Is Medicare going to hurt my Mom?

November 8, 2009 8:16 AM

My mom is TERRIFIED about the recent Health Care Reform Bill. She is on Medicare and is certain that she will no longer have the access to health coverage that she feels she needs. It sounds like changes to Medicare could have consequences for her... what might those be?

I tried searching around for real answers but, of course, some of those answers lay in what the market will do when faced with these changes. She watches a lot of Fox news and Fox news is absolutely drumming the beat that Obama is going to kill your grandma. But, sorry news orgs, having trouble finding an equally compelling (so hard to beat FEAR) news source who is explaining things in way that could reassure her.

posted by amanda to health & fitness (38 comments total)

It's impossible to say at this point, since the bill has only passed the House and will likely look different when/if it passes in the Senate (which won't be until at least January 2010).
posted by proj at 8:20 AM on November 8

Yes, proj, but Fox is SURE! Help me out here.
posted by amanda at 8:23 AM on November 8

Dunno if she'll trust this source if Fox News has convinced her otherwise, but WhiteHouse.gov is trying to combat the doomsayers...

This one addresses Medicare fears specifically. Again, your mom might not trust it but at least it's info from the people who actually created the bill.
posted by castlebravo at 8:25 AM on November 8 [3 favorites has favorites]

Argh - I watched the video linked by castlebravo, but it was vague. Reducing subsidies to Medicare insurers... no evidence the subsidies improve care... subsidies actually increase premiums (how?). What are these "subsidies"? What do insurers do with them? How much will they be reduced? How do the subsidies "actually increase" costs to the insured?

I get that too many details would be too difficult to follow, and that we're basically talking about predicting the future -- which is impossible for both political extremes -- but aren't there any more specific, concise rebuttals out there? I'll look myself, but I'm posting this to maybe articulate the question a bit more.
posted by amtho at 8:34 AM on November 8

The AARP page might be one to watch as things develop.

One good thing that appears to be happening: reform should close the "doughnut hole" in Medicare Part D. This is a huge improvement for people on Medicare.
posted by gimonca at 8:35 AM on November 8 [3 favorites has favorites]

Factcheck.org would be another good site to monitor for articles. Example from last August.
posted by gimonca at 8:38 AM on November 8

I'd simply point to the AARP's recent endorsement of the bill - an organization composed largely of Medicare recipients and dedicated to advocating for them is not going to support a bill that nukes Medicare.
posted by Tomorrowful at 8:47 AM on November 8 [3 favorites has favorites]

Seconding the AARP recommendation. I believe they just endorse the plan. On Monday, call their DC office and tell the person who answers the phone that you're trying to reassure your Medicare-receiving mother, and they should be able to connect you with someone (or something on the Internet) that will help. Don't feel silly about this - I work for an advocacy group and we get calls like this all the time.
posted by lunasol at 8:47 AM on November 8 [3 favorites has favorites]

I just caught my mom crying as she explained to my little brother how she won't be covered for this or that. I said, you've got to stop watching Fox news -- they are the ONLY organization saying this. She said, well, everyone else just won't cover the topic. [head explodes]

AARP is a good source for this and I agree that that video was less than clarifying. It's such a complicated issue in terms of how things work now (how they are supposed to work vs. how they really work) and how they might work in the future.

I admit to being somewhat obsessed right now with my friends who don't have coverage or can't get coverage and my own coverage ending soon that I get a little frustrated at these seniors and the fear-mongering that is directed towards them.
posted by amanda at 8:53 AM on November 8

I was curious also, the AARP's page is good, check it out.
posted by matteo at 8:58 AM on November 8

There's always factcheck.org, procon.org?

I know about Fox News. That's all my mom watches too; that, and anonymous email chains.
posted by lhude sing cuccu at 9:36 AM on November 8 [1 favorite has favorites]

I would appeal -- if at all possible -- to your mother's pride in her citizenship. The right has attempted to scare the elderly as part of their usual divide-and-conquer strategy. Health insurance reform will make a huge contribution to improving the US economy, and providing basic human needs to more citizens. Why is she against that? It's good for older Americans too, especially those who have kids and grandkids they'd like to see have a chance for a decent future.

