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    The Medicare Morass: Many seniors upset about changes to federal program

    BY DAVID BATES
    12/14/2003
    by DAVID BATES on 12/14/03.

    Alan Meyer followed news reports, wrote letters to newspapers and made sure that Sens. Ron Wyden, Gordon Smith and Rep. David Wu all knew what he thought of the Medicare legislation Oregon's congressional delegation was about to vote on.

    Then, after lawmakers approved the Medicare bill the week before Thanksgiving and President Bush signed it Monday, the Newberg retiree threw up his arms.

    Then he threw out his AARP membership card, angry that the nation's largest lobbying group for the elderly had endorsed the package.

    "I got pretty upset with what Congress did," said Meyer, a retired microbiologist from Oregon Health & Science University in Portland. "It looks like they're giving a big gift to the drug companies and the insurance companies.

    I don't know what we're going to do," he said. "I'm just very unhappy with it."
    Bush on Monday signed into law the most far-reaching changes in Medicare since the program's inception nearly 40 years ago.

    The bill, which includes a new prescription drug benefit, presents elderly patients with numerous and sometimes difficult choices. Republicans are hailing the bill as a political triumph they can use in next year's election to neutralize Democrats' historical advantage on issues regarding the elderly.

    Meanwhile, the reform package, which completes one of Bush's first-term priorities amid questions about its fiscal wisdom, has produced a stormy debate over whether or not it will ultimately undermine Medicare by nudging it closer to the private sector.

    Skeptical seniors
    The bill-signing ceremony was filled with fanfare. The Los Angeles Times on Tuesday described it as "something of a holiday season party for the legislation's Republican supporters and leading figures in the health care industry."

    In Newberg, Meyer cannot be dismissed as just another Bush-bashing Democrat. A Gallup Poll released last week suggests many elderly people are skeptical of the changes.

    Asked if they favored or opposed changes that Congress and Bush approved, 44 percent of adults 65 and older responded negatively, with 70 percent of those saying they were "strongly" opposed to them. Only 38 percent said they favored the changes, and 18 percent said they had no opinion.

    The poll, which was conducted Dec. 5-7, also showed that Bush's disapproval ratings on Medicare have climbed from 41 percent in late January to 49 percent this month.

    Running nearly 700 pages, the legislation is a bewildering mix of deductibles, exclusions and exceptions.
    In the analysis accompanying its polling data, the Gallup Organization notes that "realistic opinions about the actual, real-world impact of the legislation may not be available for years."

    "I haven't read it, and I don't believe in criticizing something I haven't read," said McMinnville's Jessie Elson, an 87-year-old retired nurse.

    Nevertheless, Elson - who exhibits an exuberant mix of passion, anger and humor as she rattles off stories about her own experiences with private insurance companies and hospitals - said she's skeptical and planning to deal with change as best as she can.

    "It's a profit system," she said. "The doctors are playing the game, and the hospitals have to play the game.
    "We might as well let them do whatever they're going to do, and we'll just have to deal with it," she added. "What are we supposed to do, as individuals?"

    Who will benefit?
    Medicare is the federal health care insurance program for people 65 and older, and for the disabled. It helps pay charges for hospitalization, for stays in nursing facilities, for physicians' charges and for some associated health costs.

    U.S. Census figures show that about 13 percent of Oregon's estimated 3.5 million population is 65 or older and thus eligible for the program. That ratio is mirrored in Yamhill County, where more than 10,100, or about 12 percent, of the elderly qualify based on age alone.

    The $400 billion overhaul adds prescription drug coverage to the list of covered services and products, starting in 2006. Also, beginning in May, seniors can buy a Medicare-approved discount card for $30 or less to help offset the costs of prescriptions. Republicans also wrote into the law a provision prohibiting the government from using its vast purchasing power to control drug prices.

    The law maintains a ban on importing prescription drugs. It permits such drugs from Canada, but only if the U.S. government certifies safety, which it so far has refused to do.

    "Who is that helping?" asked Elisabeth Robertson, who works part-time as an assistant manager at an apartment complex serving the elderly in McMinnville. "Is it helping me, or you or other seniors? No - it's helping the drug companies."

    Robertson, a retired program secretary from a community college in Washington, considers herself in good health. She takes only two prescription drugs. She anticipates that she will be one of those who falls into the gap, in which no coverage would be offered for drug costs between $2,250 and $5,100.

