Medicare Reform Would Benefit Families and Federal Budget

Wouldn't it be cheaper for both families and the government if day-to-day home care were covered?


Just since Labor Day, I've joined that group of Americans who are caring for a sick, elderly parent. My mother has been in three hospitals, a rehabilitation center, and a nursing home all in the last six weeks, after surviving open heart surgery for a leaky valve. Until now, she was a relatively healthy 72-year-old. Her recovery has been slow and difficult, and she needs round-the-clock care in her apartment as my siblings and I try to help her regain her strength. This has been the worst health crisis she's ever had.

They tell us if Mom can pull through this, she'll probably live another 20 years. Right now, she's on an alarming number of medications, 19 at last count. Like many older Americans, she takes beta blockers and cholesterol-lowering drugs, which have drastically reduced the rate of heart attacks these days. She's on bronchodilators for her asthma, which have helped so many manage lung ailments that used to be fatal. She's on blood thinners to reduce the risk of strokes, the majority of which are now preventable. Like my mother, 110 million Americans have at least one chronic illness; 60 million have at least two, and 20 million have five. And I'll bet that like my mother, many of those 110 million have quite a few years left in them—thanks to miracle drugs and advanced technologies. And like my mother, most of them are on Medicare.

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Medicare was created in 1965 as an addition to the legislation that created Social Security, because at the time it was difficult for people over 65 to get coverage from private health insurance. The big concern for most senior citizens was the high cost of a hospital stay, and so having the government cover healthcare for those 65 and older was extremely popular.

After President Lyndon Johnson signed Medicare into law on a hot July day in Washington, he handed the first two Medicare beneficiary cards to former President Harry Truman and his wife Bess, in honor of Truman's hard work on the healthcare issue. Then Johnson said, "No longer will illness crush and destroy the savings that [Americans] have so carefully put away over a lifetime so that they might enjoy dignity in their later years."

Harry Truman, born in 1884, was 81 at the time. He died in a hospital some years later, at the age of 88, from a combination of heart, lung, and kidney failure, and the hospital room where he died cost $59.50 a day, according to his obituary in the New York Times. His 22-day stay was paid for by Medicare and private insurance, sparing his family the cost. I can't imagine what that hospital stay would run these days.

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When Medicare was established, the life expectancy for the average American man was 67; now it is 76. Medicare was never intended for long-term care, because in 1965 the average American didn't live much past the age of eligibility. That's because the miracle drugs, testing devices, pacemakers, and diagnostic scans that keep so many alive today didn't exist back in 1965, much less any notions about healthy diets or regular exercise. Medicare was a way to help families pay for acute emergencies that required a hospital stay, like the one the Truman family faced. That's still what it does.

Here's what it doesn't do: cover much of the expense of the chronic illnesses that so many Americans deal with these days. Not only do these include heart and lung ailments, but diabetes and the newest kid on the block, Alzheimer's disease. The Medicare system pays for hospital stays, but not independent living facilities or, generally, home health aides to help one navigate daily life outside. Nursing home stays are covered only if you've spent three days sick in a hospital first. No wonder so many middle-class families are getting wiped out financially while taking care of their parents. Acute care is covered, chronic care is not. Dependency is encouraged, independence is penalized.