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Senior Citizen Politics


Senate Aging Committee Hears Changes to Medicare Unpopular with Senior Citizens, Voters

First hearing of this Congress lays out the problems and the options with a focus on fixing the cost of healthcare

Feb. 28, 2013 - The first hearing by the Senate Special Committee on Aging since the leadership was handed to Sen. Bill Nelson (D-Fl) and ranking member, Susan Collins of (R-Me) took on the challenge of Medicare’s future yesterday. But, rather than a doom-and-gloom hand wringing, it was an earnest, straight-forward approach at helping the popular senior program survive with little or no damage to its services.

Sen. Collins, it her opening statement, said,” The real key to getting Medicare costs under control is to get health care costs under control. Today, the United States spends 18 percent of its gross domestic product on health care, more than any other industrialized county. Yet we lag behind other nations on many measures of quality.”

This was close to the line expressed by all the speakers at the hearing, who discussed the options available for change and their suggestions on solutions.

Chairman Nelson noted there was good news about Medicare.

“According to the Congressional Budget Office, federal spending on Medicare has been significantly lower than predicted over the past three years,” he said in his opening statement.

“Medicare spending in FY2012 grew by just 3%, to $551 billion, according to CBO. That represents the slowest rate of growth since 2000.

“While this is great progress, we all know financial challenges lie ahead. As more and more baby boomers retire and health care costs continue to rise, Medicare spending could reach $1 trillion by 2023.

“We’re making progress, but we know we can do better.

The hearing received a briefing by Juliette Cubanski, Ph.D., Associate Director, Program on Medicare Policy, The Henry J. Kaiser Family Foundation, on the current situation of Medicare based on empirical evidence and the attitudes of American voters and senior citizens toward the program based on polling.

Two points that stood out – Medicare is very popular with senior citizens and a significant majority of U.S. voters do not want to see any cuts in the program.

Cubanski also pointed out that “Medicare is expected to face significant financing challenges due to rising health care costs, the aging of the U.S. population, and the declining ratio of workers to beneficiaries.”

And noted that “a number of Medicare proposals have been made, including:
    ● restructuring Medicare benefits and cost sharing;
    ● eliminating “first-dollar” Medigap coverage;
    ● increasing Medicare premiums for all beneficiaries or those with relatively high incomes;
    ● raising the Medicare eligibility age;
    ● changing from its current defined benefit structure to a “premium support” system; and
    ● accelerating the implementation of delivery system reforms (Kaiser Family Foundation 2013a).

“While policymakers weigh potential Medicare savings options to reduce the deficit, the public does not perceive a need for significant cuts,” she said.

“The Foundation’s recent polling shows that a majority of the public (75 percent) believes that deficit reduction can occur without major reductions in Medicare spending.

“In fact, 58 percent of Americans say they would not be willing to see any reductions to Medicare as part of deficit reduction discussions.


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“When asked about specific proposals to reduce Medicare spending in the context of deficit reduction, a majority of Americans expressed support for two proposals:
     1) requiring drug companies to give the federal government a better deal on medications for low-income people on Medicare; and
     2) requiring high-income seniors to pay higher Medicare premiums;
these proposals were supported by 85 percent and 59 percent of Americans, respectively.

“Notably, the survey also shows that relatively few Americans (roughly two in ten) are aware that wealthier Medicare beneficiaries already pay higher premiums for their Medicare coverage.

“Other proposals are opposed by a majority of Americans, including:
     1) requiring all seniors to pay higher Medicare premiums;
     2) increasing the payroll taxes workers and employers pay to help fund Medicare;
     3) reducing payments to hospitals and other health care providers for treating people covered by Medicare; and
     4) gradually raising the age of Medicare eligibility from 65 to 67 for future retirees.

“These proposals were opposed by 85 percent, 55 percent, 51 percent, and 51 percent of Americans, respectively.”

David Blumenthal, M.D., M.P.P., President, The Commonwealth Fund, noted that the views he presented are his own and not necessarily those of the Commonwealth Fund or its directors, officers, or staff.

Dr. Blumenthal recognized the cost of Medicare is forcing policy makers to face a “fork in the road.”

“On one path, policies could be pursued that cut Medicare payments to providers, reduce the benefits available through the program, or restrict program eligibility. These policies could produce program savings, at least in the short run, but they would be both morally and politically difficult, as they shift costs onto elderly Americans, renege on historic promises, and raise the prospect of second class care for a group that is particularly vulnerable.

“Moreover, these policies generally do not address the underlying causes of the health spending problem, so the payment cuts, reduced benefits, and restricted eligibility would have to become increasingly severe over time.

“An alternative - and far preferable - strategy would support comprehensive payment and delivery system changes that produce lower costs and better value not just in Medicare, but across the entire U.S. health system. This path builds on the Affordable Care Act and continues to lead away from our current fee-for-service reimbursement system with a set of initiatives that reward providers, consumers, and payers for choices that improve outcomes and use resources efficiently.

“We know this approach is viable, as many innovative changes of this type are already beginning to emerge on the health system landscape as the reform law is implemented and both public and private stakeholders act on the increasing awareness that reengineering health care is preferable to rationing it.

He concluded by saying,In summary, it should be possible to stabilize health care spending growth for both public and private payers while also improving the performance of the health system overall and both quality and efficiency of care. Through a combination of reforming provider payment, engaging consumers to make high-value choices, and improving the way health care markets function, with all stakeholders involved and pulling together, we can achieve this goal.

In combination, these policies would lead to wiser and more efficient expenditures of health care dollars, while also enhancing the benefits of health care. These policies not only would strengthen Medicare for today and tomorrow but also make our health care system as a whole more viable. The resulting savings could be redirected to other essential uses, both in the public and private sectors.

“In the end, reduced health spending by federal, state, and local governments and private employers would accrue to households, which ultimately bear the burden of rising health spending through higher taxes, reduced wages, or direct out-of-pocket costs.”

Witnesses at the hearing included the following (click names to read their presentations).

   ● Juliette Cubanski, PhD, Associate Director, Medicare Policy Project, Henry J. Kaiser Family Foundation

   ● David Goodman, MD, Director, Dartmouth Institute for Health Policy and Clinical Practice and Co-Principal Investigator, Dartmouth Atlas of Health Care

   ● Kenneth E. Thorpe, PhD,  Robert W. Woodruff Professor and Chair ,Department of Health Policy and Management, Rollins School of Public Health, Emory University

   ● David Blumenthal, MD, President, The Commonwealth Fund

>> Video of hearing available at

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