So, about your colonoscopy: did you need to make a copayment? My knee replacement was painful in more ways than one – make sure you have enough gap cover or you’ll end up needing a second mortgage – and try securing one at our age. I have to wait until next year for my cataract operation; I ran out of cover in July.
Welcome to baby boomer conversation 2025. We used to chat about racy things and the mundane delights of life: travel, frown-free Botox, advanced-for-their-age grandchildren. Now we discuss top-of-mind topics: lumbago, osteoporosis, body part replacements, arthritis, hearing impairment…
A friend calls this the organ recital. Yup. It’s got so bad that some set a time limit to go through “the list” before turning to more riveting subjects like electricity, water and the shocking state of the world.
It’s that time of year when Johannesburg turns jacaranda-purple (or mauve, violet, lavender, indigo, plum, grape – AI says there are 21 colours of jacaranda) and talk turns to health insurance. It’s now that medical schemes ask you to decide which plan you want for the next year – the rule being that switching to another plan in your current scheme or to a different scheme is only allowed in the last quarter of the year, so that whatever changes you implement take effect in the new year.
Medical scheme chatter happens a lot between September and the end of November, factoring in that South Africa goes into holiday mode in December.
As an aside: I am talking about people who, like me, pay taxes (i.e. the currently or recently employed) and buy private healthcare, and not the vast majority of South Africans, who rely on an increasingly defunct public healthcare system where corruption and large-scale theft are endemic.
Medical schemes. A truly loaded topic when discussed with my friends. Many are able to buy much more expensive cover than me, which brings out my green-eyed monster: I have health cover envy. There’s a sentence I never thought I’d write.
In recent years I have changed plans, reducing my benefits dramatically to suit my pocket. When I was employed and my contribution was subsidised, I could afford the executive option, which meant I was covered to the hilt. The irony is that I was young and healthy and didn’t really need or use the benefits of that padded package.
Now, by the end of the first quarter, I’m usually out of medical savings. Humph.
What health coverage is available and how much it costs becomes more important as the years go by. I’ve learnt, for example, that there is no one-price-covers-all medical scheme solution – even for treatment of the same ailments, surgery, scans, scopes or routine pre-checks.
(A financial wizard actuary friend has admitted to not understanding the inner workings of medical schemes, and says he is as flummoxed by the multitude of options and payment schemes. So, what hope does the average person have of making sense of it all, eh?)
An industry survey of the five biggest medical schemes reports that the cost of benefit coverage ranges from under (a completely inadequate) R1,000 to more than R18,000 per month. Of course, this depends on the plan you select, which is determined by your personal circumstances (read level of impecuniousness) and health needs. Erm… ignore the second point and go back to affordability. Older people automatically need more health coverage because they have more maladies, aches, pains, illnesses… Joints wear out, eyesight dims, diseases strike with more regularity. It’s the way life runs.
That said, older people are healthier now than their parents were and many of today’s younger generation may well live to see 100 (heaven forbid!).
A recent International Monetary Fund report found that, in some advanced economies, today’s 70-year-olds have, on average, the same average cognitive ability as 53-year-olds did in 2000 because of improvements in health, including physical and cognitive capacity. And they have increased longevity. All round, older people are “ageing better” and can be more active in the workforce for much, much longer. (Though many are not, which is a topic for another column.)
Growing old “better” is a good thing and apparently not a good thing, all in the same space. Ageing membership profiles and a greater proportion of over-65s could herald future medical scheme contribution increases well over inflation, according to our financial gurus. We know that young people and old people pay the same contributions depending on the scheme they choose, which means the young supplement the needs of the old.
But we are told that young people are increasingly doing without medical scheme cover in the gig economy because, as independent contractors, they are not entitled to traditional employment benefits. And when you’re young and fit and healthy, you don’t factor in your future old self. Why would you?
The result is that young people, who make up a significant portion of the gig workforce, are disproportionately affected and the lack of these benefits creates a “protection gap”, increasing their vulnerability to health-related financial ruin.
Which brings me to the point I want to make. The astronomical cost of healthcare. It’s not just a South African thing. Global healthcare costs are rising because of ageing populations, increased demand and advancements in medical technology.
Apparently, this trend is known as medical inflation, where the cost of healthcare services and products grows faster than general inflation. Experts say it makes healthcare less affordable for both individuals and governments.
Is AI the solution? When I was in New York in September, I had lunch with a niece who is employed by a pharmaceutical conglomerate, which also partners with a medical health insurance company. As president of ethical AI, her job is to ensure that there is no hidden bias in the algorithms that militate against users of the scheme. For example, people might find they are prejudiced if they have a certain income level, are single, or live in a specific neighbourhood.
I did not understand a lot of what she said, but the gist of it is that we will, in the very near future, have to rely on technology instead of real-life health practitioners. Why? Because medicine, both the practice and dissemination of it, is becoming prohibitively expensive. It’s no exaggeration to use the words “eye-wateringly costly”, she said. I know.
And so we will depend more and more (many already do) on our cellphones to read our heart rate, record our blood pressure, tell us when we need insulin or other medication, and so on. Next, AI will diagnose our symptoms and prescribe a course of action we should take.
Groan. All I can say is that I’m glad I’m old and I’ll soon be dead – though, if the stats are anything to go by, I’ll probably last for a while longer. I’m in rude good health and likely to continue to be – what with a combo of modern medicine and technology getting better every day.
What is sad is that those same figures indicate that my remaining years will be plagued by penury with a large chunk of my pension going towards my rocketing medical costs. You just can’t win. DM
This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.
