November 11, 2013 at 10:20 pm
By Len Lazarick
It was five days into the federal government sort-of-shutdown on a Saturday morning that I went onto the Social Security web site to apply for part A, which covers hospitalization. I knew that some units of the Social Security Administration (SSA) were supposed to be working.
This unit clearly was. I quickly filled in my information, submitted the data and promptly got back an e-mail from www.ssa.gov: “We hope you found our online Benefit Application convenient to use and easy to understand.”
Thank you. I did.
Two weeks later I got the card in the mail. I got other notices independently from the Centers for Medicare and Medicaid, also headquartered in Woodlawn. Independently, I even got a notice from Social Security concerning a private pension I qualified for, in case I hadn’t been contacted by the Washington Post. (I already had been.)
Feds Are Not Incompetent
The point is that the federal government does indeed know how to run some health insurance programs efficiently. Of course, it has had 47 years to master Medicare.
The SSA has always taken great pride in how well it delivers benefits. At least, that was true when I worked for what was then the Bureau of Health Insurance 39 years ago, which later spun off into CMS.
BHI ran Medicare, which even then was a cumbersome, complicated program with a big, bulky bureaucracy. It is even larger and more complicated now, and it is likely going broke in the next decade because we have not found a good way to get control over health care costs. People are living longer because of better public health, improved health care and access to that care — via Medicare.
It is helpful to remember the history of Medicare, a government program run by many of our neighbors, as we contemplate the disaster Obamacare implementation has become, which may or may not be temporary.
Medicare was a controversial program at its start, opposed by doctors. It has grown more complicated as Congress added benefits and coverage. But “don’t touch my Medicare” was the cry from all sides of the political spectrum, as the Patient Protection and Affordable Care Act (ACA, a.k.a. Obamacare) was being passed.
A government program for everyone over 65
Medicare is a universal coverage program run by the government, paid for by taxes on the entire working population. It has the same benefits for everyone and health insurance companies administer the benefits as contractors. (Beneficiaries can buy more enhanced coverage on the open market.)
Medicare is the epitome of what many free-market conservatives are opposing for the rest of the population; Obamacare got so complicated partly because of this opposition, and the lobbying by the insurance industry and health care providers.
The flaws in the ACA were obvious from the get-go. There were too many moving parts, too many goals, too many conflicting rules, too many provisions so open-ended that only bureaucratic regulations could untangle them. Now we’re seeing how difficult other aspects of ACA are to implement.
The political fallout from the mess that Obamacare has become is that it reinforces the notion that the federal government is ill-equipped to manage any health benefits program that serves the entire citizenry.
The experience of Medicare, for all its flaws and the fraud perpetrated on it, says that is not true. It is better, however, to start out with a simpler plan that covers everyone.