In the gap

A Durham man's dilemma illustrates gaps in health care that drain savings, and can leave older people in dire straits

Jake Smith was a working man, a truck driver by profession, and before that, a Navy veteran. He and his wife, Christine, went about the business of being solid citizens all their lives, paid off their Durham home, doubtless looked forward to retirement. As they went past 65, they turned to Medicare, the national health care plan for the elderly, and probably felt some security against costly illness.

But they discovered, as so many others have, that because they had a little income and didn't qualify for Medicaid, the program for the poor and disabled, what they had was a false sense of security. The News & Observer's Thomas Goldsmith told the Smiths' story Sunday, a story of two people who, lacking supplemental health coverage to pay Medicare's out-of-pocket expenses, found themselves strained at the very time in life when they had earned a few years of ease.

Smith's wife died of cancer last year. Bills from doctors and Duke Hospital that weren't covered by Medicare forced Smith to sell their home and move into a one-bedroom apartment. He prides himself on paying his bills. He did what he had to do.

The situation is not uncommon, and with baby boomers aging and Medicare under more stress -- along with the increased expense of health care, period -- it's going to be more and more common. And even when people think they've covered the bases with supplemental care and drug insurance, they still find themselves strained to cope.

Consider Marvin and Joyce Johnson of Harnett County. They told Goldsmith that they have a supplemental policy paid for by Marvin Johnson's former employer, and they also have prescription drug coverage. But on a fixed income, the out-of-pocket costs for their various types of coverages is running at $8,600 a year. For his part, Johnson sees the root of the problem in the influence that drug companies and insurance companies brought to bear on the drafting of legislation to provide prescription drug coverage through Medicare.

There's no doubt that those industries that make their profits in a health care system that is excellent in its science but uneven in its coverage of people -- particularly those not poor enough for Medicaid but not rich enough to cover expenses after Medicare -- have helped shape legislation to their advantage. The issue deserves to be a big one in this year's presidential race and in races for seats in Congress.

But as these "on-the-ground," human stories show, more and more people will need to rely on the almost sacred covenant that Medicare, created in 1965, has become. And given the current economic downturn, the problems with costs that go beyond what's covered in Medicare are likely to escalate. Thus, there is little choice but further government intervention, not just with more investment (yes, taxes that cover Medicare will have to increase, helping to spread cost burdens) but in negotiating costs with drug companies and providers.

A new Congress, and a new president, can go where this Congress and the Bush administration have feared to tread. And they must.