ShAARP Session: Observations from AARP

With the high-cost of prescription drugs being top of mind for many seniors, I throw my support towards legislation that will keep medication affordable for seniors. Let's allow seniors the piece of mind that they are able to follow through on the treatment plan their PCPs have prescribed for them.

Senator Baucus,

According to a Seattle times article I read on the collapse of primary care there has been a greater than 50% decline in medical students going into primary care as specialist physicians often times have salaries 2 to 3 times that of primary care providers. The Medicare Payment Advisory Commission, or MedPAC, which advises congress on medicare in recognition of the primary care crisis called upon Congress to increase payments for evaluation and management by primary care physicians. Medicare reimbursement sets the standard for physician reimbursements through the Resource-Based Relative Value Scale (RBRVS) system which has been heavily influenced by the specialist dominated AMA to overcompensate for procedures. Primary care is an extremely important, albeit neglected part of the health care system. Yet there are not enough primary care physicians entering the system. Most patients value “having a primary care physician who knew their medical problems.” Furthermore, “patients with a regular generalist physician have lower overall costs than those without a generalist physician.” In addition, many studies have shown the value of primary care over a fragmented specialty dominated medical system. For example, the finding of the 2008 Dartmouth Atlas of Health Care study of 4,732,448 Medicare patients at thousands of hospitals in the U.S. from 2001 through 2005 found that patients that used two or three times the medical and financial resources than others through undergoing the most aggressive medical care with more tests and procedures, more specialists, and more days in the hospital don't live longer or enjoy a better quality of life than those who receive more conservative treatment. In fact, according to the study,
patients treated most aggressively "are at increased risk of infections and medical errors that come from uncoordinated care, such as doctors prescribing drugs that duplicate or interact with other drugs. They also tend to receive poorer care, spend a lot more money for co-payments, and are the least satisfied with their health care." Compounding this problem is the rise of the "midlevel provider" who had significantly less education than primary care physicians being given increasing autonomy through nursing boards rather than the medical boards. Often times the degrees of Nurse Practitioner and now the "Doctorate" in nursing can be obtained on-line with minimal commitment to learning the principlas of medicine as exemplified by 39 hour degree programs with courses including such topics and the "philosophy of science". You had expressed a desire to address the primary care crisis through reforming the reimbursement system that overpays for specialty procedures and underpays for evaluation and management by primary care physicians. As a medical resident who has taken care senior patients with complex medical problems I am wondering why the recommendations made by the Medpac, the congressional advisory committee are not being addressed in either your bill or the proposals of Sen Grassley. Many PCP are limiting the numbers of Medicare patients due to financial burdens they are unable to absorb. I guess my main question is what if anything is to be done to address the severe and continuing deterioration of primary care? Thank you for your time and I eagerly await your response.

Why did the Texas Senators vote against this bill?

When are our legislators going to realize that the typical senior does not have access to the insurance plans that are so generously provided to them. Most are struggling to live with the ever increasing costs of healthcare not to mention gas, groceries, etc. Medicare needs to be fair for everyone.

As an Arizonan, I am appalled at Jon Kyl's atitude toward seniors, where Medicare is concerned.. Well, he's from Maricopa County, home of the nation's worst grandstanding sheriff. Maybe it's in the water up there...

As for McCain, he again didn't vote! That's his usual vote, it seems. Perhaps we should pass a law that when someone is too busy campaigning to represent his constituents, he should be made to resign his current job!

Will someone explain Harry Reid's vote on this issue? What is his thinking? That's a disgrace!

As a 61 year old single woman, I consider this bill to be a test that will help me determine how I will vote in November. I have repeatedly tried to contact my Senators and my congressional representative to let them know how important this kind of issue is to me. The Republican Party continues to contact me to request money, as I have consistently voted Republican my entire life. I haven't give any money to the GOP this year, and I am undetermined as to how I am going to vote this Fall. I am highly disappointed to know the President was going to veto this legislation, if it had passed, and I am especially disappointed to find that one of Texas' Senators, whose office assured me he stood with AARP on this legislation, when it came down to the roll call, voted "no". Please keep trying to get this kind of legislation passed. Thank you!

