This Is Your Brain on Ryancare: Another Reason Paul Ryan’s Health Plan Would Hurt the Elderly

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In an earlier post I repeated an observation by Yale’s Ted Marmor that nearly 30 percent of all Medicare recipients are cognitively impaired, which would leave them ill-equipped to make already-difficult consumer decisions about which option to choose under Paul Ryan’s voucherized Medicare program. A friend wrote in to object: Surely those cognitively-impaired senior citizens wouldn’t be making such consumer decisions in the first place. They’d be letting their children or some court-appointed trustee handle that. I replied that there’s no obvious bright line between cognitive impairment and non-impairment; rather, there was a continuum, and a lot of elderly people are a little foggy without being so incapacitated that they must turn decision-making over to someone else. Indeed, it’s my impression that adult children are quite reluctant to tell their elderly parents what to do, where to live, whether to drive, etc., and that they typically don't step in until their parents are pretty far gone. Who wants to tell someone they love that their existence as an autonomous person is over? I was preposterously indulgent with my late wife during the late stages of her illness as her cognition dwindled, because I knew she would really hate being told that she could no longer help herself to medication, slice herself a grapefruit, sign a check, or walk downstairs unobserved. And so she did, when I finally told her, about a week before she died. 

It is well-established that the elderly are considered ripe targets by con artists. Researchers at the University of Iowa recently identified one reason why: the ventromedial prefrontal cortex, “an oval-shaped lobe about the size of a softball lodged in the front of the human head, right above the eyes.” Apparently it starts to go after you turn 60. Not to go all David Brooks on you, but this apparently is where human skepticism resides (“the cognitive seesaw between belief and doubt”). The UI researchers gathered patients with damage to the ventromedial prefrontal cortex, damage elsewhere in the brain, and no brain damage at all. Then they showed them some ads modeled on pitches that the Federal Trade Commission had identified as fraudulent. Sure enough, the patients with damage to the ventromedial prefrontal cortex were twice as likely as the others to get suckered

The gullibility of the elderly is not the principal reason to oppose Ryancare. But it’s worth considering. 

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