• When the truth slips free

    Every once in a while, when people let their guard down, the truth slips free.  Most of the time they are able to cage it, to hold it prisoner.  But not always.

    Kaiser Health News had a good piece up on Friday about the waiting period for people with full disabilities who qualify for Medicare:

    Under federal rules, most people with disabilities who are younger than 65 aren’t eligible for Medicare until more than two years after they qualify for Social Security disability income. A coalition of more than 65 organizations led by the Medicare Rights Center has been pushing Congress to do away with the waiting period. But the effort has stalled because of the high cost to the federal government – an estimated $113 billion over 10 years, according to the Congressional Budget Office. That takes into account a $32 billion reduction in federal spending on Medicaid, the state-federal program for the poor and the disabled. Many people with disabilities go on Medicaid while they wait to become eligible for Medicare.

    Some will tell you that the two year waiting period is to make sure people are really disabled before they are let into Medicare.  It’s to catch the people who are otherwise committing fraud.  Unfortunately, these hypothetical freeloaders aren’t nearly as common as real life situations like these:

    After Russ Hillard developed Huntington’s disease, a devastating neurological disorder, he lost his $35,000-a-year job as a welder and, with it, his health insurance.

    His wife, who was working part time, had insurance, but it didn’t come close to covering the medical bills for the incurable disease, which causes uncontrolled movements, emotional problems and the loss of cognitive abilities. Eventually, Hillard qualified for Medicare, which covers disabled people under 65 after a two-year waiting period. But the coverage didn’t kick in until after the family went deeply into debt and had to take out a $20,000 loan on their home in Methuen, N.H. The delay was a “cocktail for disaster,” says Hillard’s daughter, Laura Quinn, who is 29.

    So why don’t we do away with this waiting period?  Why don’t we let people who are disabled get the care they need right now?  We’re not talking about the worried well here.  We’re talking about people with permanent life-altering disabilies.

    KHN asked Joseph Antos, who is a health care policy scholar at the American Enterprise Institute.  Here’s what he said:

    “Across the board eliminating the two years just doesn’t seem practical… This really is a money issue.”

    I give Mr. Antos credit.  No hemming and hawing.  He just said it.  It’s the money.

    Remember that the next time someone tries to scare you away from universal health care systems in other countries with specters of rationing.  They will tell you that in this country, we don’t ration.  They will tell you that in this country no one waits for care care because they are too old or because they are deemed not worth it.  But they are wrong.  Mr. Antos just told you so.

    In this country we make people wait for care all the time.  We have waiting lists because “it’s a money issue”.  We ration by ability to pay.

    And that may be the most indefensible kind of rationing of all.

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    • Wouldn’t some quickly point out that your example is a clear cut example of Government rationing health care? Like they’ve claimed all along…keep the Gov’t out of people’s health care for fears of exactly this?

      I think your example is about to be used against your general position…Perhaps you should address this?

    • Bill,

      I’m not concerned about that at all. I’m not a partisan, nor do I believe “all government is good” as some of you seem to think. I will call out government for things I think are bad just as I will call out the private sector.

      But if you think this isn’t happening in private insurance as well, I’ve got a bridge to sell you. Our whole system rations by ability to pay. We hear about it more from government because that information is public. Private insurance gets to keep its books closed more. That doesn’t make it better.

    • Aaron- You know that’s not my position on HC. How long have I been following you? C’mon…My point was that you seemed to set yourself for a cheap shot from those who believe the free market is the best solution for our health care problems.

      Its still stunning to me that many of a particular mind set feel that the ACA was purely Government intruding into our lives, when in reality its probably a moderate bit of intrusion and a massive payday for private insurance and Big Pharma.

    • Bill,

      First time I’ve seen “Bill in Dayton”. And I was reacting to a lot of email. Worth a post.

    • You seem to imply that in other countries perhaps money is not the issue? “We ration by ability to pay”. This is no different in other countries, private or government sponsored health care. And delays that occur in care and treatment in government sponsored care are inevitably down to money. This is an unfortunate truth everywhere, not just the US.

    • Rebecca,

      Yes, money is always an issue. But when you decide to ration by age, you are saying that you think money is better spent on the young. When you ration against those who are terminally ill, you are saying that money is better spent on healthier people where it might make a difference.

      I’m not defending those positions, but at least there is a logical argument behind them.

      When you ration by money alone, you make no effort to determine if you’re doing it wisely or foolishly. When you tell the permanently disabled to wait two years just because “it’s too much money”, that’s a weak argument.

      It’s so hard to talk about this without making it sound like a moral judgment, which I really don’t want to do. But too many people stop here. They say it’s too much money. Too much compared to what?

      I don’t think that’s the best way to run a health care system.

    • what cuts or increases in taxes would you propose to cover the disabled? It’s easy to hammer one side without giving your prescrtiption so that one can make an informed decision on the costs and benefits

    • Erik,

      I’m not a politician. I would be MORE than happy to cut waste out of Medicare or the prescription drug program. I’d even raise taxes. Hell, letting the Bush tax cuts on the very wealthy expire would more than pay for this.

      How about this: I propose that from now on when a drug wants approval from the FDA, it needs to prove that it is not only better than placebo, it must prove itself superior to current therapy; otherwise, it can’t get exclusivity. How about we make it so the prescription drug program pays only for generics when they are available and the name brand drug isn’t proven superior. How about we no longer pay for me-too drugs? Any of those would likely more than cover the costs of providing care for the permanently disabled without the two year waiting period.