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In defense of seniors

seniorboxer.JPGIn his column today, David Brooks says that seniors should stop ripping so much money from the federal till. You see this implication that the elderly have become greedy budget hogs in Robert Samuelson's columns, too. But it's worth making the mechanism explicit: When commentators complain that seniors are "taking money," here's what they mean: They are going to the doctor, the doctor is prescribing treatments, and Medicare is paying for those treatments.

Which part of that should we disrupt? Should seniors stop going to the doctor? Should doctors stop coming up with ways to elongate their life? Should Medicare cut back so seniors can't afford the treatments they need?

I'm not being flip. I can make a pretty good case for payment reforms that would encourage doctors to provide fewer treatments. I can make a pretty good case that seniors in many states should go to the doctor far less often than they do. But people err when they imply that individuals have the power in the medical relationship. We go to the doctor and we listen to what the doctor says. A sick senior in Minnesota costs a lot less than a sick senior in Florida, but that's not because the Minnesotan is refusing treatments. It's because his doctor is providing fewer of them. If you want to talk about a group with real power to change medical spending in this country, talk about doctors.

Instead, we have a tendency to blame seniors. Brooks calls their behavior selfish. He writes that "the federal government now spends $7 on the elderly for each $1 it spends on children." Intuitively, it seems like we should spend more on kids than on seniors, as they have their whole lives in front of them. But it costs a lot more to be a senior than a kid. I don't know if $7 to $1 is the right number there, but it won't be, and shouldn't be, $1 to $1. And it's hard to say that what seniors are doing is selfish: They're going to the same doctors as everyone else, doing the same things that everyone else does when they get there. Our health-care system is unaffordable across the board. We need to fix that, but there's no special key held by seniors (save maybe their disproportionate tendency to vote in midterm elections), and nor do they deserve special condemnation.

Photo credit: AP Photo/Charles Denson.

By Ezra Klein  |  February 2, 2010; 10:53 AM ET
 
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Comments

Hey, whaddya know -- Republicans put out an absurd plan to cut the deficit by rationing care to seniors, and here's David Brooks the next day to plant the seed for just how sensible that is.

Posted by: cog145 | February 2, 2010 10:59 AM | Report abuse

Brooks may be referring to this a bit

http://economix.blogs.nytimes.com/2010/01/18/remembering-the-little-people-accounting-for-kids/

As to Brooks' recounting of how it used to be in the old days, I'll cite Mose Allison, who is commonly cited by the Who

Well a young man
He ain't got nothin' in the world these days
I said a young man
Ain't got nothin' in the world these days

In the old days
When a young man was a strong man
All the people stepped back
When a young man walked by

You know nowadays
Well it's the old man's
Got all the money
And a young man
Ain't got nothin' in the world these days

You know nowadays, if you're the young man
You ain't got nothin' in the world these days

meanwhile, here's an interesting chart on federal receipts

http://economix.blogs.nytimes.com/2010/02/01/government-priorities/

Posted by: bdballard | February 2, 2010 11:00 AM | Report abuse

The part that maybe could change would be for those who through hard work, thrift, good fortune, or rich relatives have their own money, to take less federal money. I think they call it means testing.

Posted by: gradice | February 2, 2010 11:04 AM | Report abuse

I wasn't familiar with those particular lyrics from The Who, but I recall reading other lyrics that seem relevant:

http://press-pubs.uchicago.edu/founders/documents/v1ch2s23.html

Posted by: rmgregory | February 2, 2010 11:06 AM | Report abuse

Very well put.

Posted by: marvyT | February 2, 2010 11:08 AM | Report abuse

Wait a minute! Haven't you been telling us for weeks how awesome the excise tax on high-end health plans is because it will limit the amount spent on healthcare? So what's good for seniors is bad for union members?

Posted by: AuthorEditor | February 2, 2010 11:09 AM | Report abuse

Brooks did make one good point - the retirement age should be raised.

Posted by: mikehoffman82 | February 2, 2010 11:10 AM | Report abuse

Ezra,
Thanks for pointing out that it's the structure of Medicare spending that is driving spending and not some intrinsic selfishness of seniors. I would point out, however that the 7 to 1 ratio is actually highly misleading. Henry Aaron wrote an excellent response to her paper challenging the value of trying to separate spending by children and seniors(it's on the Brookings website). The ratio of spending tells you almost nothing about the actual well being of children and seniors, or how we support families.

