Home and FamilyAgeist Health 'Reforms' Can Be Lethal
Many women are angry with the House health bill for its abortion exclusion. But the plan also singles out poor people over 50--a group dominated by women--for legal and lethal bias, says Margaret Morganroth Gullette. And that"s not the only danger ahead.
A recent Boston Globe cartoon by Joe Martin shows two people sitting at a table, a balding man looking up from a paper at a woman.
He says, "According to this, "70 is the new 50" . . . And 90 is the new "older than dirt.""
A lot of women 50 and over, were they to know more about congressional health care plans, would be feeling 90.
The ageist details have nothing to do with the sessions the Republicans called "death panels," which refer to conferences between a doctor and a patient about future care the patient might want if unable to make her wishes known.
But two likely "reforms"--one affecting low-income "boomers" right away and the other affecting frail elderly people down the line--would leave gaps in coverage that could really be lethal.
The first of these reforms affects millions of Americans, as young as 50, who are poor.
The House public option bill passed last weekend--already problematic for younger women--is going to charge people 50-plus twice as much as those under 50.
Massachusetts" coverage, considered a model, already does this. No law makes such age discrimination illegal. It is called age rating.
Insurance coverage based on age rating is dangerous, especially for midlife women, who are poorer than men and less likely to have health coverage.
The Uninsured Are Dying Faster
Before they crawl across the finish line to Medicare at 65, people without insurance, according to a forthcoming report from the American Journal of Public Health, are likelier to die. The group between ages 55 to 64 died at the highest rate, 10.7 percent.
Where is the outrage that millions of midlife people with chronic conditions are likely to be priced out of the market?
OWL, an organization for midlife and older women, has argued for the egalitarian alternative--called "community rating"--where everyone pays the same, as in Medicare. The argument against equality is supposedly that premiums would go up for younger individuals. But data from New York state show younger people don"t in fact opt out.
The other problem in the current health care reform plans arose for frail elderly people as soon as the government announced $450 billion cuts in Medicare and Medicaid. Pundits and public-health strategists started talking about how to cut costs for those over 65.
There are some good ways, such as reimbursing primary caregivers more and specialists less, managing preventive care better, or bargaining, as Veterans Affairs does, for cheaper drugs.
But one likely solution is capitation, aka "global payments." Whatever you call it, this is a controversial alternative to fee-for-service, criticized decades ago for giving incentives for under-treatment.
Global payments mean paying providers the expected amount their patient population should cost. This can force them to refuse coverage, most predictably to the oldest and sickest. Reimbursements can also be cut under the name of "efficiencies" or "regional overuse."
Efficient Cutting of Lifelines
The Congressional Budget Office in 2006 explored strategies for identifying which kind of Medicare enrollees are likely to be "future high-cost beneficiaries." These strategies, gerontologist Robert Binstock warns, could be "a preliminary step for identifying those whose care might be rationed."
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