Opponents of health reform have targeted seniors with a blunt message: You will be big losers if “Obama-care” is enacted. In the words of Republican National Committee Chairman Michael Steele: “Senior citizens will pay a steeper price and will have their treatment options reduced or rationed.”
Scary words. But, in truth, seniors are likely to be big winners if responsible health reform passes and prime victims if it fails. The casualties will not only be today’s elders, but the Baby Boomers, who are the next generation of seniors. They will all pay the price if the existing health system is allowed to fester.
It is true that, today, seniors have a pretty good deal; nearly all those over 65 already have insurance through Medicare--a government program. Seniors and younger people with disabilities who are both very poor and unable to care for themselves are also eligible for long-term care benefits through Medicaid, which is run jointly by the federal government and the states.
So if seniors already have coverage, don’t they have everything to lose from change? Isn’t cost control just a fancy euphemism for cutting benefits? And what about those bureaucrats deciding who gets care and who doesn’t?
These claims are both irresponsible and wrong. But their biggest flaw is that they ignore the real problem: Without fundamental changes, Medicare and Medicaid are unsustainable. Like a poorly-built house that has gone too long without repairs, they will soon collapse without major renovations. And seniors will face both massive tax hikes and huge increases in their monthly insurance premiums.
To understand why, remember that Medicaid and Medicare Part A hospital insurance are funded with tax revenues. Medicare Part B coverage for doctor visits and Part D drug coverage are financed through a combination of taxes and premiums. Many seniors also pay extra for Medicare Supplement (Medigap) insurance.
In just 10 years, according to the Medicare trustees, Part B premiums are expected to increase from about $96-a-month to more than $130, while Part D premiums will rise to $50. Add a few hundred dollars more each month for Medigap coverage and many seniors will be spending $5,000 annually on Medicare. Higher income seniors will pay far more—as much as $420-a-month for Part B alone. That is the future seniors face if we do nothing.
The pressure on taxes will be even greater. In a decade, nearly 30 cents of every federal tax dollar will go to Medicare and Medicaid. By 2035, these two programs will spend more than 40 percent of our taxes. That means we’ll need huge tax hikes to pay for these programs and keep the rest of the government running,
What about rationing? Medicare already decides what to cover. Nobody seriously expects it to pay for any treatment a patient wants. It also rations by deciding how it pays physicians and hospitals. For instance, because doctors are paid more for tests than office visits, patients get more MRIs and less face time with their physicians.
Health reform is not about choosing between rationing or not. Rather, it is about whether we will continue to spend health dollars in the crazy way we do now, or find a better way. Done right, it can mean less treatment but better health.
One example: Critics of reform call “comparative effectiveness research” a backdoor trick to deny care for the frail elderly. They are wrong. Done well, it can improve care at less cost. Today we know very little about how medications affect seniors. As a result, they often get too many drugs that can make them ill, or even kill them. Wouldn’t it be nice to have a research program to tell us what drugs work best for the elderly?
How about Medicaid? Today, because the program is required to pay only for nursing home care, beneficiaries are more likely to get their assistance in a facility than at home. But health reform could give consumers more choice. Instead of a government bureaucrat saying you must move into a nursing home to get benefits, seniors would have more opportunity to decide where they want to live. It is hard to see how that makes them worse off.
Critics are right to say that poorly-designed changes could put seniors’ health at risk. But with well-structured reforms, seniors would get better medical and long-term term care, and get it in a way they and the nation can afford. That’s why they, as much as anyone, should be supporting health reform.
Howard Gleckman, a senior research associate at the Urban Institute, is author of Caring For Our Parents and a frequent writer and speaker on long-term care issues