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OPINION: US Health Care System Leaves Senior Citizens Suffering

by Kate Harveston, published

Seniors in America have it tough. Instead of granting COLA (cost of living adjustments), the Republican-controlled Congress has been hard at work finding ways to slash Social Security and Medicare, the two programs which provide the majority of income and medical coverage to millions of retired Americans.

Just this past June, House Republicans released a proposal that claimed it would balance the budget in nine years. A worthy goal indeed, were it not being proposed that we attain it by making large cuts to entitlement programs like Medicare, which President Trump once vowed not to touch.

Although many of the Trump administration's ideas have not come to fruition throughout the course of the tumultuous presidency, it's worth noting that the proposed budget serves as an expression of this administration's willingness to turn it's back on those it once vowed so vehemently to protect.

And to make matters worse, at a time when many look forward to seeing even their meager living stipend slashed further, many Americans are woefully unprepared to finance the long-term care that would enable them to enjoy the greatest quality of life during their golden years.

Whether it is suddenly discovering that Medicare no longer covers a specialty medication that has given them a new lease on life to the prospect of living out one's final days in an institution instead of in the homes they love, many American seniors face a grim medical future.

There is hope, of course. But that hope will only become a reality when enough Americans insist upon the implementation of a better health care model in our nation. Until then, many of America's seniors will continue to suffer, paying more and more money for a greatly decreased quality of life.

Issues with Medicare

While Medicare has many advantages, the fact remains that it is inadequate when it comes to covering many seniors’ specific health needs.

The first area where many seniors hit trouble is when they go to pick up their prescriptions. Medicare will not pay for prescription drugs that a senior takes at home; they will only cover the cost of prescriptions given in a hospital.

Many seniors do choose to opt into a Medicare Part D plan, which is specifically designed to offer senior coverage. However, these plans need to be carefully evaluated, as they are inconsistent about which medications they will in fact cover. Many times, newer, more expensive drugs like biologics, are not even covered under Part D.

The Number of Seniors Who Need Long-Term Care

What is even more troubling about the gaps in Medicare coverage is the fact that the plan will not pay for any long-term care, only a handful of medically necessary days in the hospital post-surgery. And lack of long-term care coverage can truly make a senior's final days a dream – or a nightmare.

If a patient is indigent, oftentimes they can get Medicaid coverage along with Medicare. But while the availability of Medicaid is useful to some seniors, it doesn't cover all.

Coverage and income limits vary by state, and some states have even introduced work requirements for receiving Medicaid – work requirements that seniors may find impossible. And even if they are granted coverage, they don't get much of a choice in their care.

Those who have the privilege to purchase private long-term care insurance have the choice of staying in their own home, for example, and may have a worker come in only every few days or weekly for help with certain chores.

Those lacking private insurance for in-home visits, however, may face no choice but to be sent to an inpatient care facility. Even seniors who have means are not immune, and some have even fallen victim to cruel state caretaker laws that allow for the seizure of a senior's home and other assets to pay for medical care.

Finding the Right Fix

There are many reasons a universal health care system could benefit seniors that it is difficult to expand upon them all. But first, a quick lesson in how insurance works.

Insurance – be it home insurance, car insurance, or health insurance – can offer better coverage to more people the more members they obtain. Why? Because you spread the risk.

Currently, in our cash-based model of insurance, Americans pay more for their health care, yet have markedly worse outcomes. How is this possible? In our system, the only people who pay into the system are the employers and their employees, limiting the size of the pool. When the pool size is limited, insurers must collect more money from fewer people to pay for care.

They are also more likely to decline care based upon cost factors alone, not the potential impact on the individual patient.

Simply adding in a solid government option would drop costs; however, a true universal system would slash them significantly. Why? Because you can't possibly have a bigger pool to draw from than the entirety of the American populace. Everyone pays in, and everyone benefits from the lower prices.

In addition, in universal systems, governments negotiate with drug manufacturers to cap the amount they can charge for their products. This further slashes costs while giving vulnerable Americans access to the care they need, no matter their age.

One final and often overlooked way a universal system would save costs is that seriously ill individuals would seek medical care far sooner, not waiting until they had coverage or until they reached age 65 or until they ended up in the ER to care for something that could have been easily caught and treated much earlier.

We intentionally create more sick people under our current system, then gripe about the high costs of care. This makes no logical sense, and much of the diseases that plague older adults could be combated earlier with a universal system.

The United States Must Catch up

In almost every culture on the planet, our elders are looked up to for their wisdom, their knowledge of history and their insights into the world. Sadly, in America, we seem to have lost sight of this, as is evidenced by so many elderly Americans returning to work and even living in their cars.

Instituting universal health care in America could, no doubt, help people of all age groups, but it stands to markedly impact seniors the most. It's well past time we as Americans commit to establishing a better healthcare model, as well as making every citizen's end of life journey a happier and healthier celebration of their years.

Photo Credit: Tyler Olson /

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