From Uninsured to Medicare Beneficiary-Who Suffers and Who Pays?

Covering more people would necessitate a more coherent delivery system. Dr. Narrett commented that Medicare’s current reimbursement environment makes it nearly impossible to manage costs and quality because Medicare finances, rather than organizes, care. David Knowlton, MA, New Jersey’s former deputy health commissioner and currently the president of HealthWell Foundation, a charity that contributes more than $7 million each month to help uninsured and underinsured patients pay for prescription drugs, puts the issue starkly: Head and neck cancer is a priority for us, as are rheumatoid arthritis and other cancers. If you have a serious chronic condition you need your meds. For the field of ENT, ultimately that may mean that moms who believe their kids’ ears needs drains would pay for it, as should the 90% of parents who insist on prescriptions for antibiotics for viral infections. Mr. Knowlton would prefer payers to use copays and deductibles rationally, with lower rather than higher out-of-pocket expenses to keep chronic and life-threatening conditions in check. (For information on referring patients, go to www.healthwellfoundation.org .)

Despite the unsustainable cost of Medicare insuring 50-to-64-year-olds, the consequences of leaving them unprotected weigh heavily on physicians. Dr. Har-El, who has seen his share of patients who are smokers, who have been hoarse for five months and cannot swallow or breathe properly, but who didn’t get diagnosed because they didn’t have health insurance, said that medicine has failed the uninsured. Our problem is the people who aren’t poor enough for Medicaid, don’t have a regular workplace, own their own business, and have to choose between health care and feeding their families. For him, when previously uninsured patients get their Medicare cards it’s like a poor person getting a windfall check and going on a shopping spree. Balancing the ballooning US health care bill against providing care for all who need it remains a tough challenge.

AARP: Filling the Gap?

AARP started selling insurance to retirees eight years before Medicare existed. Until the establishment of Medicare, retirees or their employers funded their health care.

AARP is again taking the lead on health insurance. On January 1, 2008, AARP-in partnership with UnitedHealth Group and Aetna-will offer health plans for those ages 50 through 64, the underinsured, and seven million uninsured. In addition to covering medical care, the plan will offer wellness, prevention, and treatment of depression programs. AARP plans to track plan outcomes and to reward or penalize the carrier based on performance.