Medicare has become a punching bag for politicians. In fact, it was controversial right at the start. But for many decades now, it has been one of the most popular programs for senior citizens, allowing them access to health care they otherwise couldn’t afford. What will happen to Medicare as the federal budget gets battered?
Dr. Jonathan Oberlander has written the book on Medicare as well as a perspective in the influential New England Journal of Medicine.
Guest: Jonathan Oberlander, PhD, is professor of Social Medicine and Health Policy & Management at the University of North Carolina at Chapel Hill. He holds an adjunct appointment in the department of Political Science. His book is The Political Life of Medicare.
The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for six weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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  1. Gail R.

    This was an absolutely terrific show! I learned so much about Medicare works, as well as about how our very fragmented and inefficient medical system functions. The information and perspectives regarding the Affordable Health Care Act were particularly interesting. Dr. Jonathan Oberlander is able to explain things in a crystal clear way.

  2. Dr. Don Selvidge

    What bums me out about Medicare is that it will pay for prescription drugs to the hearts desire, but it does not pay a penny to help a senior citizen get on a regular dose of fish oil that makes many expensive drugs unnecessary…….. I declined Medicare Part II and took an insurance plan that pays for natural treatment for illnesses. Saves Medicare huge amounts of money and I live a healthier life without drugs. I wish more senior considered this option. Nature first…. drugs and surgery when necessary.

  3. cpmt

    TO JEAN S. Are you sure is not covered, I would call them if I were you. They make mistakes sometimes.

  4. Jean S.

    I am a new listener to this program, I found this morning’s show, i.e. Medicare, very interesting. Admittedly Medicare is confusing to most of us.
    Recently my husband had a cancerous lesion removed from his liver – the surgery was NOT covered by Medicare – am puzzled by this. Should I investigate this? I have to assume the hospital is bearing the cost – as we did not get a bill for same.
    Have ordered Dr. Oberlander’s book.
    Thank you,

  5. cpmt

    To Linda- Can’t you get COBRA?

  6. MJW

    Why are we getting lost in all these intricacies? Have we lost sight of the fact that good healthcare is in the interests of all, and that its costs will be borne by us all, regardless of whether the government, insurance companies, or individuals actually expend the money?

  7. Linda

    In 7 months I will turn 65 and be Medicare eligible. I can’t wait ! Since my employer sponsored health insurance ends November 1, I have been researching coverage to cover this 7 month gap. I found that United Health Care will provide short term coverage but it stops 2 months prior to turning 65 years. (this is true for all people seeking such coverage – why, I could not ascertain from the representative). So that doesn’t work… 2 months with no insurance is too risky to me. The representative suggested a major medical plan – but I had to quickly apply for and hopefully be granted coverage because it could not be issued to anyone after 6 months prior to my 65th birthday. Such frivolous rules and policies create a feeling of helplessness and confusion.

  8. pd

    Does insurance agent get a kick back for signing one up for the Advantage plan?

  9. cpmt

    Oh my God. I am more confused than before. I will be turning soon 65 and now I don’t know what to do or choose. With whom may I contact to get information and explanations in my state, PA?

  10. Phil

    Dave, in your diatribe against the Medicare positions you said,, among other things, “…something a majority of Americans think should be repealed.” I have heard this statement from others who, like you, do not agree with the President in many things, including his support of Medicare. But I have never seen any objective data to support your contention that this is not approved of by the majority of Americans.
    Do you have some objective, factual information to support your statement, and if so, would you please share it with us?

  11. Dan K

    I teach a class on Medical Insurance and spend a fair amount of time discussing the ins and outs of Medicare. Although I only heard part of Dr. Oberlander’s presentation I found most of what he said correct. Whether you believe in the concept of Medicare politically is another story. But most of the rest of the developed world consider universal health insurance a moral right; for some reason we do not. Medicare is just a first step toward universal insurance.
    Since American doctors are not controlled by the federal government they are free to accept or not accept patients insured by any plan, just like they can refuse to treat any patient as long as it is not based on racial discrimination. So the person in NM is up one of NM’s dry creeks. They may have a restraint of trade case but it would be very hard to prove.