I appreciate the inclusion of preventive care coverage, but would also like to suggest additional "alternative" care coverage be included. This will also lower the need for prolonged, more expensive care in the future.

I definitely agree that this is the best bill that Congress can pass this year. We need to protect seniors and low-income seniors to get the benefits they need. Seniors need to get quality care no matter where they live. The seniors born in the 30's and the 40's were the "quite generation" the people who worked hard brought up their children with decent values and now they need to be protected.

Why don't you people stop kidding your self into thinking the congress or senate or your representatives are going to do anything as there pockets are not hurting.2003 the Medicare bill that stopped Medicare from going out for competitive bids The Drug Lobby!! Over 2 trillion dollars out of the Soc.Sec. account get a lock on It Why??? Our special interest boys as well as Bill Clinton did draw and continue to draw from It and NO lock Will ever be put on It As long as the boys In Washington need it.Who are they kidding when AARP with 39 million members wont make a move to disturb the apple cart.And now the drug lobby gives to the FDA $400 million dollars and no conflict of interest?? We have a bunch of Idiots In this country and the writing Is on the wall where we are going.Drug Co.s doing $366 billion where Is It going to end.Not one candidate bringing up these issues,lets see how far they get in Washington to do there CHANGES !!! JOKE,BIG JOKE

I cant take this anymore you work all your life and retire on a fixed income like Social Security and a parcial pension and you are expected to pay constant increases of medical costs that sky rocket faster then a Cola is given to you only once per year. What are we to do and it should not be a threaschold only because i miss the poverty level by a couple of hundred dollars it is just not fair

on't y on the wall where we are going.Drug Co.s doing $366 billion where Is It going to end.Not one candidate bringing up these issues,lets see how far they get in Washington to do there CHANGES !!! JOKE,BIG JOKE

Florida: 1 yea; 1 nay. Thanks Mr. Republican who has one of the best medical plans in America. I shouldn't have to be paying so much for my dad's medicine.... $600-$700 every 3 months, plus the premiums for medicare; $90, I think and another $55 for his HMO. Then my situation is about the same Oh, he's 80 and I'm 58 and a disabled veteran rated well above 100%. Hmm, does my "nay" senator realize how many veterans are on medicare? I don't think so!! Do senators from the rest of America realize how many disabled veterans are on medicare.... I don't think so. I bet they are as angry as me when I see seniors who are broke, can't pay bills, going into bankruptcy because of the social security payments are below the poverty level. And disable veterans who can't get medicine because the medicine is not available because the VA does not have it or does not want to give it to a vet. I don't want anything for free, because I already paid for it when Uncle Same poisoned me with Agent Orange. I just want to get treated like a four star general and not a E-1 private. And I want my dad to be treated with respect. Thanks to my Florida Republican Senator who is clue-less and selfish!!

Some of these same Congress People that voted against this bill are the same ones in favor of making legal citizens out of illegal aliens, with no possible way to pay for that.

I am personally going to start a blog on http://The-villages-online.com to exposé all those that voted against these senior bills.

The most reveling vote is not allowing Medicare to negotiate lower prices. So you and I can buy drugs a Wall-Mart and Target cheaper than Medicare… and that’s all right.

Frankly I don’t want anyone represent me, which cares more about the drug industry than me. I am going to make shore all my readers are informed about whom there friends are.

This nonsense has to stop some Time lets make this the time and place.

We are proud of our Senators from Pennsylvania. Both Senator Spector and Casey voted yes on the bill. i know we could count on their support.

I am disappointed that those who were campaigning so hard in the primaries did not take time to vote on this important issue. Included Senetor's McCain, Obama & Clinton. Is that any indication of what all three think of those on Medicare????It should be a law that all Government(State & Federal) employees have to rely on Medicare and SS for their retirement and healthcare. We would see things change in a hurry then. They all have the best pension and best health care on retirement. We all know this can not happen overnight but until we start going that way it will never happen. The politicians only listen to the "Money Men", They have no idea of what the average "working Joe" has to do to survive and support a family in today's economy. Vote all those that voted Nay out, that is the only thing they understand.

