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Before “Medicare for All,” there was just Medicare, the very popular program that serves 60 million Americans age 65 and older or younger people with certain disabilities.
But while Medicare is much loved by most of those it serves, it is anything but simple.
This week KHN’s “What the Health?” podcast takes a deep dive into Medicare. First, host Julie Rovner talks with Tricia Neuman, a senior vice president in charge of Medicare Policy at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
Then, panelists Paige Winfield Cunningham of The Washington Post, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner join Rovner for a discussion of some of the Medicare issues on the front burner in Washington in 2019.
Among the takeaways from this week’s podcast:
- You can’t understand Medicare without getting a handle on its alphabet, from A to D.
- Medicare also has a robust role for private insurance. About one-third of beneficiaries opt to join private insurance plans that contract with the federal government to provide an alternative to the traditional, fee-for-service government program. And that business is highly profitable for private insurance.
- As Americans age, many fondly look forward to Medicare, imagining it will pay all their health bills. But the program has hefty cost-sharing requirements and doesn’t cover many expenses, including long-term nursing home care, dental care and most vision care.
- Federal officials are eager to find ways to cut Medicare’s drug costs. But that raises many questions, such as whether Medicare should negotiate with drugmakers over prices or set up its own formulary of drugs it would cover.
- An even harder question is how Medicare can work to control costs for the pricey drugs administered in doctors’ offices. Strong congressional lobbying from doctors and drugmakers has derailed efforts to do so in the past.
- A vexing issue for some seniors is getting observation care at the hospital when they are not sick enough to be admitted but are too sick to go home. Patients receiving observation care likely face bigger cost sharing than if they were admitted and Medicare won’t pay for any nursing home care.
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This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.