JONATHAN COHN OCTOBER 27, 2010
Opposition to health care reform isn't uniform across the generations. It's heavily concentrated among senior citizens. And while that partly reflects the fact that seniors, on the whole, are least supportive of President Obama, it also reflects the specifics of the Affordable Care Act. The law will take about $500 billion out of Medicare over the next ten years. As Marilyn Werber Serafini notes at Kaiser Health News, Republicans have made good political use of that figure this election season:
Until this spring, lifelong Democrat Carolyn Land never had a second thought about voting for Rep. Allen Boyd, a Democrat who has represented her area since 1997.
But the day after Boyd cast his vote on March 21 for the new health care overhaul law, Land, 65, got out of her La-Z-Boy, switched her registration to Republican and began stumping for Boyd's Republican challenger, Steve Southerland. The law "cut $500 billion from Medicare," she complained. "Right now, I can see a doctor when I need to, but I'm afraid I won't if that happens. I foresee a long wait."
The real story of how the Affordable Care Act will affect Medicare is a lot more complicated, as Serafini quickly explains. The Act actually strengthens Medicare's guaranteed benefits, by making preventative care free and covering a greater share of seniors' prescription drugs. The reductions come primarily from reduced payments to providers and lower subsidies to private insurers that serve Medicare beneficiaries. In other words, they take money from the health care industry--not Medicare beneficiaries.
Critics argue that the difference is semantic. They say these reductions will mean less access to care--if not through reduced benefits, then though longer waits as doctors become less likely to see Medicare patients. Reform proponents suggest that's unlikely, because, among other things, reform will spend Medicare money more efficiently, getting more health care bang for the same Medicare buck. (Keep in mind spending on the program would still increase--it just wouldn't increase as quickly as before.)
Who's right? I side with the proponents, as you might guess. But even to the extent that seniors hold different views, it's surprising they believe Republicans will keep Medicare sacrosanct. After all, this is the party that opposes government-run insurance (which Medicare is) and has tried repeatedly to privatize the program. Young Guns, the new book by three House Republican leaders, calls for turning Medicare into a voucher program that would dramatically reduce the program's guaranteed benefits--an idea that, as Serafini points out in a separate story, seniors strongly oppose.
Then again, the Republican proposal, taken from Representative Paul Ryan's "Roadmap," would leave Medicare in place for everybody who retires before 2020. Privatization, and the ensuing decline in benefits, would affect only younger workers. Maybe the sentiments among seniors make sense after all.