Robert Pear’s article in today’s New York Times appears under an intriguing, if typically Times-ian, headline: “A Basis Is Seen for Some Health Plan Fears Among the Elderly.” The story seems intended to provide a policy-heavy counterweight to Kevin Sack’s entertaining front-page dispatch from a senior community in Florida, where erstwhile Obama supporters are now worried that the president’s coming after their Medicare benefits. The old folks are worried, Sack reports. And they have some reason to be, the headline on Pear’s article indicates.
As a moderately well-informed reader, I was interested to read the article. I know that the American system often provides too much medical care, thanks to incentives that encourage doctors to overtreat. I know that the Obama administration wants to cut costs by eliminating some of this overtreatment in Medicare. I also know that other countries achieve comparable or better results for far less money than we do. But I can see reason to worry about whether the government would make the right decisions about which treatments to target. And while I’m a long way from Medicare eligibility myself, I wouldn’t want to see a family member denied important care while technocrats are working out the kinks in the system. So if there’s real reason to be concerned, I’d like to know about it.
Right from the outset, though, we get an indication that the article won’t deliver on its promise. Pear’s lede:
White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods. But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational.
Leave aside the slightly confusing term “insurance counselors” for the moment, and strip that down to ordinary language. Here’s what it amounts to: “Democrats say old people have no reason to be worried about health care reform. But old people say they do too have a reason. Who’s closer to being right? You won’t find out here!”
Then, after a quick recap of the situation, we get this:
The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life.
“May explain why some people think.” OK, so that’s a potential explanation for fears, but not the “basis” the headline promised—not, you know, actual facts that persuade us to take an instinctive emotional response seriously. And the next ten paragraphs deliver, in order:
• A quote from a seventy-nine-year-old man who fears cuts to Medicare
• Evidence that proposals in the House would actually provide new benefits to seniors
• A new survey showing that a third of older Americans think they will be worse off if reform passes
• A quote from a spokeswoman for a senior services organization (the insurance counselor, presumably) who says seniors are worried and don’t trust the government
• Another quote from the seventy-nine-year-old, including his completely unexamined claim that the swift treatment he received for prostate cancer would not have been provided “under the new health plan”—though which of the many proposals in circulation he’s referring to as “the new health plan” is unclear
• More data from the poll saying older Americans are confused by the health care debate
• A quote from a fifty-nine-year-old man who’s worried about the plan
• A claim from a federal panel that some seniors, especially blacks and Hispanics, have trouble accessing care under the current system
• A boilerplate quote from the president
So, basically, plenty of “fears,” but not much “basis.” Then, this:
The House bill would cut payments to private plans by more than $160 billion over 10 years. Mr. Obama says those payments “boost insurance company profits, but don’t make you any healthier.”
In the past, insurers reacted to such cuts by increasing premiums, reducing benefits or pulling out of the Medicare market, and beneficiaries complained loudly.
This sounds like it could be reason to worry. But it raises a whole set of other questions, among them: Were those loud complaints linked to an actual decline in the quality of care or broader health outcomes? If they were, do the other measures in the current proposals do anything to address these concerns? The White House, for example, has announced some principles that might mitigate these issues. Would they, really?