Older Americans spend more on healthcare than peers in 10 other developed democracies, a new Commonwealth Fund report found.
The new report highlights how Medicare, the public health insurance program for people older than 65 and people who are disabled, has significant cost-sharing requirements – including co-pays, deductibles and no ceiling on out-of-pocket costs.
“Even though nearly all older adults in the US are covered by Medicare, this study highlights areas where the program has room to improve,” Munira Z Gunja, senior researcher for international health policy and practice innovations at the Commonwealth Fund, said in a statement. “In some countries, almost no older adults are skipping or delaying care because of the cost.”
Medicare is available through two programs – traditional Medicare, also known as “fee-for-service”, and Medicare Advantage, which is managed by private insurers.
Traditional Medicare lacks many benefits older Americans and disabled people need, such as vision, dental and hearing care, and long-term or home care. While Medicare Advantage offers some of these benefits, it has been criticized as unfairly denying care and being unnecessarily costly, and has been the target of federal fraud investigations.
Conservatives have proposed further privatization of Medicare by instituting “default enrollment” in Medicare Advantage. The president-elect, Donald Trump, promised “no cuts” to the program in the official Republican platform, though there are few specifics beyond that promise.
Trump’s pick for the Department of Health and Human Services, which oversees the Medicare program, is Robert F Kennedy Jr, an environmental attorney, conspiracy theorist and the nation’s leading vaccine skeptic.
The Commonwealth report used data from the fund’s international survey of older adults to compare health benefits across 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States.
It found that almost a quarter of older adults in the US spent $2,000 or more on healthcare in the past year, compared to less than 5% in France and the Netherlands. Similarly, older adults in the US reported the highest levels of cost barrier to care, although less than 10% reported encountering such barriers. One in five older adults in the US, Australia and Canada reported skipping needed dental care, compared with less than 5% in the Netherlands and Germany. Less than 5% of adults in all countries reported skipping needed mental health care because of cost.
The US has the most expensive health system in the world. In spite of these high prices, it performs poorly on metrics of health equity, accessibility and outcomes.
“This study highlights how vital Medicare is for older adults in the US, but it also underscores the challenge of affording needed care,” said Gretchen Jacobson, vice-president of Medicare at the Commonwealth Fund, in a statement. “Rising costs are forcing many older Americans to pay more out of pocket, leading to delayed care, poorer health and higher long-term spending.”
