The conservative 60 Plus Association is running a TV ad saying Congress plans to pay for overhauling health care "by cutting $500 billion from Medicare." It claims that this "will mean long waits for care" and cuts to MRIs and other imaging services, that "seniors may lose their own doctors" and that "government, not doctors, will decide if older patients are worth the cost." Actually, the House leadership’s version of the health care bill would trim a net total of only $219 billion from the projected growth of Medicare spending over the next 10 years, according to the Congressional Budget Office. And Congress isn’t proposing to cut benefit levels or to deny treatment to anyone who is "not worth the cost." We find this ad to be mostly false.
The 60 Plus Association bills itself as nonpartisan and conservative. It says on its Web site that it is for "free enterprise, less government, less taxes" and claims to be "the conservative alternative" to AARP.
Sixty Plus Association Ad: "Sacrifice"
Narrator: Seniors have sacrificed. Surviving the Great Depression. Landing at Normandy on D-Day. Raising strong families. And protecting our freedom in a dangerous world. Now, in their most vulnerable period, seniors are being asked to sacrifice, again. Congress plans to pay for health care reform by cutting $500 billion from Medicare. For seniors this will mean long waits for care. Cuts to MRIs, CAT scans and other vital tests. Seniors may lose their own doctors. The government, not doctors, will decide if older patients are worth the cost. And the cruel joke here is that many of our politicians are designing a health care plan for the country that they don’t want to apply to themselves. So Congress could get better health care than the rest of us. Tell Congress, don’t pay for health care reform on the backs of our seniors. They’ve sacrificed enough.
Incredible Shrinking Benefits?
After celebrating the accomplishments of older Americans, the narrator gets straight to the scary stuff: "Congress plans to pay for health care reform by cutting $500 billion from Medicare." The ad doesn’t mention that the $500 billion is a gross figure that counts only proposed cuts while ignoring any increases, including a big increase the bill proposes in projected payments to doctors. The nonpartisan Congressional Budget Office has estimated that the House bill would result in "savings" of $219 billion after all increases and decreases are netted out. The House bill would trim projected increases in payments for hospitals, insurance companies, pharmaceutical companies and others, including home health care providers and suppliers of motor-driven wheelchairs. But it also proposes what CBO estimates is a $245 billion increase in spending for doctors, by canceling a scheduled 21 percent cut in physician payments. None of the "savings" or "cuts" (whichever you prefer) come from reducing current or future benefit levels for seniors. AARP, in a "Myths versus Facts" rundown of what’s being said about the health care bills, contradicts the claim made by 60 Plus:
AARP: Fact: None of the health care reform proposals being considered by Congress would cut Medicare benefits or increase your out-of-pocket costs for Medicare services.
We can’t resist noting that Democrats are getting a taste of their own medicine here. Late in the 2008 campaign, Republican presidential nominee John McCain’s advisers spoke of holding down the rise in future Medicare costs to pay for part of his health care proposals. Although a McCain aide was quoted as saying no cuts were being proposed in benefit levels, the Obama campaign ran two ads falsely accusing McCain of proposing benefit cuts. One said McCain’s plan "means a 22 percent cut in benefits. … Nursing home care could suffer and so could your choice of doctor." The other said seniors would "receive fewer services, and get lower quality care." We called Obama’s claims against McCain "bogus" and "false" and also an example of "Senior Scare." The same now goes for 60 Plus’ claims against Obama’s plan.
Image-ining the Worst
The ad’s next claim is that the Medicare reductions "will mean long waits for care." We can’t predict, and neither can the 60 Plus Association, whether trimming projected increases in payments for skilled nursing facilities, for instance, might result in fewer such facilities being available and thus lengthen wait times for seniors.
As back-up for this assertion, the sponsor offers an article from USA Today about a provision in the House bill that would reduce increases in payments for doctor-provided imaging services such as MRIs. But it’s not the newspaper saying such reductions could result in long waits. The article is just quoting claims from groups fighting for the status quo:
USA Today, July 16: Groups lobbying against the change say paying doctors less for performing tests in their offices will make the practice unaffordable for some. If they shut down their in-house machines, doctors would send patients to hospitals that, in rural areas, could be miles away, or that, in large cities, could require long waits.
Which leads to the narrator’s next statement: "Cuts to MRIs, CAT scans and other vital tests."
What the House bill does, in section 1147, is change one element of the formula used by Medicare to calculate how much to pay doctors for imaging services that they, as opposed to hospitals or others, provide. The change would result in savings in projected reimbursement rates totaling $4.3 billion over 10 years, according to CBO.
