DENVER — Far from the hue and cry over health reform erupting in town hall meetings across the U.S., many older citizens are quietly confused about what a health-care overhaul might mean to them.
The opinions they form in weeks ahead may well prove crucial, as seniors are a highly influential, politically active group of voters.
They bring a unique perspective to the topic: Older Americans are the only group in the country with guaranteed health care, from Medicare. Also, they're the heaviest users of medical services.
On a recent afternoon, a group of 80- to 90-year-olds at a 14-story retirement complex just north of downtown Denver voiced some of the same questions about health reform circulating in living rooms, retirement communities and senior centers throughout the country.
"Will it affect how quickly I can get in to see my doctors?" asked Anna Janeway, 80, a retired marriage and family counselor.
"You hear all these things about Medicare going broke if we do nothing. Where would that leave everybody?" asked Anthony Mehelich, 82, a former construction company administrator.
"Do we really have to make so many changes all at once?" inquired Joseph Duffy, 90, a former accountant. "Couldn't we just take parts of the problem and solve those?"
Rep. Eliot Engel, D-N.Y., said his offices had received "hundreds of calls" from older people eager to understand how they might be affected. Other members of Congress report a similar outpouring of concern.
A tough sell
Convincing these experienced voters of the need for change is proving to be an uphill battle. A recent CNN/Opinion Research Corp. poll found that a majority of voters over 50 years old oppose a health-care overhaul while most voters under 50 support it.
The lack of a definitive plan only adds to seniors' uncertainty. The picture could change after Congress returns. But the essential thrust of reform isn't likely to change.
Gail Wilensky, who once ran Medicare as head of the Health Care Financing Administration, a federal agency that has since been renamed, said, "The major focus of reform is clearly not on seniors. It is on expanding coverage to the under-65 population."
Every U.S. citizen who turns 65 qualifies for Medicare. The government pays the bills for care provided by private doctors and hospitals, and beneficiaries contribute.
If that sounds like a government-run health-care plan, it is, although many people don't understand that. Among them are elderly constituents who Rep. Jim Tanner, D-Tenn., said have contacted him, saying, "I'm happy with Medicare; don't let the government take it over."
Perhaps the most controversial charge raised by critics of health reform surrounds care for seniors at the end of life. The House bill for the first time would pay doctors for discussing end-of-life treatment options with patients every five years. The discussions would be voluntary. Currently, doctors aren't paid for having these discussions.
Although federal law has recognized advance directives as legitimate for years, critics have seized upon these provisions in reform legislation as leading to euthanasia or government control of older people's end-of-life decisions. Those charges are false, according to numerous organizations and a close reading of the legislative language.
"Nothing could be further from the truth," according to a statement issued last week by the Association of Bioethics Program Directors, representing leading medical ethicists across the U.S.