Mt. President, I Have Bad News

The bad news comes in two parts:

• The young, aged 16 to 24, who make up about 40% of the uninsured, and who voted overwhelming for you, don’t particularly like the individual mandate in your plan. The law may force them to pay a 2.5% levy on their adjusted income ($1000 for an income of $50,000). This is important because 17.6 million of the 30 million uninsured (your new figure for the uninsured) make $50,000 or more. In Massachusetts, which has a universal plan, and where less than 3% are now uninsured, many individuals have chosen not to participate, and 40% who have bought individual plans have dropped out. Furthermore, costs in the Bay State, already the highest in the land, are rising at 5% to 10%. causing officials to consider paying only for episodes of care rather than paying fee-for-service. If you consider waiting long times to see a doctor as rationing, Massachusetts leads the country in waiting times. The bad news is that not only has the individual mandate and covering the uninsured failed to contain costs, but these young folk are notorious for not voting in off-year elections, like in November 2010, the first broad electoral test of your policies.

• The other piece is bad news is that the old, 65 and older, don’t trust you. This is not new news. Seniors were the only age group to vote for John McCain, by 53% to 45%, the mirror image of your 53% to 47% total electoral margin. Today the situation is even worse among the elderly. Only 35% approve of your handling of health reform, and seniors made up the bulk of those protesting your policies at town hall meetings, tea parties, and the march on Washington. They are leery of the $500 billion you propose to cut out of Medicare over the next ten years. They have the sneaking suspicion Medicare cuts will come out of their care. They know firsthand Medicare has prolonged and bettered their life with striking reductions in deaths from heart attacks, strokes, and cancer. The chances of living longer are greater in America among middle-aged adults and older are greater in America than in other countries. As Fred Barnes, a conservative commentator recently observed. “If you reach 80 in American, most people are dependent on health care. Your chances of reaching 90 are at least as good as and probably better than anywhere else in the world. The older you get in America, the better your chances of getting to 100.”

There’s another problem too. Seniors are concerned about the present and the future. They fear today’s economic situation will spur inflation, eat into their savings, and burden their offspring with unpayable debts. They have benefited from American capitalism, which for them has been a blessing, and fear Socialism, which purports to spread the wealth equally among all, and in the process, taking away from the old and giving to the young. This may be the right thing to do if you subscribe to the collectivist philosophy, but so far the elderly have not bought in.
Finally there is anxiety your reform will ration their care. The old consume a disproportion amount of health care resources. You and many Democrats still claim that our new health-care system won’t feature the kind of rationing in countries like Canada and the United Kingdom. Yet when given the opportunity to add language to prevent the newly established Center for Comparative Effectiveness Research from rationing health-care services on the basis of cost (as a similar commission in the United Kingdom already does), Democrats rejected the amendments during committee markup.

So seniors are wary. They know the National Health Service acts as Britain's national triage service, deciding who is most likely to respond best to treatment and allocating health care accordingly. The NHS sets priorities for those who can benefit most from medical treatment and who is most likely to respond. This is called comparative effectiveness.

Because of rationing among the elderly and cut-offs for expensive care, a crisis is brewing in the UK. British seniors are restless. The Patients Association, an independent charity, is concerned about end-of-life care. The charity reports “a consistent pattern of shocking standards of care” and “appalling treatment.” In the U.K. in 2007 and 2008, 16.5% of deaths occur as a consequence of “terminal sedation.”
You and your followers dismiss concern about reporting of these events as GOP “scare tactics,” and perhaps it is, but, irhgtly or wrongly, the elderly fear you will take “my Medicare” away and to them talk of “death squads,” which you and I know to be inaccurate, is real.

A scarcity assumption similar to the British mentality underlies your proposed health-care overhaul. You have said, "We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it," That may be true for the population as a whole, but not for our seniors. You claimed in your address to Congress last Wednesday that this situation threatened America's economic competitiveness. This rhetoric does not satisfy the elderly. Until now, they have had the best American medicine has had to offer, and they would like to keep it that way.

The last piece of bad news for you, of course, is that In America, seniors vote in greater numbers than any other population sector in off-year elections. You are going to have to do something to satisfy their apprehension. I am confident you recognize the age gap crisis, which will grow worse when 78 million baby boomers begin to enter the Medicare market in 2011. I am not worried, as your chief-of-staff, Rahm Emanuel, known affectionately at Rahmbo, says, “Never let a crisis go to waste.” Waste not, Mr. President.