After half a lifetime of following the Medicare program, on October 1, 2013, I became a Medicare beneficiary. I turned 65 on October 31. I'm part of the leading edge of baby boomers joining the program, ten thousand a day. We're going to change this program, both by how we use it and what we expect its keepers in Washington to do to improve it.
Here are some reflections upon joining Medicare.
1. Don't Refer to Me as "Retired," Please. I'm still working (hard) and paying Medicare as well as income taxes every month. Like most of my fellow boomers, I lack the financial cushion I want in order to stop working. Additionally, for what it's worth, like all too many boomers, I don't know how not to work. So my main goal, which is closely aligned with the country's, is to stay healthy enough to keep working long enough to be able to retire comfortably when I wish to do so.
I plan on staying a long way away from the expensive parts of our health care system, if only to avoid being inadvertently harmed. Rest assured that if I know I'm dying, you won't find me in a hospital if I have any say in the matter.
I don't consider myself "entitled" to Medicare, or to subsidies from younger people. I'm paying more than $400 a month in Part B fees and the special assessment on Part D that got tacked on in the Affordable Care Act. After what I've already paid in, that's not exactly a flaming bargain. I've paid Medicare enough over my working lifetime to buy a house, and will pay more Medicare taxes for years to come for each month that I work. Nothing makes me angrier than the suggestion that I'm somehow sponging off my kids by participating in Medicare.
2. The Regular Medicare Program Is a Relic. There is a lot of political fog enshrouding Medicare. Personally, I could care less about the politics of this program. The big choice was fairly cut and dried: either regular Medicare plus a supplemental plan or Medicare Advantage. After logging onto Medicare.gov, I found the regular Medicare benefit completely incomprehensible — chopped up into Parts that may have made legislative sense in the 1960's. If you included the supplemental coverage, there were just too many moving parts that didn't seem to fit together into a unified benefit.
So I chose Medicare Advantage. It's simple to understand and user-friendly, and looks a lot like my previous coverage. My doctor is a participating physician as is my beloved community hospital, Martha Jefferson. And the price is right: zero dollars after my Part B premium. More than 40 percent of boomers are picking Medicare Advantage, largely because it's easy to use and remains a bargain. It will eventually be half the program.
3. I Want My Doctor to Work for Me. My doctor is the single most important part of the health system. Call me a traditionalist, but I think my doctor's core obligation is to be honest with me about my medical risks and thoughtful about how I manage them. I want my doctor to work for me — not the local hospital, or a health plan, or some faceless medical conglomerate. So it makes no sense that his time is worth less to Medicare or any other insurer when he in his own exam room talking to me than it is if he's a hospital employee talking to me.
Don't cut secret deals behind my back to change how he cares for me. And stop wasting his time on meaningless, check-the-box billing and documentation requirements. He spends half his time on paperwork, in order for him to qualify for "quality" bonuses or to be certified as a "meaningful user" of health care IT. Sadly, a lot of private health plans are even worse than Medicare is. To all of them I say: "Stop telling my doctor how to practice medicine." If I'm dissatisfied with his responsiveness or the care he provides me, I'll find someone else.
4. I Still Cannot Get the Information I Need to Make Good Care Decisions. Last year, my father-in-law needed his knee replaced. After consulting orthopedic surgeon friends about how they'd go about selecting a surgeon, they told me to find out the surgeon's "re-do" rates for their past knee replacements, and their post-operative infection and complication rates. None of the hospitals he was looking at could tell me. When I went online to Medicare's Hospital Compare, I found 87 (!) well meaning "quality" metrics obviously negotiated with hospitals' advocates so no one would look bad. I don't care about whether the hospital "participates in a systematic data base for nursing sensitive care" or "tracks clinical results between visits" or whether people got their flu vaccine. I don't have time for 87 "core" measures. Just give me the good stuff — the key information that helps me limit my risk.
5. Treat Me Like a Sentient Grown-Up. When I visited my physician earlier this year, he told me that Medicare was requiring him to hand me, an "elderly" person, patient education materials about my new status as a "senior" as a condition of his getting paid.
When I read it, I learned, among other things, that "you may notice physical changes such as the graying of the hair, vision changes requiring glasses, decreased hearing, minor injuries taking longer to heal, decreased muscle strength, slower coordination of the reflexes, constipation, etc." Thanks for wasting my doctor's time and for patronizing me. Medicare, note well: It's actually been hard to avoid all the advice about staying healthy. I'm doing all of it.
When I want your help, I'll ask for it.
This post originally appeared on The Health Care Blog on November 16, 2013.