    "I haven't sat down and examined it penny for penny, but it looks to me like I'm going to be paying more," she said.
    Unusual alliances
    Supporters of the bill include Bush, Republicans, some Democrats - including Oregon's Wyden - the American Medical Association, the American Alzheimer's Association and the nation's largest lobby for the elderly, AARP.

    Detractors and critics include an unusual alliance of both liberal and conservative nonprofit public interest groups, ranging from Ralph Nader's Public Citizen on the left, the Consumers' Union, Families USA Foundation and, on the right, the Cato Institute and Citizens for a Sound Economy.

    AARP, formerly known as the American Association of Retired Persons, threw its support behind the legislation and has faced a backlash by some of its rank-and-file members, like Meyer, as a result.

    So why is AARP taking so much heat?
    There are a couple reasons, and both concern money.
    First, the criticism by some Democrats, such as New York Sen. Hillary Rodham Clinton's remark that the Medicare bill is a "cruel hoax," stems from the powerful influence that the drug, health care and insurance industries have in Washington.

    Since Nader's group, Public Citizen, began tracking the pharmaceutical industry's lobbying about six years ago, drug companies have spent nearly $478 million on lobbying, according to a study the group published in June.

    The same report notes that the industry hired 675 lobbyists in 2002, which translates to seven for each U.S. senator. That's on top of the more than $48 million drug companies shelled out to congressional candidates since 1997.

    The second reason pertains to AARP's own financial interests.
    In a last-ditch effort to undermine AARP's support for the bill, critics in November pointed to what a trade group for independent drugstores called the elderly lobby's "well-documented, inherent conflict of interest based on income from health insurance products" sold to the AARP's membership. That remark, reported in the New York Times, was made by a senior vice president of the National Community Pharmacists Association.

    Public Citizen also joined the fray, issuing a statement a couple of days before the House voted that "AARP would stand to gain many millions of dollars in new income under the Republican Medicare bill.

    "Maximizing corporate-related income and profits poses a significant conflict of interest for an organization trying to represent the best interests of its members," the nonprofit said.

    AARP responded that its commercial interests would probably be damaged, not helped, by the Medicare bill, because members presumably wouldn't be as likely to use the group's mail-order pharmacy anymore.

    Writing in the L.A. Times one day before the Senate approved the bill 54-44, Dale Van Atta, author of "Trust Betrayed: Inside the AARP," reported that the lobby had polled about 500 of a "nationally representative" sampling of its members and that 75 percent supported the bill.

    There was one caveat, however.
    Only 10 of those polled - 2 percent - said they "were very familiar with the plan."
    Insofar as that goes, Meyer - who watches stations like C-SPAN and PBS's NewsHour with Jim Leher - is a tiny minority that at least claims to know what's going on. Most seniors contacted for this story said they hadn't followed the issue much, and were naturally unfamiliar with the details.

    "I don't know a thing about it," said Richard E. Meyer, who heads Yamhill County's AARP chapter, which meets every other month in Newberg, sometimes with fewer than half a dozen attending. "I don't know what it contains or what it doesn't contain."

    Meyer said he's been out of the state recently and had not followed the news much while traveling. Not that it would have been any easier if he had.

    If the example of The Oregonian - the state's largest daily newspaper - is representative, press coverage of the Medicare package was sparse until literally days before the vote.

    In the three weeks prior to the House vote in the predawn hours of Nov. 22, Medicare showed up on the newspaper's front page only once, five days before the vote. In the more than 150 editorials, columns and guest essays published during that period, what scant attention to Medicare that made it into print didn't appear until Nov. 17.

    Little more than a week later, the bill was on the president's desk ready for a signature.
    One element of the Medicare reform bill that got even less attention was coverage of the flurry of behind-the-scenes lobbying in the final days before the House and Senate votes.

    Two days after the Senate vote, syndicated columnist Robert Novak reported that Rep. Nick Smith, R-Michigan, "had never experienced anything" like the arm-twisting he was subjected to, even - as Smith himself alleged, and has since retracted - bribery. The U.S. Justice Department has announced an investigation into the allegations.

    Such drama seems far away from the world of people like Elson.
    The more practical matter on her mind is the minor surgery she's preparing for in two weeks. She is covered by Medicare, and she dismisses the wrangling over it inside the Beltway.

    "We might as well let them do whatever they're going to do," she said. "We'll just have to deal with it."
    - The Associated Press contributed to this report.