Far from the hue and cry over healthcare legislation that is erupting at town halls across the country, many senior citizens are quietly confused about what an overhaul might mean for them. And the opinions they form in the coming weeks may well prove crucial.
Seniors are an influential group of voters who bring a unique perspective to the topic: They already have guaranteed healthcare under Medicare, and they also are the heaviest users of medical services.
On a recent afternoon, a group of people in their 80s and 90s at a Denver retirement complex voiced some of the same questions about healthcare that are circulating in living rooms and senior centers throughout the country.
"Will it affect how quickly I can get in to see my doctors?" asked Anna Janeway, 80, a retired marriage and family counselor.
"You hear all these things about Medicare going broke if we do nothing. Where would that leave everybody?" asked Anthony Mehelich, 82, a former construction company administrator.
"Do we really have to make so many changes all at once?" inquired Joseph Duffy, 90, a former accountant. "Couldn't we just take parts of the problem and solve those?"
Members of Congress have reported an outpouring of concern from their senior constituents. Rep. Eliot L. Engel (D-N.Y.) said his offices had received "hundreds of calls" from older people eager to understand how they might be affected.
And convincing them of the need for change is proving to be an uphill battle. Last week, a CNN-Opinion Research Corp. poll found that a majority of voters over 50 opposed the healthcare overhaul effort, while most voters under 50 supported it.
The lack of a definitive plan is adding to seniors' concerns. Three House committees agreed on a bill to be taken up after Congress' August recess. The Senate, however, recessed without sending legislation to the floor.
But as Gail Wilensky, who was administrator of the Medicare and Medicaid programs under President George H.W. Bush, pointed out: "The major focus of reform is clearly not on seniors. It is on expanding coverage to the under-65 population."
Another problem is that many seniors, said Rep. John Tanner (D-Tenn.), don't seem to understand that Medicare basically is a government-run healthcare plan. The lawmaker's office has been fielding calls from older constituents who say: "I'm happy with Medicare. Don't let the government take it over."
Lawmakers were careful not to meddle with Medicare essentials in crafting the House's proposed healthcare overhaul. There was no attempt to limit basic services and no effort to ration care -- a charge raised by critics. "Nobody is talking about reducing Medicare benefits," President Obama said in a recent AARP teleconference.
In fact, some Medicare benefits could be enhanced: Congress has said the overhaul would close a gap in coverage for prescription medications under the Medicare drug program.
Fears about rationing arise from several sources. The proposed creation of a center to study the effectiveness of medical treatments has prompted some critics to allege that results would be used to discourage or deny care not deemed effective. Supporters have said the research would help doctors and patients make better decisions.
Proposed cuts to projected Medicare expenditures also have raised concerns. The House bill would help pay for the overhaul's estimated $1-trillion cost over 10 years by extracting about $500 billion in savings from Medicare and Medicaid, a government health program for the poor. Of that amount, about $231.4 billion would come from Medicare's budget, according to AARP.
Many seniors wonder how it is possible to cut that much without affecting medical care. The administration says there's a lot of unnecessary care being delivered -- as much as 30% by some accounts -- and it could be eliminated without compromising seniors' health.
But many experts are skeptical.
Hospitals would take the biggest hit, with payments reduced $220 billion over the 10-year period. "The question for seniors is whether or not access to care will be impaired by these [provider] cuts," Wilensky said.
"I don't think that will happen," said Henry J. Aaron, a health policy expert at the Brookings Institution. Instead, he suggested, hospitals would focus on reducing administrative costs and reorganizing the delivery of care.