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Seniors and Health-Care Reform

Matt Yglesias has a good graph providing some context for the fact that seniors are pretty opposed to Barack Obama's health-care reform plans. Turns out that seniors were also pretty opposed to Barack Obama.

votebyage.jpg

This is playing out in health-care reform, too. As the situation stands, folks under 50 support the effort. Folks over 50 oppose it. That mirrors not only political preferences but also life situations. Folks under 50 stand to gain more than folks over 50. This graph of the uninsured by age (pdf) tells the tale pretty well:

uninsuredage.jpg

Folks under 50 are less likely to have stable jobs offering good health-care insurance, or million-dollar incomes that will be taxed to pay for the plan. Folks over 50 are likely to have a pretty stable insurance situation, or be on Medicare, and are also more likely to have high incomes. Now, it may be that feelings on health-care reform are just a proxy for feelings about the president. In fact, I think that's probably a big chunk of what's going on. But they also reflect the realities of the bill's impact. And one reason that it's been hard to explain the appeal of the bill to the insured population -- which tilts older and votes in higher numbers -- is that it doesn't have a lot to offer them.

By Ezra Klein  |  August 6, 2009; 5:30 PM ET
Categories:  Health Reform , Polls  
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Comments

They are more likely to be racist (admit it), less likely to have voted for Obama, and they got their single-payer socialized health insurance, so screw the rest of us!

Posted by: AZProgressive | August 6, 2009 5:39 PM | Report abuse

The facts you marshall help explain the difference in the level of support for health care reform between those over 50 and those under 50. But the idea that this "makes it hard to explain" the appeal of health care reform to the over-50 crowd seems glib to me. After all, many of those over 50 have children in their twenties, thirties and even older, and those over 60 may have grandchildren. They have every reason to be worried about access to health care and affordable health insurance for their children and their children's young families. I am 56, with excellent health benefits from my job (though my share of the premiums has increased sharply). But I am acutely aware of how vulnerable my children (28, 24 and 19) are in the current climate, where any job is hard to get and hard to keep, and benefits are few when you do find a job. I cannot be the only one in my age group with this perspective.

Posted by: DavidA2 | August 6, 2009 5:45 PM | Report abuse

As a Medicare recipient, it seems to me that there's some actual logic in the seniors being lukewarm about the current direction the 'reform' healthcare plan is taking.

Obama keeps harping on the runaway cost of Medicare/Medicaid - suggesting we can't afford to stay with the current program. Baucus is negotiating solely with those who hated Medicare in 65 and hate it today. Bipartisanship (in scare quotes) has produced something that may turn out as good but is just as likely to be anti-Medicare, and very bad. I can see some big parts of Medicare Parts A (hospital) and Part B (physicians) being given over to the private insurers as the price for passage. There are no moral scupples in the smoke-filled congressional conference rooms at 2AM when the lobbyists swarm.

There is nothing in the current plans that helps current Medicare recipients. I'm actually surprised that about half of seniors support more reform. Whether this concern for their children or grandchildren or confidence that the Dems wouldn't dare cut Medicare benefits or increase costs, is hard to say.

From my point of view is that the meat has gone through the sausage grinder more times than produces good sausage, and it scares me more than a little. But of course I'm madder than heck that the Dems have collapsed so completely and are ready to let the most extreme rightists control the legislation.

One more thing on Max Baucus: I think he's positioning himself to be the only dealmaker on the final conference report legislation between the House and Senate. To do this, he has to steer the Senate to the right so he gets all the trump cards.

He well deserves to be a name that lives forever in infamy. "He destroyed a 45 year old Medicare program that was and is overwhelmingly approved by the electorate".

Posted by: JimPortlandOR | August 6, 2009 6:01 PM | Report abuse

People over 65, with rare exception, get Medicare for free, that they can never lose, from the big government that's, gasp, single payer (and polls show they love it). But people 50-64, although they have much lower uninsurance rates than younger Americans, risk much greater devastation if they do lose their insurance. They can easily lose everything because it's far harder and more expensive for them to buy insurance, and they're far more likely to experience a serious medical problem. They should be very concerned. A big part of the problem is they're more Republican. They came of political age during the Reagan years with the big promises, before we came to see how tragically false those claims were.

