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A Basis Is Seen for Some Health Plan Fears among the Elderly
By Robert Pear, NY Times.com
August 20, 2009
White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods. But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational.
Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient.
President Obama has sold health care legislation to Congress and the country as a way to slow the growth of federal health spending, no less than as a way to regulate the insurance market and cover the uninsured.
Mr. Obama has also said Medicare and private insurers could improve care and save money by following advice from a new federal panel of medical experts on “what treatments work best.”
The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life.
“I don’t think we will get the quality of health care with this plan that we get now,” said James T. Aronis, 79, of Wichita, Kan.
But the House version of the legislation would help older Americans with their drug costs. It would eliminate co-payments for screenings and preventive services, and it could improve the coordination of care they receive from different doctors.
A new survey, released Thursday by the Kaiser Family Foundation, found that 34 percent of people 65 and older believed they would be worse off “if the president and Congress passed health care reform,” while 23 percent said they would be better off.
Carol H. Carter, a spokeswoman for LIFE Senior Services in Tulsa, Okla., a nonprofit group, said she and her colleagues had been deluged with questions from Medicare beneficiaries.
Much of the concern results from “fear of the unknown,” Ms. Carter said, adding: “Getting specific information about the proposals and what they mean is really hard. Seniors don’t trust the government to carry it off.”
In an interview, Mr. Aronis explained his reasons for concern. “I had prostate cancer,” he said. “My doctor removed it immediately, one day after getting the results of a biopsy. That probably would not happen under the new health plan.”
In the poll, among those 65 and older, 62 percent said they were confused by the debate in Washington, compared with 43 percent of those under 65.
Mark D. Eaton, a 59-year-old AARP member in Lancaster, Mass., said: “Medicare might stay the same. But by the time you provide insurance to millions and millions and millions of people, we will be out of money, and we’ll be out of doctors.”
An independent federal panel, the Medicare Payment Advisory Commission, conducts annual surveys of beneficiaries and says they generally have good access to care. But, it said, some beneficiaries have difficulty finding new doctors, especially primary care physicians, and blacks and Hispanics are more likely than whites to report problems.
Mr. Obama has repeatedly said, “Nobody is talking about cutting Medicare benefits.” At the same time, he wants to eliminate what he describes as “unwarranted subsidies” and giveaways to private Medicare Advantage plans, which use some of the money to provide extra benefits.
More than one-fifth of the 45 million Medicare beneficiaries are in Medicare Advantage plans operated by insurance companies like Aetna, Humana and UnitedHealth. The House bill would cut payments to private plans by more than $160 billion over 10 years. Mr. Obama says those payments “boost insurance company profits, but don’t make you any healthier.”
In the past, insurers reacted to such cuts by increasing premiums, reducing benefits or pulling out of the Medicare market, and beneficiaries complained loudly.
Knowing that Medicare itself faces a financial crisis, many older Americans object to Congress’s tapping the program to help pay for coverage of the uninsured. They say they do not believe that all the Medicare savings will come from eliminating waste and inefficiency, as Mr. Obama says.
“Medicare is nearly broke,” said James P. Ivey, 66, of Deer Park, Wis. Mr. Ivey predicted its financial problems would grow as the ratio of beneficiaries to workers increased in coming years.
In effect, Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries. Many doctors are dubious.
Medicare officials recently proposed changes that could increase payments for some primary care services but reduce payments to many specialists. Cardiologists would be especially hard hit, with cuts of more than 20 percent in payments for electrocardiograms and 12 percent for heart stent procedures.
“Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients,” said Dr. John C. Lewin, chief executive of the American College of Cardiology.
Mr. Obama has been unable to dispel the concerns of older Americans because the health care bills in Congress are long, complex and evolving.
Moreover, if a bill becomes law, no one can say for sure how it may be applied or extended. The 1965 law that created Medicare prohibited “any federal interference” in “the practice of medicine or the manner in which medical services are provided,” or in the operation of any institution providing health care.
Sara Rosenbaum, a professor of health law and policy at George Washington University, called this “a majestic message from Congress about how it expected the Medicare program to be run.”
But the meaning of that guarantee has shrunk as Medicare officials and Congress have set more detailed standards for doctors, hospitals, nursing homes and others in Medicare.
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