How Medicare Puts the Elderly on Hold
MARGOLIS, RICHARD J.
States of the Union HOW MEDICARE PUTS THE ELDERLY ON HOLD BY RICHARD J. MARGOUS Neoconservattves and neoliberals keep urging the rest of us to privatize Medicare, chiefly on grounds that...
...The husband spoke up...
...Have you put in a claim to Union Fidelity...
...They suggested she call Blue Cross, the local intermediary, but Mrs...
...It had been accompanied by a mysterious check for $95.58...
...Bratter and Harper made an effort to explain Medicare's complex benefit rules, emphasizing the deductibles and the copayments...
...Her Social Security benefit was $499 a month...
...We can't afford a real house," the wife explained, adding that her husband had worked "in the woods and in the mills all his life," but now he was retired...
...her monthly pension, the reward of 48 years as a garment industry seamstress, came to $88...
...He also must have been given blood tests, because "we are getting these bills from some doctor we never seen...
...She spread the papers on the table for the attorneys to read...
...At first I was skeptical of such tales, so I conducted my own unscientific survey, making it a point to dial a surrogate's number in each city I visited...
...One woman told of an afternoon call she'd made to Medicare's intermediary in Boston...
...When anybody calls up the Castle from here, the instruments in all the subordinate departments ring, or rather they would ring if practically all the departments—I know this for a certainty —didn't leave their receivers off...
...Harper asked...
...It is fashionable nowadays to speak glowingly of the achievements of publicprivate partnerships...
...He calls himself a hematologist...
...She put it to her ear...
...People seeking help filed in all day long...
...In effect, the pitcher becomes his own umpire—and the elderly patient strikes out...
...It takes me about 10 rings to get from the kitchen to the phone...
...In 1985 carriers and intermediaries together grossed $933 million...
...Berlin, "those things you're telling me seem right...
...Most of the questioners revealed only a scant knowledge of how the program functioned...
...I gave him my number because he said he wanted to call me back...
...That's us...
...Much of the trouble arises from medigap's oddly dependent role: It plays caboose to Medicare's little engine that can't...
...Then came lots of static and violin music...
...She thought Medicare had paid for everything...
...One paper in particular caught Harper's attention...
...She wore a short-sleeved gray dress, and her arms were brown and muscular...
...States of the Union HOW MEDICARE PUTS THE ELDERLY ON HOLD BY RICHARD J. MARGOUS Neoconservattves and neoliberals keep urging the rest of us to privatize Medicare, chiefly on grounds that the health care industry can operate the program more efficiently than the government...
...The hematologist's bill was for $953...
...rather, it argues for dismissal, and for a reassertion of control by Federal authorities...
...The violins were still playing...
...I'm 84 years old and I'm getting funny in the head...
...The year before, she told Harper and Bratter, she had gone twice to the hospital—once for "an operation on my innards" and again "because I was full of adhesions from the first operation...
...She had dinner, read a magazine and went to bed...
...Don't think so.' The "extra insurance" that the husband had been roused from bed to buy was a "medigap" policy, so named for its alleged power to fill the holes in Medicare's own sieve-like coverage...
...oneof their jobs was to visit different neighborhoods and suburbs and try to untangle the knots...
...All I get is the Social Security and the union pension...
...It doesn't seem to help to be exceptionally bright or well-educated...
...They keep sending us forms and we keep sending them back...
...Medicare don't say who the checks are for," the wife complained, holding up a packet of papers...
...They had received several checks from Medicare and had passed them along to one doctor or another, never certain they were paying the right amount to the right creditor...
...We were asleep...
...Scanning the EOMBs Mrs...
...Now the hospital was dunning her for $870 that she didn't think she owed...
...Nearly all the beneficiaries I talked with recounted similar experiences...
...They served as circuit-riding answerwomen for beneficiaries caught in the coils of Medicare...
...The elderly were like the villagers who lived in the valley below...
...A recorded message assured her she would be answered "momentarily" and urged her not to hang up...
...To enlarge the metaphor, medigap offers its policyholders end-of-the-train protection mostly for deductibles and co-payments...
...Mary Berlin walked in with a cane and needed help mounting the two steps to the stage...
...In the end, my picture of Medicare came to resemble that of the Castle in Kafka's famous no vel...
...When she woke up the next morning, the first thing she saw was the receiver off the hook...
...Blue Cross and Blue Shield affiliates do most of the work for Medicare, but a number of private insurance companies—Aetna, Equitable and Prudential among others—also hold contracts...
...I don't know what the amount refers to," she wrote...
...While there the second time she suffered a stroke...
...Is that correct...
...Yes," said Mrs...
...In the afternoon there arrived a "snowbird" couple from Michigan's Upper Peninsula, who wintered each year in southern California...
...Congress should restore Medicare to its rightful owners...
...But medigap, a $6 billion a year industry, is itself gap-ridden...