How can someone you vote for be so far removed from reality? I want Oklahoma to get enlightened, the politicans provide an 18th Century mentality to 21st Century residents! Get mental health, eye and dental care into the single health benefit. Why someone who gets cancer, ulcers or heart trouble be treated and someone who has poor eyesight, cavaties-crooked teeth or ADHD, depression or anything be eliminated from treatment or given as specific amount of time to get well, whether or not you are, you're cut off, is beyond me. Just because we don't know much about a disease should not be a reason to not consider it real! It would be wonderful to have the best health package in the USA, actually one that people would want to re-locate to the state to participate in the program. You don't think they would arrive alone do you?! Oklahoma could be 1st @ something finally.

How can someone you vote for be so far removed from reality? I want Oklahoma to get enlightened, the politicans provide an 18th Century mentality to 21st Century residents! Get mental health, eye and dental care into the single health benefit. Why someone who gets cancer, ulcers or heart trouble be treated and someone who has poor eyesight, cavaties-crooked teeth or ADHD, depression or anything be eliminated from treatment or given as specific amount of time to get well, whether or not you are, you're cut off, is beyond me. Just because we don't know much about a disease should not be a reason to not consider it real! It would be wonderful to have the best health package in the USA, actually one that people would want to re-locate to the state to participate in the program. You don't think they would arrive alone do you?! Oklahoma could be 1st @ something finally.

I have read both sides of the issue as presented by AARP. Now I think it is time to take a real look at the bill itself, not just opinionated excerpts and references. If anyone knows where the bill can be viewed, please post. I would also like to be aware of any earmarks that are attached (or is that information just available to Washington insiders?).

In reading some of the comments it brings to mind 2 items.
1. I think it is time that the medical profession recognizes that "alternative medicine" is just as effective as the poison the drug companies want us to take. It is cheaper and thank goodness is not regulated by the FDA!! The FDA is not on the side of the consumer. They advertise on TV, magazines, radio and spend fortunes on "free" goodies. They are not free as we pay for them every time we take their drugs. Did you know that they can petition Congress for up to 30 years to keep a monopoly on a new drug? That means no other drug company can "copy" that drug.

2. The drug companies want us to take drugs cradle to grave. Their whopping billions of income does not look to me like all their money went for R&D!!! If people would look up the drugs they are taking they would see the side effects, and bad reactions that come with the drug. Most of the time there is a herbal supplement or homeopathic remedy that would work just as well and for a longer period and be less expensive. I have done my investigating. I won't take the statins as the herbals work just as well. I would never take Coumadin as there are alternatives. People please do your own research and make your own decisions. Most docs will go along with you. There is a bill before Congress now that if the drug companies give more than $25 to anyone they must give the reason why. Hurray. its about time they had to reveal what they spend on meals, vacations, "seminars", candy, boose, tablets, pens, toys, soaps, clocks and all the other "freebies"

Thanks for listening, now I hope you do your own homework.

thank you all that voted against this bill. We can't afford this bill. Since the prescription bill went in the spending increased 3x the amount that medicare was. We can't afford extra spending. My medicare is enough. thanks dennis

I am deeply disappointed that Hilary Clinton a member of the Senate Committee on Aging and an outspoken advocate of Universal Health Care during her campaign not only did NOT vote for S.3101 Medcare Bill but didn't vote period. If she explained this inaction publicly, I missed it. As a 55 year old Disabled American who supported her campaign financially when I am struggling to make ends meet to say the least...I just plain feel like a fool who fell for political rhetoric one more time. If indeed she has a better idea then let her get back to work and iniiate legislaion ASAP.

Thankyou for letting me know my Senators Hutchison and Conyn in this part of Texas voted "nay" for the Medicare bill. I never miss voting in our elections, and most of my Senior friends do also, and we compare notes.

