Saturday, April 4, 2009

A eulogy, of sorts.

(The following originally was published, in slightly different form, by the Saint Paul Pioneer Press, June, 2006.)

Twila Brase's June 8 diatribe against Medicare hit my dining room table only a few hours after I had learned of my mother-in-law's death at age 91, of Alzheimer's. This political extremism requires a response.

Brase calls upon Republicans to "follow the enduring conservative principles of individual liberty and personal responsibility" in building a "new Medicare free generation." Brase writes either from ignorance or blind faith in mythical economic and political systems. She assumes that Medicare is the result of and encourages personal irresponsibility and that it somehow threatens personal liberty. Her assumptions are not just wrong; they slander generations of men and women who have struggled to survive and thrive in this society.

My mother-in-law, Alice, took responsibility for herself and others throughout her life. Born in 1915, the eldest of 14 children, she saw only 8 years of formal education before her father died. She went to work on neighboring farms to help support her family. She married and had four children of her own, as she and her husband, Bill, worked a small farm east of Crookston, MN. Before her husband died in 1991, they had moved to a small home in Red Lake Falls, MN, living off their tiny life-long savings and a meager social security check. But for Medicare, they would have received no meaningful medical care in the last decades of their lives. They simply could not have afforded it: not because they were irresponsible, but because of the time, place and economy into which they were born.

Jobs were never plentiful in the Red River Valley. Small farms abounded, homesteaded by immigrants in the 19th century, handed down in bits and pieces to sons and daughters. Poverty was and remains a constant in this and many other parts of our country. Absent Medicare, and similar government funded medical programs, Alice, Bill, and thousands of elderly or disabled citizens would have received no medical care in the last 40 years other than, perhaps, the emergency care required to save a hand or keep a heart beating.

Brase's imagined threat to individual liberty is merely paranoid rhetoric. There has never been and will never be a law in this country that limits what an individual may pay for the medical treatment he or she wishes to obtain. Virtually every medical care provider in this country charges a number of rates for its services, varying only with the person paying the bills. If a patient is covered by Medicare and a doctor chooses to treat Medicare patients, the Medicare rate is charged. If the patient is covered by a private health insurance plan and the doctor has chosen to treat that patient, the agreed upon rate is paid. That rate typically is higher than Medicare's. Ironically, it is those patients who are covered by nothing but their own wallets who are charged the most for medical services.

If Medicare, an HMO, or a private insurer does not cover a given procedure, a patient is free to purchase it on the patient's own. Most simply can't afford to do so. The claim that Medicare and similar programs limit what medical care there is to be had is equally baseless. If you can afford an existing treatment, you can get it.

In all the decades before and since the advent of Medicare, neither our medical profession nor our insurance industry has found a way to make medical care universally available and affordable. Our once widespread medical insurance system was largely a by-product of labor shortages following WWII. With the collapse of the labor movement, we have seen corporations unilaterally abandoning both retiree health care and pension plans, reneging on payment of wages already earned by years of labor. These actions are not the result of any lack of personal responsibility on the part of retirees. They do, however, guarantee increasing reliance on the plan that we, as a society, have undertaken to insure medical care for ourselves and our parents. There is no reason to believe that the future will be any different, whether shaped by Republicans or Democrats. We do know, however, that if we dismantle Medicare, we abandon older Americans to unnecessary disease and death.

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