My spouse becomes eligible for Medicare this year so we've been paying attention. We've had to pay attention to insurance for a number of years as I have a genetic condition that causes a chronic disease. It has been under control for me since 1987 but that is irrelevant. On the open market, I was not insurable at any price. I had medical insurance available through our denomination but it was nearly $4K a month and was no longer affordable by my employer or my family. The ACA saved us... me... literally. (This is not about the ACA and I see serious problems there which I have addressed before a number of times). So paying attention to Medicare didn't feel unusual.
I noticed quickly that while some folk have complaints, few of them are the elderly folk on Medicare... and the complaints that population does have are no different than the general population dealing with any insurance company - costs, restricted access, complexity... I do hear younger folk who say that Medicare is proof that the government can't run a healthcare insurance system. They say it is nearly bankrupt and doesn't work anyway.
So, with those thoughts in mind, we went to a two hour seminar yesterday to get a basic understanding of Medicare presented by a non-profit that advocates for the elderly and helps them with issues around Medicare. I came away with some impressions... Medicare is too complicated. Negotiating part D and supplemental plans is difficult and clearly a lot to ask of some seniors. $300-400 a month for a newly retired person in California for part B, a reasonable part D, and an F class supplemental plan is a lot of money, especially for someone on a fixed income... and it will only go up. The "free market" alternative - Medicare Advantage - may work somewhere, but it requires a population density that we don't have where we live so the choices here are thinning rapidly (there are only three plans available in Santa Barbara county now and only one that covers the entire county) as the companies can't make the level of profits they desire. Even where it might work, it still has the significant limitations commonly associated with HMO's. The donut hole is scary for someone with a chronic condition but the way that the ACA is filling in the hole is at least a little heartening.
It seems that making Medicare a single payer system, eliminating the need for Part D and supplemental plans would go a long way to simplifying the system. Both pieces feel to me like compromises made with the private sector so they can continue to get some portion of income from this group of high consumers of medical care. We are worried about the realities of paying that much money a month for insurance after having employer provided insurance our entire lives but I am more than glad to know that I will at least have coverage. I anticipate that at least one of my meds (which is stupidly expensive) may not be covered but that will be what it is. I have 3+ more years until I become eligible and another year beyond that until retirement so some of those worries are meaningless. A Republican president and congress could make the entire program go away. A Democratic one of each might strengthen the programs... time will tell there.
Of course there are the big public policy questions that continue... Is healthcare a right that everyone should be provided regardless of their economic condition? For me as a theologian, what are the theological implications of that question? How do we control costs while at the same time insuring good care? And for me a central question, what role should the profit motive have in healthcare? (I would argue none)