Posted by: terencekane | February 2, 2010 11:13 AM | Report abuse

Has anyone done a study of the impact on medical cost of doctors owning hospitals and outpatient treatment centers (compared to non-doctor-owned facilities)? I've read antedoctal suggestions that such ownership encourages doctors to order more hospitalizations and testing (which they directly profit from, due to their ownership interests), but I haven't seen hard evidence on the topic (only the Medicare per capita disparities in various cities/states, as you reference here). I know Congress has looked skeptically at physician-owned hospitals in recent years. But is it time to look at it from the perspective of controlling health-care costs, and anti-competitive effects?

Posted by: reach4astar2 | February 2, 2010 11:21 AM | Report abuse

The tough decisions are being kicked down the road.

Really the decisions shouldn't be that hard.

1. Tax the rich and make it harder for the super-rich to cheat.
3. Negotiate better deals with providers, medical suppliers, and pharma companies.

Seniors are being selfish when they insist on preserving low-taxes for the super-wealthy; top-dollar prices from providers, suppliers, and for drugs; and for preserving a level of care that is fairly high quality.

Posted by: JPRS | February 2, 2010 11:21 AM | Report abuse

Limiting a tax exclusion and limiting the worth of a Medicare voucher are very different things. If the excise tax was instead a proposal to bar businesses from spending more than X amount, which grows slower than HC costs, on employee plans, I'd oppose it.

That said, the fact that doctors are key decision makers doesn't mean insurers don't have a role. Kaiser is cheaper than an Aetna PPO, in part because it treats it doctors differently. The excise tax pushes people towards Kaiser, which I think is good. Seniors, of course, are mainly in Medicare, not choosing between Kaiser and Aetna, so focusing on insurance choice doesn't make much sense.

Posted by: Ezra Klein | February 2, 2010 11:24 AM | Report abuse

Say, Ezra, I think it's only fair that a link to the obituary for the late Joe Rollino (who's in the photo for this entry) be made available!

http://www.nytimes.com/2010/01/12/nyregion/12ironman.html

Posted by: bdballard | February 2, 2010 11:27 AM | Report abuse

The Brooks column just seemed really.... weird. It sounds like he's saying that seniors are basically greedy and don't deserve as much of the pie as they're getting. It sounds like he's making an argument for "rationing!" and "death panels!" but I guess what he is really trying to say is that the federal government shouldn't be responsible for the heath needs of seniors and if they can't afford to pay for their own medical care, too bad. I think if that's really his argument he should just come right out and say so.

Posted by: willow8300 | February 2, 2010 11:29 AM | Report abuse

It's not that seniors are being greedy, it's that everyone else wants as good a deal as they're getting. Medicare for all!

Posted by: AuthorEditor | February 2, 2010 11:38 AM | Report abuse

Seniors on Medicare do choose health plans, that is, choose between Kaiser and some other plan. The plans bill the gov't and the gov't pays most everything according to its formulas.

There was a good discussion of the impact of doctor-owned facilities in increasing both usage and cost by Atul Gawande in the New Yorker some time back. He said that the biggest difference in cost among different areas is whether doctors see themselves as primarily healers or entrepreneurs and patients as patients or potential profit centers. This is why the push has to come at the Dr level. It isn't fair, as Ezra points out, to expect seniors to ration themselves.

But end-of-life care is where the big savings are. It is rich that the party that invented "death panels" and "killing Grandma" is now talking about rationing seniors, although in all fairness David Brooks criticized the GOPers' exaggerations.

Posted by: Mimikatz | February 2, 2010 11:41 AM | Report abuse

Brooks is kind of the Malcolm Gladwell of the opinion pages: a real artist at working with the tropes of the chattering class you and your readers (including myself) belong too, but unhampered by the need to grapple with the truth. For him, the truth is whatever will give the more prestigious half of his audience the thought "another sharp column by Brooks today." In short, he's kind of a menace.

