War or Medicare?

President Bush’s aggressive pursuit of imperialist wars has pushed even the editors of The New York Times to express a sense of outrage about the resulting destruction of Medicare and the rest of the domestic “safety net.”

An early February Times editorial, “The Axis-of-Inefficiency Budget,” warned that “the budget undermines the security of the nation’s social safety net and the government’s ability to carry out some of its basic responsibilities over the next two decades.”

The editorial continues, saying the budget “jeopardizes the future of Social Security and Medicare, whose trust funds would be siphoned away to underwrite outmoded military projects and tax reductions favoring the rich.”

The very next day the Times ran another editorial, “The Pentagon Spending Spree,” which hammered home the same point. The editorial noted that the President wants to give the Pentagon $378 billion in the next fiscal year, which is an increase over this year of $48 billion or 11.6 percent.

In addition, Bush would like to hand over $2 trillion to the military in the next five years. The editors of the Times responded: “Spending so much on defense … squanders money needed for compelling domestic priorities, like protecting Social Security and Medicare and expanding health coverage for the uninsured.”

Medicare is already a seriously damaged program that increasingly fails to protect the health of the elderly. Medicare provides health insurance coverage to some 40 million mostly elderly people in the United States. The number of those covered by Medicare is projected to double by the year 2030, due primarily to the aging of the population. However, coverage by health insurance is not the same thing as affordable, accessible health care.

Between 1999 and 2001, out-of-pocket expenses for elderly people in ill health in a Medicare health maintenance organization (HMO) rose 62 percent to $3,578. For sick Medicare patients in a traditional Medicare program, their out-of-pocket expenses for drugs and services not covered by Medicare may be as much as twice that of Medicare patient in an HMO. Millions on Medicare are already foregoing needed medical services and prescription drugs because they simply cannot pay for it.

At the same time that Medicare costs have become impossibly high, patient access to health care under Medicare has been evaporating. During the last four years HMOs have dropped 2.2 million Medicare patients, reportedly because Medicare reimbursement rates were too low and are getting lower. In January, for example, Medicare payments were cut 5.4 percent. For many providers, that was the last straw.

According to the American Academy of Family Physicians, 17 percent of family doctors and general practitioners are refusing to take new Medicare patients. Some physicians are going a step further and are refusing to take new patients in their late 50s and early 60s because these potential patients are approaching the age when they will be eligible for Medicare.

Finally, the practices of health care providers who are established in under-served, economically depressed areas, such as inner cities or rural areas, are being hit the hardest. At one time they had the ability to charge higher rates to patients with private insurance than they charged those with Medicare. In this way, they were able to subsidize the low Medicare reimbursements with the higher private insurance reimbursements.

Now, however, the health insurance industry uses reimbursement formulas that consider low Medicare reimbursements as part of the “usual and customary” charges. The result is that the private health insurers pay lower reimbursement rates in communities that have higher proportions of Medicare patients. It is a double whammy.

There are two parts to a permanent and effective solution to this massive failure to provide adequate health care to the elderly. The first is to stop the hemorrhage of the nation’s wealth to feed the Pentagon’s permanent world war. The second is to take all profits out of health care. Support proposals like Congresswoman Barbara Lee’s United States Universal Health Service Act (HR-3080).

The author can be reached at pww@pww.org