Saving Medicare and a Nation in the Process: A Psychological Perspective
It’s a common maxim in Evangelical circles that if you want to find a person’s heart, look in their checkbook. The theory being that—no matter what one professes—on that which one cares the most, one spends the most money. This maxim is often delivered by preachers just prior to asking for a contribution to their ministry, but its application has a broader more enduring presence in the minds of many—and not without some merit. When one understands this within its religious context, it is then not so surprising that a budget debate can suddenly revolve around an abortion issue. Add to this a firm fixed belief in Hell and one can understand the intransigence that may accompany a religiously rooted budgetary position. Some may believe that if they do not fight for a particular belief to the end, they will not only lose the battle in this life, but suffer Hell in the next.
This is not to say that all calls to shut down the government over insignificant sums come from those willing to trade comfort in a worldly kingdom for glory in a heavenly one. Surely, some shouts also come from those who have oppositional-defiant personalities, and enjoy taking their place among the radical anarchistic right. Other voices, often softer in tone, work behind the scenes, organizing those with sincere religious concerns and those with rebellious tendencies to work against their own economic self-interest in order to support an earthly system that favors the rich at the expense of the poor and middle income. Watching the rallies can be like watching economic hostages with Stockholm Syndrome. “They’re playin’ you,” President Clinton warned. (Rachel Maddow and her team with the “Rachel Maddow Show” at MSNBC, and Keith Olbermann and his “Countdown” team when he was at MSNBC have provided information about the big money interests behind the rallies, as have others there, and more information regarding this may be available from the MSNBC website.)
Might I draw attention to the fact that in the recent budget battle on the Hill there was no change regarding Federal funding for abortion. Though some may have presented as if they were at Golgotha and not the Capitol, Federal funding for abortion was prohibited before the battle and after. Not a jot in the legislation nor a penny in the budget was changed in that regard. But the issue was able to be used as a bargaining chip in a “good cop: bad cop” scenario such that hundreds of millions of dollars were cut from community health programs and supplemental nutrition programs for women, infants and children, another 45 million from the Substance Abuse and Mental Health Administration, hundreds of millions more from other programs that effect poor and middle income individuals and families, (according to Pat Garafalo in The Wonk Room for thinkprogress.org, on 2011, April 12) while continuing to preserve cuts to income and estate taxes for those with no financial need for themselves or their families for generations to come. “Them that’s got shall get.”
It appears the next budget battle will be about the debt ceiling. Once again, those who for religious reasons may welcome a global financial collapse as a harbinger of the Rapture, may be coalesced with those who enjoy calamity, by those who manipulate monetary policy and people to their own benefit. Hopefully, this time, personal stakes in our nation’s overall economy and global financial markets will preclude the sort of hostage taking and brinksmanship we have seen in the past.
That brings us to the 2012 budget and Medicare. Civilized societies look after their old and their sick. With that understanding, Medicare was signed into law during the Johnson administration in 1965. (You can find a history of Medicare at www.cms.gov.History.) Though merely middle-aged in human terms, Medicare now needs to be put on life-support if we want to remain a civilized society. The ways in which we save Medicare will say a lot about whom we are as individuals and who we want to be as a nation.
As people brainstorm, various ideas are being bandied about. Under the premise that they are, “saving Medicare for future generations,” some propose changing the benefits that those now under the age of 55 years will receive when they turn 65, while the benefits of those now over the age of 55 years will remain as they are.
For example: currently, individuals now over and individuals now under the age of 55, after working 40 quarters of Medicare covered employment, become eligible for premium-free Medicare benefits upon turning 65 years. (Others pay a monthly premium based on a prescribed schedule.) The government pays these benefits directly to doctors and hospitals in a way that is pretty much hassle-free for the patient. Some have suggested changing this such that those currently under the age of 55 will be covered by “privatized” (sometimes called “personalized”) healthcare, receiving a sort of “voucher” (sometimes called “premium support”) to purchase health insurance on the private market after they turn 65 years. Unfortunately, this places a cap on the amount the recipient will receive for healthcare, and puts the elderly ailing patient in the position of having to negotiate with insurance companies for services. Furthermore, insurance companies that sell to this highest-use demographic will run into the same expenses the government now runs into without the same bargaining power the government possesses. Such companies will either have to stop covering seniors, charge seniors more than the voucher provides, or limit the services they provide seniors—otherwise, like Medicare, they too will risk bankruptcy. Though one can see how reducing benefits to those now under the age of 55 might preserve Medicare for those now over 55 years, claiming it saves Medicare for future generations seems disingenuous.
