For the last half century, Americans over the age of 65 have relied on Medicare, with prescriptions covered for the last decade. Yet according to a study by the Commonwealth Fund, a private foundation promoting better health care, it's not doing them as much good as you think.

An international survey of older adults finds that seniors in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Moreover, nearly a quarter are considered "high need" — meaning they have three or more chronic conditions or require help with basic tasks of daily living.

chart of health care About 23% of American seniors with Medicare still don't get care. (Photo: Commonwealth Fund)

It's pretty shocking. The USA has the best hospitals, the best doctors, the best medical care in the world — if you have the right insurance or are very rich. But many do not, and that means by the time they reach 65 and are eligible for Medicare, more Americans have more chronic conditions than citizens of any other nation. And many of those chronic conditions like diabetes, hypertension and high blood pressure are often caused by lifestyle choices.

problems faced in countries Different countries, different problems. (Photo: Commonwealth Fund)

Seniors in different countries face different problems; Canadians, Swedes and Germans have to wait longer to get a call back from a doctor or get an appointment (though this is changing with new health care delivery programs). The Swiss have high out-of-pocket expenses, although there are apparently caps and income-based subsidies, which is why fewer people skip treatments there.

But the real shocker is that even when they get Medicare, Americans still have co-pays and limits on treatment that mean there's still a lot of expense that makes people avoid getting the treatment they need.

Despite near-universal coverage through Medicare, U.S. seniors stand out for the financial barriers they experience in getting care. Nearly one-quarter (23%) of older adults in the U.S. said that, in the past year, they had not visited a doctor when sick, had skipped a recommended test or treatment, had not filled a prescription, or had skipped medication doses because of the cost. Five percent or fewer of respondents in France, Norway, Sweden, and the U.K. reported these cost barriers.

adults with issues

Percentages of adults ages 65 and older in 11 countries who had selected health and socioeconomic characteristics, 2017 (Photo: Commonwealth Fund)

What about the boomers?

My current preoccupation is the wave of boomers who are aging rapidly, and as the study notes, "health care systems face unprecedented demographic changes, with increases in the elderly population and rising rates of chronic disease and disability." Not much is being done to prepare for this wave. But it isn't just health care; nothing is being done about housing, about food, about transportation, about loneliness. One of the authors of the study explains to MarketWatch why a quarter of Americans have such problems, and why other countries have different ones:

"That has a lot to do with the safety nets and income disparities," said Robin Osborn, lead author of the report ... "We know that poverty, food, security, unstable housing, along with things like social isolation and mental health contribute to higher rates of chronic illnesses," she said. More than 10% of respondents in France, the Netherlands, Norway and the U.K. reported living alone and said they felt "socially isolated." Loneliness is considered as much of a public health hazard as obesity.

Danger UXB Danger, unexploded bomb! (Photo: Thames TV)

Danger: An unexploded bomb might blow up Medicare

In fact, with the current tax proposals working their way through Congress, there might well be less money for Medicare when more people need it. While the tax cut proposals don't specifically affect Medicare, there's an unexploded bomb that was planted back in 2010 that will explode in a few years. The 2010 PAYGO law required that no new legislation could increase budget deficits, and the new tax law does exactly that, to the tune of $1.5 trillion. So according to the Congressional Budget Office:

Without enacting subsequent legislation to either offset that deficit increase, waive the recordation of the bill’s impact on the scorecard, or otherwise mitigate or eliminate the requirements of the PAYGO law, OMB would be required to issue a sequestration order within 15 days of the end of the session of Congress to reduce spending in fiscal year 2018 by the resultant total of $136 billion. However, the PAYGO law limits reductions to Medicare to four percentage points (or roughly $25 billion for that year), leaving about $111 billion to be sequestered from the remaining mandatory accounts.

So just as millions of boomers are entering their Medicare years, its budget could be cut by $25 billion. For many politicians who dislike entitlements, this is a feature, not a bug.

For citizens of other countries, there are going to be increasing pressures on budgets as medical expenses continue to grow, and changes in how doctors operate to rein in costs. One can complain about how awful the American health care system is, but every country is facing the inevitable truth of demographics. The British NHS, the Canadian universal health care system — you name it — they are all under pressure.

One thing residents of other countries seem to do better than Americans is ensuring that they're in better shape when they hit 65. Canadians live the same suburban drive-everywhere lifestyle and eat pretty much the same diet as Americans, yet 36 percent of American seniors have three or more chronic diseases, compared to 26 percent north of the border. The biggest difference is likely the universal access to health care and medical advice when Canadians are younger.

Perhaps some of that advice is what we've noted repeatedly on this site: Get out and exercise, walk instead of drive and fix your diet. In short, take care of yourself, because the only thing we can be sure of is that if you don’t, nobody else will.

Lloyd Alter ( @lloydalter ) writes about smart (and dumb) tech with a side of design and a dash of boomer angst.