SPECIAL FROM Next Avenue
Now that President Barack Obama has been re-elected, many older voters are wondering what the effect will be on Social Security, Medicare and Medicaid.
Obama faces serious challenges on potential changes to federal retirement and health programs from liberals in his own party and other supporters who had stifled their criticisms while hoping for his re-election. Sen. Majority Leader Harry Reid (D-Nev.) told reporters in a post-election news conference: “We are not going to mess with Social Security.”
But the reality may be different.
“There is going to be the fight of our lifetime to maintain Social Security, Medicare and Medicaid,” says Eric Kingson, co-chair of Social Security Works, a liberal lobbying group.
A "Grand Bargain" May Be Coming
Look for serious talk in Washington about a “Grand Bargain” in which the president and Democrats would accept changes to Social Security and Medicare while Republicans accept tax increases.
The specifics of such a deal are unknown, but Obama reportedly offered to increase the Medicare age to 67 in last year’s budget discussions with Republicans. And, according to CNBC, in 2011 he proposed a new way to calculate annual Social Security Cost of Living Adjustments that would effectively reduce yearly increases in that benefit.
A Grand Bargain is anathema to many senior advocates. It would mean “these programs are going to be in great jeopardy,” says Kingson, who is also a professor of social work at Syracuse University.
The debate in Washington for the last two years has been “about the federal budget and hasn’t been much about the impact of changes on health and retirement security,” says David Certner, legislative policy director for AARP, the politically potent lobby for people 50 and older. “What has been missing from this equation has been the focus on people.”
But Social Security, Certer says, has "its own funding source and is not part of the federal budget and should not be dragged into the budget debate.”
The Obama-Nixon Parallel
When it comes to changing Social Security and Medicare, Kingson sees Obama as a potential Democratic version of President Richard Nixon going to China. Just as only a Republican president could open relations with China without being accused of being soft on Communism, he says, only a Democratic president could cut programs that were the basis of Democratic electoral success.
Some conservatives say Congress and the president need to strike a compromise. “It’s time now to move beyond slogans and move into specific discussions about what we do about Social Security,” said David John, a retirement and Social Security expert with the conservative Heritage Foundation.
Key Parts of Obamacare Ahead
Regardless of the negotiations, the re-election of the president means that key provisions of Obamacare affecting the health of Americans 50 and older will remain locked in place:
- Beneficiaries with Medicare Part D drug coverage will continue receiving a 50 percent discount on brand-name prescription drugs and a 14 percent discount on generics once they have reached the “donut hole,” spending between2,930 and4,700 on prescription medications.
- Medicare will continue offering its new, expanded list of preventive care services and treatments.
- The federal government will establish a basic package of health insurance benefits for policies sold through insurance exchanges beginning in 2014.
- Private insurers will not be allowed to turn away prospective policyholders due to pre-existing medical conditions.
Beginning in 2014, states will be given the opportunity to expand Medicaid coverage to millions of poor people who are currently ineligible for the federal health program. Among the beneficiaries would be large numbers of people in their 50s, working at low-wage jobs without health insurance.
“All these important things now have a chance to go forward,” says Bob Blancato, a consultant on aging issues.
He is also optimistic that Congress will provide financing for additional ombudsmen to oversee the quality of care in nursing homes.
How the Fiscal Cliff Could Hurt
The coming “fiscal cliff” -- massive federal spending cuts and tax increases that would automatically go into effect in 2013 unless Congress strikes a deficit deal -- could also weigh heavily on vital programs for elderly Americans, says Forbes columnist Howard Gleckman. “According to the Leadership Council of Aging Organizations, if Congress goes over the cliff and the cuts last through 2013, the consequences would be severe,” writes Gleckman. Among the drawbacks: caregiver support would be cut by $12.6 million and social service block grants, which fund programs such as meals and transportation for people 60and older as well as and adult foster care, would be cut for 345,000 people.
Now that the election hoopla is over, the serious work begins.
Bob Rosenblatt is a writer and editor specializing in aging issues. He is a Senior Fellow at the National Academy of Social Insurance, a think tank dealing with Social Security and Medicare.
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Remember that joke that asks, "What do you call the guy who graduated at the bottom of his medical school class?" The answer is "doctor." Let's just say it: Not all doctors are created equal. And as the boomer bubble swells into the next stage of our lives, chances are, we are going to insist on the best. We have formed online communities to recommend hotels, electronics and pretty much everything else. You can expect to see an uptick on online communities that recommend doctors and hospitals.
Patients Banding Together
There are sites like <a href="http://PatientsLikeMe.com" target="_hplink">PatientsLikeMe</a> that hook you up with others who share your diagnosis. This site, with about 1,000 diseases covered, is especially noteworthy, says Harvard's Herzlinger because it just organized the first patient-run clinical test. Clinical tests have remained the purview of drug companies who hope to market a profitable product. In this case, it was a bunch of patients who wanted to test lithium's effectiveness in treating Lou Gerhig's disease (ALS). They found it wasn't, but the world learned in the process that patients can take things into their own hands and not wait for Big Pharma to figure things out for them.
Greater Patient Convenience
Baby boomers like convenience, which is why the house call movement is picking up steam. Also watch for increased evening and weekend office hours by doctors. Pharmacies already stay open late; why not your doctor?
Pharmacies Become Service Centers
Walgreens <a href="http://www.chicagotribune.com/business/ct-biz-0110-walgreens-flagship-20120110,0,1421093.story" target="_hplink">just opened a two-story, 27,000-sq.-ft. downtown Chicago store</a> that represents the future of pharmacy. It offers a health clinic offering a wide range of services including vaccinations, health tests, physicals and treatments for common illnesses and minor injuries. The pharmacy also features an "Ask Your Pharmacist" desk, consultation rooms, a Health Corner space to host health and wellness community events and Express Rx kiosks for swift checkout. (There's a sushi bar and mini-spa to boot.)
Using Tech To Connect
Telemedicine enables patients to "see" their doctors using video conferencing or services like Skype. It eliminates distance barriers and could bring a higher level of care to those living in rural areas. It also could just make patients' lives a whole lot simpler. The doctor calls at a pre-arranged time. You can download your glucose readings straight from your hand-held meter into the computer for him to see. Herzlinger says that a phone call appointment with the doctor is in the not-too-distant future for minor health events, which would cost $30 to $50, she said.
Standardized Record Keeping
Keeping medical records online may have made the life of your doctor's office manager easier, but up until now, they haven't done much for patient health. The reason is that there are more than 2,000 IT systems in place tracking patients and those systems, unbelievably, don't talk to each other. Watch for a common IT system that enables all your doctors to have the same information on you. No more faxing test results between offices and having things lost.
Rewarding Healthy Lifestyles
Employers are already implementing programs that reward workers with prizes and low health care premiums for maintaining a health lifestyle, such as <a href="http://us.virginhealthmiles.com/pages/home.aspx" target="_hplink">Virgin's Healthmiles program</a>. A website called <a href="https://www.healthprize.com/consumer/login.do" target="_hplink">HealthPrize</a> collects daily compliance data from users, verifies their prescription refills, and rewards them for adherence with prizes. In the future, expect to see your insurance premiums go down if you agree to have your retina scanned when you go to the gym and wear a device that measures how much oxygen you have flowing through your blood to make sure you aren't just sitting on that exercise bike reading a book.