Waste and abuse can be cut from every human system under the sun. But no matter how you slice it, providing healthcare to the aged, a condition from which one does not recover, is going to be expensive. From a strictly monetary perspective, one way to help save Medicare could be to adjust FICA by lifting the cap off taxes paid into Social Security and reducing the percentage of FICA a person pays toward Social Security in order to increase the percentage a person pays into Medicare (which has no cap.) Some may protest that it is not fair for the very wealthy to pay into Social Security and Medicare more than they will likely use. However, that presumes that the wealthy are solely responsible for their wealth. It is unlikely that Bill Gates would have developed Microsoft had he been born on a beach in Somalia to parents that had died of Malaria. His success was contingent on the structure provided by society as a whole, and the people who make up that society should not be forsaken. Fortunately, Gates seems to realize this.
Some other economic solutions that are currently being contemplated, such as the voucher system, may work on a balance sheet, but fail in a society. They violate the grand “we’re all in it together” orientation that nourishes the sense of national cohesiveness from which Medicare arose. Such solutions change us as a people and when we choose such solutions a little of whom we are as individuals dies. We become smaller inside. Maybe it’s time for psychologists to work in conjunction with economists to conceptualize an expanded pie.
None of us knows if we will be the person who dies suddenly of a heart attack at age 60 without reaping a single benefit, or run up millions on life support for a decade or more. Before you decide you would rather die quickly at 60, let me share that I have an uncle in his 90’s who was injured in a boiler explosion and remained unconscious for what seemed like forever as skin was grafted from one part of his body to another. Eventually he healed and now flies around the country visiting his kids and grandkids and drives himself all around town and up and down the coast. He’s outliving his cohorts. You just don’t know.
The current Medicare system is personalized. The person who requires a lot is given a lot. The person who requires a little is given a little. There is nothing personalized about handing everyone the same lump sum of money and telling them to go see what they can get for it on the private market. Privatized (a.k.a. personalized) solutions seem to me to have been conceptualized by people in the prime of their lives who have no concept of what it is like for many, many elderly people who are ill and achy and may have diminished capacity, and poor eyesight and require supplementary oxygen and help getting about and are not at all up to fighting for services with private insurance companies, as they go in and out of the hospital and rehab facilities, overwhelmed by the paperwork these stays generate, deluged by bills as their shaky hand attempts to sign the checks and confused by correspondence mixed with mountains of junk mail when they return home—if they return home. The challenges that accompany the aging process, which eventually turns into the dying process, are not in the least like the experience of a person who has a surgery when they’re forty and goes back to work in a week or two.
Meanwhile, family members may have all they can do to maintain some semblance of their own lives while struggling to protect parents from the medical perils that lurk around every corner of every hospital: whether it be the aide that forgets to turn his or her patients in their beds, the nurse who comes to work sick, the doctor that fails to wash his or her hands between patients…. Trying to keep a vulnerable and aging loved one alive can be like chasing a ball that’s rolling downhill. People who have been through this experience know how important it is to keep everything else as simple as possible. The current Medicare system attempts to do this—somewhat successfully I might add. It’s not what needs to change. How we finance it is.
