Published in the Concord Monitor on October 14, 2012.
A big packet of paperwork was on the table in front of Reid Taube, 83, as he chatted with friends and waited for a group of Democratic candidates at Havenwood-Heritage Heights, a retirement community in Concord.
An undecided, independent voter and retired executive, Taube wouldn’t say who he voted for two years ago and doesn’t know who he’ll vote for in November.
He had a question for Annie Kuster, a Hopkinton Democrat in a tight race for the 2nd Congressional District seat with Rep. Charlie Bass, a Peterborough Republican who beat her two years ago by about 3,500 votes.
“If she comes to this table, I’m going to ask her: What are you going to do to fix this?” Taube said, his gnarled fingers handling some of his Medicare paperwork.
“Why does it take 418 pages to explain a simple program to senior citizens?” he said.
Last year, 48.7 million people depended on Medicare for medical expenses. Of them, 180,643 lived in New Hampshire, and the number of people in the state between 65 and 74 is likely to double in the next 20 years, according to a 2012 report by Kenneth Johnson, senior demographer at the University of New Hampshire’s Carsey Institute.
Medicare has spent more than it takes in since 2008 and could be “exhausted” by 2024, according to the 2012 Medicare Trustees’ report. More than a dozen possible fixes have been proposed, from increased premiums and means-testing to aggressively prosecuting fraud.
In short, Medicare reform is one of the hottest-button topics in the 2012 campaign, and the 2nd Congressional District candidates talk about it all the time.
Both say they want seniors to live healthy, productive lives and have access to the services they need. Both preach competition and efficiency.
They just disagree on how to get there.
Kuster’s view
When Kuster discusses Medicare, she does it with the understanding of a former caregiver and the savvy of an attorney who lobbied for hospitals and pharmaceutical companies for 20 years.
She often likens health care to a triangle: access, quality and cost.
Approached correctly, you can have all three, she says. She supports the Affordable Care Act, referred to as “Obamacare,” in part because she says it helped with access. Her concern with the new law, she said, is that it didn’t adequately address the cost of health care.
But, she said, if we can “bend the curve” on costs, then we can pay for the bulging demographic of retirees for the next few decades until we hit a point where the population on Medicare once again shrinks.
“It’s going to be very expensive to accommodate my generation in these facilities because there’s many more of us,” Kuster said in an interview at Havenwood-Heritage Heights.
“But then the costs are going to shrink down. So what we need to do is plan for the big baby boom generation in their senior years.”
Kuster said moving away from the traditional fee-for-service model for Medicare is the best place to start.
Take, for example, an older woman who needs hip surgery. If she’s sent home after the surgery, without the right support and follow-up care, she’s likely to get an infection or suffer complications that require yet another hospitalization, Kuster said.
“Right now the incentives are all in the wrong place,” Kuster said. “The hospital gets paid the first time. The hospital gets paid the second time and the third time. So they’re making money. Why would they want her to not come back? It’s kind of perverse, the more you think about it.”
So, the elderly woman who just had hip surgery should get frequent maintenance visits from, say, nurses and physical therapists, Kuster said. And, in some instances, hospitals should pay a penalty if a patient is rehospitalized.
Such measures, plus electronic record keeping and more transparency in the costs of procedures, is enough to get us through the baby boom, Kuster said.
“It will cost less, and we’ll be healthier,” she said.