It's also very important to note here that the Census Bureau counts as uninsured only people who were without insurance for the entire calendar year. Looking at the percentage of people without, gasp, single-payer, big government Medicare that risked physically and financially devastation for themselves and their families by having no insurance, at some period of time in the last two years, the figure is just over 1/3.

Details are in a March 5th, 2009 CNN article (at: http://money.cnn.com/2009/03/05/news/economy/health_uninsured/index.htm), including:

• Nearly three out of four of those uninsured Americans were without health insurance for at least six months.

• Almost two-thirds of them were uninsured for nine months or more.

• Four out of five of the uninsured were in working families.

• People without health insurance are less likely to have a usual doctor and often go without screenings or preventative care.

Posted by: RichardHSerlin | August 6, 2009 6:39 PM | Report abuse

People over 50 are most likely to be in the remaining bigot rump of the Republican party. Let's not mince words. They are what's left of the Southern Strategy.

Posted by: pj_camp | August 6, 2009 7:45 PM | Report abuse

Ezra, people of all ages like buying things with other people’s money.

Over 50 – most people are getting their healthcare paid for by someone else and they want that to continue.

Under 50 – most people are paying for their own healthcare (through lower wages and employer subsidies) and they want some free healthcare too.

Posted by: kingstu01 | August 6, 2009 9:13 PM | Report abuse

This has to be said - seniors in this country are literally ruthless and selfish to the point of breaking future of their own children. No matter how much you try to put lipstick on the pig, it is ugly. Just that no one wants to say it openly.

Why in the world people cannot see how mere couple of months of life extension in ICU would come at the cost of over $100K in Medicare, paid by young tax payers? Yes, we know these seniors did pay Medicare costs too and they worked hard for prosperity in America. But runaway inflation which is making their past contributions paltry compared toexorbitantly expensive care they receive, is not all fault of young taxpayers.

It is social cannibalism of American kind. Granted, unlike some parents in South Asia who expect children to take care of their parents as the first thing in life; seniors in America do not expect their children to be with them and take care of them all the time. But all that is compensated by the way these seniors and AARP members hold American taxpayers at ransom. What else to say when all these seniors were still grumpy when George Bush passed Medicare Drug extension plan of 1 Trillion Dollar without balancing the budget? (That is the reason why these Republican jokers do not have any credibility whatsoever when they criticize Democrats in not balancing medical coverage extension.)

Okay, now the personal disclosure - at the age of 42 with 2 kids of age 7 and 2; I do have vested interest in limiting exposure of Federal Budget to the runaway bomb called Medicare. But by next 7 years, I will be eligible to AARP (their literature has already started to hit my mail box); so not that I will not benefit in future when all legitimate needs of American Taxpayers are pushed aside to increase my life by few days when I will be in comatose state. Still I believe any rational person should see the total failure of America ahead in future unless this wreck train of Medicare is controlled.

It seems sometimes, Barack simply missed the bus in this regard. He should keep on hitting the campaign trail with a graph of ever increasing cost of Medicare and tell how it will destroy Fed Budget in future unless checked and keep on harping the question of stable future of all young kids and taxpayers of today. Is it a class warfare of demographic kind? Come on, we expect Barack Obama to be smart enough to avoid such bobby traps but still address the root problem.

Posted by: umesh409 | August 6, 2009 11:38 PM | Report abuse

Ezra, you are misrepresenting the survey. There is no meaningful difference between the 30-44 and 45-64 age groups.

As I believe you have reported, those from 50 to 64 are the group most at risk from losing their employer group health care. Many in that age group have one or more "preexisting conditions," cannot get reasonably priced individual insurance,and they cannot afford to pay the $1200 or more monthly premium for COBRA or other continuing group coverage.

Posted by: dside | August 6, 2009 11:39 PM | Report abuse

That's what it is, isn't it? With each passing day, a certain voting bloc dwindles in size, headed to a place where all the votes get counted ..... Everytime.