I know, radical, right? Underneath all these right wing lies about the specifics is one big lie: that health insurance reform will cost more than it saves.
posted by fourcheesemac at 10:13 AM on November 8 [2 favorites has favorites]

Unfortunately it is never easy to tell someone else (a parent noless) "not to worry". But, you could try to reason with her by giving her illustrations of things she worried about in the past that did not occur. (I have an older friend who thought for sure the world would spin off it's axis with Y2K). Your Mom and the rest of us have to see how this plays out. Remind her how resilient she has been..and make sure she is doing all that she can for herself healthwise. That's about all you can do, short of marching on Washington together.
posted by naplesyellow at 10:20 AM on November 8

Another thing to question is that if Medicare is so great, why do people need supplemental insurance? No matter what the answer is, you can then remind them that there will certainly be similar supplemental insurance available to cover any gaps that reform might change.

But ultimately, the answer is really that she needs to expand her sources of information. It is truly frightening that our senior citizens, who saw the world nearly taken over by nazis and fascists, can't see it when their news sources use the same tactics. (Like "the other guys are lying, you should believe only us, respect the president only when he is one of us, etc.) On the other hand, these are probably the same kinds of people who were all about the McCarthyism. If you can't prove they are doing wrong, make what they ARE doing wrong. If you can't do that, make people fear what they might do. In other words, when you can't attack facts, attack motivations.
posted by gjc at 10:25 AM on November 8

This page links to a summary (.pdf) of the proposed changes. It has actual facts.

The usual disclaimer: I work for the organization that produced the summary, but I don't have anything to do with the writing/policy analysis side of things.
posted by rtha at 10:43 AM on November 8 [2 favorites has favorites]

AARP is not necessarily the real friend of the elderly. They have such huge investments in the insurance industry.

This is a really bizarre and inaccurate take on AARP.

I think you need to do a lot more research.
posted by Sidhedevil at 10:51 AM on November 8

[Bunch of comments removed. More helping the asker with sources and facts, please, less general arguments about healthcare or FOX or calling people dumbfucks, thank you.]
posted by cortex at 10:51 AM on November 8

you could point out that the same crowd that is saying that about medicare NEVER would have voted for medicare in the first place. The people trying to pass health care reform would have suppored medicare.
I mean that has to mean something.
posted by alkupe at 11:01 AM on November 8 [1 favorite has favorites]

We really don't know, and that is scary. I suggest active listening, "Mom, it sounds like you're really scared about the possible changes to Medicare." with a bit of reassurance "you know that I will always do my best to make sure you're taken care of, and so will [other family member or close friend]"
posted by kathrineg at 11:10 AM on November 8

I always hate wading into these questions with anyone, especially family members, because most people who are to the point where they used words like "scared" and "fearful" on any political issue these days tend to: a) talk in generalities ("it will destroy medicare"); or, b) recite objectively false statements (e.g., death panels are on p. 623 of the bill).

If you're determined to wade into this, you have to employ the "Count to 10 Rule" to listen to what her "fears" are WITHOUT responding or arguing them in any manner at this point. Figure out which of these two categories (general or false specific) her issues fall into. Don't respond with your position, "that's nonsense, or fall into responsive argument of any kind.. At this stage, you're only allowed to ask clarifying questions (Mom, why do you think the HCR bill will hurt your medicare coverage?). Only ask "why" and "how" questions. Then, go home and research each specific one yourself, point by point. Then come back to her later and show her the results of your work, putting it in the form of "Mom, I know you're worried about these things, so I thought I would find out more for you."

Good luck and remember, none of this has a snowball's chance in hell of working. That's why we don't talk politics and religion with family. Try not to get written out of the will.
posted by webhund at 11:11 AM on November 8 [5 favorites has favorites]

The one major change to Medicare will be cuts to Medicare Advantage plans. Medicare Advantage was a poorly conceived attempt to allow a "private option" for Medicare. It was intended to save money but ended up being subsidized by the government so that it is 14% more expensive than fee-for-service Medicare. The subsidy for private insurers will be removed which means that most of those private insurers will very likely exit. Medicare Advantage customers will have to move to the standard fee-for-service plan.

For everyone else, Medicare will be strengthened. In particular, it will plug the doughnut hole in Medicare Part D to provide better prescription coverage.
posted by JackFlash at 11:52 AM on November 8

"Mom, suppose everything you're afraid of is true. What do you need to do to make sure you're okay? How can I help? Because just worrying about it won't help. Let's do something." Validating feelings, even if feelings are divorced from facts, can help you get to a level playing field and then address facts.