...Well, the next day the phone rang but by the time I got there the party was gone...
...This winter they were renting a two-room trailer in space #22 of a camp on Live Oak Street in Arcadia...
...We' re still paying for them tests...
...A less jaded beneficiary might have attempted to telephone her carrier...
...G ve never put in a claim that says I've paid him anything...
...Sounds right," the husband answered...
...It's supposed to all be in here but I can't make it out...
...Often they seemed unaware of Medicare's multiple imposts—the deductibles and copayments that the program exacted from the beneficiaries...
...Maybe they were in a hurry...
...But when I get home G11 forget them...
...One woman I interviewed, a 68-year-old editor in New York City, had spent her entire career deciphering esoteric copy for technical publishers, yet the EOMBs she received from Empire Blue Cross and Blue Shield defied her understanding...
...The agency that is supposed to run Medicare is known as the Health Care Financing Administration, or HCFA (pronounced "hicva" by those in the know...
...Quite a few, in fact, had the impression that Medicare paid for everything, including prescriptions and eyeglasses, which it does not...
...It's just that last summer he was feeling weak and the doctor put him in the hospital for lots of tests...
...The husband seemed smaller and considerably older, but he looked resplendent in apurple jacket, red-checkered shirt and multi-hued trousers...
...She did most of the talking at first...
...I must have made dozens of such calls, but I never reached anyone...
...But their performance as Medicare's front-line representatives does not argue for privatization...
...I don't know why they sent me a check for $95.58 or one to Dr...
...Corporations send to beneficiaries sheets full of gray, computerized type, each sheet said to contain an explanation of Medicare benefits, or EOMB for short...
...Fellow got me out of bed to sell me the policy...
...In the case of Medicare we have less a partnership than a shabby alliance, whereby government responsibilities are delivered up to market place appetites...
...Harper and Bratter set up shop one morning in the Arcadia Town Hall, using the auditorium stage as their office and a long conference table as their desk...
...The resulting temptation to surrogates is easy to understand but perhaps hard to resist...
...We got no phone so he just come one night and knocks on the door...
...Its payments defray the elderly's total health care expenses by just 5 per cent, compared with Medicare's contribution of 44 per cent...
...However, I've given up trying to figure it out...
...He's 69 and he's hard-of-hearing," she began, "so you'll have to talk loud...
...Wegeta check for $266 from Social Security every month," she said, "and that's all we see...
...many needed the table's full length to accommodate the thick bundles of Medicare documents they had brought with them...
...Worse, many of Medicare's corporate surrogates are also in the medigap business, and this has created a kingsized conflict of interest that nobody likes to talk about...
...Berlin had brought along, the attorneys could not be sure who owed what to whom...
...While the clarity of EOMBs varies from state to state, the average is not high and the overall effect has been one of vast befuddlement among elderly patients...
...Her note to me bespoke the sort of resignation that receipt of an EOMB can easily inspire...
...I believe we paid for that one...
...Berlin said she had done that already: "I had a hard time getting through, but one time 1 did talk to someone up there...
...Our cousin in Michigan helped us fill them out...
...But this woman had tried that before and had never succeeded in talking to anyone: either the line was busy or else she was put "on hold" for so long that she finally gave up...
...Medicare's failure either to speak clearly or to listen attentively—its essential dumbness and deafness—has kept the elderly in a steady state of nervousness...
...Actually, the corporations have been running a big part of Medicare all along— the part that deals directly with elderly beneficiaries...
...It looks like you bought extra insurance from Union Fidelity and Globe," she said, "and you're paying them $46 a month...
...Have they sent you any money...
...She sent me a copy of one...
...To deny a Medicare claim is to withhold a medigap benefit...
...Instead of conducting its own business with the public, HCFA appoints private surrogates to sort out claims and make payments...
...The beneficiaries and the corporations seldom meet, but they do correspond...
...I was able to eavesdrop on a few of their anxious moments when I went to Arcadia, California, with Eileen Harper and Bess Bratter, young lawyers who worked for the nonprofit Medicare Advocacy Project in Los Angeles...
...Jacobson for $23.74...
...The surrogates are called "intermediaries" or "carriers," depending on whether they deal with hospital or doctors' claims...
...Yet from the beneficiary's angle of vision HCFA is neither visible nor accountable...
...He's not what you'd call sick...
...The cap he carried matched his jacket and bore a John Deere imprint...
...The left ear is his good one...
...I don't have the money," she said...
...Can't say for certain...
...I'll just deposit their check, send an equivalent amount to the doctor, and forget it...
...There's no fixed connection with the Castle," explains the village Mayor, "no central exchange that transmits our calls farther...
...Although they sometimes say otherwise, the surrogates seem well-paid for their services...
...One series of tests, hesaid, "was when the doctor put me under these machines...
...The woman listened to this for what seemed like a long time, after which she placed the receiver on her night-table and went about her business...
Vol. 70 • June 1987 • No. 8
