Recent mention here of Medicare is bringing in a variety of information and comment.
Two letters disputed my view that Medicare and Social Security are bargains. But the thesis that private insurance is cheaper has already been argued in so much detail that I see no purpose in flogging this horse yet another time around the track.
It will suffice to let the record show that my opinion of Medicare's worth is not shared by everybody.
A good sprinkling of mail has been from people who have undergone major surgery and been saved from financial disaster by Medicare. Three letters deal with the theme that Medicare is very good on hospital bills but very poor on protection against monstrous fees from surgeons. These letters caused me to wonder about the differences between society's approach to legal fees and medical fees.
Lawyers assigned and paid by courts to defend people who can't afford a lawyer are not permitted to make a separate charge to the client. The lawyer is supposed to be satisfied with whatever the assigned fee is. Asking the client for an additional fee can lead to disciplinary action.
However, society deals with surgeons in quite a different manner. The government does not "assign" patients, nor does it tell a surgeon how much he can charge.
One who wants his life to be in the hands of a specific surgeon must agree to pay that surgeon's fee, regardless of how much of it his insurance covers.
I offer no argument that this is either good or bad, but it does seem pertinent. We are left to wonder what would happen if Medicare said to surgeons, "The fair and usual fee for this operation is X dollars. If you want the job, that's how much you'll be paid -- 80 percent from us and 20 percent from the patient. Take it or leave it."
There would almost certainly be an immediate storm of protest. But I wonder what the long-range outcome would be.
Back to the mail: James J. Dwyer of Potomac sent me a photostat of a medical bill rendered to him. On June 24, he was charged $13 for an X-ray of his right hand, which was then placed in a cast (for $150). On July 30, the cast was removed and Dwyer was charged $23 for another X-ray of the hand. t
When he phoned to ask why the cost of a hand X-ray had gone up 77 percent in a month, a woman on the doctor's staff responded, "We've been hit by inflation too." I guess Medicare does have to keep a sharp eye open to make sure it doesn't base its 80 percent payments on arbitrarily inflated fees.
One phone call was received from a woman who said, "You might be interested to know that, like you, my husband is on Coumadin and must have his 'pro time' checked frequently. But he doesn't have to pay for office visits. He just goes straight to a lab here in Silver Spring and pays $4 for the whole job."
Several letters told of long delays in collecting on Medicare claims and warned that all paper work should be filled out fully and accurately to minimize snafus. "Sometimes they goof even when you do your part," one man told me. "Don't use my name and then I won't have to worry about their getting even with me for complaining, but as an example of my dealings with them, I filed a claim in April and had to refile in June when they admitted they had lost the paper work.
"Their check finally arrived on August 7."
Paul W. Hodler of Bethesda wrote; "I read your rather feeble slap on the wrist for Medicare payments that bear only a vague resemblance to actual surgeons' fees. This is applicable not only to Medicare but to the whole medical insurance picture.
"About a year ago, my wife had a rather expensive operation. We tried ahead of time to find out what the Blue Shield policy would pay. We were denied this information.
"Even after a written request from the physician, no information was available. Since it was the best coverage sold on an individual basis by Blue Shield, we went ahead on the implied trust that the payment would be reasonable. When the check arrived about three months after the operation, we found that it was for 19 1/2 percent of the fee.
"Later we found that under a standard federal policy the payment would have been for 100 percent. Moral: In the Washington area, you must either have taxpayer-subsidized Civil Service coverage or you must be poor enough to qualify for Medicaid."
Well, I have learned a good deal about fees, Medicare, Medicaid, the bureaucracy and associated subjects.
But my opinions have not changed much. I am grateful that I do not qualify for Medicaid and grateful that I do qualify for Medicare. I am concerned about the amounts not covered by insurance that must be paid by people of modest means.
I hope that one day soon the cost of good health care will fit comfortably into every family's budget.