Posted by: deepthroat21 | August 7, 2009 1:37 AM | Report abuse

Older people have a clear interest in extending medicare to other age groups. It is an obvious sitting duck for budget cuts. If health care reform goes down because of the perceived selfishness of seniors, they will have no one defending their entitlements later on. That's exactly why social security covers wealthy seniors, to give them a reason to support it.

I am not sure older peoples' opposition is driven by race. At least in Arizona where I am from, older people also tend to have the "screw 'em" attitude on paying property tax for funding schools, even though others helped to fund their kids education. The screw 'em attitude is not unique to older people, but in this case they may have more to lose so they are going to shout the loudest.

Posted by: emily16 | August 7, 2009 3:26 AM | Report abuse

If Barack Obama's healthcare reform passes and it relies on $500 billion dollars in Medicare "savings" to fund this new entitlement, then what happens if the changes to Medicare don't save as much money as predicted? Millions of people will be receiving their healthcare through the exchange paid for by the government. It will come down to either kicking people off their insurance or going thru with the Medicare cuts regardless ... which would affect quality and or availability of care.

Maybe many of those over 50 aren't willing to take the risk of that coming to reality, maybe they would rather see a reform plan with a more reliable and predictable source of revenue.

Posted by: cautious | August 7, 2009 4:03 AM | Report abuse

"And one reason that it's been hard to explain the appeal of the bill to the insured population -- is that it doesn't have a lot to offer them."

Wanna bet? How many of those of us in stable jobs with steady coverage have children about to graduate from college and lose their insurance? My daughter spent 18 months without insurance, and a couple of months after her insurance (from a teaching job) kicked in, she had a detached retina. There's no way we'll let our second daughter go without insurance when she graduates, so I'm really hoping the coverage-up-to-26 rule is left in the final bill.

Posted by: KathyF | August 7, 2009 4:09 AM | Report abuse

Contrary to the representations of one of the contributors above, people over 65 do not get their Medicare for free. I know, I will be enrolling in 8 or so months. My basic premium will be around $100 per month and supplemental insurance to make the benefits comparable to my current will bring my total monthly cost to around $300. Still a good deal compared the $750 per month my current private insurance costs (I am self insured). While I am getting old, my memory is still clear as to the fact that money was deducted from my paychecks for nearly forty years on the pretense that I would have affordable, quality healthcare when I retired.

I surely have sympathy for the uninsured. But I don't think it is greedy at all for me and people like me to work to preserve what we have worked hard to obtain. That being said, Medicare was a deal made with the devil. Its was never actuarily sound. It needs to be reformed. Its costs need to be controlled. Perhaps the people who are now so quick to criticize the greed of the blue-haired droolers who are showing up enraged at these town meetings should consider that the critics of these angry people are, for the most part, being promised the moon and stars by our politicians. New coverage, protection of existing coverage and no new taxes. We have been promised that the rich will foot most of the bill and the remainder will be funded by reducing Medicare costs. The CBO has made it clear that most of the reductions which can be expected in Medicare costs will ultimately come as a result of reducing benefits.

It is my belief that much of the anger and frustration of the older (Medicare) crowd comes as a result of a fear of the unknown -- not of what is being said, but of what is being left unsaid. Let Obama and the Congress move their lips on behalf of this contingent and tell them that they won't be called on to give up anything. Or if they can't, let them be honest and tell us that someone affiliated with the government is going to ultimately decide when and how each of us will die. Frankly, that must be the inevitable result of controlling end of life costs. But it is clear that the spineless weazels we have elected simply prefer to ignore the concerns of older people and say nothing.

The older people who are angry are many things, but they are not stupid. Many of them have made the kinds of life and death decisions with regard to loved ones that we will inevitably turn over to the government. A little respect, clarity and honesty with regard to the issues that concern them would go a long way toward returning the debate to a more civil plain.

Posted by: mrdon | August 7, 2009 9:07 AM | Report abuse

Mind Power United Golf Outing
Sponsored by Mind Power United, LLC Benefiting the Heart Fund at the Children’s Hospital of Pittsburgh Foundation

The seniors will be golfing and reforming health-care on the course of life. Golf Pride. Have more golf outings and keep out of the rough. Any good club tips?

