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Why Do Elders Oppose Health Care Reform?

HEALTH CARE ESSAYS: When I listed links to everyone's health care reform essays on 20 August, somehow Pete Sampson's got lost. His topic, in a very personal story, is end-of-life consultation. You can read it at his blog, As I Was Saying.


category_bug_politics.gif It has been around no more than a month and already it's a tired, old joke: “No socialized medicine and keep your hands off my Medicare.” Except that it is all too true. In every poll, people 65 and older – those who have Medicare – oppose similar health care for everyone else by about two to one. What could the reason be?

The “death panel” explanation has been pretty well put to bed now, and if anyone still believes Medicare benefits will be cut, they are operating on mental fumes.

In major stories on Sunday, two journalists addressed the question - Matt Bai in the magazine of The New York Times and Ezra Klein on the Opinion page of the Washington Post. I hoped, when I dived into the newspapers yesterday, that these two journalists might have an answer for me. Both disappointed.

Mr. Bai attributes elders' disinclination to support health care reform to political ideology:

“[A] 70-year-old American today, born in 1939, probably has no personal memory of F.D.R., but he would have lived through the pain of disappearing manufacturing jobs and family farms, and the rapid deterioration of urban neighborhoods and schools, conditions unabated by government experiments in welfare and public housing.

“For these new senior citizens, even the Social Security and Medicare on which they often rely may be viewed less as instruments of beneficent government than as a partial repayment for decades of taxes.”

Mr. Klein, noting the “incoherence” of elders on this issue, agreed with Bai that today's elders are Reagan conservatives, not FDR liberals, but disagrees with me that everyone, by now, should be disabused of the propaganda that Medicare benefits will be cut to pay for health care reform:

“From the beginning, Medicare has been named as one of the potential sources of savings that would fund subsidies for the uninsured. That sounds like service cuts, even if the specific changes don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program).

“So the fear is not of a welfare state but of changes in their welfare state.”

From placards and yelps at August's town hall meetings, that last statement appears to be so, but Messrs. Bai and Klein have no more hard information as to elders' reasons than I do. We're all three guessing.

One of my guesses is that the Reagan conservative argument is suspect. I'm only 18 months shy of Mr. Bai's mythical 70-year-old and like the majority of people I've known in my age group, my mother, who came of age during the Depression, put the fear of god into me about it. Even if, like my mother, they didn't like FDR or his policies, they grudgingly respected his efforts.

Elders are the only age demographic that President Obama did not win in the 2008 election. Mr. Bai in the Times (and others elsewhere) suggest that racial prejudice is in play with the generation who grew up in a still segregated U.S. It pains me to think that a majority (27 or 28 million of the 35 million 65 and older population) of old people haven't come around in the 45 years since the Civil Rights Act of 1964.

Even if they have not, wouldn't the fact that some reasonably large number of those elders have adult children - and a grandchild or two without health coverage - change their minds? Wouldn't they set aside their less charitable leanings for the betterment of their families' health?

Or, more greedily, wouldn't they support reform to guarantee the continued existence of their own health care program?

Projections tell us that if nothing is done to reform the health care system in the U.S., Medicare will run out of money in just eight years. Within a decade, it is said, health care costs will be three or four times what they are today if nothing is done. Congress knows that elders vote in much larger numbers than young people. All of the House and one-third of the Senate are up for re-election next year so they will pander to the old-age crowd, and if elders hang on to their fear or dislike of reform, that scares the hell out of me.

The only reasons on the table for so many elders' opposition to reform are political doctrine, greed and bigotry. Is it really that or are we missing something? What do you think? And what can be done to change elders' minds?

At The Elder Storytelling Place today, Lyn Burnstine: The Bird Parade

Comments

My opinion on why some elders object to this change in the American healthcare regime is simply because it is change. Not all change is bad, but I suspect that for many elders today, it has been mostly bad, starting with the Depression, moving through several wars, and the ups and downs of the economy about which one can do absolutely nothing. Government seems to have some power in all of these changes, but it never seems to get it right, the common person always seems to get it where it hurts. Why would this change be any different?

One of the big changes in getting old is losing control and power. More and more one is at the mercy of others due to increasing frailty or simply due to losing employment (aka retirement). One's opinion counts less, younger people seem to have taken over. Change becomes more to be afraid of simply due to the sense of having lost any power to control it. Doesn't matter how much others tell us that the change will be good for us, yeah right, and they say that about going into a nursing home too!

Not saying this is right or that I subscribe to this view, but I think it is understandable that over time one might come to distrust government bearing gifts. What the heck is up their sleeves anyways? Maybe they do have our best interests in mind, but experience seems to indicate otherwise.

