Clinton Aims to Win Seniors Back

NO group of Americans has fallen off in support of the Clinton health-care proposal since last fall as steeply as the very group that cares about it most - senior citizens.

``The president really needs that group back,'' says health policy opinion expert Robert Blendon of Harvard University.

President Clinton is now in his third week of concentrating on getting that group back. Among other activities, the White House plans a conference call later this week between the president and seniors around the country on long-term care.

Support for the Clinton proposal to remake the health-care system has eroded slightly overall and stands at about 51 percent, although in general the public knows very little about it.

But for most people the urgency of reforming the system has faded a bit as well. While people rated only the economy last fall as a more urgent national problem than health care, crime now tops the list. Health care ranks third.

So many voters may cast their votes in 1994 and 1996 on other issues. But seniors tend to link their votes to health care and Social Security issues.

``They are quite willing to punish congressmen and senators when they vote,'' says Dr. Blendon. This means that legislators are apt to pay close attention to the views of seniors before they cast their votes for any health-care plan this year.

The dominant organization of seniors, the 33 million-member American Association of Retired Persons (AARP), has resisted the president's appeals to endorse his plan, although its board has reiterated since last fall that the Clinton plan is ``the strongest and most realistic blueprint to date for achieving our health care reform goals.''

The concern that appears to be driving seniors away from the Clinton plan so far is that Medicare benefits may be disturbed and that seniors may be pushed into managed-care programs where access to medical services is limited.

The Clinton plan does aim some cuts at Medicare, but most of them are cuts in payments to providers - that is, doctors and hospitals.

This raises some legitimate concern over whether Medicare recipients may face discrimination by providers who are already paid less by Medicare than by private insurers, says Marilyn Moon, a health-policy expert at the Urban Institute.

But Dr. Moon believes that seniors are ``big net gainers'' under the Clinton program. Medicare would cover prescription drugs for the first time. After a $250 deductible had been reached, Medicare would pay 80 percent of drug costs and all costs once an individual had spent $1,000 out-of-pocket on drugs within a year.

Counting gains

The Clinton plan also covers long-term care, including home-based and community-based care for the severely disabled. Long-term care remains a means-tested benefit, however, so life savings are not protected. ``Seniors are clearly better off in the Clinton proposal than they are now, but not as much better off as they had hoped,'' says Moon.

One object lesson from recent history hangs over the debate like a warning cloud, a lesson known simply as ``catastrophic.''

In 1988, Congress passed a program of catastrophic health insurance for Medicare recipients. The bill had the support of the AARP and many of the champions of the elderly in Congress. But by the time it had cleared Congress, the program was a bundle of benefits that, whatever their merits, were delayed and not well understood by the public.

The taxes that financed the program, however, were immediate and understood all too well. The outpouring of outrage among seniors overturned the program within a couple of years.

It was the first time that seniors had been asked to pay something close to the actual cost of their benefits. The lesson, says Moon, is that ``people are not prepared to pay taxes for all the benefits they want.''

The White House took that lesson to heart last spring when it decided to fund its health-care proposal through employer contributions rather than through a payroll tax. Although the money comes from the same place in economic terms, individuals do not experience it as a tax.

Changes in Medicare

Medicare pays, on average, about $4,000 a year on behalf of each participant, or about 90 percent of the cost of their health care. This is no more widely understood among seniors than that most retirees were paid back their lifetime Social Security contribution in less than two years of retirement.

But under the Clinton plan, Medicare would change only at the margins while the health-care system is transformed around it. The Clinton plan also guarantees that each regional health alliance would provide at least one traditional fee-for-service insurance plan for all who want it.

This approach would help ensure that networks of doctors, hospitals, and clinics remain in existence to serve Medicare patients in their traditional, fee-for-service mode.