  12. Dave

    Dear Joe and Terry,
    I wake up every Saturday morning to your show on the local WPR affiliate. Being a science-based individual, I always appreciate the commentary, open mind to new things and cheery attitude on life you both have. Let’s just say I’ve been a fan of your show for years.
    But I was very disappointed this morning to hear you bring on a guest that was so one sided on President Obama’s health care plan. I could email arguments pro and con, but I think everyone’s tired of that song and dance, and your show is not the format for such arguments.
    I just got up, made coffee and skipped the rest of your show. It’s my view you abuse your format on public airwaves by doing such activities. There was a “pro,” but no “con” to your discussion. It was a cheering session for something a majority of Americans think should be repealed.
    Please stick to your knitting and don’t abuse your position on public airwaves.
    Dear Dave,
    Thanks for taking the time to communicate about our most recent radio show (#829) about Medicare []. We’re a bit puzzled. Are you asserting that the majority of Americans believe Medicare should be repealed? Do you have any data to support that belief? What would replace it?
    Since Medicare was the topic of the show (not health care reform), we don’t quite understand your objection. Are you suggesting that we should have had someone arguing against Medicare? Dr. Oberlander is clearly one of the country’s most knowledgeable experts in the Medicare arena. Part D, the prescription drug componenet of Medicare, seemed to us an important part of our conversation and very much a People’s Pharmacy topic of concern to our listeners. There is a lot of confusion and Dr. Oberlander seemed like the most appropriate guest for a topic that is very much in the news.
    We’re sorry you were so bummed out.

  13. Carole H.

    Dr. Are you restricted to one diagnosis per consultation? Your lack of patience will become lack of patients! I am glad my primary care doctor has time for me.

  14. Helen M

    My Medicare Advantage insurance, owned by doctors, is geared to both containing costs while providing the “complex” services needed by many aged 65+.
    I will mention briefly the complicity of government and the large food suppliers, such as Monsanto, that has brought about a generation that will live long, but not well. The next generation is projected to live shorter lives than this generation. A way of containing the costs of caring for ill seniors. Point made.
    Caremore, my insurance, provides many services in-house at their wellness centers. Every six weeks I see either a toe nail tech, who trims my nails, or my podiatrist who also trims my nails while inspecting my diabetic feet. For people who cannot manage their diabetes on their own, the center provides the service. If some of the questions I have heard are a reflection of the majority of those patients, this service is sorely needed. I am currently in therapy with an in-house social worker. They sponsor Tai Chi twice a week in other venues, because a larger space is needed. Part of the wellness center is turned over to a fitness facility. There are social events and seminars; all geared to keeping the insured as healthy as possible; the main thrust is spend a little now, save a lot later. I love my coverage, wish that all had access to this kind of care.
    Because I am a diabetic I get specific coverage for a higher premium. Yet, somehow, lower than the premium I paid to a United Healthcare owned Medicare Plus insurance provider.
    This will enable me to live out my life without being an undue burden on the government, and thereby the people. Families have traditionally cared for their own and assumed those costs. This way the medical costs are spread out, and the family’s burden reduced. The company even offers a low cost coverage to any on Medicare, $19 here, no cost elsewhere. Their social services dept will assist a patient in getting help with their premiums.
    Aside from doctors who fear socialized medicine because they see their incomes going down the tubes, what is not to like?

  15. Cathryn, M.D.

    I am a primary care physician running as lean a practice as I can. Yet I cannot afford to continue to care for Medicare patients. They are complex in their needs and require more time than I can afford to spend with them. I am not allowed to charge them extra for that time.
    I believe the problem is that our system is biased toward procedures and specialists. Will there BE primary care physicians for patients as they age into Medicare, or have we decided as a society to let that job fall to mid level providers?

  16. Sandy

    Am I correct in my understanding that the “taxes” that are taken from payroll to cover Medicare is limited each year to only the first $90,000 or so dollars of salary like Social Security? Why don’t we eliminate the “cap” and tax the people making much more each year?

  17. J. W.

    Thank you for the show about Medicare with Dr. Overlander. Terry asked him
    the great question: What is Medicare? I could not write down his answer that
    quickly. Could you please tell the answer again in response to this email?

  18. K. A.

    I caught the tail end of your program that included a discussion of health care costs with Dr. Overlander. I know from having lived in Germany and Switzerland for a few years that each country has a schedule of standard fees for all medical procedures that all physicians have to accept and apply nationwide. Each country also has universal and mandatory health insurance. In Germany, its the GOÄ ; in Switzerland its the TARMED. Is there an equivalent to this in the U.S.?