If along the way your mom is empowered to contact her representatives, saves more money to pay for more of her own medical care, eats better, exercises a little more, worries less, works on a project with you... would all that be so terrible if she's mistaken (a little or a great deal) at this exact stage of things? It's terrible now, but it can be part of getting towards something better.

And maybe you will also learn along the way that she and FOX aren't entirely wrong. The plan has some flaws, so prepare for them. Don't fight her 100% disaster thinking with 100% awesome thinking.
posted by eccnineten at 11:54 AM on November 8 [3 favorites has favorites]

Amanda, I think that the problem lies in the cognitive dissonance between how FOX News viewers perceive FOX News, and how the rest of the world does. If you are a FOX News viewer, you buy into what the channel is selling: that they present fair and balanced reporting, that any Democrat is the most evil person in the world, and that every Democratic proposal will destroy the Earth's iosphere.

What you're essentially asking us is how one might convert a FOX News viewer into someone who recognizes the folly and untruth of what they're reporting. That's a tall order, and it's made even taller by your mother's age. While it's not a sure-and-fast rule for every single person at her age, most people's flexibility to adopt entirely different worldviews calcifies as they grow older.

So is there much you can do? I'm not sure there is. I think that of the various suggestions made thus far, KatherineG probably has the idea that has the highest scenario of success: approach the question not from the facts, but from the emotion. Your mother is terrified (thanks to FOX) that she'll be one of the "dead grandmas" FOX keeps touting. Basically, that could be even an at-a-remove manifestation of a larger fear, that of her approaching death (which hopefully is decades off, but she may be hearing the clock tick more loudly).

So reassurance that you'll care for her and be there to protect her -- coupled with a more generalized pointing-out that many a disaster has never happened (such as, as previously cited, Y2K, which had next to no effect despite the years of preceding media hype) -- I think would have the best chance of success.

If you think she's flexible enough that you'd want to try to point out to her that FOX News preaches a load of shit, my own guess would be that perhaps some of the more highly-ranked Jon Stewart Daily Show compilations might be useful -- the ones where FOX News clips are cut so clearly as to show the channel's hypocrisy in stark relief. Here's one. And a separate Ask Mefi would probably yield you some good clips as well. The reason I think Stewart might work is, well, he's funny, and humor's got a penetrative ability. Once you're laughing, your defenses are down.

If she's hooked on the idea that FOX is truth, then you're pretty much going to be stuck doing an emotional patch-up job through repeated scenarios, because she's going to get scared and scared and scared again. Because that's what FOX News is doing with the Obama Administration: pretty much lying their ass off to pander to their party and their base. And as a result, if your mother takes the lies in wholesale with no filter, then there's only so much you can do. Maybe counsel her to get an anxiety-pill prescription?

One last suggestion would be to kind of walk her through, "Okay, I don't think it will happen, and the AARP doesn't, nor does [etc.]. Still, let's just say it did. What would we do, Mom? Okay, well, let's look up how much some of the supplement-to-Medicaid plans cost on the private market. Oh, it's just $[x] a month ... heck, that's something I could definitely help you out with." If you walk through the practical implications of the scenario you're terrified of, sometimes that does a great job at defanging it.

P.S. *sigh* I was just about ready to submit this comment, and was clearing out some tabs. I had clicked on an outdated FOX News link, so it redirected me upward to the main FOX News Opinion webpage.

Which had as its main lead in large type "Kiss Your Freedoms Goodbye If Health Care Passes", with this lead-in: "Congress recognizes no limits on its power. It doesn't care about the Constitution, it doesn't care about your inalienable rights. If this health care bill becomes law, America, life as you have known it, freedom as you have exercised it and privacy as you have enjoyed it will cease to be."

Gee, I can't imagine why your mother is scared. They're so even-tempered and calm and rational over there ...

I'm truly sorry that you have a loved one who is buying hook, line and sinker into their fear tactics.
posted by WCityMike at 12:13 PM on November 8 [2 favorites has favorites]

Even if your mom's benefits are affected in some way, she will be ok. You, your brother, and other family members are there for her and are willing to help her navigate whatever new healthcare system or changes to Medicare she might face. I don't know if persuading her that Fox News is wrong about healthcare reform is possible or even necessary.

