Seniors Seek Care They Need, Not Free Ride

On Aug. 17, Rep. Dan Rostenkowski faced a situation that has been repeated in every congressional district and state across this country. At a senior-citizens center in his home district of Illinois, he was confronted by a large number of people who were upset about the Medicare Catastrophic Coverage Act.

This firestorm of angry opinion has been growing since earlier this year when Medicare enrollees began to learn of the legislation’s specifics. Unless Congress begins to listen seriously to the concern of seniors, we have seen only a small glimpse of what will come.

The late Rep. Claude Pepper summed it up best when he said that the real catastrophe facing the elderly is the cost of long-term care, and this will continue to be the catastrophe in spite of the so-called Catastrophic Coverage Act. What Congress passed last year severely misses the mark.

The act’s title led seniors to believe, reasonably enough, that Congress was working on something that would protect them from the financial ravages of long-term care in a nursing home, a catastrophe that visits 5% of the elderly population. They have been unable to protect themselves against this expense through the private insurance market. This expense forces nearly 1 million Americans a year, two-thirds of them elderly, into poverty.

Millions of seniors nationwide are actively opposing the act because they’ve come to learn two things about it: It does not address their area of greatest need, long-term health care, and it forces them to pay for lesser benefits that they don’t want or need.

Many people are under the impression that seniors are up in arms because they don’t want to pay for their new benefits. This is a gross mistake. The avalanche of opposition is bearing down on Congress because the act forces seniors to pay for benefits that they don’t value highly, while it still does not provide benefits they do value.

Ducking the protests by merely trying to reduce the program’s expense or the level of the “surtax,” or by making the general taxpayer pay for the mistake, (as Rostenkowski’s Ways and Means Committee recently attempted to do) is not a responsible solution. Instead of arguing solely about the act’s costs, we need to determine what health-care product our nation’s seniors really need.

There are many portions of the original catastrophic health-care bill that we all would like to have. It would be wonderful if all Americans could receive free, or virtually free, prescription drugs and mammogram exams, for example. But are those senior citizens’ priorities? If not, why are we forcing them to pay for their inclusion under Medicare?

According to the tens of thousands of seniors I have heard from on this issue, long-term care is their No. 1 concern. It cuts across all economic and social boundaries. The possibility of being financially ruined by the high cost of nursing-home care is not a concern of just the nation’s wealthy, as some have contended. It is a concern for every senior, especially those on fixed incomes.

Seniors are not criticizing the principle that they should pay for new health-care benefits. They want to protect their spouses from impoverishment, and are willing to pay for that protection. They want and will pay for long-term hospitalization and care in skilled nursing facilities. What they emphatically reject is being forced to pay for benefits they neither want nor can afford.

Although the committees with responsibility for this issue in Congress have talked of reexamining the Catastrophic Coverage Act with an eye toward reducing the premium, the major issue--the benefits--is being ignored.

This legislation must get more than a cursory glance from those in Congress who have not been responsive to their elderly constituents. The Catastrophic Coverage Act must be changed so that seniors get protection from what they consider truly catastrophic and no longer are forced to pay for that which is not.

In February, I introduced a proposal that would preserve the spousal impoverishment protection, skilled nursing and long- term hospitalization portions of the act, which have already come on line and which are largely dedicated to covering costs that cannot be covered in the private insurance market. My proposal would delay implementation of all other provisions in the act, most of which can be obtained through private insurance, as well as the provision for an income-based premium. It would require Congress to thoroughly study, with the help of seniors, what changes need to be made.

We have an obligation to give serious attention to the impact our acts have on the lives and pocketbooks of older Americans. Until we do, Rep. Rostenkowski and others in Congress can expect to face a lot more protests when they venture out among their constituents.

“As you can see from the monitor, Mr. Bale, we are now entering your wallet.”