Posted by: DaffyDuck2 | February 2, 2010 11:43 AM | Report abuse

You seem to view "seniors" as one vast lump of indistinguishable parts. Actually, there are rich seniors, middle class seniors and poor seniors. There is no reason whatsoever for the rich and middle class seniors to continue to be subsidized.

As you are fond of pointing out, the cost of medical care to federal and state governments is spiraling out of control, in not so small part as a result of undeserved subsidies to perfectly well off seniors. Maybe we should actually, oh, I don't know, do something about that problem?

Posted by: ostap666 | February 2, 2010 11:45 AM | Report abuse

Nice to see that others know and can quote Mose Allison. By the way, most of the debate on HCR can be summed up by another quote from Mose: "Your mind is on vacation and your mouth is working overtime."

Second point: I have made this point before, but it bears repeating: medical costs are high because people go to the doctor too often; they go to the doctor because they are not healthy; they are not healthy because they do not eat properly. Good diet means good health and a drastic decline in the diseases of civilization (heart disease, type II diabetes, obesity, hypertension, asthma, allergies, etc.). We could easily reduce health care costs if we gave up wheat, plant oils and sugar, reduced fructose consumption drastically, consumed more animal fats and animal products from grass-fed and pastured animals, and got more sun. Reform the Standard American Diet (SAD) and you can solve health care costs.

Posted by: johnsonr1 | February 2, 2010 11:52 AM | Report abuse

I'm as reluctant to blame doctors as I am seniors. Both are indivuals reacting to how society has organized incentives within it's health institutions.

Posted by: ideallydc | February 2, 2010 11:56 AM | Report abuse

*they go to the doctor because they are not healthy; they are not healthy because they do not eat properly*

That may well be true. But OLD people are not healthy because THEY ARE OLD. That is the nature of medicare: we accept that the aged and retired are not going to be a profit center for any insurance company.

Posted by: constans | February 2, 2010 11:57 AM | Report abuse

the difference between the elderly and the rest of us is that we pay for the older people's car (or we will now that medicare costs are rapidly outstripping medicare payments). most other people (albeit in an indirect manner that hides the cost) pay for their own care. you have to be more circumspect when you're spending other people's money.

Posted by: jfcarro | February 2, 2010 12:07 PM | Report abuse

haha, care, not car. but given the bailouts to the big 3, we may pay for their cars as well.

Posted by: jfcarro | February 2, 2010 12:09 PM | Report abuse

Ezra -The point is this: there is no reason for the young to subsidize wealthy seniors. the current and near 65 cohort of the US is the wealthiest generation in history. Why should the young and working age population subsidize EVERY person over 65. Sure, we should subsidize health care for the poor, but why the upper-middle class and rich?? That is the issue that needs to be addressed.

Means test Medicare, please.

Posted by: MBP2 | February 2, 2010 12:29 PM | Report abuse

Ezra,

I appreciate all your thorough coverage of this issue.

But I think you've got a bit of a blind spot about the excise tax. This same argument--that we shouldn't penalize people for needing to go to the doctor--is also part of the very strong argument against the excise tax.

Some serious people have also demonstrated that while it looks effective on paper, the excise tax would really negate many of the positive effects of reform--it would force employers to choose between reducing benefits or paying more to provide the same level of benefits. Charging rich people a surtax is, to my mind, a better way to pay for covering everyone. I hope you'll revisit this.
Here's the link to Larry Mishel's early paper on the excise tax: http://www.epi.org/analysis_and_opinion/entry/the_excise_tax_shares_flaws_of_the_tax_cap_but_with_even_worse_results/

Posted by: unionmaidn | February 2, 2010 12:34 PM | Report abuse

Sort of unfair of you to argue with such intellectual midgets as David Brooks and Ross Douthat. Come on, Ezra, pick on someone your own size!

Posted by: randrewm | February 2, 2010 12:58 PM | Report abuse

Good take on the same topic from Dean Baker: http://www.prospect.org/csnc/blogs/beat_the_press_archive?month=02&year=2010&base_name=the_government_spends_100_on_t

Posted by: alekdavis | February 2, 2010 1:12 PM | Report abuse

Ezra, I think you and many of the commentators here are missing the point that David is making. He's saying that seniors are being selfish by exerting their disproportionate political power to prevent changes to a failing health-care legacy program. Blocking needed Medicare reform (and also Social Security reform) in order to preserve their currant benefits without regard for the effect on future generations is selfish and writing that he's advocating seniors go to the doctor less is simply the same fear-mongering that the right-wing is currently engaged in.