Cable news of any political persuasion thrives on convincing people that there are urgent, scary, important things happening right now and it is critical to stay tuned for more information. Fox News's "Obama wants to kill your grandma" stories aren't especially different from "Something in your bathroom could kill you, details at 11" local news teasers. My political views are the opposite of your mother's, and I find that I am sometimes overwhelmed by reporting on my pet issues. When I get to the point where I feel panicky about, say, healthcare reform (worrying, unlike your mom, that nothing will ever change), I've realized I need to take a break from the blogs and news. Inducing panic--as contemporary editorialists and commentators are sometimes wont to do--is entertaining and compelling, but it isn't informative.

I wonder if the place to start might be encouraging her to recognize that the proper source for information (not opinion, not commentary) on her medical benefits is not Fox News pundits but rather someone who is actually in a position to know her situation and her benefits. Perhaps there is a local or national organization that could set her up with a counselor who could discuss her needs and available benefits.
posted by Meg_Murry at 12:17 PM on November 8

Also, just as an FYI, this might be useful. Quite literally, and with no hyperbole nor bias whatsoever, it is FOX News suing for the right to broadcast false information.
posted by WCityMike at 12:17 PM on November 8

Hey, listen, I don't want to sound like I'm Pepsi Blue-ing my FPP, but if you're looking to counter-introduce some positive news sources into her life, I put together a FPP for that purpose (basically, because of the same thing Meg_Murry says: I found my own news sources to be really overwhelming in their pessimism, and I needed some counterprogramming to convince me the world wasn't truly going to crap).

They're not particularly liberally biased, either, so I think your mother, even if she is of a conservative bent, might find them palatable – and thus it might serve as counterprogramming to the emotion of fear being pushed by FOX.
posted by WCityMike at 12:20 PM on November 8

Relevant part from this article in the Wall Street Journal, which is hopefully red-blooded enough for her:

Seniors on Medicare: Over time, the bill would close a gap in prescription drug coverage. Currently, Medicare participants are responsible for paying drugs' full price in the "doughnut hole," which kicks in when their drug spending exceeds $2,700 and goes up to $6,154 per year.

Medicare recipients would no longer have to pay out of pocket for preventive care. Certain early retirees could tap into a new fund that offsets the cost of high-cost health claims.

Since cuts to Medicare spending are one of the bill's biggest funding sources, some benefits could evaporate from the program. Core benefits aren't likely to be affected. Most likely to be eliminated are benefits such as free fitness classes offered by private insurers who cover some people on Medicare.
posted by mattholomew at 1:38 PM on November 8

WaPo's FAQ on health-care reform -- see question #7.
posted by Jaltcoh at 2:24 PM on November 8

Here's a nice summary by the reputable Betsy McCaughey* on just the things that my Mom is so upset about: online.wsj.com. Sounds pretty scary to me. The thing is, if the bill supporters can't fill in the blanks then people will do it for them and convincingly.

"In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions."

Sounds scary to me!

*yes, I know. This opinion article came out yesterday. I guess she's still got weight.
posted by amanda at 4:26 PM on November 8

Rupert Murdoch owns not only FOX News, but the paper that printed the article to which you linked. The Wall Street Journal is most definitely not an unbiased source. And while I'm not personally familiar with Ms. McCaughey's work, I note she's a Republican, so her position isn't exactly likely to be unbiased either.
posted by WCityMike at 5:09 PM on November 8

Here's a nice summary by the reputable Betsy McCaughey* on just the things that my Mom is so upset about...

Media Matters is great at debunking this kind of stuff: On the eve of House vote, McCaughey spews falsehoods about health reform

If a source is prominent enough (such as the WSJ) it is easy to find a thorough debunking of misinformation just by Googling for phrases within the text. I suspected that Media Matters or FactCheck might have a response to this, and the easiest way to find it was Googling for the phrase you used.
posted by grouse at 5:59 PM on November 8

I can only assume you were being sarcastic in your description of Betsy McCaughey. See here for more. (Though given your mom's preferences, I can understand why she might think McCaughey is reputable.)
posted by Conrad Cornelius o'Donald o'Dell at 6:01 PM on November 8

Disclaimer: I did not go through all the links others have posted, nor do I watch Fox - or any news channels for that matter. But from the position of a wife whose husband is a physician, by biggest fear for her would not so much having procedures denied as much as actually finding a doctor who will continue to take Medicare patients if such drastic cuts in Medicare are taken that are proposed. For all the naysayers out there, Medicare generally ALREADY pays below cost for most procedures.....private insurance profits is what allows them to perform those procedures anyhow to offset the loss.

