"No longer will older
Americans be denied the healing miracle of modern medicine. No
longer will illness crush and destroy the savings they have so
carefully put away over a lifetime so they might enjoy dignity
in their later years. No longer will young families see their
own incomes, and their own hopes, eaten away simply because they
are carrying out their deep moral obligation."
President Lyndon Johnson,
July 30, 1965
You may or may not
remember Lyndon Johnson's words nor followed what has happened
to the fulfillment of that promise. If you don't, Medicare is
the National Health Insurance Program signed into law in 1965.
It covers women (and men) 65 and older, some people with disabilities
under the age of 65 and those with end-stage renal disease. More
than 5 million Americans with disabilities are enrolled in the
program.
Medicare is a program
that has worked well for women until recently. It has been, as
President Johnson predicted, a source of financial as well as
healthcare security for those it covers. Its benefits package,
however, is outdated. Today, there are gaps in the program which
need to be addressed.
The program no longer
covers all of one's health care needs and average out-of-pocket
costs for services not covered by Medicare are rising at an alarming
rate. In 1998, Medicare covered only 53 percent of health care
costs.
The program needs to
be strengthened and modernized. One of the serious gaps in the
Medicare program is the lack of prescription drug coverage. Secondly,
the media and some members of congress lead us to believe that
due to the aging of the baby boomer generation, Medicare will
become bankrupt by 2015. Because the number of Americans over
age 65 will nearly double by 2030, those entitled to Medicare
will also nearly double, putting a large drain on the Medicare
Trust Fund. Another gap in the system is that the payments for
mental healthcare are not on a parity with coverage for physical
healthcare. Lastly, without changes to the current Medicare program
beneficiaries out-of-pocket costs will climb markedly over the
next 25 years.
Let's examine why Medicare
is a woman's issue.
- Women's longer lives, lower incomes in retirement, and chronic
illnesses make protecting Medicare a woman's issue.
- Nearly three out of five older Americans are women. This
proportion rises with age and, according to the U.S. Census
(1996), women comprise 71% of those over age 85.
- Six out of ten people receiving Medicare are women.
- Women live an average of six years longer than men. However,
the gift of longevity is frequently accompanied by chronic
disease and disability.
- Because women are more likely to suffer from chronic health
conditions they require more costly medical care. According
to a new OWL publication, "The State of Older Women in America,"
the average women spends 20% more on prescription drugs then
men.
- The chance that a woman will live at or below the poverty
line increases with age. Data shows that women are almost
twice as likely to live in poverty as their male counterparts.
Even with Medicare benefits, health care costs are a growing
burden for older women. In 1998, older consumers averaged
$2,936 in out-of-pocket health care expenditures, a 33% increase
since 1990. To add to the problem, the annual Part B Medicare
Premium paid by beneficiaries is projected to increase by
more than 80 % by the year 2025.
Prescription drugs
costs are not covered by Medicare. Medicare beneficiaries
must pay out-of- pocket, pay for an expensive Medicare Supplemental
Policy, or join an HMO and hope it will cover some of their prescriptions.
Prescription drug prices are rising by as much as 14 to 18 percent
a year making them even harder to afford.
One in every three
Americans over age 65 is without prescription drug coverage. Many
women without such coverage spend as much as 30% of their after-tax
income for health care. Even those with coverage can face large
out-of-pocket costs. Health care costs place a disproportionate
burden on women who have retirement incomes about half that of
men's. Many women avoid filling their prescriptions because they
can't afford to pay for them. Many have to choose between eating
well, paying their rent or purchasing their medications.
Although some Medicare
supplemental insurance policies pay for medications, these policies
are usually too expensive for many women to purchase. Many of
these policies have large deductibles and co-payments as well
as unrealistically low caps on coverage. Secondly, most insurers
refuse to sell policies that cover prescription drugs to elders
who have prior illnesses which might require the need for medication.
For the 31% of women without prescription drug coverage the problem
will become even larger as the cost of prescription drugs continues
to increase. Women who obtain their health care through managed
care companies (HMO's) may have some pharmaceutical coverage but
every year these companies decrease their coverage or increase
cost sharing. Some no longer cover prescription drugs.
Strengthening and preserving
Medicare for women now and in the future is imperative. Benefits
must be modernized to better reflect today's medical practice.
Prescription drugs have become an important part of our health
care. New drugs can sometimes replace surgery (e.g. heart bypass
surgery) or help prevent brain damage in people who have strokes.
Other drugs help lower cholesterol levels. Prescription drugs
are especially important in managing chronic illnesses such as
arthritis, osteoporosis and hypertension, to name just a few.
In some cases they may postpone institutionalization.
Another key to good
health is health screening. Although Medicare does cover various
screenings, women with low incomes sometimes avoid taking them
because they can't afford the co-payments and deductibles, keeping
them from taking advantage of many preventive health services.
As mentioned above,
Medicare does not pay for mental health care on a parity with
physical health care. Why, we might ask, should mental illness
be treated differently than physical illness? The Surgeon General's
report ( December 1999) noted that nearly 20 percent of Americans
age 55 and older experience mental disorders that are not part
of "normal" aging. According to Dr. Robert Butler, Professor of
Geriatrics at Mount Sinai Medical Center, "Depression is the most
common of all mental illness disorders" "and women are almost
twice as likely to develop depression." Because of limited Medicare
coverage these women are unlikely to get the care they need.
The last U.S. Congress
(106th) debated changes to Medicare but ended its session without
acting on any bills which address these issues. The 107th Congress
is expected to take up Medicare changes again. As those most affected
by changes to this program, women must understand their Medicare
needs and make sure they are met.
Medicare was established
to provide affordable health care for all retirees. For some women
it is turning that commitment into an empty promise. Whether you
agree with these particular changes or not, I urge you to contact
President George W. Bush and your Congressional senators and representative
about protecting and upgrading this program. Since women have
the most at stake they must be included in the Medicare debate.
I would like to
suggest that Medicare revisions should:
- Guarantee the
use of some of the federal surplus to extend the solvency
of the Medicare Trust Fund.
- Control the cost
of pharmaceuticals and other healthcare costs.
- Address the income
shortfall of the Medicare Trust Fund.
- Establish a voluntary,
affordable prescription drug plan covering all Medicare Beneficiaries
and subsidizing coverage for low-income recipients.
- Eliminate the
existing deductibles and co-payments for preventive testing,
such as cancer screenings and bone density testing.
- Equalize coverage
for mental and physical illness. Importantly, any changes
to the Medicare program should have a stop gap measure to
limit out- of-pocket expenses. Long term care assistance also
needs to be addressed but may have to be looked at as a separate
issue.
Only
with these changes will women (and men) be protected as President
Johnson promised when he signed Medicare bill into law. There
is an old saying "If it ain't broke, don't fix it." Medicare"
ain't broke" but does need a little fixing. I urge you to be actively
involved in fixing it. If you do, we will continue to have a program
that will allow us access to affordable, high quality health care.
If you have any questions, please contact me at Milbet@aol.com.
