Medicare: The Diagnosis Lottery

Many US citizens assume that Medicare is their right. They assume that the health reimbursement program provided by the United States government on behalf of persons who are over the age of 65, blind, and/or disabled has always been there, and always will be.  But this is not the case.  Medicare and its ugly twin Medicaid did not actually exist until recently; July of 1965. The Medicare-Medicaid Act was part of a number of reforms implemented by President Lyndon Johnson and the Democratic majority. President Johnson stated:

“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles and their aunts. And no longer will this nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.”
Providing for seniors marked a major shift in our societal view of who should carry the cost of providing medical care for senior citizens. The world was different in 1965. I was 15 years old and I remember most of the aged poor of our community went to the county home for the aged and infirm. Most men died before the age of 65, and women before the age of 70. There were few long-term care facilities, because few were needed. Today we have millions of people with long-term care needs. Medicare was built on a 1965 acute care model, designed to provide healthcare for the individual who has a probability of recovering from his or her disease. Medicare is not designed to pay for long-term care. Medicare was designed to ‘care’ about acute medical care; heart disease, gall stones or cancer. Medicare does not ‘care’ about diagnoses such as Parkinson’s Disease, Alzheimer’s, dementia, or long-term mobility problems. If you need long-term care, then you have lost the “diagnosis lottery”. You are lucky if you are given a diagnosis that has a Medicare reimbursement code. However, if you need care in an assisted living facility or a nursing home, your care is not acute but long-term, and Medicare stops ‘caring’ about you. As soon as Medicare stops ‘caring’, you are on your own! You will need to have a substantial long-term care insurance plan, a deep pocket-book, or become impoverished. If you are impoverished as defined by the Medicaid program, then you will meet Medicare’s ugly sister, Medicaid.  And that is a whole other story.