New York Times on the new health care deal...

[candyman]

A Basis Is Seen for Some Health Plan Fears Among the Elderly

WASHINGTON — 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.

[Reaper]

Here is State Representative Mike Rogers from Michigan and his take on the current health care bill.

http://www.youtube.com/watch_popup?v=G44NCvNDLfc

Edited August 30, 2009 by Reaper

[peelingchrome]

Just tossing my two cents into the mix, here.

We do not need health care reform. There is nothing wrong with our system, relative to other countries. I say this because our national life expectancy has hit an all-time high ( NYTimes) and, when removing traffic accidents and homicides from the data, America has the highest life expectancy in the world ( this table).

In short, we're living longer and (controlling for asshats and idiots) we're number 1 IN THE WORLD. Um, why do we need health care reform? WTF?

[StormKnight (1)]

Worsening infant mortality rate among developed nations is one. Keeping mother healthy during and after pregnancy are key (healthy/durable moms=healthy/durable babies.) Access to neonatal/pediatric care is another issue, both availability of pediatrics and cost of pediatrics. I suspect a lot of kids/mothers fall in the "too well off for Medicare/Medicaid, too poor for private insurance," group.

Also, look at the time when the oldest people in the nation grew up and where for the most part. Most were still farmers, doing physical work during during the late 1920's to 1930's, when that generation was born/grew up. The diet was not as refined nor as loaded with stuff that was mostly unhealthy for you. A lot more durable people in those times.

If anything, look at the generations of 1961-1981 and 1981-2001. Then look at the demographics for where most of the disorders/diseases lie around, (diabetes, obesity, etc.)

Look at how many people in our birth years (1961-1990,) are around at the ages of 50-60 years. I suspect as the last two generations get closer to middle/old age, we are going to see a precipitous drop in US life expectancy. We are not as healthy as the generation that is currently 78-80years old were at our age ranges.

In other words: looking at the oldest generation as a meter of national health *currently* is not reliable. What is happening to the last two or three generations is a much better indicator of the nation's health.

Welcome to the wonderful world of epidemiology, and the way it makes you look at why is this a problem in this population.

[candyman]

Worsening infant mortality rate among developed nations is one. Keeping mother healthy during and after pregnancy are key (healthy/durable moms=healthy/durable babies.) Access to neonatal/pediatric care is another issue, both availability of pediatrics and cost of pediatrics. I suspect a lot of kids/mothers fall in the "too well off for Medicare/Medicaid, too poor for private insurance," group.

Also, look at the time when the oldest people in the nation grew up and where for the most part. Most were still farmers, doing physical work during during the late 1920's to 1930's, when that generation was born/grew up. The diet was not as refined nor as loaded with stuff that was mostly unhealthy for you. A lot more durable people in those times.

If anything, look at the generations of 1961-1981 and 1981-2001. Then look at the demographics for where most of the disorders/diseases lie around, (diabetes, obesity, etc.)

Look at how many people in our birth years (1961-1990,) are around at the ages of 50-60 years. I suspect as the last two generations get closer to middle/old age, we are going to see a precipitous drop in US life expectancy. We are not as healthy as the generation that is currently 78-80years old were at our age ranges.

In other words: looking at the oldest generation as a meter of national health *currently* is not reliable. What is happening to the last two or three generations is a much better indicator of the nation's health.

Welcome to the wonderful world of epidemiology, and the way it makes you look at why is this a problem in this population.

So where does smoking fall into all of this? I mean the age groups you pointed out are around when some of the heaviest smoking was done in America...percentage wise. So I am just wondering what the official say on smoking is in the medical community. Mostly because alot of blame is being put on smoking but it seems that the people that were around when there was alot of smoking being done are doing better than us. With the way things have been going with smoking bans and the total numbner of smokers shouldn't we be seeing longer life spans here?

[StormKnight (1)]

So where does smoking fall into all of this? I mean the age groups you pointed out are around when some of the heaviest smoking was done in America...percentage wise. So I am just wondering what the official say on smoking is in the medical community. Mostly because alot of blame is being put on smoking but it seems that the people that were around when there was alot of smoking being done are doing better than us. With the way things have been going with smoking bans and the total numbner of smokers shouldn't we be seeing longer life spans here?

Good question. My thought? They possibly could have died before the census was taken from the diseases.

The study shows how *long* people live, based on death certificates, not *how many* made it to live to be that old, which would be a ratio of how many births from year x died in year y. Most of what we know from the cancer risks of smoking came from the old generation as well. The relatively mild surgeon general warning (softened by the tobacco lobby,) found in the early seventies (Warning: The Surgeon General Has Determined that Cigarette Smoking is Dangerous to Your Health) was based on the older generation disease trends, i.e., cancer in the older generation. If you can find some of the old CIBA illustration books by Frank Netter, those were drawn during that time frame as well, most of his models were people in those heavy smoking generations (and he himself was a avid cigar smoker.) Pretty gruesome.

The best way to find out how many people are living to that age would be to review the number of births during that year, and track them through the decades until death, (for example, out of 100 people born during 1930, 5 are still alive today, while the other 95 died from the following during these years...) As records become automated, this can be gleaned better (there are ways to do chart reviews without privacy being violated. It is currently done all the time.) It' isn't easy with older generations, as a lot of births weren't documented, and while better now, still aren't documented well.

As for seeing longer life spans, we will not see the results of changing lifestyles now until 30-50 years from now, when the younger generations should reach that age. It might decrease the cancer/lung disease causes of death, but cardiac death (i.e. heart attacks,) and accidents will be the top two ways to die.

This is what makes preventive medicine un-glamorous. The benefits from the interventions won't be seen for years. But keeping in shape, eating right, etc. and the benefits they reap long term are taken for granted. Most people don't worry about the little steps to live longer; instead we wait until the crisis hits to react, instead of preventing it.

This is supposed to be discussed with primary care doctors (who should have much longer residencies compared to what they have now.) However, with time, they are allowed to see patients (15minutes,) and the poor compensation (up to 50% of what they take in goes to malpractice, the rest is divided between overhead of office upkeep and salary of their employees before the doctor sees take home income,) hammering the need to take care of yourself falls to the bottom of the priorities of things to be discussed.