A few days ago I referred to a long list of benefits we get from the government. One was the Medicare insurance program that helps old folks with their medical expenses.
Charles Frank of Rockville thinks I ought to tell readers how Medicare really works. He says:
"My experience has been that if they pay half your cost you are doing good.
"From Jan. 1 to July 1 this year, I submitted claims for $875 and was paid only $208.70. When you add dental bills and insurance premiums, the total of my medical bills to July 1 is $2,200.
The worst part is in trying to get them to pay just claims. My wife has submitted claims that go back to April of this year for which we have not been paid.
"When we phone, their answers are evasive, wrong, and sometimes outright lies. They say they will call you back. They never do. You call back and try to talk to the same person, but he's not available. You talk to someone else and get different answers.
"If you doubt my word on this I suggest you call Karen Shapiro in Congressman Barnes' office. She called Medicare on my behalf and by the time she finished she was so angry she was ready to chew nails. I think that if we can get enough public and congressional pressure we might get Medicare to do the job for which it was created."
Charles, I know how you feel but I am not in complete agreement with you.
I know how you feel because I have been covered by Medicare insurance for three years and have frequent dealings with that agency.
After I underwent open heart surgery, I was told that I would have to take Coumadin for the remainder of my life, and that because it is such a powerful chemical my blood would have to be checked every three weeks.
Each visit to the doctor costs $33, with $15 of that amount being the charge for the office visit and the other $18 consisting of two $9 lab fees.
I have before me a settlement sheet that explains the $17.44 check sent to reimburse me for my $33 expenditure. In it, Medicare informs me that the normal charge for an office visit in Washington is $10, the normal charge for one of the $9 lab tests is $5, the normal charge for the $9 test is $6.80, and therefore Medicare can approve only $21.80 of the $33 I pay out. However, Medicare reimburses people for only 80 percent of what it "approves." So I lay out $33 per visit and get back $17.44.
On the other hand, when the surgery was performed, the hospital bill came to more than $18,000 and Medicare paid all but about $200 of it. So one's opinion of Medicare depends on the nature of its service to him.
If one is under the impression that Medicare was designed to pay all our medical costs, he is quickly disillusioned. It was not designed to do that and it doesn't do that. It was designed to provide a tremendous amount of medical insurance at an extremely modest cost. And it certainly does do that.
I think it is inexcusable for an agency of government to frustrate citizens who try to deal with it and obtain help from it. Bureaucrats who transfer callers endlessly from one office to another, or promise to call back but don't, or don't really give a hoot about the consequences of their insensitivity, ought to be fired.
Medicare's schedule of allowable fees is several years out of date, and I suspect that keeping it behind the times may be a high-level policy decision aimed at saving money. If that's really what Medicare is doing, it's dirty pool. Shameful!
A government that has been unable to control inflation should at least be aware that it exists and make allowance for it in its aid programs.
Fortunately, Charles Frank and I can afford to pay the difference between what Medicare allows and the amounts owed. I have a steady job and I could pay for having my blood checked even if I got nothing back from Medicare. But what about old and infirm people who live on fixed incomes of as little as $50 a week? What are they supposed to do?
Something is better than nothing but in many cases it's not enough. I think that $28.80 per quarter I pay for Medicare coverage is the biggest bargain in America because it saves me so much -- even though it very plainly doesn't cover everything.