Despite Medicare, Financial Barriers to Care Plague Older U.S. Adults

People in the U.S. over the age of 65 are more likely to be sick and more likely to have problems paying for the cost of health care than similarly aged counterparts in 10 other industrialized nations, according to the findings of a survey published by The Commonwealth Fund. The survey, which asked people 65 and older from 11 different industrialized countries about their health and financial access to care, revealed that the U.S. falls behind in almost every category, when compared to other industrialized countries.


According to a Commonwealth Fund press release, the survey analyzed responses from 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S. According to the release, the study offers an interesting view into the comparative effectiveness of Medicare, because the older adults in each of the other high-income countries surveyed have some form of universal health insurance coverage.

High Costs

Among the most notable of the findings were the financial costs that older adults in the U.S. face for health care, despite having access to the broad coverage of Medicare. For example, 21 percent of older adults in the U.S. spent $2000 or more a year in out-of-pocket costs for health care, while only 2 percent of older adults in the U.K. did. Similarly, while U.S. respondents were most likely to report difficulties paying medical bills, with 11 percent of older U.S. adults indicating reporting such financial troubles, only 1 percent of older adults in Sweden and Norway reported those problems.


Costs were also reported more often as a financial barrier to accessing care in the U.S. than they were in any of the other 10 nations, with 19 percent of U.S. adults 65 or older reporting they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription, or skipped doses because of the cost of care. The reasons behind the higher costs, according the Commonwealth Fund, are “high deductibles and copayments, especially for pharmaceuticals, and limitations on catastrophic expenses and long-term care coverage.”


U.S. respondents reported relative difficulty getting same- or next-day doctor’s appointments, with only 57 percent saying they could obtain such appointments, while 83 percent in France and New Zealand, and 81 percent in Germany were able to be seen the same- or next-day. In a related matter, older adults in the U.S. were more likely to rely on the emergency department for care that a primary physician, if available, would have been able to provide. Specifically, 39 percent of older U.S. adults reported using the emergency department in the past two years and 35 percent of those adults indicated that they used the emergency department for something their primary doctor would have treated.


The survey did have some bright news for senior care in the U.S. For example, at 58 percent, older adults in the U.S. reported some of the highest rates of discussing treatment plans for chronic illnesses with their doctors. Less than half of chronically ill older adults in the other 10 countries, with the exception of the U.K., reported the same. Older U.S. adults also had a high prevalence of reporting that they had a treatment plan they could carry out in their day-to-day lives. High rates of positive patient-doctor communication, low occurrences of gaps or confusion in transitions from hospital to home, and high rates of end-of-life planning discussions were also reported by U.S. adults over 65. Specialty care appointments were another area where the U.S. excelled, with 86 percent of older U.S. adults saying they were able to get an appointment with a specialist in six weeks, which outranked the older adults in Norway and Canada, where only 46 percent of older adults could get a specialist appointment on the same timeline.

Stop Smoking Campaigns: Hit Teens Where They Live

Whether anyone knows it or not, November 20, 2014, marked the 39th anniversary of the American Cancer Society’s (ACS) Great American Smokeout. The event takes place the third Thursday of every November. The event challenges tobacco users to stop using the harmful products on that very day and is geared to make tobacco users aware of tools they can use to help them quit and “stay quit.” In November 2014, the Centers for Disease Control and Prevention (CDC) wrote that youth smoking rates will cause their early demise, but are young adults and kids paying attention? Have they ever heard of the Great American Smokeout?

The event is publicized on the local level and rallies volunteers to press for laws that control tobacco use and discourage teen tobacco use. The event highlights strategies for quitting such as: telephone smoking-cessation hotlines; online quitting support groups; nicotine replacement products; and family and friend support. The ACS notes that a combination of strategies works best to keep people tobacco-free.

Humble Beginnings

According to the ACS, the Great American Smokeout began when during a 1970 event in Massachusetts, Arthur P. Mullaney asked people to give up cigarettes for a day and donate the money they would have spent on cigarettes to a high school scholarship fund. That sparked a Minnesota editor to front her state’s first “Don’t Smoke Day” in 1974, and two years later, the California Division of the ACS was able to get almost 1 million smokers to quit for the day. The ACS credits the movement with the many state laws that now ban smoking in public places; raise taxes on cigarettes, limit cigarette promotions, and discourage teen cigarette use.


The Surgeon General January 2014 report claims that 5.6 million youth currently aged zero to 17 will die prematurely from a cigarette smoking-related illness unless youth smoking rates drastically drop. The CDC sees combustible tobacco products such as cigarettes, cigars, hookahs, and pipes, as the main culprit.

A November 2014 Morbidity and Mortality Weekly Report (MMWR) reports that almost 23 percent of high school students currently use a tobacco product. According to the CDC’s 2013 National Youth Tobacco Survey (NYTS), 46 percent of all high school students and 17.7 percent of middle school students reported using a tobacco product at least once. Further, youths who say they use more than one tobacco product are at higher risk for developing nicotine dependence that can lead to continued smoking into adulthood. The NYTS indicates that “most youth who use tobacco believe they will be able to quit, but about three out of four high school smokers continue smoking into adulthood.”

Other Efforts

Other smoking cessation efforts have included the FDA’s launching of The Real Cost in February 2014. The year-long national marketing campaign is aimed at youths between the ages of 12 and 17. Additionally, CVS stores removed all tobacco products from store shelves in September 2014.


