I’ve been on the road speaking a lot. Yesterday, I presented on the health reform debate to a conference on Healthy Aging.
My message to them, not shockingly: seniors need to be engaged in this health reform and coverage expansion discussion. In part, I wanted to blow up the myth that seniors and their concerns aren’t relevant because they largely have coverage through Medicare and Medi-Cal.
1) In fact, it is because they do have such coverage that they need to pay attention. Every time there is a recession or a deficit, we face calls to cut these programs. As health and consumer advocates, we argue that the increases in these programs are actually less than the overall private market, which leads us to conclude: We don’t have a Medicare problem, We don’t have a Medicaid problem, we have a health care problem.
And unless we fix the overall health care system problems, cutting Medicare or Medi-Cal isn’t going to help. At the same time, Medicare and Medi-Cal will also be targeted for cuts until we get a handle on the overall system.
2) Medicare is a model, for those of us who support a universal, single-payer plan (like SB840), and related plans. Senator Kennedy and Representative Dingell just introduced a “Medicare for All” bill last week, allowing people to buy-in to Medicare. Professor Jacob Hacker calls his proposal “Medicare for Many.” Introducing younger, healthier populations into Medicare, which right now is by definition older and sicker, could actually help the long-term financial picture for the program.
3) Many seniors rely on Medi-Cal, which could in store for major improvements. On the table are major Medi-Cal rate increases, which could increase access to care for many seniors, children, and people with disabilities. This also includes Medi-Cal expansions, not just for children but for low-income parents and adults without children at home: that’s a big hole in our current system now, one that a lot who are in the 50-65 year old range fall through.
4) Speaking of the 50-65 year olds, they have perhaps the most to gain from comprehensive health reforms. Many are in the types of jobs that don’t provide health coverage, and would benefit from an expansion of employer-based health coverage. Early retirees and others often find it impossible to buy coverage as an individual, either because it is unaffordable or unavailable, because of “pre-existing conditions” that virtually anybody who has lived sevreal decade has. Reforms on the table include prohibitions for insurers to deny or discriminate against consumers because of their health status.
5) Seniors are the biggest users of health care. Any effort to change or improve health care will naturally have a disproportionate impact on those who interact with the system the most.
6) Everybody has an intergenerational stake. Seniors also care about their own care, but that of their children and grandchildren. They want their family to have the social compact they had, where if they worked and paid taxes, they would have the security of health coverage. But they recognize that wihout action, that compact is unravelling.
Seniors can be an important voting block and political constituency, and so the success of reform, both in terms of if something gets passed and what gets passed, could hinge on the senior community.