You write at the end of your post, "we need to fix that, but there's no special key held by seniors (save maybe their disproportionate tendency to vote in midterm elections)." I know you're aware that this is the EXACT reason why any sort of meaningful reform is impossible, so why are you writing a lazy post full of red herrings?

Posted by: js_francis | February 2, 2010 1:17 PM | Report abuse

I didn't think the article suggested seniors are selfish, necessarily, so much as it made a call to arms to the grandparents of America. I was taught in public health school (no cites, sorry) that in focus groups about bioterror&pandemic response, many seniors said they would rather vaccines or treatment go to their children or grandchildren than to themselves. Brooks' point seems to be that sacrificing for the grandkids happens on a micro-level all the time, why not make a social revolution out of it and do what Washington is too inefficient and cowardly to make happen themselves?

Posted by: KatieD145 | February 2, 2010 2:09 PM | Report abuse

The models of Medicare and other entitlements are the problem. Most seniors are spending more than they've paid in, which is likely what David Brooks was referring to. I recall reading about the first social security recipient, Ida May Fuller....The accumulated taxes on her salary during the three years she worked was a total of $24.75. Her initial monthly check was $22.54. During her lifetime she collected a total of $22,888.92 in Social Security benefits.

Hopefully, the idiocy of this model is apparent to all who read this.

And today, people are living longer than Social Security and Medicare were meant to cover, and yet the ages of eligibility have barely budged.

It is this that I believe David Brooks was alluding to.

Posted by: boosterprez | February 2, 2010 2:52 PM | Report abuse

Thank you, Ezra, for bringing some common sense to the discussion. As a "senior" I am on Medicare and believe that, for the most part, my care has been excellent. As for controlling costs, I do believe that the retirement age should be raised a couple of years; I retired at 70. The best way to lower costs, though, is to means test; there is no sense in a federal program paying for Bill Gates' medical care -- or any other rich seniors. I know some seniors don't believe that, but Medicare should be like any other federal program -- it should be designed to help those who cannot help themselves.

Posted by: RonKH | February 2, 2010 3:03 PM | Report abuse

Medicare was origianlly "sold" as healthcare insurance for those 65 and older. Everyone with earned income paid their Medicare payroll taxes since 1965. In addition, the seniors have been paying taxes since the 1960's too. Medicare probably would never have passed if it was sold as anything other than an insurance program that everyone pays into and get similar benefits.
Like paying for life insurance then being told, gee you don't really need this, let's give it to someone else more in need.

Posted by: alantich2000 | February 2, 2010 3:05 PM | Report abuse

I agree with you. I believe we should instead stop paying for the health costs of illegal immigrants, not for citizens. The illegal immigrants are an incredibly huge financial burden on our system. They do not pay into our system and have broken our laws so they have no right to the same benefits of country that citizens receive. I realize many people don't think that matters because our country has always taken in immigrants. We've taken in those who follow and respect our laws! Laws are to create order. To live here, as in any country, people must respect our laws!! What a waste to be afraid to include such an impactful component in the national discourse on health care!

Posted by: gehrlich2004 | February 2, 2010 3:07 PM | Report abuse

I'm 84 years old and am starting to have some health problems now. But for FIFTY-FIVE years I've been paying into my HMO without a peep while I've been as healthy as a bull. So now I have to give up my health care so the children of the boomer generation can run up the Federal deficit while playing their computer games. Phooey.

Posted by: Paaa | February 2, 2010 3:11 PM | Report abuse

As a reasonably healthy senior a couple of years from 80, I understand the right wingers' notion that we oldsters are hogging the medical funds. What with prostate problems, hemorrhoids, monitoring a repaired aortic aneurysm and a few heart stents, and occasional skin things that they want to biopsy, my annual repair and maintenance bills are right up there. But I do go to work everyday, however, and pay quite a large tax bill. Personally I think that a more efficient health care system could provide for me and the youngsters at a cost closer to those paid in all the other industrialized countries. I don't think we old folks should be the scapegoats for what's wrong with our healthcare system. Instead, blame those who benefit most from its staying as is.

