Medicare and how a grandmother worries about its costs

Originally published in MedPage Today

by Liz O’Brien

My grandmother and her hospital roommate — aged, tiny, frail, and sporting matching bright pink hairnets.

They looked like twins — two thin shrubs in winter that had each sprouted an improbable, big pink rose.

Although sick and scared, my grandmother had admired the pink hairnet on the lady in the next bed, so my mother bought her one too, to make her feel better.

It was 1966 and the first time my 77-year-old grandmother had ever been a patient in a hospital.

I felt sorry for her. Her English was broken, her understanding of medical science minimal, and her outlook definitely “old world.” She was here to find out why she felt so weak.

But over three days, as the parade of physicians, nurses, and assorted medical professionals marched in and out of her room, with endless examinations, questions, and tests, the poor lady found she had something more to worry about than ill health.

“How can we afford all this?” she whimpered again and again.

And my mother — who was probably wondering the same thing herself — nevertheless heartily reassured her, “Ma. Ma, don’t worry. Medicare sent all these doctors. Medicare is going to pay for it.”

This was our family’s first encounter with Medicare, which had been enacted shortly before my grandmother’s hospitalization. While my parents weren’t sure how this Medicare business worked, for the moment the “magic word” quieted my grandmother down — at least until the next doctor showed up.

Finally, she was discharged. The diagnosis was inconclusive and, I suspect, — this was over 40 years ago — probably there wasn’t much they could have done about whatever ailed her anyway.

Then the bills started to arrive — for hospital charges, tests, supplies, services, and specialists of all stripes. My parents’ eyes crossed in amazement at all the treatment my grandmother had received. And — yes! — Medicare delivered, paying off the bills as advertised.

“She was a goldmine for all those people,” my mother murmured, shaking her head.

“And yet,” she admitted,” You can have a lot wrong with you when you get old, so I guess they had to try everything they could think of.”

It was just that it was so expensive — unbelievably so for a working class family. We didn’t pay for it, but somebody’s tax dollars did. And, if Medicare in 1966 was anything like today, the doctors paid for it too — subsidizing my grandmother’s care with the reimbursement rates they accepted.

I bring up the memory in the light of all the talk today of healthcare reform and its costs.

In retrospect, my little old foreign-born grandmother, who at the time I pitied for her age and ignorance, was wiser than I thought.

“How are we going to afford all this?” was her immediate response.

Life had taught her a lesson. Peasant hardship in Eastern Europe, poverty as an immigrant in America, the Depression, the privations of World War II had made it clear: There’s no such thing as a free lunch. No matter how desirable, or important, or even essential it is to have something, it has to be paid for.

As does every single item in the proposed healthcare reform legislation.

And the tab is in the trillions — and will affect generations to come.

I know, insurance premiums and healthcare costs are high now. Reform is supposed to bend the cost curve, reduce the deficit, etc., etc.

I don’t pretend to know anything near what I’d need to know about the intricacies of healthcare policy and the complexities of our financial and government institutions to fully understand it all.

But one thing I do understand is the voice of common sense when I hear it.

“How are we going to afford all this?”

I don’t know, Grandma. I don’t believe in magic words.

What happened to my grandmother? She went to live with my parents and took up residence in my old bedroom. She lived for another 14 years, welcomed four great-grandchildren, and died in her sleep at the age of 91.

Liz O’Brien is production editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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