a health care system in which there is Medicare for all, and I do not believe it will take a civil war (or an extension of our current very uncivil war) to get us there. It will take, as most important social reforms do, sweat, toil and tears.

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