Posted by: charleyskipper | February 2, 2010 3:13 PM | Report abuse

Everyone wants to play the blame game. In my town, seniors pay ridiculously high property taxes, which largely help fund a school system they haven't used in decades. Thus children, including mine, receive at least $7 worth of muniicpal services for ever $1 worth delivered to seniors, the inverse of the purported federal outlay.

But in a society - which, by the way, is more than an economy - these sorts of disparities often arise. And in the end, assuming we all cycle through an average life, they all tend to even out.

Posted by: charlespaone | February 2, 2010 3:22 PM | Report abuse


I am one of those fortunate and never been sick or hurt. I am at an advanced age and I still do not need medical care. Since I was a child never needed a doctor to tell me how to take care of my body or how to enjoy living. Genes, right atitude toward life and some luck certainly helped.

My entire working life I had payments deducted from my paycheck for Medicare and for company's health care benefits. Other than the mandatory annual physical exam I never needed a doctor save one or two cortizone shots and a hernia repair for doing too much.

All those money went to benefit those that needed. So now if sometime in the future I will be needing medical care will I be one who abuse the system? Not fair, man !!!!

I take it Ezra you are still at a younger age. Wait until you get old. Then we talk again about right or wrong.
But I do agree there are way too many who abuse the system and majority of them hardly put any contributions into it. They are the ones to be weeded out. The way America works that will never happen. Too many bleeding hearts out there.

Posted by: paulr10 | February 2, 2010 3:33 PM | Report abuse

My mother-in-law is almost 95 years old. After surgery for a blocked vein in her leg, and the implant of a pacemaker, three months in a nursing home she is back home. We discovered in looking for home care that things like a little nursing care ($70 an hour) and physical therapy ($123 30 to 40 minutes). She declined all of them even though Medicare would pay. She felt the cost was too excessive and wouldn't help that much. Didn't want the government to have to pay those fees. We should all be asking what we are paying for some of these treatments and how necessary they really are. Too many service providers are taking advantage of Medicare it seems to us.

Posted by: lakeviewaa | February 2, 2010 3:46 PM | Report abuse

The current system is geared to MORE care, not BETTER care. So a loty of treaments don't extend anyone's life and don't make the quality of life any better. All they do is open the patient up to dangerous complications and line the pockets of the medical provider.

Posted by: wdague | February 2, 2010 4:23 PM | Report abuse

Gehrlich2004 is in error (mostly) if he claims that illegal aliens do not pay into the medicare system. If they are employees of a company that follows the Social Security/Medicare deduction rules, they WILL have deductions made to their paychecks. If the employer does not make the deductions he will be breaking the law.
Some "employers" avoid the payments by hiring illegals as "private contractors" but there are strict tests that they must adhere to in order to correctly classify the employees as contractors, and if they make mistakes, it could cost them. There are Mexican help groups out there that are watching to detect situations such as this and love to report it to the Feds.

Posted by: jiacone2 | February 2, 2010 4:23 PM | Report abuse

One example of how someone qualified for Medicare:
When a school district has a retirement plan for its teaching staff, the teachers do not qualify for social security / Medicare.
Therefore, the teachers are "allowed" to qualify for Medicare if they have a deduction of approximately 2 1/2% of their monthly check sent to Social Security during 40 year period for career teachers.
If the teacher when turning 65 then qualifies for Medicare, and they also have a retirement check each month, they then have to make additional payments (premiums) to Medicare.
These payments are made despite the fact that the Medicare / SS payments were taken from their checks for over approx. 40 years.

Since so many doctors have been "burned" by Medicare, not all accept Medicare and, in this case, teachers need a supplemental insurance policy.
As a result, this teacher would be paying up to $750 per quarter
for Medicare ($3000 per year) plus monthly premiums for supplemental insurance of approximately $350 per month ($4200).
So have a little compassion for this and other examples where a "senior" at 65 is paying premiums of $7200 a year for health care, $3000 of that may or may not be touched at all if doctors do not accept Medicare, in which case, the supplemental insurance is called upon to pay.