The stop smoking efforts are admirable, but useless, if the audience they target does not even notice. When asked in November 2014 whether they have heard of the Great American Smokeout, 40 Nevada teens said, “The Great American what?” Smoking cessation campaigns like the Great American Smokeout should be bombarding online video games, Instagram, Twitter, Tumblr, Facebook, Vine, and any other social media site that teens use in order to make the difference that the Surgeon General and American Cancer Society desire.

Part B Consumers Beware: ‘Pitfalls, Problems and Penalties’

In a report that included recommendations for improvements to the Medicare enrollment system, the Medicare Rights Center also focused on the existence of issues that often plague Medicare enrollees and how to avoid these pitfalls so as to escape often severe and long-lasting penalties. Besides identifying how consumers may sidestep these issues within the complicated program, the report, entitled “Medicare Part B: Enrollment: Pitfalls, Problems and Penalties,” also called for a streamlining of the enrollment system as it noted that the aging of the American population was occurring “at an unprecedented rate.”

Pitfalls and Problems

To premise the review of the Medicare Part B enrollment process, the authors noted that, “an often reported fact is that 10,000 Baby Boomers turn 65 and become Medicare-eligible each day,” yet, “less well known and commonly misunderstood, are the rules concerning how to enroll in Medicare.” To highlight the issues faced by many enrollees, the Medicare Rights Center reviewed more than 15,000 calls received by the Medicare Rights’ national hotline in 2013 and found that almost one-quarter of the calls were from individuals that were experiencing some type of challenge regarding enrollment. Of those callers, 38 percent were “navigating a specific hurdle,” 28 percent did not understand the enrollment periods, and 13 percent were not able to determine whether they were eligible for enrollment in Medicare. Another area that the report identified in terms of what types of challenges that consumers were experiencing during enrollment was transitions from existing coverage to Medicare. In sum, the Medicare Rights Center found that the majority of issues for enrollees fell into one of these three categories: (1) navigating coordination of benefits rules; (2) understanding enrollment time frames; and (3) dealing with late enrollment penalties. 


In addition to coverage gaps due to failure to enroll in a timely matter, “higher out-of-pocket costs in the form of lifetime late enrollment penalties (LEPs) may also apply.” While some may be able to appeal LEPs through a process called equitable relief, in which those who can prove they were provided misinformation from a federal source about enrolling in Medicare are granted immunity from those penalties, it is estimated that in 2012, approximately 740,000 Medicare beneficiaries paid Part B LEPs.

Fixing the System

In addition to educating consumers regarding the rules of Part B Medicare enrollment, the Medicare Rights Center also recommended steps to take in order to improve the process itself. Among the suggestions for streamlining the complicated process, the report included the following: (1) increasing education for soon-to-be enrollees; (2) simplifying enrollment periods; (3) increasing avenues for consumer relief; and (4) filling gaps in knowledge. With regard to the final suggestion, the report noted that “the true impact of enrollment changes on newly Medicare-eligible seniors and people with disabilities is difficult to discern,” and as such, “Congress should take steps to analyze the true scope of these issues.”

Highlight on Colorado: Marijuana Revenue Use May Send Mixed Message in Colorado

As of September 2014, legalized marijuana sales in Colorado have accumulated to $7.2 million. With an approximate 30-percent sales tax on purchases and 340 pot shops in Denver alone, $40 million of Colorado pot sales is slotted to go to Colorado’s school system, but there is an argument brewing between marijuana proponents and watchdog groups, who say that they are not certain that there is proper oversight of the product or that revenue is being appropriately delegated. Watch groups wonder why kind of message is being sent about revenues funding children’s education amidst the drug’s negative health risks.

The Colorado Smart Approaches to Marijuana (SAM) Coalition maintains that the product being sold in retail and medicinal stores is too powerful and commercialized, with some products made to look like regular edibles, such as cupcakes and candy, enhancing their appeal to unknowing children and teens. Likewise, SMART Colorado attests that kids under the legal age of 21 are able to get the edibles, and therefore, a black market still exists despite the drug’s legalization. A poll shows that only 60 percent of Coloradans purchased marijuana legally, because the regulated price and tax are very high (no pun intended).

There have also been reports that homeless shelters are almost at full capacity because homeless youth across the nation are flocking to Colorado to take advantage of the absence of legal consequences.

On the other side of the watchdogs is Taylor West of the National Cannabis Industry Association (NCIA), who argues that Coloradans should be thankful for marijuana legalization because the product is much safer now than before legalization.

According to SAM members, it makes no sense that federal and state government would downplay tobacco and alcohol use, touting their harmful effects, and yet some states like Colorado promote the use of marijuana.

Health facts on marijuana use include:

  • Increase in respiratory illness including daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections;
  • Increased heart rate by 20-100 percent shortly after smoking, which may lead to increased risk of heart attack in the first hour after smoking the drug;
  • Increase in risk for mental illness from long-term use; marijuana use has also been linked to depression, anxiety, and suicidal thoughts among adolescents; and
  • Marijuana use during pregnancy is associated with increased risk of neurobehavioral problems in babies.

In a November 2014 Gallup poll, voter support for legal marijuana waned by 12 percent since 2013. Yet, translated to the nation as a whole, 51 percent still support legal pot.

Oregon, Washington, D.C., and Alaska have legalized marijuana as of the November 2014 mid-term elections. Nevada is now considering following in Colorado’s footsteps, with over 200,000 signatures turned into the Clark County Elections Department in North Las Vegas on November 12, 2014, in support of legalizing the drug. The school system in Clark County, one of the largest in the nation, could certainly use the type of revenue generated in Colorado, but with the types of increased health risks resulting from pot’s use, the much needed funding may be best collected from some other avenue.