I think Annie is at least 75% correct. Maybe more. It's certainly been my experience in interacting with elders that they resist change without reason. They can't give me a coherent reason for their opposition to health care reform. The other 24.8% are Reaganites and don't need a reason to oppose changes to our health care system.

The .2%? That's a small group that includes me and we embrace change because nothing can remain static. And change allows us to make corrections to what we have done wrong...it's the ultimate 'do-over'...

(I'm 69 and blessed by being born into a thoroughly liberal family that demanded that we be free thinkers)

I agree with the comments above. That said, I wish to reiterate that unless we move forward and make our voices heard, we will not have the best options for health care moving forward.

The Republicans and conservative right wing Democrats are out in force to defeat healthcare reform. ALL of us will suffer. All of us.

I do think when the administration and Democrats began by saying they would decrease what Medicare paid to hospitals and doctors it was a red flag to some elders. Already Medicare recipients know that not all doctors will take them on because the payments aren't what they want to accept. I think they feared this would add to it. It is a selfish concern and if they were more informed, they would know Medicare is at risk anyway unless health costs are reined in.

The big thing that has to happen and what I don't see enough from Obama (given his deals with pharmaceuticals and continuing to block buying prescription drugs from out of the country) is that he hasn't addressed enough of this need to bring down prices.
This is because he and Democrats want money from those industries to run their campaigns in 2010 and 2012.

Basically this goes to our corrupted funding system for political candidates. It gives those who want to profit more power than those who want to do right. Obama, considering how he got elected, the promises he ran on, could have done differently but he wanted to play with the powers already in place (including those in Congress). I don't know if he will change his stance now but it has cost a lot of faith in his ability to do anything except make more profits for the big medical corporate interests. That doesn't reassure anyone who is paying attention.

I think also an hysteria has set in among the elderly who are in communities. I saw an article on how they laid the label of Hitler onto Obama and it was about the reasoning of those who are going to tea parties and these town halls with such signs. They get all their news from Fox and right wing media players like Limbaugh and Glenn Beck. They literally do not trust anything but that group. We have never had such a lousy time for real information to be out there equal to the lies. It won't just impact health care if we don't get a handle on it.

Call me an alarmist, but if this works, I see it ruining our entire system of education, environment, all of it. It's a corrupted, immoral and very selfish viewpoint that about half this country is listening to and following. It is profiting a narrow sector but they are using many others to make it work, people who end up voting and operating against their own best interests based on this hysteria. It scares me a lot for where we might head. Very weird times. Very weird.

We definitely need our voices heard. While watching a program on CNN yesterday there was a crawler on the bottom that stated "Hatch (Orin, and Ted Kennedy's good friend)believes public option will not pass the Senate"

In general, I think there is more wisdom about what is going on for elders in the comments above than in all the "data" I've been reading about the health care struggle. Opponents of reform have unleashed a whole bevy of contradictory fears. Like everyone else, elders are sometimes prey to fear when hope would get us closer to where we'd like to go.

Newsweek has a terrific article on the unleashing of fears in this controversy that we'd all benefit from reading. Just a snippet that, perhaps, particularly pertains to elders:

The power of "death panels" as a phrase and a scare tactic also works because Americans are deeply uncomfortable with death. We don't like to think about it or talk about it, says bioethicist Tom Murray, president of the Hastings Center. Only 29 percent of us have a living will. As a result of that discomfort, reminding people of death sends them off the deep end, into the part of the neuronal pool where reason cowers behind existential terror.

Having spent the weekend trying to be present to a friend of my own age whose son (35) died Saturday of pancreatic cancer while the living faced insane bills, I'm in a mood to demand of folks that we face our fears. This is no game.

Oh -- and one more: check out Nicholas Kristoff's column today.

Have you read the cover issue in the current Atlantic Monthly? I'll still be at the pro-reform vigil in Seattle on Wednesday evening, but author David Goldhill's arguments concern me. Chiefly this: the current "customer" of our health system is the insurance industry; thus there is no incentive at the consumer level for reasonable pricing -- somebody else pays. Universal health insurance simply expands this. From 2000 to 2005, per capita health care spending in UK, Canada, France grew at rates comparable to the US's 40%; bureaucratic control is insufficient to stop it. Goldhill proposes universal health care based on health savings accounts, funded where necessary by government funds, because this would reestablish accountability between patient and doctor/hospital. His good example: Lasik surgery is so cheap, because a true supply-demand relationship exists for this procedure that insurance does not cover.
Still, we have to do SOMETHING!

I have a friend who takes me to the grocery store and I was complaining to him that I was ashamed of my peer group. Elders are very inconsiderate, leaving their carts in the aisle so you can't pass, glaring at you if you dare to politely ask them to move, etc. He said he thought it was a feeling of entitlement. I think he's right. I think elders like the status quo because "they have theirs". They are afraid that any change will somehow hurt them.