Seniors do their part to pay the system(s).

Still, Medicare fraud was supposed to be addressed by the Obama administration - but they are only interested in penalizing the abusers if this administration gets their HC the way they want it. And, I'll not hold my breath while they are cleaning up the fraud that has created the problems with Medicare.

Vote of No Confidence in this Administration.
All the wrong people are benefitting from Obama's proposed policies.

Posted by: pjcafe | February 2, 2010 4:27 PM | Report abuse

Well said -- but the problem goes further than stated. I took early SS retirement at 62 because I was forced to by the Ageism that is rampant at all companies, big and small. Since the VPs who do the hiring tend to all be in their 30s and 40s, don't want to work with those older than themselves -- no gray hairs, no mom and dads to be hired ever by these managers -- anyone 50+ or 55+ is DOA now. Talk to the HR people and corp search people off the record as I have, and they will admit this reality. They hire no one 55+ unless they are previous Presidents of companies or divisions. None. So yeah, some $9/hr jobs are available, but that's not livable income. So the young have only forced the Ageism issue on themselves, and will now have to pay for the millions they refuse to hire.

Posted by: jcluma | February 2, 2010 4:38 PM | Report abuse


Being on Medicare is not an option. When you turn 65 any private insurance you might have had is over or becomes a secondary insurance. So don't look at seniors as being the problem, look toward Wash DC and their mismanagement of yet another "program". Same story with Social Security – our money was taken from the employee/employer trust fund and squandered on other “programs”. More mismanagement.

Posted by: wpeake | February 2, 2010 4:48 PM | Report abuse

1.Don't blame seniors. They use free health care. Make it not free and the behevoir will change.
2. Any doctor will tell you that Medicare is an Eldorado. They milk it all vigoriusly, yet it pays with no question asked. Make the claim processing same as private insurance and doctors will treat more younger patients while seniors will look healthier to them overnight. I don't suggest that literally, but you got the point.
3. Medicare pays for lot of things that are not health care. Well, it is, but not quite directly. Social Clubs with hot meals, free mobile phones, resort like recovery program are just a few things that come to mind. Cut all that and money will save without any health concerns.

Posted by: alexbunin | February 2, 2010 6:11 PM | Report abuse

I know that we value people who make the most money more in this society than Seniors, who as a group, are no longer the big money makers.

In many cultures, and it used to be in our own, Seniors were called "Elders" signifying respect for the wisdom that comes from experience. Today we have no place for Elders or respect for wisdom of experience. Today we respect short term gain, the shorter, greater the more dramatic the better. We respect war. We respect "celebrity." We elect a young President. Journalists quote Sarah Palin. People believe Rush Limbaugh. Kids get their codes of conduct from millionaire sports heroes. Seniors are not wanted but are sorely needed in our short sighted culture - and we keep repeating the same mistakes.

I had respect for David Brooks. But it seems he is just another wing of those who want us to believe that food stamps are sinking our economy but ignore fighting 2 1/2 unnecessary wars, shiping jobs offshore, having troops stationed around the world pumping our money into other economies and catering to corporations and policies favoring Wall St and trade imbalances.
Well, I can't blame him. Those things are messy and a little complicated. It's much easier for David to toss the blame on seniors now-a-days and continue down his path that lead him to wealth. Wouldn't want to upset his aple cart now would we?

Posted by: thestoryplease | February 2, 2010 6:30 PM | Report abuse

Duh? The seniors have been PAYING PREMIUMS for years.

Posted by: jackbrumbelow7 | February 2, 2010 6:49 PM | Report abuse

Ezra,

"But people err when they imply that individuals have the power in the medical relationship."

Certainly that's a true statement today. But it does not follow that it must be true. Singapore has a system that is universal, popular, has extremely good health outcomes, costs 3% of GDP and 66% of which is financed by private dollars, mostly through health savings account. The only way to truly empower patients is by letting a price system evolve and work.

Did you ever comment on the David Goldhill piece in the Atlantic: How American Health Care Killed My Father.

