Occam's Razor

In my last post, I noted that a majority of Americans favor a single-payer health care plan over the current system. Some people though effectively do have socialized medicine already here in the United States: much of the U.S. military, veterans, the poor that can get on Medicaid and 65+ Americans like me, i.e. seniors.

I’ve been on Medicare for a year now. To be fair, it’s not quite socialized medicine or a single-payer health plan. Medicare Part A (hospital insurance) is sort of free in that I don’t pay a premium for it, but there may be $400/day copays if your hospitalization lasts more than sixty days. I did pay for it through payroll taxes during my earning years, I just don’t pay any premiums now for it. You might need to pay a premium if you paid less than ten years of these taxes.

There is a potential $1600 Medicare Part A annual deductible to meet. I was hospitalized twice last year. At least so far, I haven’t gotten a bill for either hospitalization. After any deductible though, it’s free.

Medicare Part B (out-of-hospital insurance) is not free. It requires a monthly payment of $164.90/month. It covers outpatient visits mostly, including the radiation I am getting for my brain cancer. There is a $226 annual deductible. As best I can tell, I never got a bill for that either. There’s one big exception to Part B: it doesn’t cover prescription drugs.

For that, many people in Medicare sign up for a Part D plan. I don’t have a Part D plan because my wife is not yet of Medicare age. I need to keep her insured, so I maintain my old federal employee health plan. So she gets to pay all the usual copays and deductibles. Since it’s a joint plan though I can use it for prescription drug benefits. Currently we pay $437.71/month for this insurance.

For me, Medicare is the primary insurance. But because I still have a federal plan, it tends to pick up all the copays, coinsurance costs and deductibles. That’s much cheaper for my federal plan than paying Medicare’s costs. Medicare gets steep discounts. While a provider doesn’t have to accept Medicare, almost all of them do because in most cases they’d lose a ton of income if they didn’t.

The result of all this is I pay little in the way of medical bills, despite eight days in the hospital in 2022. Mostly when I get a bill, it’s in error. The provider doesn’t know (or conveniently forgot) that I’m on Medicare now. So I often have to tell them, and they bill Medicare and my federal health plan instead.

What I do pay for are prescription drugs. I still get the discounts provided by my federal health plan, which generally means no more than $15 for a prescription. But there are exceptions: specialty drugs. The anti-cancer drug I take (Temodar) for my current radiations had to go through a CVS specialty pharmacy. That cost in $900 altogether in copays for a 42-day supply. The 145 milligrams needed daily were split into three bottles of 120mg, 20mg and 5 mg pills. Naturally, CVS considered each a separate prescription so they could make more money, otherwise it would be $300. I still feel ripped off about this, but there’s nothing I can do. But considering what I would be paying for all these bills had I not been on Medicare when all this happened, it all feels like a bargain.

It’s horrible to come down with a cancer like I did. But there were a few fortunate accidents from all of this. First, I just happened to get treated by one of the best institutes in the country working on brain cancers: Massachusetts General Hospital, run by the Harvard Medical School. Second, at least it happened after I turned 65. While my survival odds would probably be increased had it been detected earlier, being on Medicare saved me probably tens to hundreds of thousands of dollars. I’ve seen some of the list prices Massachusetts General Hospital wanted for my stay there, and it amounted to over $100,000.

But also, it’s hugely less hassle than it used to be. It’s practically a full time job just keeping up on appointments, drug therapy and consulting with various physicians. Dealing with deductibles, coinsurance costs, and copays from so many different sources would make my care exponentially more challenging and stressful too. At least I know that my costs will be reasonable and the Medicare and my federal plan pay for at least 95% of it.

No wonder so many Americans are enthusiastic about a Medicare for All health plan. Medicare is hardly perfect, but as someone who has stumbled through our needlessly confusing private health insurance system all those other years, Medicare’s relative lack of hassles and peace of mind is a godsend.

If Medicare for All works at least as well as Medicare, most Americans would be thrilled to death. Only crazy people would want to go back.