After EMS: Medicare and Marx

I was going to start this month’s column by fantasizing about retirement: a comfortable lifestyle financed by half a century of savings; friends and family close but not too close; cute house pets trained to let themselves in and out; pickleball by the pool; endless socializing without having to work the next morning…

Maybe some other time. Let’s talk about Medicare instead. It’s such an important topic for retirees. That’s no fantasy. Neither is the wisdom of exploring Medicare before you need it.

Then there’s the debate about whether Medicare is worth its price. To me, it is. To the government, I don’t know. I’m not one of those high-IQ people trying to cut a trillion dollars from the federal budget without breaking any promises to 60 million seniors. Most of us appreciate subsidized healthcare, but I’ve seen non-retired colleagues compare Medicare (and Medicaid and Social Security) to Marxism. How bizarre.

Some of my best friends are Marxists. I hate to generalize, but they all have one thing in common: They’re big fans of Groucho, Harpo, and Chico, a family of funny Marxists who were still popular in the 50s when we had hydrogen bombs but no Medicare. Hey, that reminds me of the time I rescued an atomic cat in my pajamas. How it got in my pajamas, I’ll never know. (Thanks, Groucho, you silly Marxist.)

The Marx brothers, whose humor often targeted social norms of the 30s and 40s, would have loved making fun of Medicare—a giant, expensive entitlement package with lots of moving parts. Despite its density, Medicare works pretty well, I think, compared to income taxes, do-it-yourself plumbing, and other harrowing endeavors that leave me not right in the head. (I caught my wife nodding when she proofread that.)

A good way to prepare for Medicare’s complexity is to begin with a decision you’ll make just before applying: Do you prefer traditional Medicare or Medicare Advantage? Let me highlight some pros and cons so you don’t feel we’re wasting time here.

Traditional Medicare

Pros

• You’re covered by any U.S. doctor who accepts Medicare—98% of them—even if you’re away from home.
• Medicare parts A (hospital) and B (medical) offer consistent coverage nationally. You don’t have to pick an insurer.
• Most subscribers get Part A for free. Part B premiums are deducted from monthly Social Security benefits if you’re receiving them.
• The Medicare website is helpful and relatively easy to use, assuming a critical mass of Medicare employees keep their jobs.

Cons

• You’ll need private insurance known as Medigap to cover the Part A deductible plus Part B’s 20% copayments.
• Prescription drug plans (Part D) are separate, optional, and inconsistently administered.

Medicare Advantage

Pros

• Many plans add hearing aids, dentures, and dental services, yet cost less than traditional Medicare.
• A single insurer usually manages all your benefits.
• Policies include annual out-of-pocket limits.

Cons

• You’re restricted to designated regional providers and facilities. Travelers aren’t fully covered for nonemergent care outside their local networks.
• You’ll need prior authorization for many services.
• Reimbursement decisions are made by private insurers.

These are uncertain times for Medicare. How long we’ll have it and what it’ll include, no one knows. Helen and I prefer the greater flexibility of traditional Medicare, but I predict we’ll all be steered toward Medicare Advantage within a few years as healthcare becomes more privatized and less subsidized. Meanwhile, prospective retirees should understand the basics. The best book I’ve found to help with that is Get What’s Yours for Medicare by Philip Moeller, who writes about Medicare as if he’s in on the joke. Choose the “revised and updated” (second) edition so you don’t miss a single confusing aspect.

I’m rooting for D.C. dealmakers who label Medicare untouchable, but we’ve seen how quickly priorities can change, and how the instrument of change can be an axe instead of a stiletto. Cutting costs is a sensible goal; reducing core support for needy citizens suddenly, without thorough review, seems short-sighted and even punitive. Our leaders may try to justify that new normal by borrowing a line from Groucho: “What have future generations ever done for us?”

Guys, he was joking.

Mike’s Exit Poll #4: One city, one meal, no charge: What do you order and where?

I’m going with shrimp and lobster sauce Boston-style, a staple of my youth. The main ingredients of this dark, savory delight are ground pork and black bean sauce. Shrimp is optional. Lobster is not. There is no lobster in lobster sauce. Some would call that misleading, like chicken-fried steak. The feds should leave Medicare alone and make menus more truthful.

Mike Rubin is a retired paramedic and the author of Life Support, a collection of EMS stories. Contact Mike at mgr22@prodigy.net.