Regards,

Steve

Posted by: FatTriplet3 | February 2, 2010 7:11 PM | Report abuse

Ezra, love your column and read it frequently. Re David Brooks, he frequently makes sense but one poster below also thinks he inserts into tropes frequently and thus has an appeal to all comers. He need to stick to his RW origins. Now, as an aging guy of 74, no ailments, Kaiser HMO, dropped Med Advantage, saved a ton annually after a very careful review of benefits, have jogged 1,000 miles annually for 40+ years, I dont expect to incur large medical costs until age 85+; however, should I, I really plan to enjoy each pill, needle prick and scan! I joined the Medicare world on Day 1, 1965 while working as a MedTech in a Catholic, nonprofit hospital lab at rather low pay. I have worked very, very hard in my jobs and by god, like many old timers should offer absolutely no apologies for using my Medicare account. And Mr. Smartypants Brooks, I promise you I will never abuse it! So there you chatty wordsmith!!!!

Posted by: JLF0425 | February 2, 2010 7:38 PM | Report abuse

Here's the deal! I'm 54 years old. I have made just over $1,000,000 in my life time. I have paid ONLY $15,000 of my income toward Medicare; that's 1.5% of gross. That's it. Social Security isn't much more than that, at 6.5% of the first $115,000 for last year. The cap has been progressively lower in past years.

Very-very few of these seniors have paid more than $15,000 into Medicare in their lifetimes. One hip replacement, and they are on the public dole! And that is fine! I get it! But, they make statements in public like "I've paid into this all of my life, I earned this" and "leave my Medicare alone," as they attend Tea Party meetings in order to deny what they enjoy from others who are denied to purchase, or can't afford in this abysmal economy. Especially the young!

Now, I have paid for their Medicare for all of my working life. Last night I listened to a Republican Congressman from Texas say that people under 55 are going to have to settle for something "other" than Medicare! Sounds like my golden years are going to be short and painful!

The over 65 crowd needs to keep their mouths shut, and not whine when we as a society try to come up with a way to help more people because their Medicare may be reviewed for cost. They appear as petty, whiney ingrates who are not well informed enough to know just who butters their bread.

I don't deny them the medical care, but they don't have a right to complain that they aren't getting enough, or fight to deny others the same "freebie" YES , I said "freebie" that they themselves enjoy.

Posted by: Georgiabiker | February 2, 2010 9:39 PM | Report abuse

In the great land down under, we elderly people are regarded as a liability and yet for those of us with problematic health, in my case chronic pain, there is a strong case for assisted departure when the time comes. Not for me a hospice with all the lies they tell you about people being pain free - there is no such state that I have discovered. And I have tried everything in the way of pharmaceuticals, all legally prescribed but to little avail. So when the time comes, I want to go with dignity.

However, my main reason for joining this little debate is that I would like to thank Ezra for his comments. Youth culture dominates everything in Australia and many of us feel unwanted and a burden to society, not withstanding the fact that we have given our lives to the country along with taxes. In a strictly relative sense, you could say that I am better off financially than some but without health, life can be very trying and the stigmatization of the elderly for being old gets to you occasionally. Why people think that age automatically means senescence is quite beyond me. I don't know how you educate a whole culture to accept that the elderly have built what the young enjoy now.

Posted by: cjward1 | February 2, 2010 11:08 PM | Report abuse

Thanks Ezra Klein!

There's DIFFERENCE between:
Regular Medicare &
MORE EXPENSIVE Medicare Advantage Private Plans.

Various REFORM BILLS now pending should ACTUALLY MAKE Medicare better for most beneficiaries —
-by enhancing drug coverage,
- eliminating co-payments for preventive services
- helping KEEP MEDICARE SOLVENT.
…exception is SOME of 10 million people that participate in Medicare Advantage Program Private Plans.....
— might sustain a dilution of some EXTRA benefits they get that other Medicare beneficiaries do not.

To “help them compete” against traditional Medicare Fee-For-Service program, Congress granted these plans LARGE OVER-PAYMENTS,
essentially SUBSIDIES….

Which subsidies are required to be used to reduce charges to their beneficiaries, add extra benefits, such as vision, dental benefits, or even gym memberships.

