Not unlike both the 111th Congress that passed the Affordable Care Act and the 115th Congress that recently amended it with the new federal tax bill, we are often in the dark about our own health care and health insurance systems.
Whether you think this is a matter of being in good company or a national embarrassment, I can think of no problem greater among our citizenry than health insurance illiteracy in general, and about Medicare and Medicaid, in particular.
Many of us, for example, learn about the limits of our own individual health care coverage at the clinic check-in window or in the pharmacy check-out line. These are the wrong venues at which to ask questions and consider the implications of plan and coverage design.
Polling data reveals that the majority of Americans do not understand that Medicare offers only a limited long-term care benefit, for example. As citizens, we generalize about health care and health insurance in ways that may be profoundly inaccurate as well as personally disadvantageous, though they seem intuitive to us. When we do this, we bargain in the dark over both our own future and that of our fellow Americans.
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Older people are at a particular disadvantage in this “understanding your health insurance” game because older Medicare beneficiaries are often retired, remote from former employers’ human resource departments and they are often reluctant to burden adult children with the task of attempting to decipher coverage.
Government-funded health insurance beneficiaries are required to choose, choose and choose again in a system that requires them to make selections at every turn, even if they must be made in the near dark.
Traditional Medicare or Medicare Advantage? Medicare Part D coverage and, if so, what plan? Medicare Supplemental Insurance and, if so, at what level of coverage and cost?
We have made Medicare and Medicaid so complex that the quality of our own understanding of the individual implications of enrollment, and also the debate over various reform proposals are degraded. Is it a defect or a feature of these programs that ordinary intelligent citizens of good will have difficulty understanding both their own government-funded health insurance and the proposals to reform both Medicare and Medicaid throughout our society?
The UMKC Consortium for Aging in Community is hosting two public events on Medicare and Medicaid in March, in an effort to create a bridge between health care experts and the community’s need for information. It is our hope this series will enable all of us to be better health care beneficiaries, both more aware and more concerned about why the system is structured the way it is.
Ordinary intelligent people ought not be excluded from the current debates over the future of Medicare and Medicaid. Indeed, those very people ought to drive the debate, as they are the ones with the most at stake in any reform proposal.
Ann Marie Marciarille is a professor of law at the University of Missouri-Kansas City.