Posted by: Dermitt | August 7, 2009 9:22 AM | Report abuse

I don't know if the data exists, but it would be interesting to see the plot above of % uninsured by age at intervals of maybe 10 years going back about 50 yrs.

I'd be curious to know how much of the peak in uninsured % between 18-30 yrs is a function of age and how much is generational. I could easily imagine that folks in their 20s feel invincible, would rather spend their money elsewhere, work jobs that don't have good benefits...these could be true across the last 50 yrs.

However, I could also imagine other factors such as baby boomers coming of age in a job market where health benefits were a given (e.g. factory/manufacturing jobs), more workers of that generation stayed with a single employer for their entire career, etc. while the current, younger generation is working in a job market with more service industry, no/low benefits jobs, etc.

Anyway, it would be interesting to see how that breaks down if you were to look back at how/whether the shape of the curve has changed over the last 50 years.

Posted by: AnonymousInMA | August 7, 2009 10:35 AM | Report abuse

To those who fear that the reform bills will cut back Medicare benefits, I offer this little bit of information for your consideration.

One of the Energy & Commerce amendments to the House bill would add Medicare coverage for "post-mastectomy external breast prosthesis garments." In other words, mastectomy bras.

Now, although I do have sympathy for senior breast cancer patients, personally I would never, ever, expect my health insurer to pay for my bras, mastectomy version or not.

Don't you think that proposed Medicare coverage expansions like this at a time of ever-increasing health care costs should be sharply questioned by those on both sides of the aisle?

Posted by: Policywonk14 | August 7, 2009 12:54 PM | Report abuse

Policywonk14:

Don't worry. When the proposed medical advisory committee gets done deciding what benefits to add, subtract or continue under a mandate to reduce Medicare costs, the bra will be gone as likely will be advanced treatments for very old and/or very sick people like Obama's grandmother.

As I understand the proposed legislation the intent is that a Medical Advisory Committee will perform what is termed "best practices" analysis on Federal benefits and adjust benefits to match available funding. While we are "promised" that treatments will not be rationed, the CBO seems to suggest that expected savings from increases in efficiency and reductions in waste will not come close to delivering the reductions in Medicare costs that the Administration is suggesting. This leaves mandated reductions in fees paid to providers for services and reduction in benefits.

Presumably the Feds can dictate any fee structure they please. It is my understanding, however, that there is nothing in the legislation which will compel doctors to accept Medicare patients. Currently many providers simply refuse to take Medicare patients. Three of my doctors continue to take existing patients who are on medicare but will not accept new patients who are on medicare. So to the extent that the Advisory panel dictates rates for certain benefits, they will almost certainly create shortages of providers who will serve Medicare patients.

That gets us to the Advisory Panel eliminating or placing restrictions on benefits. While I am not aware that the proposed legislation requires such actions, the President has made it clear on numerous occasions that he believes that part of the reform which is needed is a substantial reduction of services to people who are old and/or critically ill based on some criteria which measures the likely benefit of certain services depending on the expected prognosis. He may be right on this matter. But it will be, by any definition, a reduction in current benefits.

At the very least you would expect the panel to conclude that the bra might be sufficiently beneficial to a 65 year old "looker" to justify the cost, but not sufficiently to a 95 year old geezer to similarly justify the cost.

The Medical Advisory Panel may or may not be a good idea. But it will be flying directly into an ethical and moral storm which will ultimately dwarf the controversy surrounding abortion. And it may not divide along the same party lines that divide us on abortion. It has long been a liberal tenet that you cannot put a dollar value on a human life. But that, ultimately is what we will likely do. And it may ultimately what we must do. Who knows. I only hope that I will not live to see it -- perhaps the government will step in and assist me in that aspiration.

Perhaps the ultimate solution will be the development of some sort of lighted implant which will extinguish when it determines we are "done".

Posted by: mrdon | August 7, 2009 2:07 PM | Report abuse

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