The incredible expense of getting old in America

The Kaiser Family Foundation has recently done some excellent reporting on the out-of-pocket expenses faced by seniors on Medicare. Using data from the 2016 Medicare Current Beneficiary Survey (MCBS), they found that the average Medicare beneficiary pays $5,460 out-of-pocket each year for health related expenses such as co-pays, medical supplies, or medications. This spending amounts to 12% of these seniors’ total income, reducing the amount of money they have available for food, housing, or transportation.

Elders have struggled with these costs, resorting to putting their health at risk by skipping doses of necessary medications or delaying necessary medical care.

Working in primary care, I see this brutal self-rationing all too often. Elder patients who cannot talk to their grandchildren because they cannot afford hearing aids, who cannot eat the foods they enjoy because they cannot afford dentures. It’s devastating.

For seniors that require long-term care services such as a rehab or skilled nursing facility, average out-of pocket spending was $23,045 or 79% of their income. For context, 70% of people over the age of 65 spend at least some time in a skilled nursing facility. For seniors who need full-time nursing care which is not covered by Medicare, the average cost is $102,200 per year.

Because our current Medicare program does not cover long-term care, seniors are forced to spend-down, essentially selling off all of their assets to pay medical bills until they are impoverished enough to qualify for Medicaid. The majority of people in nursing homes end up in this situation.

Access to needed medical services need not impoverish us in our later years when we should be spending our time and energy with the family and friends that bring meaning and joy to our lives.

Bernie Sanders’ Medicare For All plan addresses all of this. It removes cost-sharing for medical care and expanding benefits to cover hearing, dental care, and long term care services.

The specific proposal to make long-term care services a covered benefit of Medicare is quite popular in polling. Even with a negative framing, Data For Progress found that 60% support while only 27% oppose this benefit expansion.

Seniors are understandably anxious about politicians messing with Medicare. After all, Republicans have tried again and again to reduce Medicare benefits and increase medical costs for seniors. However, single payer Medicare for All makes the program more generous for seniors, while giving all Americans access to the same high quality level of care.

Author: Harrison Kalodimos

I'm a family medicine resident at Swedish Medical Center in Seattle.

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