The media is shameful in their lack of coverage on what will happen if we don't make changes.

I think we should take a page from the playbook of the right-wing and start scaring the stuffing out of elders on the fact that at the current rate their medicare is in danger if we don't reform health care.

To go along with what many of you are saying in the comments today, I just ran across a story in The Nation by Patricia J. Williams. A quote:

"...if you listen as though deciphering pig Latin and realize that this demographic is speaking from a well-managed, near-hypnotic looking-glass world where every word from the mouth of a Democrat (or a liberal, or a Latina, or a Canadian) is a lie, a betrayal... then it all makes sense. Their world truly has been turned inside out, by the election, by the economy, by the precarious conditions that threaten us all. But for those whose sense of identity has been premised on a raced, masculinist, conservative Christian hierarchy of American power, the world must seem even more emotionally terrifying than any actual facts would indicate."

You can read more here.

I have an adult (39) son who is without health insurance and is also several hundred thousands of dollars in debt because of a series of botched spinal surgeries. I am for universal health care for this and many other reasons. Despite that, I wonder if the dream of health care for all actually gets accomplished, where are the medical personnel who will provide services for the over forty million new health care recipients. How is this potential problem being addressed?

Mary Davies' comment inspired me to respond. I support the public insurance option because it gives us some alternative to for-profit insurance companies. However, what's gone unsaid is this: Nobody needs health insurance; what we need is health *care*.

What I'd like to see is some discussion of clinics/health care centers/hospitals run and staffed by government employees that somehow--don't know how--cut out insurance altogether. Insurance seems to be a middleman that drives up prices. I don't even know how this would work, but we manage to educate millions of kids via tax-funded schools. (Yes, I know many are lousy - but many are great.)

Or else eliminate all but catastrophic insurance coverage. Make it legal to buy drugs in other countries for resale here, with no insurance subsidizing the payment for medication. Lose drug advertising. Do *anything* that hacks away at the insurance companies.

Hi Ronnie . . Can't add much to the comments made by Annie and Rain. Yes, since it's founding our Government has slowly gained control over our lives, and American citizens have slowly given up some of our independence. I suspect this is a tendency all government structures suffer from, and I don't think it's necessarily a bad thing.

Could the resistance to Mr. Obama's incompetantly drawn and overwhelmingly confusing plan be simplified.

1. Americans resent having any monster government program forced upon them.

2. Americans resent the apparently uncontrolled cost of this huge program.

The people I know agree that our medical care insurance does not cover everyone that it should. They know that Medicare and Medicaid are great programs but flawed because they are unsustainable. If Mr. Obama's concept does get voted up, will it just become another unsustainable polical mess?

Dixon

Older generations have a higher percentage of whites than younger generations; and whites are more likely to be Republican regardless of their age. It could be as simple as that.

I agree that reluctance for change and the fear-mongering on issues contribute mightily to those whose views oppose universal health care. Also, I think there is a touch of racism for some and a clearly stated desire to see our current leadership fail. I'm appalled by the number of people who see Fox as a viable accurate impartial source of news. I'm almost ridiculed at times when I try to rationally and logically demonstrate concrete examples of how warped their alleged fact presentations often are.

I think it's strangely ironic that at a time when technologies provide us so much capability for instant circulation of information that sources are diffused and diluted with viability and credibility so difficult to discern. I guess I shouldn't be surprised as I watched the overall quality of the broadcast media deteriorate when we gained more providers years ago -- quantity of choices increased but overall quality disintegrated. Likewise news productions became even more commercialized and entertainmentized. The public seems not to think, having acquiesced to eating the pablum of the masses -- "let them eat cake" -- and is obsessed with celebrity. There is such a thing as too much of a good thing -- more is not always better.

As for your question about how to change elders minds, that is the challenge -- especially if so many are raging and shouting, not listening or sincerely desirous of seeking reasoned discourse.

We must continue to speak one to one, pursue expressing facts in any forum possible, recruit media if possible for fair presentation of both sides of issues. Dare I suggest pressure on those who represent us in D.C. via all means? Repeated exposure need to continue in every way possible of the sources of our Reps. and Senators political donations and the like.

Change.

Inevitable as day and night
As inescapable as death.
Resisted by many - regardless of age.
Hated by some like age itself.

Some say life itself is change.
Others hope it won't happen to them

"...what's gone unsaid is this: Nobody needs health insurance; what we need is health *care*."

PM put a finger on an important issue. Many of us lived "in the olden days" without health insurance...but...we got health care. In 1955, a dentist asked me if $10 was more than I, a struggling college student, could afford to pay him for having dug out an impacted wisdom tooth. In 1959, an OB/GYN worked with me to determine the "fair" amount that I should pay him for pre-natal/delivery of our first child. We didn't have a stinkin' insurance company to deal with. And that was good!

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