Friday, August 12, 2011
The Alternative to Medicare: Ice Floes
When anthropologists first began studying the Eskimos, so the story goes, they found out that when a member of the tribe became so old and infirm that he or she was a burden to the family, the elder was wrapped up, put on an ice floe, and pushed out to sea to die quietly and away from everyone’s sight.
We don’t do that in America today — not yet, anyway — because we have Medicare and Medicaid to cover health care for our old people. But with the Republicans having voted unsuccessfully to end Medicare and replace it with private insurance vouchers, there’s a large and simple question that has to be asked here:
What happens if Medicare no longer exists to guarantee basic medical care to Americans from the time of retirement to the time of death, regardless of what may happen to them in between?
Whether Congress cuts back the scope of Medicare or passes the buck to private insurers, the reality is that some old and sick people — maybe your parents, your siblings or you — will reach a point where their medical coverage runs out. At that point, I see only three options:
First, the coverage will be picked up by Medicaid or some other government program. This simply transfers the cost from one government agency to another, probably at greater expense owing to duplication of services.
Second, the old person in question goes through every cent he or she has, then the children go through their resources until they file for bankruptcy, and if the old person is still alive at that point, the government takes over in some fashion.
Or, third, we put them on ice floes and say sayonara.
Call me sentimental, but I don’t see Americans embracing the third option. And call me a realist, but I don’t see the second option being viable for very long. Once voters realize their life’s work and savings have been placed in a lottery, where losing means utter ruin, they’ll start voting for people who promise to alleviate the risk. All of which leaves us back at option one or staying the course — in other words, about where we are now.
For all the talk about curbing entitlements and living within our means, the reality will be that medical care for the elderly is what it is. There surely are ways of cutting costs and providing more effective health care, and those ought to be vigorously pursued, but it’s hard to imagine they’re going to cut the overall cost of senior health care by any dramatic amount. Ten percent, I suspect, would be a big win, given the age of the human machinery in question and how long it yet has to run.
A century ago, when the life expectancy of an American male was 47, and when people got sick they generally got well or died in a couple of weeks, we didn’t need Medicare. Today the wealthiest one percent of the population and the healthiest two or three percent may never need government help with health care, but the rest of us will, and it’s only a question of when and how much.
That’s a point most people instinctively grasp, either as a matter of self-interest or as a question of compassion and human dignity. And that’s why, in a wealthy and democratic society, the question will have to be, how do we make it happen?