HEARING - U.S. Senate Special Committee on Aging

44
Senator HEINZ. So things are working well when they are being
paid for; when they are not being paid for, they. are not working
well.
Mr. SHAPLAND. That is right.
Senator HEINZ. We could have figured that one out.
Mr. SHAPLAND. The statement was limited, and maybe it was not
clear, and I apologize if it was not clear. The statement was meant.
to convey that within the field of the items covered by Medicare,
Medicare leaves some catastrophic gaps within its own field of coverage.
There are lots of things it does not cover, but within the
fields that it does cover, Medicare has some gaps, and those gaps
have been closed by the private insurance industry and Medicaid
and so on-and which I can explain.
Senator HEINZ. And-if the Chairman will allow me--
Chairman MELCHER. Yes, certainly.
Senator HEINZ [continuing]. You are saying that you feel, after
having listened to the testimony of the first two witnesses, both of
whom had "catastrophic coverage" and who clearly had serious
problems, you believe that catastrophic. coverage needs are being
met by the private insurance they describe?
Mr. SHAPLAND. No, that is not what I said, sir.
Senator HEINZ. Well, I am just unclear as to what you are
saying.
Mr. SHAPLAND. OK, I will try to explain it.
Senator HFINZ. I guess what you are saying is--
Mr. SHAPLAND. I think you are asking a good question. I think
you are asking a very intelligent, good question.
Senator HEINZ. But I do not understand your answer.
Mr. SHAPLAND. So I will try to rephrase it so I can answer it.
Within those types of coverage covered by Medicare, which is a
limited laundry list that does not cover drugs, does not cover eye
care, does not cover nursing care, aside from those items--
Senator HEINZ. It does not cover prescription drugs, which cost
one of our witness $90 a month.
Mr. SHAPLAND. Absolutely, that is right.
Senator HEINZ. It does not cover doctor bills over and above
those that Medicare will pay.
Mr. SHAPLAND. That is right, that is right.
Senator HEINZ. I mean, we are not talking about long-term care.
We are talking about the catastrophic nature of a ~whole bunch of
little things adding up to a huge burden that will break the camel's
back.
Mr. SHAPLAND. We are all agreeing. It might not sound like we
are agreeing.
Senator HEINZ. No, we are not. When you say you are agreeing--
Mr. SHAPLAND. No. You think we are not agreeing, but I want to
explain that we really are agreeing. The insurance industry knows
that all those things you mentioned need to be dealt with. And we
do not ever intend to say-even though a statement there might
have implied it, we did not mean to imply it. The insurance industry
says all of those problems you just mentioned exist; they are
not being taken care of by the Government or the private insurance
industry. Now are we in agreement?