I’ve finally found the time to read through last week’s Health Wonk Review, hosted at The New Health Dialogue. My favorite post in this edition comes from Maggie Mahar who delivers a particularly thoughtful article about the possibility of more cost-sharing with Medicare beneficiaries. As I read through Maggie’s article, I kept finding myself saying “but what about… xyz?” And then two paragraphs further down, I’d get to the part where she addressed my thoughts – and soundly defended her position that we should not be increasing the financial burden that healthcare already presents to seniors.
At first glance, the idea of charging higher Medicare premiums for “upper-income” seniors is probably appealing to most of us. But Maggie points out that the current proposal would call for the “wealthiest” 25% of Medicare beneficiaries to pay additional premiums. And a single senior earning $33,000/year is in the top 20% of all seniors as far as income goes. $33,000 does not exactly mean that one is dining on caviar and Cristal. While it’s true that there are seniors who are quite well off, Maggie makes the point that increasing their Medicare premiums might drive some of them out of the system all together. I don’t know what the likelihood of this is (especially if the price increase were capped at 15%), but it’s definitely something to consider.
Politicians who have advocated increasing Medicare cost-sharing (including a penalty on seniors who opt to purchase the most benefit-rich Medigap policies) tend to say that they want to encourage seniors to be more efficient “consumers” when it comes to healthcare. They want seniors to avoid “unnecessary” care (and incidentally, they want the rest of us to be good healthcare consumers too – avoiding non-essential care and shopping around for the best value. Unfortunately, that’s easier said than done). But Maggie very rightly points out that healthcare is not demand-driven. In most cases, the patient doesn’t know what needs to be done. The healthcare providers make recommendations, order tests, perform surgeries… and in general, the patient does what the doctor recommends. And really, isn’t that the way it probably ought to be? Most of us have not been to medical school. When something seems amiss with our health, we need to feel that we can rely on our doctors to tell us the best course of action. Increased cost-sharing tends to increase the number of people who skip healthcare in general – including very necessary care like keeping diabetes and blood pressure under control.
Go read Maggie’s article if you’re curious about more cost-sharing in Medicare. It’s definitely worth your time.