Greedy Geezers vs Granny Bashers

To protect the future of Medicare and contain runaway Medicare costs we need thoughtful deliberation and responsible advocacy.

Instead, what we're getting is a shouting match between "Greedy Geezers" and "Granny Bashers."

Greedy Geezers are the over-65 folks who turned against the Democrats by 21 percent in the November elections, largely fueled by fear that health reform would undermine Medicare. Granny Bashers are the largely under-65 folks who see the Medicare set as selfishly protecting their own federally funded entitlement while refusing to bring others into the insurance tent.

To salvage the economy and protect it over time we have to restrain Medicare costs. But if we go at those costs under the banner of blame, the Greedy Geezers will go to war. (I'm allowed to use the "Greedy Geezer" term since I'm part of the Medicare cohort. I'm talking about "us," not "them.")

James Ridgeway, who writes the progressive "Unsilent Generation" blog "for pissed-off progressive old folks (and future old folks)," tells us what the real problem is. Here's what Ridgeway says in his response to David Brooks's New York Times op ed "The Geezers' Crusade":

Politicians are talking about the urgent need to cut Medicare because Democrats and Republicans alike won’t take on the real enemies of affordable health care: the insurance companies, Big Pharma, and other providers of medicine for profit. They’re saying we have to “reform” Social Security (a program which, compared to Citibank and Goldman Sachs, is a model of financial solvency) because they are unwilling to really take on Wall Street. They’re devising ways to skim off of entitlements, which have lifted millions of old people out of dire poverty, because they won’t consider a more “socialist” tax structure--like, for example, the one we had in the United States during the Nixon Administration.

This fabrication serves a myriad of purposes. It substitutes a phony intergenerational conflict--a phantom battle between young and old--for the real conflict in American society: the conflict between the interests of poor and middle-class people, who pay more than their fair share, and the corporations and wealthy elite, who get an easier ride in America than they do anywhere in the developed world...But hey--why talk about taxing the rich when you can balance the budget on the backs of those Greedy Geezers?

The problem isn't that the Medicare crowd is greedy. Ridgeway is right - it's that cutting Medicare (and social security) doesn't pass the smell test when we read about Wall Street shenanigans. In my 45 years of clinical practice I was impressed with how unselfish my elderly patients were, not with their greed.

Medicare is a superb social program, but it's way too costly for the benefit it provides. Medicare recipients won't join in on a campaign that looks like blaming "Greedy Geezers" for Wall Street's greed. Here's what I see as the three pillars for an advocacy program that progressively minded Medicare recipients could get behind:

1. Overtreatment. Seniors aren't driving the overly interventionist, overly technological treatment approach that characterizes so much of the Medicare world. It's the combination of the for-profit medical-industrial complex, fee for service reimbursement, and an all-too-common profligate style of practice. At best, overtreatment creates costs without benefit. But commonly it causes injury. Advocating for the right treatment at the right time in the right place, as defined from a patient-centered perspective, is a position many Medicare recipients will support.
   
   
2. Direct costs to the elderly. A just-released Employee Benefit Research Institute report shows just how substantial retirement health care costs are despite insurance. Men retiring this year at age 65 will need anywhere from $65,000–$109,000 in savings to cover health insurance premiums and out-of-pocket expenses in retirement if they want a 50–50 chance of being able to have enough money; to improve the odds to 90 percent, they’ll need between $124,000–$211,000. Women retiring this year at 65 will need between $88,000–$146,000 in savings if they are comfortable with a 50 percent chance of having enough money, and $143,000–$242,000 if they want a 90 percent chance.
   
   In other words, even though Medicare recipients are the best insured population in the U.S., commercial profiteering and profligate practice styles are driving very substantial out-of-pocket costs. Continued cost escalation will lead to even more cost sharing. Advocating for practices that reduce out-of-pocket costs that provide little or no benefit (or even cause harm) is a position Medicare recipients will support.
   
   
3. If reducing overtreatment and managing the care process in ways that reduce direct costs to the elderly curb overall Medicare expenditures, that will be a positive "side effect." Those who agree with Ridgeway will continue to advocate for progressive economic policies. Those who don't, won't. But reducing overtreatment and direct costs to the elderly won't be seen as blaming Greedy Geezers for the mess we're in. It's an responsible, progressive advocacy position that Medicare recipients can get behind.