As rumors swirl, seniors demanding answers on health reform

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As rumors swirl, seniors demanding answers on health reform

Health care bill's fate could ride on key bloc's approval

By Judith Graham and Janet Hook

Tribune Newspapers

August 12, 2009, Los Angeles Times

DENVER

-- Far from the hue and cry over health reform erupting in town hall meetings across the U.S., many older citizens are quietly confused about what a health care overhaul might mean to them.

The opinions they form in weeks ahead may well prove crucial, as seniors are a highly influential, politically active group of voters.

They bring a unique perspective to the topic: Older Americans are the only group in the country with guaranteed health care, from Medicare. They're also the heaviest users of medical services.

On a recent afternoon, a group of 80- and 90-year-olds at a 14-story retirement complex just north of downtown Denver voiced some of the same questions about health reform circulating in living rooms, retirement communities and senior centers throughout the country.

"Will it affect how quickly I can get in to see my doctors?" asked Anna Janeway, 80, a retired marriage and family counselor.

"You hear all these things about Medicare going broke if we do nothing. Where would that leave everybody?" asked Anthony Mehelich, 82, a former construction company administrator.

"Do we really have to make so many changes all at once?" asked Joseph Duffy, 90, a former accountant. "Couldn't we just take parts of the problem and solve those?"

Rep. Eliot Engel, D-N.Y., said his offices had received "hundreds of calls" from older people eager to know how they might be affected. Other members of Congress report a similar outpouring of concern.

Convincing these experienced voters of the need for change is proving to be an uphill battle. Last week, a CNN/Opinion Research Corp. poll found that a majority of voters older than 50 oppose a health care overhaul while most voters under 50 support it.

The lack of a definitive plan only adds to seniors' uncertainty. Three House committees agreed on a bill to be taken up after Congress' August recess; Senators recessed without sending a bill to the floor.

The picture could change after Congress returns. But the essential thrust of reform isn't likely to change. Gail Wilensky, who once ran Medicare as head of the Health Care Financing Administration, a federal agency that has since been renamed, said: "The major focus of reform is clearly not on seniors. It is on expanding coverage to the under-65 population."

Indeed, health coverage is not a concern for older Americans: Every U.S. citizen who turns 65 qualifies for Medicare. The government pays the bills for care provided by private doctors and hospitals, and beneficiaries contribute. .

If that sounds like a government-run health care plan, it is, although many people don't understand that. Among them are elderly constituents who Rep. Jim Tanner, D-Tenn., said have contacted him, saying, "I'm happy with Medicare, don't let the government take it over."

Congress has been careful not to meddle with Medicare essentials in the House bill. There is no attempt to limit basic services covered in the bill and no effort to ration care -- a charge raised by opponents of reform. "Nobody is talking about reducing Medicare benefits," President Barack Obama said late last month in a teleconference sponsored by AARP, which represents older Americans.

In fact, some Medicare benefits could be enhanced: Congress has said it would close a gap in coverage for prescription medications under the Medicare drug program.

Fears about rationing arise from several sources. The proposed creation of a center to study the effectiveness of medical treatments has prompted some critics to allege that results will be used to discourage or deny care not deemed effective. Supporters claim the research will help doctors and patients make better decisions.

Proposed cuts to projected Medicare expenditures also raise concerns. The House bill would help pay for reform's estimated 10-year, $1 trillion price tag by extracting about $500 billion in savings from Medicare and Medicaid, a government health program for the poor. Of that amount, about $231.4 billion would come from Medicare's budget, according to AARP.

Many seniors wonder how it's possible to cut that much without affecting medical care. The administration says there is a lot of unnecessary care being delivered -- as much as 30 percent by some accounts -- and that eliminating this will help pay for reform without compromising seniors' health. But many experts are skeptical.

Hospitals would take the biggest hit under the House's reform plan, with payment reduced $220 billion over a 10-year period. "The question for seniors is whether or not access to care will be impaired by these (provider) cuts," Wilensky said.

"I don't think that will happen," argued Henry Aaron, a health policy expert and senior fellow at the Brookings Institution. Instead, hospitals will focus on reducing administrative costs and reorganizing the delivery of care, he suggested.

Also hit will be Medicare Advantage plans, run by private insurance companies. Those plans get subsidies that would stop under the House bill, generating savings of $162 billion over 10 years.

"Insurance companies are already really profitable," Obama said in his AARP teleconference. "We shouldn't be giving them billions of dollars worth of subsidies."

Perhaps the most controversial charge raised by critics of health reform surrounds care for seniors at the end of life. The House bill for the first time would pay doctors for discussing end-of-life treatment options with patients every five years. The discussions would be voluntary. Currently, doctors aren't paid for having these discussions.

Although federal law has recognized advance directives as legitimate for years, critics have seized upon these provisions in reform legislation as leading to euthanasia or government control of older people's end-of-life decisions. Those charges are false, according to numerous organizations and a close reading of the legislative language.

"Nothing could be further from the truth," according to a statement issued Tuesday by the Association of Bioethics Program Directors, representing leading medical ethicists across the U.S.

jegraham@tribune.com