September 25, 2003 | WebMemo on Health Care
A recent Kaiser Family Foundation survey illustrates a huge problem facing seniors who stand to be profoundly affected by the outcome of America's Medicare prescription drug debate: Too many know far too little about it.
The Kaiser survey also reveals that seniors don't understand what the bills recently passed by the House and Senate will mean for Medicare.
Among congressional offices, however, a preliminary survey by Heritage Foundation staff shows a profound unwillingness even to comment on key issues, as well as evident confusion or logically conflicting views on broader Medicare policy objectives.
What Seniors Don't Know About the Medicare Bills
Among the key findings of the survey:
The Role of
It is ironic that a majority of seniors are concerned about an excessive expansion of the role of government. While still not a central issue in the House-Senate conference, where Members are haggling over the details of a massive entitlement expansion, the role of government is in fact a key issue facing the Medicare program.
The governance question, how Medicare actually works and would work in the future, is a key issue in Medicare reform. As policy analysts of every political persuasion know, Medicare is heavily micromanaged by both the Congress and the Centers for Medicare and Medicaid Services, the agency that runs the program. The problems of bureaucratic complexity, centralized planning, and excessive red tape are indeed creating a managerial crisis in Medicare and discouraging both doctors and other medical professionals. These growing managerial problems are also a contributing cause of the increasing difficulties that some newly retired Americans encounter in even getting an appointment to see a doctor. For example:
Congress Won't Say About the Medicare Bills
While seniors are evidently confused and unsure about the pending Medicare legislation, most Members of Congress, based on a survey of their offices, aren't even talking about it.
The staff of the Center for Health Policy Studies at The Heritage Foundation conducted an anonymous survey among members of four important committees involved in federal health policy or the drafting and amending the Medicare legislation now in a House-Senate conference committee. The Heritage staff agreed to keep the names of respondents and their responses to the questions on the legislation confidential. The universe of Members were those on the following committees: the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; the House Ways and Means Committee; and the House Energy and Commerce Committee. The offices of 139 Members were contacted three times each between July 25 and August 11. There were 12 questions on key policy issues facing the House-Senate Medicare conference. Only 40 of 139 offices responded: 14 of 60 Democrats (23 percent); 26 of 78 Republicans (33 percent); and 0 of 1 Independent. In other words, only 28 percent of congressional offices contacted responded to the survey.
While the low response rate made a valid survey impossible, some revealing insights can still be gleaned from the limited data that were collected. Take just two key issues:
Being Dumped Out of Private Drug Coverage
A central issue in the current Medicare drug debate is whether the creation of a universal drug entitlement will lead to "a crowd out" of existing private drug coverage, particularly the coverage now provided by employers to retirees. The congressional office responses to this issue were instructive.
Of the responding Democrats:
Of the respondents who favored the government supplanting private-sector financing and delivery of prescription drugs for seniors:
Of the responding Republicans:
Essentially, these members favor having government be the only entity that provides any form of prescription drug benefit to seniors but also oppose letting companies stop providing that coverage because the government is willing to pay for it. They are also willing to provide these companies with tax dollars or other forms of relief to prevent them from doing something they say they essentially support.
Government Regulation of Private Benefit
Responding Members were asked whether they supported a provision in the Senate bill (S. 1) that would require the standardization of the benefits offered to seniors, essentially the same benefit for everyone. They were also asked whether they believed seniors had a right to choose their own private plan.
Confused, Congress Mute
As the recent Kaiser Family Foundation survey reveals, many seniors are indeed confused about the proposed Medicare legislation now in a House-Senate conference committee. As the more limited Heritage staff survey of congressional offices reveals, many Members of Congress are simply not talking about the most important issues emerging from the Medicare debate. These issues will affect the lives of millions of Americans. Moreover, those that do respond seem profoundly conflicted on some of the major issues in the current Medicare debate.
The author thanks
interns John Dayton and Ian Ellis for conducting and organizing the
data of The Heritage Foundation survey.
Kaiser Family Foundation and Harvard School of Public Health, "Medicare Prescription Drug Survey," August 2003, at http://www.kff.org/content/2003/20030903a/3374chartpack.pdf.
For information on these bills, see Lanhee Chen, Edmond F. Haislmaier, Robert E. Moffit, and Nina Owcharenko, "An Analysis of House Medicare Legislation," Heritage Foundation Web Memo No. 302, June 25, 2003, and Edmund F. Haislmaier and Robert E. Moffit, "Analysis of the Evolving Senate Medicare Bill," Heritage Foundation Web Memo No. 296, June 17, 2003.
Sally Trude and Paul B. Ginsburg, "Growing Physician Access Problems Complicate Medicare Payment Debate," Center for Studying Health System Change, Issue Brief No. 55, September 2002.