  19. RJM

    Today’s show regarding Medicare was very informative but did not address what I will add as my negative experiences under Medicare Advantage. In 2005 I turned 65. Immediately researched Advantage Plans available in Carlsbad, NM.. and enrolled in a NM larger PPO network plan offered in NM…and was induced by the number of in-network providers listed in the plan for Carlsbad.
    After several months of paying the extra premium for that Advantage plan I attempted to find a primary care physician as required by plan… obtain a wellness physical and since it was flu season, a flu shot. No physician in the PPO Advantage network in Carlsbad would allow me to become a patient. One physician even lectured me as he asked me to leave his office on the evils of “socialized medicine” and that is why he would not accept me as a patient even though I was enrolled in a premium-paid PPO network.
    I contacted the plan and was told that was permissible as none of their plan doctors were obligated to accept any insured PPO patient. I contacted the CMS and was told they could only dis-enroll me and allow me to switch to another carrier plan… the premiums already paid would not be reimbursed.
    I contacted the State of NM Insurance Commission.. and was told they have no jurisdiction over a Medicare Advantage provider as it was under Federal jurisdiction. Thus, I was living in Carlsbad, a paid insurance plan subscriber and could not even get a flu shot.
    I moved to another town.. 260 miles away where doctors were still accepting Medicare patients in 2006. Three years later (beginning in 2008) that changed as doctors there stopped accepting Medicare patients. I contacted the AMA to research if others had experienced what happened happened to me and they provided data…a study of NM doctors showed that over 48% of physicians in NM were on record as refusing new Medicare patients no matter they were enrolled in an Advantage plan incurring an extra premium.
    That trend most likely will continue and spread across the nation. My angst comes from there is no avenue where an Advantage enrollee can petition for help in recovering lost premiums…save legal tort claims… my Congressional Representative would not assist as he said he was opposed also to socialized medicine vis a vis Medicare.
    In summary, we have no advocates as politicians and NGO’s.. ***.org’s… publish statistics, but no one accepts the real issues in the Medicare crisis: No one champions the fundamental rights of our aging population to live out their days.. sustaining their lives with access to medical services that are personally affordable.. IE can only be secured via an insurance provider.. whether public or private.
    At the core of the “problems” we keep hearing about in public forums… “can’t afford to provide” via deficit impacts.. etc… is the notion that profits have to be built in to alleviating human suffering.. as if dictated by a “Supreme being” … which in our “Civil” religion proclaims is what we are obligated to not be concerned with the needs of our fellow citizens in a humanity-oriented social construct. Instead, we are “religiously” obligated to support a free market approach all aspects of our daily lives.. to not support such liturgy is considered “blasphemy” and as such.. according to our “Civil” religion… tribal belief system… renders one “unpatriotic.”

  20. Greg

    There is the “fable” of Medicare cost sharing, and the truth. The fable is that beneficiaries pay for it, that it is not an entitlement. The truth is that the actuarial value of the services paid for by Medicare far exceeds the contributions made by payroll taxes that a beneficiary paid for Part A. Additionally, by definition, benefifiaries pay 25% of the Part B cost, typically $115 for those with income under $80K annualy. The other 75% is from general fund, taxes paid by working people not on Medicare. Medicare Part D is almost entirely unfunded by beneficiaries.
    The guest today made a comment that Medicare has done a better job of holding down cost over the past decades than private insurance. The guest looks at Medicare in a vacuum. Medicare is cost shifting onto private insurance, typically employer sponsored plans. The employer sponsored plans pay higher premiums and pay more for Medical costs than they would otherwise. This is an invisible tax on working families and it is immoral.
    Medicare is not in a vacuum. Medicare and Mediciaid are 55% of the health insurance market in the US. Scale and political inertia prevent Medicare from proactively addressing problems. For example, Medicare did not cover preventive care or drugs until only a few years ago, decades later than private health insurance!
    The good intentions of Medicare are tainted by the imorality that young people with no hope of a solvent Medicare program to provide their benefits when they retire, go uninisured, pay more for their health insurance, and pay taxes to provide for Medicare coverage for other people.

  21. C.F.

    So right, Margie, No one on Medicare or Tricare, both Government Programs, would give it up, it is earned through life long work, and even through Social Security.

  22. paulbyr

    JMH, thank you. I totally agree that I drifted out of line. However, The original article did say “one of the most popular programs for senior citizens” which two other writers addressed in their comments too.

  23. JMH

    This is the first “political” style post I have ever seen on this site. Please stay with the important information Terry and Joe provide to those of us who wish to help ourselves stay well. Hats off to the Graedons for all the really good work they do to keep us informed! Talk about that, paulbyr, please.

  24. MJW

    “Popular” is an odd choice of words for a program essential to the well being of Americans.

  25. Margie

    This is in response to paulbyr, above. The “someone” paying your doctor bills is, mostly, yourself. Medicare isn’t an “entitlement” program; payroll taxes are deducted for Medicare from every paycheck we earn, and about $100, for most people, is deducted from every Social Security check we receive, as well. And “popularity” isn’t the reason Medicare needs to be kept intact for elders–it’s the right to medical care that we have earned over a lifetime of work.

  26. paulbyr

    I like having someone pay for all my Dr. bills but I really don’t think I am “entitled” to it! The (few) thoughtful politicians need to evaluate the real cost of having a lot of really sick poor people walking around, spreading disease, against the cost of providing poor people needed medical care. Since the feds decided that EVERYONE who shows up at the ER MUST be treated, the hospitals have to factor that cost into their bottom line. Then Medicare has to pay higher hospital bills.
    To me, the bottom line is, massively important decisions can’t be made based on being “one of the most popular programs for senior citizens”.

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