I totally agree with all of you. Our Ga. Senators are the biggest liars I know. And you are right when you say how greedy they are. Money in the governments pocket is what it's ALL about. Including the gas and food prices. THEY can BUT will NOT do anything about anything for the American working man and woman.. President Bush has been a HUGE dissapointment to us.
It seems THEY are ALL the same except a few. GOing around with thier heads in the sand. WE need men and women that will stand up for America, and I DON'T mean free medical and free drugs. After all look at Canada.
The Bush era did away with American jobs and now
want to do away with everything Americans have worked for all thier lives. THEY continue to give it away to other countries.
God said take care of the poor and that included Americans.

How can they stand and say "GOD BLESS AMERICA"? Yea, right into
bankruptsy and straving the poor.

We need to take a stand against evil leaders and vote them out.
RON PAUL was the smartest man in the Primeries and the news media
tore him apart. Guess what? What he told us during that time, we have now found to be true. God bless Him.
If you saw the news tonight, you saw just how tainted our government is. Fema had stored millions of dollars in food and comodities. They were suppose to give to the people of Ala., La.&
Mi. They were trying to get rid of it by giving it to Police Departments and Fire Departments.
Sorry to vent all this but it sure feels great.

I am a professional nurse, as well as a senior citizen living on an earned retirement, but Medicare premiums & co-pays for health care for my husband & I is making it unable to aford on our income. I do not have anywhere to turn for assistance.

Taxation without representation unless of course you’re a pharmaceutical or energy company, etc.! There’s an old saying; I may no always believe what you say, but I always believe what you do. Senator Mary Landrieu (D-LA) did not vote to improve Medicare and Senator David Vitter (R-LA) voted NO. Why? Americans should receive American tax dollar related benefits. Not foreign countries or illegal aliens. I’m all for helping those in need, but lets take care of the needs of Americas citizens first. To deny appropriate and affordable healthcare in any form is disgraceful and is a direct reflection of those elected to supposedly serve in the best interest of their constituency.

I am fast approching the age when I will need more help. My family all have lives of their own and family to raise. I don't want to be a burden on them anymore that I have to. We need to protect or Medicare and Medcaid for the future of or seniors and disabled in this country. We need to the protect the future of the system.

So now you all know.Your stinking Republicans and a jerk Democrat, Harry Reid,who should be in jail, have sent you a message. They deserve free health care while you should pay increased premiums. Get the list of the bums who voted no, and kick them out in November.
If you don't act, you deserve what you get. Peter.

Hillary Clinton I liked. She is not canvassing anymore. I'm sorry to see har go. Why was she not present for voting.Of course she could not manage her finances after receiving so much cash contibutions. Least she could do was vote for this bill. When in position they are all the same --- repblican or democrate. Makes no difference.
Let us see what the New guy OBAMA does when he becomes president. Hopefully, we will have decent total medical care like other european countries.

I think it is a disgrace that congress thinks so little of the american people that they pay to represent the people . Lets stop
paying them by stop paying tax's and we can pay for our own health
care and medicare instead of paying for theirs. Lets not re-elect
these senators that have so little regard for the people they represent. I think it is a disgrace that we can pay for every other
country in the world except take care of our own. What has this country come to in the last 30 years. As for John Kyl and John McCain
that represent the state of Az. I won't be voting for either one.

FYI.
Harry Reid voted against the bill for prodecural reasons... so that it could be brought up again.

The insurance industry has so compromised all of medical care that it is a wonder our system continues to function. One can only guess how long it will continue to work.

The plight of primary care physicians is unforgivable, and we are at risk of losing our primary source of medical care. Medicare recipients may be the first to feel the hurt.

The latest country to initiate universal coverage, Taiwan looked the world over for the best system for medical coverage and in 1995 settled on the best they could find - Medicare. Their model is based on Medicare 1995.

Now it looks as though the best system will become a waste land for the scrape heap if our current president has his way with Congress and Big Insurance.

It is a sad day when many in the senate have a hand out for big insurance instead of a helping hand for older Americans.