I have an additional idea for saving Medicare that I would like to share with you for your consideration. One provision that everyone seems to like in the Patient Protection and Affordable Care Act, and which Republicans retain in a competing plan, is the extension of healthcare benefits to offspring up to the age of 26 in their parents’ healthcare plans. That’s good, but what about the emancipated young person perhaps living in a separate state, maybe even married with children, who is concerned about their parents becoming privy to their utilization of reproductive services, psychological services, addiction recovery services… through insurance reporting? Or what about the young person from a difficult or economically disadvantaged background who may not be in touch with his or her parents, or whose parents don’t have health insurance. These young people may not have a lot of money to spend on health insurance. Yet PPACA, which has been signed into law, does not offer anything to these independent young people outside the costly commercial market.
Stanton Peele, Ph.D., J.D., in 7 Tools to Beat Addiction, (2004) discusses the effectiveness of the kind of Brief Intervention (BI) a patient could have in a regular exam with a General Practitioner in the treatment of problems such as alcohol abuse. According to Peele, “The World Health Organization conducted an international evaluation involving ten countries, both developed and developing. BI therapy resulted in substantial reductions in drinking across the wide variety of cultures this study encompassed.” He goes on to state, “Nearly every systemic comparison of two or more treatments for alcohol problems found that the less intensive treatment is at least as successful as the more intensive one.” (p. 56) According to Peele, continuity of contact, demonstrated by regularity and extent of follow-ups, is a powerful component of the BI model, which he states can be successfully applied to any behavioral or addictive problem. (p. 56)
One can only wonder how many alcohol, drug, tobacco, obesity or promiscuity problems might be nipped in the bud if young adults between the ages of 18 and 26 years had a trusted physician trained to conduct on at least a yearly or bi-yearly basis the sort of non-judgmental Brief Intervention that Peele prescribes in his book. Since problems like addiction, obesity and promiscuity often develop over a period of years (becoming very costly as they progress) the healthcare system, family services, and the justice system would ultimately cut substantial costs through early remediation. Yet if affordable healthcare is not provided to young people between the ages of 18 and 26, these problems, so costly in terms of lives and dollars, may take root in more individuals and family systems—becoming increasingly intractable and leaving irreparable physical, psychological, social and even criminal destruction in their wake. And this is not even taking into account the spread of contagious diseases that results from failing to provide healthcare to those in need.
Young people often think themselves impervious to serious illness and injury. That’s why some tend to be reckless and take so many more risks than would a more mature person. They’re not all too cognizant of consequences. This can be in part because their brains and cognitive functions are still developing, and in part because many haven’t been around long enough to experience first or second hand just how much a body can go through over the course of a lifetime. For such a young person, the temptation to forgo health insurance can be high. You may recall that initially President Obama did not want to make obtaining health insurance mandatory. This was the major difference between his proposed plan and Hilary Clinton’s when they were running against each other in the primaries. I consider it likely that he was reflecting on times when he was young and single and chose to go without health insurance in order to save the money.
But the years between 18 and 26 are too crucial a period for the healthcare system to ignore. We do so not only at the peril of the individual, but also at society’s peril. Therefore, I suggest allowing young adults between the ages of 18 and 26 the opportunity to buy into Medicare at a reasonable rate. Although some in this demographic will undoubtedly suffer from catastrophic illnesses, vehicular injuries, pregnancy complications… (and therefore it would behoove all to be fully covered) the overwhelming majority will likely see a doctor once or twice a year, and maybe get a prescription for birth control, or a nicotine patch, or the occasional antibiotic. Unlike elderly Medicare recipients, most young adults would contribute more to Medicare than they would use in their youth, thereby helping to ensure it will be there for them when they are aged.
Participation in Medicare by people between the ages of 18 to 26 would not only help Medicare to be solvent for them when they retire, but likely would help them establish the sort of healthy lifestyle that would reduce their reliance on medical interventions for health maintenance in their later years, and thereby reduce the overall cost of healthcare. Furthermore, with the consent of the participant, outcome data could be collected contributing to longitudinal studies of those who entered Medicare in their youth, comparing them along the way and also when they reenter the system at age 65 (if that remains the standard age of eligibility) with their cohorts who were not in the Medicare system between the ages of 18 to 26. This data could then inform the nation’s future healthcare discussions. It’s a total win situation.
** Nothing connected with this blog or this website should be considered counseling or treatment. **
