Post-Election Woes
ELDER MUSIC: Some Classical Things

GRAY MATTERS: Misunderstanding Medicare

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

I read somewhere that the White House and congressional offices have been besieged by phone calls and emails from older people complaining at the news that, for the second consecutive year, there won’t be a cost of living increase in Social Security benefits.

I don’t take issue with those complaints, for most of us know that the cost of living has gone up measurably, especially for people who depend on those Social Security payments. But what caught my attention and disappointed me was the news that some seniors “erroneously believe it is the Congress and the White House that are denying them raises.”

It seems to me that people who are on Social Security ought to know enough about their most important federal program to understand that the Cost of Living Adjustment (COLA) is based on the rate of inflation measured by the Bureau of Labor Statistics in the Consumer Price Index for workers, called the CPI-W.

Some experts want to substitute the CPI-E (for experimental) which would be closer to the reality for elders, but that’s another subject.

My point is that most of us ought to know that neither the Congress nor the White House is responsible for the freeze; indeed, many congressional Democrats have been pushing for a one time payment of $250 for everyone on Social Security.

If that doesn’t happen in the lame duck Congress because of the coming changes in power, those deluded seniors who voted for Republicans because they were angry over the COLA will get what the rest of us don’t deserve – cuts in Social Security benefits or maybe an attempt at privatization.

Similarly, if the polling was accurate, millions of older voters who should have known better were suckered into falling for the ads of the phony right wing senior group, 60 Plus, the Republicans who all voted against health reform, the U.S. Chamber of Commerce and, of course, the health insurance lobby, and believing that the reforms will cut more than $500 billion from your Medicare over the next decade. They were wrong.

One of the best health care reporters, Trudy Lieberman, of the Columbia Journalism Review, put the so-called Medicare cuts in perspective on November 1:

“The health reform law cuts the growth in Medicare spending by $533 billion. Some might like to call that a saving [as President Obama has done] because Medicare might not be spending as much as it otherwise would, but the term can be confusing.

“But the law also adds $105 billion in new spending for more coverage for seniors who have very high drug expenses and the elimination of copayments for preventive services. The net reduction in Medicare spending is $428 billion over ten years...

“About 40 percent of these cuts come from cuts in payments to hospitals and other providers, except doctors. That money will be used to subsidize insurance policies for the uninsured.

“Another 25 percent comes from reductions in the overpayments to Medicare Advantage plans,” which cost nine percent more than Medicare spends per beneficiary.

“Phasing out the overpayments,” Lieberman continues, “will also hold down increases in Part B premiums...While cuts to MA plans may be unpopular with those who have them, they do strengthen Medicare for everyone.”

So, why will we haggle over the price of meat or an oil change, but we will believe the very people who voted against health reform and have promised to kill the best parts of the bill that passed? How come older Americans confused over the health care selfishly voted to put Medicare itself in danger?

Democratic pollster Celinda Lake said the right wing propaganda campaign was working in the mid-term elections.

“The biggest problem Democrats have with the health care bill,” she said,“ is the dislike of the bill by senior citizens, who have been scared to death about it.”

Judith Stein, who runs the Center for Medicare Advocacy, said of the ad campaign,

“It’s a way to get seniors to vote against those who supported health reform.”

President Obama shares some of the blame when he helped sell the reforms by emphasizing that they would “save” more than $500 billion in Medicare. The so-called savings strengthened Medicare. But because the reforms were themselves complex, what got lost in translation were at least two facts: the savings extended the life of the Medicare Hospital Insurance Trust Fund, and cut only some of the overpayments to private insurance companies that sell Medicare Advantage coverage. Those policies are not good for traditional Medicare.

Let’s recall that such policies were instituted by Republicans under Newt Gingrich in 1995 to wean seniors away from, and undermine, traditional Medicare in favor of HMOs and PPOs. Fifteen years later, only 25 percent of seniors have such insurance and under the reforms, they would not have lost their coverage.

The federal government has spent billions of Medicare dollars to subsidize that 25 percent. But these short-sighted Medicare beneficiaries were willing to privatize their Medicare. Some beneficiaries even declared during town meetings that “government should stay out of Medicare,” an obvious oxymoron since the government runs Medicare.

Now they may get their wish for they’ve opened the door to a new Republican effort to get the government out of Medicare. One coming proposal would substitute your Medicare benefits for vouchers, which beneficiaries would use to buy coverage from insurance companies.

To allay fear of change, none of the MA companies, under the law, are permitted to reduce Medicare benefits. But most were remaining in business despite the cutbacks in federal subsidies.

In any case, as Stein points out, nothing in the law could reduce Medicare’s benefits; indeed, they were expanded with the savings able to pay the full cost (no more co-pays) of yearly physical exams, preventive services such as mammograms, colonoscopies, prostate tests, flu shots and vaccinations.

Republicans, who will be in control of the House come January, have vowed to kill many of the health care reforms perhaps by starving the reforms of funds. And they want to hold hearings to grill Health and Human Services Secretary Kathleen Sibelius and the head of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick.

But some of the reforms, like the free preventive services and coverage for children and adults with pre-existing conditions, may be too popular for Republicans to attack. In addition, the Democratic Senate can, in a turnabout, block the excesses of the right-wing House. And President Obama can use the power of the veto, if he hangs tough.

Sadly, though, nothing new for seniors - like long term care - will get done in this reactionary, penurious new Congress.

Lieberman concluded in the Columbia Journalism Review:

“Most people, especially those on Medicare, have never really understood how the program works. That made it easier for each side to get away with advertising flim-flam.”

I wonder if those older people have learned enough to protect not only Medicare, but the Republicans’ favorite target – Social Security.

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I realize that I am being naieve, but I am constantly amazed at the absoute ignorance of the American public. That goes double for the Elders who voted against their own best interests. You would think that age brings wisdom. Sadly, this is rarely the case.

What Darlene said!!!

That *anyone* is against social security tells me they are plain damned stupid. I am embarassed by the old fools railing against Medicare on their Medicare- paid scooters this proving that old adage: "There's no fool like an old fool."

Darlene and Kay--you are so right! When I heard older Americans with those silly tea bags hanging from their hats railing against healthcare reform and with their next breath yelling hands off my (government operated) Medicare, I could hardly believe what I was hearing. Who do they THINK paid for those scooters anyway--the Scooter Fairy?

Saul, great column, once again! I know that neither Congress nor the President control SS cost-of-living adjustments, and I thought that most older people were aware of that. I should know better by now, but I'm still consistently astonished by people and what they THINK they know vs. the facts.

Flabbergasted by how much people don't know about SS & Medicare. When I tell people that LBJ had a heckuva' time passing medicare & how the drs. (I worked with) were all vehemently against it, they look sceptical! Also I believe that it took FDR at least 3 years to get SS accepted & passed. Indeed the enemy is us! Dee

Great thoughts, Saul. I've posted a link to the column at my blog. Most seniors do not have the media literacy skill to navigate through the fearful advertisements and evaluate election media that appear on their television sets.

I am 75 years old and I say the hell with social security. I paid into social security for 60years of my life and now I don't get one penny from them. Why? Because as an educator I paid into my own private retirement fund. So don't tell me I am a fool because I do not believe in social security. Who can call anyone a fool? Only another greater damn fool. Posted by Nellie Montoya Monday. 08 November 2010 at 3:45 PM

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