Medicare is Part of the Discussion on Entitlement Reform, but is it Truly an Entitlement?

Entitlements. This is a term we hear a lot recently, and it seems to mean different things to different people. Entitlement reform and entitlement spending discussions come up often in our popular media. But the true definition of what constitutes an entitlement depends on who you ask. Many programs clearly meet the definition, such as Medicaid, the joint federal and state venture designed to provide health insurance to the poor. Another would be the EBT program, or food stamps which provide money for low income individuals to buy food. One program that interestingly keeps coming up in this discussion is Medicare. Medicare is the federal government's medical insurance program for America's senior citizens. Those greater than 65 qualify, along with select individuals who are disabled or those with chronic kidney disease on hemodialysis. It is here that the definition of entitlement becomes open to some interpretation.

Medicare is a frequently discussed spending program due to our country's budget woes. Spending on Medicare accounts currently for 3.7% of GDP, to grow to 5.7% by 2035. The number of persons enrolled in Medicare was about 45 million in 2009. It is expected to increase to 80 million by 2030. Approximately 1 in 5 enrollees are younger than 65 years of age, but are classified as disabled. These are no doubt extraordinary expenditures, but it is ultimately incorrect to classify this purely as an entitlement program.

Medicare is paid for through several means according to current law. All working citizens pay 1.45% of ordinary income towards Medicare through the FICA tax, with no cap related to total earnings. Additionally, there is an annual premium for beneficiaries that is progressive, meaning your premium is higher if you have more income. There is also a small deductible for outpatient services, and a different deductible for inpatient stays. You will pay 20% of the outpatient bill as well unless you have supplemental insurance, as Medicare is responsible for the first 80% of the bill alone. A Medicare Advantage plan provides some relief from this, but usually at the expense of larger deductibles and coinsurance, and often higher premiums. This is just a small sampling of associated costs, but it illustrates the idea of what Medicare beneficiaries can potentially spend from their own pockets.

How is this all relevant to the people of Connecticut? Ask many of Connecticut's seniors about their experience for an honest answer. Finding a primary care physician continues to become more difficult. Specialty care as well. Some physicians no longer accept new Medicare beneficiaries, and this problem seems to worsen each year. Some areas of Connecticut have extraordinary wait times to see the doctor, and navigating the health care system is continually becoming more complex. I have had the privilege of caring for many Medicare beneficiaries through my oncology practice, and complaints are plentiful. Seniors are often surprised to find a large coinsurance responsibility, and sizable deductibles. Some do not fully understand the purpose of supplemental insurance, and are shocked when they receive their bill for the uncovered portion of care. Often, people simply assume they will be taken care of after supporting the program through their working years. It is an incorrect assumption.

Now, if one is taxed for this program through their working life, and fulfills all of their obligations to the program under law, why is this called an entitlement program? Certainly, nothing is being given away for free. We spend tremendous sums of money on true entitlement programs, where an individual did not earn the benefits they receive. Clearly, we have to get a handle on our extreme addiction to spending citizen's tax dollars. However, assailing a program like Medicare, where many good people have paid their dues is not the way. Several social programs on both a state and national level are worthy of our ire. Social service programs continue to consume our hard earned money at an alarming rate, and we constantly search for ways to give even more. Let us focus on those who have been receiving something for nothing, and consider ways for them to become more self sufficient. That is a much more constructive use of our legislators time. Money is short and the line of takers seems endless, but Medicare is one program where hard working senior citizens followed the rules. They have earned over many years the rights they receive today, and ultimately deserve to have their commitments honored.