"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 581.6 Part 1 

Guests: Senator Bob Kerry (D.NE), Sen. John Chafee (R. RI), Rep. Robert Matsui (D. CA), Rep. Pete Stark (D. CA) 

Topic: Medicare reform efforts 

Reporter: Aaron Cohen / Health on the Hill 

Host/Producer: Steve Girard 

NEMA: A make over for Medicare is making waves on Capitol Hill, and if a Senate plan becomes law, would mean the health insurance plan for the the elderly would be linked to income for the very first time in its 30 year history....Aaron Cohen has Health on the Hill....  

COHEN: Since Lyndon Johnson signed Medicare into law in 1965, the program has charged recipients about the same amount for government health insurance...but that all could change as a result of Senate finance committee action. They decided to "means test" Medicare, raising the annual deductible of 100 dollars to 540 dollars for individuals and some couples and over 2 thousand dollars for more wealthy seniors. Nebraska Democrat Bob Kerry says the change is progressive and more fair to those low income beneficiaries who are helping to pay for the more well off elderly...  

KERRY: Of all the changes that need to be made in order to fund the"baby boom" generation, this is one of the easier ones. I mean, it doesn't get any easier after that, it gets harder. So, you've got two choices: stick your head in the sand and ignore the problem because you're afraid what will happen the next time we walk to the ballot box...of try to solve it. And I think it's better to solve it now, rather than waiting - let people know that we're going to look at the facts, we're going to look at the numbers, and we're going to propose a solution today, rather than pretend it doesn't exist.

COHEN: The committee didn't stop there...not only will seniors be forced to pay more out of pocket for health care, but they wouldn't even become eligible until they reach their 67th birthday. The reason? To coincide with the increased age of Social Security eligibility...also age 67. Committee Republican John Chafee of Rhode Island...  

CHAFEE: It looked toward the future of doing something about the cost of this program, not just next year or the year after...but in the out years, into the 2000's. And that's why I very strongly voted for the raising of the age so it coincides with the eligibility age so it coincides with Social Security...I believe it's the year 2020, Social Security - you can't collect until you're 67. Well, we moved this up right along that same pattern, we put a provision in there that the richer people have to pay more...  

COHEN: Despite bipartisan support for the changes in Medicare, the plan faces a rocky road in the full senate and beyond...the white house says the means testing proposal violates the budget agreement it has with Congress. The senior citizens lobby calls it unworkable, and a top house democrat says bluntly that the plan is a "dumb idea". Senate finance's sister committee in the House passed 115 billion dollars in Medicare changes as part of the budget deal, but without making waves. California Democrat Robert Matsui says the senate bill is veto-bait because of the change in eligibility...  

MATSUI: You could find many cases where many seniors will have a gap in their coverage, because when they retire at age 65, they won't have coverage until the age of 67 if this, in fact, goes into effect. And it would create a lot of hardship for many senior citizens.  

COHEN: The seniors' lobby, led by the AARP, the American Association of Retired Persons, is opposed to the bill because doctors have no way to know a senior's income before charging for services. Here's California Democrat Pete Stark...  

STARK: There's no way that they'll be able to enforce it...I don't mean enforce it, even operate it. The income figures are not available, except through the tax code. And they have not set up a way for the Internal Revenue Department to do this. How is the doctor going to know your income?...to know what to charge you and collect a co-pay....there's just absolutely no way that this can be facilitated, so they won't be able - it isn't a matter of enforce, they won't be able to implement it.  

COHEN: Senate action is unlikely to mean the end of the debate. As Majority Leader Trent Lott says, the debate over Medicare will not be a sprint...this is a distance race. For Health on the Hill, I'm Aaron Cohen.  

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THIS SCRIPT CONNECTS WITH SHOW 581.6, part 2 - FDA/"CHOMPERS" & EPHEDRA