But it’s UNFAIR to FORCE THOSE ENROLLED in TRADITIONAL MEDICARE to HELP FOOT bill — currently $43 a year EXTRA for EACH PARTICIPANT — to HELP SUBSIDIZE Private Medicare Advantage Plans.
Federal taxpayers have contributed heavily as well.

Private Plans didn’t start out costing government more.
In 1980s - 1990s, assumption was Private Health Maintenance Organizations could do a better job of coordinating care and saving money than government.

Private Plans were paid 95% of what SAME SERVICES would cost in traditional Medicare,
(assumption was that money would allow them to deliver extra benefits.)
1997 Budget cuts drove many Private Plans to drop out of program, so Congress STEADILY RAISED PAYMENTS.

Medicare pays private plans, on average, 14% MORE THAN SAME SERVICES WOULD COST in TRADITIONAL MEDICARE.

Bill being considered by Congress is projected to CUT SUBSIDIES to Medicare Advantage Companies by more than $100 billion over 10 years.

REPUBLICAN RHETORIC has TRIGGERED FEARS that Medicare Advantage enrollees MIGHT LOSE THEIR COVERAGE ENTIRELY if Private Plans drop out of system.
Actual effect of bill would LIKELY be MODEST on AVERAGE.

Douglas Elmendorf,
Director of Congressional Budget Office, said…
……under bill as proposed by Committee Chairman, he expected that ALMOST ALL Medicare Advantage plans would continue to operate, & ALMOST ALL of THEIR CURRENT ENROLLEES WOULD STAY ENROLLED.

Total enrollment in Medicare Advantage would creep up by 200,000 over next decade (about 2.7 million fewer new enrollees than expected under current trends),
a REAL CHANCE for SAVINGS....!!!!!!

What Republicans AREN’T saying —
& Democrats CLEARLY AREN’T SAYING ENOUGH —

…VAST MAJORITY of Medicare recipients,
THOSE enrolled in TRADITIONAL MEDICARE,
should ACTUALLY have IMPROVED HEALTH CARE with proposed REFORM.

Posted by: AZperson | February 3, 2010 12:03 AM | Report abuse

It's pretty obvious to me that we should reward seniors for choosing less expensive treatments. Of course, that would require doctors to publish costs. But I know most of my family members that are on Medicare are also clipping coupons and looking for cheap prices on stuff. They are pretty good at it.

I think we could push a bill through that would require all licensed medical providers to publish their costs. If we aligned it with some percentage style co-pays, we would see the over-medicating of America drop significantly.

Posted by: staticvars | February 3, 2010 12:25 AM | Report abuse

I find this entire discussion amazing. All we old geezers have paid more than our share through the years. What no one ever discusses is how over the years there was massive amounts of money in the social security fund. All that money sitting there was more than the congress could stand. They could not control themselves and they spent much of it. The program was well designed. The best thing that could happen to social security would be a law written that will not allow any congressional access to those funds. those clowns never met a pile of money they didn't love.

Posted by: oldpol | February 3, 2010 12:47 AM | Report abuse

There are seniors and seniors but the responsible do not relish the pain and suffering that calls for cure or relief that the medical profession can provide. Given a choice, many would be only too glad to move on and, consequently, cease to be a burden to anyone. I know; at 90 years of age, I suffer with the incurable condition akin to, if not of purgatory.

Posted by: corners | February 3, 2010 2:03 AM | Report abuse

David Brooks, MD.....who in hell operated on his brain in the first place????

Posted by: connyankee1 | February 4, 2010 9:47 PM | Report abuse

Like Margaret Thatcher said "Socialism only works until you run out of other peoples money" Medicare, Social Security and other incrementally socialist programs always break down into pitting various interest groups against each other to battle over "entitlements." Old versus young, rich versus poor, doctor versus patient and healthy versus sick. The winners are the politicians that distribute the spoils and gain more and more power over our lives. Everyone else loses in the long run including the taxpayer and those value liberty. We need to take steps to wean especially the middle class off the government dole and minimize government intrusion into health care. Otherwise we risk the U.S. being another populist basket case like Argentina.

Posted by: zimmer_mark | February 5, 2010 4:06 AM | Report abuse

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