What's left? It appears that our elected representatives care nothing about the average retiree. They are soo beholding to the drug companies and others with money that they just ignore us. Is it time for a 3rd party? Is there anyone in an elected office that cares about those who elected them? I think not.

I appreciate all the interest and response. The legislation must be reassessed. Hopefully, we can salvage the legislation just vetoed; it has value. Many thanks to our Washington Sen. Murray and Sen. Cantwell for voting yes and continuing their support of their mature constituents. I am particularly interested in prevention programs. The Inland Northwest Senior Wellness Conference (INSWC)is held annually in Spokane, WA. It is strongly supported "in-kind" by the local area agency on aging - Aging and Long Term Care of Eastern Washington - and is sponsored by PED-Prevention Education and Development which creates programs for "successful aging". The INSWC features 150 resource exhibits, 20+ free health screenings (with the outstanding support of our local medical community), a nationally recognized keynoter, 12 cutting-edge educational presentations, wellness book sale, art and quilting exhibits, and a senior awards ceremony and dynamic closing. This year a special falls prevention project will run for five hours teaching the 1450 attendees that falls are preventable. They must be . . . Falls in our state represent five times more hospitalizations than motor vehicle accidents and as many deaths for adults age 65+ as motor vehicle injuries for all ages. A comprehensive falls prevention program could be developed throughout the country not to mention the possibility of having wellness conferences developed and managed by the nation's Area Agencies on Aging. Let's think with vision and try again! Marian D. Herzer, Spokane, WA

Neither Barack Obama nor John McCain voted on the Medicare bill. Where were they? Of course, Obama's NV is no surprise. He often does not take a stand and makes us wonder how he would function as President. If he does not vote on crucial issues, how can he lead the nation? I am surprised that McCain did not bother to vote.

I guess senator Lugar of Indiana don't think that seniors in his state need any consideration when it comes to their health care.

My husband and I worked very hard, saved and planned for our retirement which included social security. Because we did this, we have a comfortable retirement. Then along came Part D for prescription coverage and my husbands co-pay for doctors visit, lab tests, etc. tripled under his extra medical plan. Then 2 years ago when Part D prescription costs were costing the government more money than expected they found a creative way to cover this increased cost by charging some Seniors more for Medicare to pay for the cost of other Seniors instead of seeking competitive bidding for drugs. Seniors like my husband and myself who already pay 85% of our social security in income taxes have the added surcharge which takes another $100, $200, or $300 a month from the social security check depending on your income plus they consider your total income before all the taxes we pay to the state and federal government to determine which amount you will be surcharged monthly. That amount can be $1200, $2400, or $3600 yearly for one person. My husband paid the maximum amount into social security and now we are having to pay even more. It is an injustice to surcharge some Seniors to cover other Seniors.

Not only are the elderly affected by Medicare and the part D or having to pay X-amount of fees that are deducted from Social Security before you get your check, then there are the fees you have to pay part D for meds and the fees you have to pay out of pocket to pick up your meds and let's not forget the co-pays to see the doctors and additional fees that are billed after the fact. Wow! People who are disabled on Social Security Disablity just as affected as the elderly, but only the elderly are in the spotlight about Medicare issues. People with dissablities are pushed aside as if there isn't a medical need therefore they usually are inelegible for gap insurance coverage. If a dissabled person does happen to find additional gap insurance that covers what Medicare doesn't, well, the you pay a higher premium (rate) because of age and/or disability. This makes it so a person cannot afford to have that added security and you may as well sell your soul because there isn't enough Medicare money to pay for that too...well, you may as well forget that idea. I am very dissapointed in McCain and Kyle. I thought they would be more humanitarian. McCain because he suffered when he served this country. But, I guess some people get harder with age and lose any compassion they may have had. I wonder if they had any at all???

Before anyone jumps to conclusions about republicans not doing anything about this, I'd suggest taking a look at this blog.

Senator Grassley's bill is much more convincing.

http://thedoctorblogger.com/2008/06/16/doctor-blogthe-current-medicare-debate.aspx

Is long term care insurance embedded in the health reform that the Senate is tackling right now?