Wasilla resident Jack Miller's experience with Medicare illustrates how America tosses its disabled and elderly citizens into an underpowered and complicated health insurance program.

Miller, 58, is disabled. He has had three pulmonary embolisms -- a condition in which the artery to the lungs is blocked.

After 22 years in the Army and more than 10 years with the FAA, he was well covered with two different kinds of insurance -- Tricare, which he earned from Army service, and Blue Cross Blue Shield, which he paid to continue after leaving the FAA.

He was well covered until the first of November, when going onto disability status forced him onto Medicare.

Suddenly, he's worried about how long his doctors will continue to see him.

Medicare, if you have it, becomes your primary insurance and substantially undercuts any other insurance. But Medicare pays doctors much less than other health insurance -- less than half of what a doctor here might charge. The doctor is not allowed to charge the Medicare patient more than the Medicare rate, even if the patient has other insurance.

The result: Many doctors say "No, thanks" to Medicare.

Miller has relatives who work in health care. "They sat me down and tried to explain how this worked. And I couldn't believe it. I was just dumbfounded."

Especially in Alaska, there's a large gap between what Medicare will pay and what doctors say they need to maintain their practices.

That gap will remain even after Medicare raises rates for Alaska doctors in January.

With three health insurance plans, Miller has lots of insurance, yet feels like he doesn't have enough. He said he would cancel Blue Cross, but his wife won't be eligible for Medicare for four more years, so she needs it.

"I've paid my own way my entire life. I've worked and done what I need to do. And I just feel like I have my hat in my hand when I go in to see my doctor because I know he's not getting paid what he should."

Medicare is built on an unrealistic formula that attempts to control health care costs with built-in cuts to doctor payments. Congress is constantly having to rescue the senior citizen population by voting down an automatically scheduled cut and putting more money into Medicare so doctors won't cut off older, fragile patients.

Last year, Alaska's congressional delegation won a 35 percent increase in physician payments in Alaska effective in January. But that may not be enough to convince most Alaska doctors to see Medicare patients; it will still be well below what they normally charge.

Miller's case is one more example of why Medicare needs a major overhaul.

There are some good ideas for doing that.

Sen. Lisa Murkowski, R-Alaska, is co-sponsoring a law that would change the Medicare reimbursement formula to an index that reflects actual health care costs, and would give doctors more stable rates. That would be an improvement.

Sen.-elect Mark Begich, D-Alaska, says Medicare is dysfunctional in many ways -- too much paperwork, not enough co-ordination among different federal insurance programs like Medicaid and the VA system, a lack of ability to negotiate costs.

"You've got to clean up the system" before expanding it, he said.

And until Congress does that, Alaskans like Jack Miller will continue suffering from the flaws in the current Medicare system.

BOTTOM LINE: Fixing Medicare would be one big step on the road to real reforms in the nation's health insurance.

Spill checks

Due next week; make no bets

Judge H. Russel Holland might just get some 1989 Exxon Valdez oil spill lawsuit checks into the hands of the plaintiffs in time for Christmas.

The judge has ordered Exxon to disburse $151 million.

That's less than half the $383 million Exxon has already agreed to pay.

That's less than a third of the $507 million the U.S. Supreme Court set as the upper limit of damages in June.

That's 3 percent of the $5 billion the federal jury originally awarded 18 years ago.

In this case, justice delayed has been justice denied and justice decreased.

Earlier this month Holland rejected a claim by fish processor Sea Hawk Foods Inc. to reallocate the settlement. That claim further delayed payment of even the vastly reduced amount.

Exxon has agreed in principle to pay another $232 million, but it will come later.

Of course. Everything in this case has come later.

Still unresolved is the question of whether Exxon should pay interest on the $507 million approved by the Supreme Court -- and from what date to calculate that interest. Paid from the original decision in 1994, interest would be $488 million. The 9th Circuit will hear arguments in that case in December.

Think this case will be over by the time of the 20th anniversary of the spill on March 24? Neither do we.

Closure? Just put the checks in the mail. The plaintiffs will close the books as they can, on their own.

BOTTOM LINE: Small measure of justice is better than none.

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