The Health Care Pitfall Seniors Are Falling Into that No One is Talking About
I first met Mrs. Lee one Sunday morning working my usual weekend shifts in the hospital. She was hospitalized for a broken hip after suffering from a fall in her home. Mrs. Lee was a widow living in a San Francisco home she had bought with her husband forty years earlier. She was a sweet, pleasant woman, but because of her worsening memory and now limited ability to walk from her hip, it was no longer safe for her to continue living alone.
Her daughters lived on the east coast with their own children and lives, and would not be able to care for their mother. When our hospital social worker told her that nursing home and care giving costs not be covered by her private insurance plan or her Medicare beyond three months, she was left with one option: spend down her life savings and sell her home until she was poor enough to qualify for Medicaid. Only then would she be able to afford her nursing home costs.
Mrs. Lee is among the majority of senior Americans who wrongly assume that when they or a loved one become too frail from old age and chronic illness, their private insurance or Medicare plan will kick in to cover their long term care services. Such services might include a caregiver to help with feeding, dressing, and bathing, or residence in a nursing home when living at home is no longer an option. In our aging society, nearly all of us face the possibility of needing such care for ourselves or our loved ones eventually. Medicaid does cover these services, and for that we should all be grateful. But unlike Medicare, which covers all seniors, Medicaid is means-tested. It only covers those with an income and net worth low enough to be considered in poverty.
So countless seniors are in a bind. It’s estimated that over 70% of seniors over age 65 will need long term care at some point in their life. On average, living in a nursing home costs over $83,000 a year — an exorbitant out-of-pocket cost few working or middle class families can afford. For those who can’t afford to pay such costs for years or decades, there are only two remaining options: either struggle caring for themselves at home without the resources they need, or be forced to spend down all of their assets until their net worth is small enough to qualify for Medicaid. Taking this latter path means losing their home, life savings, financial security, or possibly all the assets they were hoping to pass on to their families.
As a doctor who’s cared for countless hospitalized seniors in San Francisco who can no longer live safely at home and require 24/7 care, this story is becoming all too common. Our seniors are literally forced into poverty when they become too sick or too frail, and our current health insurance system does nothing to protect them from this fate.
For the majority of Americans, health care is the most important issue in this year’s election. Health care costs and premiums keep rising. Drug prices remain unreasonably high. Medical debt is the number one cause of bankruptcy in the nation. The public insurance option, a.k.a. “Medicare For All Who Want It,” aims to tackle these problems by making Medicare available for purchase on the insurance exchanges for those under 65. However, the public option would still fail to cover long term care services. Thousands of seniors every year would still continue to fall into this gap in our system.
The Medicare For All plan backed by Senator Bernie Sanders is the only plan that expands our current Medicare system to include long-term care coverage like nursing home and care giving costs, as well as dental care, hearing aids, and medical equipment that is so vital for the health of our seniors. Under Medicare For All, Mrs. Lee could’ve kept her home in San Francisco, kept her life savings, and continued to live with dignity knowing that her assets could be passed onto her children and grandchildren in the future.
As a doctor, I’ll be voting for Bernie Sanders in the California Primary in March and hopefully again to be the next president of the United States. Our health care system is failing our seniors and their families, and we could be doing so much more to protecting all our patients from falling prey to devastating medical debt and financial insecurity. I hope the rest of California joins me in demanding comprehensive, single-payer Medicare For All that includes long-term care. Electing Senator Sanders puts us on a path to build a better health care system for all.