The bigger problem is that if these huge Medicare cuts (or a public option based on Medicare rates) go through, then it's not hard to imagine that doctors will say "Hey, I don't want to lose so much money on this patient - No thanks!" So the problem won't be so much as the govt saying "Grandma is too old to receive such treatment" than "Good luck grandma trying to find a doctor who will give her that treatment."

Now before everyone starts throwing stones at me, my DH works at a non-profit hospital so things for us will be business as usual, though in the long term I'm sure it will reduce our paycheck. But for physicians in private practice, this is a very real deal that will hurt their practice. I already know several physicians who are no longer taking Medicare patients b/c they have heard that being a Medicare physician will automatically enroll you in any public option. Regardless (and w/out going into the eternal debate of the proposed legislation), there will be a huge strain on the existing medical system.
posted by texas_blissful at 7:55 PM on November 8

Ugh, after rereading what I wrote, at worst sound trollish and at best sound like I have my own interest in mind. But honestly it's neither; I'm just a "lets jump to the point and be realistic here".
posted by texas_blissful at 8:00 PM on November 8

Actually, texas, I don't think you sound trollish at all. That is a very complicated piece of the puzzle. I'm not sure that this reform addresses that -- how can it, really? It seems like everyone has someone else over a barrel in the health care industry. We subsidize the private health insurance industry with federal dollars. The insurance industry has incredible leeway in terms of who they cover and what they will pay. The doctors are beholden to this industry, it's how they get their patients. It seems very difficult for an individual to negotiate their own care even if they wanted to. Most primary care physicians say they don't get enough time with their patients. Who's winning here?
posted by amanda at 9:11 PM on November 8

Amanda, what texas says is true, and part of the puzzle. Medicare is going to go broke, perhaps this decade, perhaphs next, because of the increasing bills once the boomer generation retires. The solutions are to either raise payroll taxes on those still working, increase charges to the retired, or decrease payments to the providers. Guess which is the most appealing, in Washington?

This is a problem that has been on the horizon for years. If no new healthcare bill was passed, this would still be an issue that would have to be dealt with. Fearmongers are capitalizing on this.
posted by Midnight Skulker at 7:21 AM on November 9

Amanda,

What texas said is not completely true. Specifically, the statement, "Medicare generally ALREADY pays below cost for most procedures...private insurance profits is what allows them to perform those procedures anyhow to offset the loss." sounds right. But like so much common sense, the reality is more complicated.

Looking at research in this area, Health Economist Austin Frakt speaks about this basic economy fallacy. "Price differentials, which [the report] describes, do not support the conclusions reached," writes Frakt. "Just because payers A and B pay different prices does not mean that if payer A paid more payer B would pay less."

What does this all mean practically? Keep in mind what the purpose behind an argument such as texas's is geared towards (note she may/may not realize this). The dynamic is that:

1. Smaller Medicare payouts will lead to larger private insurance payouts,
2. Larger private insurer payouts will lead to lesser sustainability of private insurance approach.
3. Faltering private insurance leads to a gradual government takeover.

In other words, the cost-shifting argument can be seen as a code for "government takeover".

So what would lower Medicare payouts mean? Ezra Klein, "[Y]ou can argue that the private insurance industry has accelerated the growth of health-care costs because it is too weak to hold fast against price increases from providers....The current health-care system needs current spending plus the current rate of growth in spending to survive in its current form. If Medicare lowers payments, it will attempt to make up the money elsewhere. If Medicare doesn't lower payments, it will attempt to make more money elsewhere. The system would like as much money as it can possibly get. But if the rate of growth flattens because Medicare and Medicaid and private payers decide to hold down rates, the system will settle on a new and lower equilibrium."

So what's the difference? Well, having lower revenues is not the same as shifting costs. The health care industry will have to do more with less...but less from everyone. And this might not be bad. Klein again, "I think the health-care system spends too much money for not enough return, and so I think it's a good thing."

Now, could texas's interests still be negatively affected based on the above. Yes. But it won't be because costs are being shifted to the private market (thereby killing it). It will be, in my opinion, because the market, as a whole, will more efficiently spend its limited resources.
posted by Hypnotic Chick at 8:59 AM on November 9

Remind her that there are bigger, more important and tangible dangers to worry about, like the world ending in 2012, just like the Mayan calendar says.
posted by WeekendJen at 2:32 PM on November 9