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Health care’s senior moments

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Ellen Goodman
September 3, 2009
— When exactly did Republicans start operating one of those marketing scams that target the elderly?

It was bad enough when Sarah Palin told a bald Facebook lie that there were “death panels” in the plans to reform health care. It was worse to see Iowa Sen. Charles Grassley flunk the “pants on fire” test as he seconded this myth. Republicans planted the fear that President Obama wants to “kill Granny.” Now they want Granny to kill health care reform.


I understand the marketing. Seniors were the only age group that Obama lost in last year’s election. He was change they didn’t believe in. Now polls suggest the folks covered by Medicare are the least likely to think health care reform will help them. In Gallup polls, almost 40 percent think it will worsen their care.


Then last week Republican Chairman Michael Steele began to sell a “Seniors’ Health Care Bill of Rights”—a pitch that contained no rights but an awful lot of frights. He targeted folks like the white-haired South Carolina man who furiously insisted at a town-hall meeting: “Keep your government hands off my Medicare.” (Memo to fact-checkers: Public Policy Polling reports that 62 percent of Republicans also think government should keep out of that government-run program!)


Steele promised, among other things, to outlaw “any effort to ration health care based on age” and “prevent government from dictating the terms of end-of-life care.” I would stipulate that neither of these things is in any version of the bill, but that would just reduce my chance of being invited on Fox News from zero to none.


He also promised to “protect Medicare”—presumably from the plan to save $500 billion out of a projected growth in its spending. He did not mention that the proposals would also close the “doughnut hole” in prescription drug coverage, provide subsidies to low-income seniors and give the Medicare trust fund five more years of life.


This is not just a robo-call to enlist senior citizens in making this Obama’s “Waterloo.” Republicans are basing the sales pitch on the idea that expensive care is the best care and that what elders really want is more. In health care, that translates into endless doctors visits, tests, procedures and maybe even more ventilators.

Could we put that on hold? First of all, “senior” is now a political demographic that encompasses a huge and varied life span. It includes someone who was fighting in World War II and someone who was born during World War II. What you might want at 65 you might not want at 85.


Second, with age and experience come the knowledge that more is not always better. Nor are doctors the only people to assess what’s necessary.


In the wake of Ted Kennedy’s death, there were questions delicately—and sometimes, I fear, indelicately—raised about his treatment for brain cancer. This aggressive, cutting-edge treatment gave him about the same survival time as standard care would have done. This was mostly good time. But other bereaved families are left asking whether they prolonged life or prolonged suffering. They are left unsure whether doing “everything” for their elders was the right thing.


The fear-mongers are also selling the idea that there is something pernicious about a designated panel of experts studying and comparing the effectiveness of treatments. Such panels are not, as advertised, an automatic precursor to “rationing” but hopefully an aide to behaving rationally. Why would you not want to know what treatment was effective?


And if we may go back to the voluntary end-of-life conversations so deliberately framed as euthanasia, this may yet produce a gray backlash. Remember when conservatives thought that “rescuing” Terri Schiavo was a political winner? Seniors didn’t see it that way. There is a leap of illogic that turns a conversation into coercion. How many of the elderly politicians who took this item out of the Senate bill have themselves signed a living will?


Finally, and forgive my optimism, I don’t think older Americans are dupes for generational conflict. The Medicare cohort is being told they can only protect what they have—a government-run plan called Medicare—by trashing a public option for their children. They’re being told to protect their Seniors’ Health Care Bill of Rights by denying rights for those who are younger and uninsured.


If someone comes selling that as your legacy, Granny, check your caller ID and block that con artist.


Ellen Goodman is a columnist for the Boston Globe. Her e-mail address is ellengoodman1@me.com.

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