Supporters of cutting the imaging fees often cite a June 2008 Government Accountability Office report that found Medicare spending for physician-provided imaging services more than doubled from 2000 to 2006, and that the proportion of those services that was performed in doctors’ offices increased as well. There was information suggesting that "not all utilization was necessary or appropriate," said GAO, and other studies have found that doctors are more likely to order up imaging tests when they own the equipment.
Opponents of the cuts, like Tim Trysla, a partner at the law and lobbying firm Alston and Bird and also executive director of the Access to Medical Imaging Coalition – which is backed by major imaging equipment manufacturers such as GE Healthcare – point to a GAO study done several months later. That one takes into account cuts in payments for the doctor-provided imaging services that were mandated by the Deficit Reduction Act of 2005, which took effect in 2007. GAO found that in 2007, Medicare expenditures for physician imaging services fell 12.7 percent on a per-beneficiary basis.
Trysla and others say the more recent findings by GAO indicate that further cuts may not be needed. But the report undermines one of the key arguments that he and other opponents of the payment changes make, which is that doctors will stop providing the imaging services and patients will have a harder time getting the tests if fees are further reduced. That may happen in some cases. But according to GAO, utilization of the doctor-provided services continued to grow in 2007 despite the cuts ordered by the law, albeit more slowly, and the Centers for Medicare and Medicaid Services commented that "it was pleased that (GAO’s) findings suggested that overall beneficiary access to imaging services was maintained and remains concerned about the high volume of imaging services."
Losing Your Doctor?
We left messages with the 60 Plus Association to ask about their back-up for the claim that "[s]eniors may lose their own doctors," but we didn’t hear back. On screen, the ad cites the New York Times of April 2. But we couldn’t find a mention of this subject in any of the Times‘ articles dealing with health care on that day. And in any case, April 2 was well before any overhaul bills emerged from Senate or House committees.
Actually, seniors should be a less likely group to lose their doctors under the pending overhaul bills. That’s because the bills cancel scheduled cuts in payments to physicians, giving them less incentive to stop seeing Medicare patients.
The ad’s penultimate claim is that "government, not doctors, will decide if older patients are worth the cost." To back up this claim the sponsor cites a Los Angeles Times story about Obama’s response to a questioner at a June town hall meeting. The questioner raised the subject of decisions about care for her 105-year-old mother.
Obama, June 24: [W]hat we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know, and your mom know, that you know what, maybe this isn’t going to help, maybe you’re better off not having the surgery, but taking the painkiller."
As we have noted previously, Obama did not say that government will make decisions about who gets care. Just the opposite. In his answer to the June questioner he said, "I don’t want bureaucracies making those decisions." And he also said, "The point is we want to use science, we want doctors and medical experts to be making decisions that all too often right now are driven by skewed policies, by outdated means of reimbursement, or by insurance companies." And in any case, we find no language in bills before either the House or Senate that would have government officials making determinations about which patients are "worth the cost."
Good Enough for Us, But Not Congress?
It’s a "cruel joke," the narrator concludes, that the lawmakers who are drafting the health care overhaul for the nation "don’t want to apply it to themselves."
It’s true that an amendment by Nevada Republican Rep. Dean Heller to require elected federal officials to enroll in the federal plan failed in the House Energy and Commerce Committee 21-18. But it’s also true that a similar amendment, by Oklahoma Republican Sen. Tom Coburn, which would automatically enroll all members of Congress and their staffs in the so-called public plan, passed in the Senate Health, Education, Labor and Pensions Committee. However, "We certainly expect it to be pulled out of the final bill," a spokesman for Coburn told the Wall Street Journal.
We find it unlikely that anyone with relatively generous employer-provided benefits would opt to join the proposed federal plan, which proponents describe as being aimed at those who don’t have coverage or have poor coverage now. “I don’t know why we should require ourselves to participate in a plan that no one else needs to participate in. This bill goes to great lengths to show that the choice is there for everybody,” said Sen. Jeff Bingaman, a New Mexico Democrat, at the time.
Members of Congress do have excellent coverage. They are covered under the same program as all federal employees, the Federal Employees Health Benefits program. It offers a wide variety of private insurance plans.
– by Viveca Novak and Brooks Jackson
Nicholas, Peter. "Obama Discusses Deathbed Measures." The Los Angeles Times. 25 Jun 2009.
Fritze, John. "Battle Looms Over Funding Cuts for MRIs." USA Today. 16 Jul 2009.
Murray, Shailagh. "Obama Eyes the Purse Strings for Medicare." The Washington Post. 16 Jul 2009.
Kornblut, Anne E. and Michael D. Shear. "Obama Faces ‘Scare Tactics’ Head-On." The Washington Post. 12 Aug 2009.
Boulton, Guy. "Debate on MRI payments just one hurdle for reform." The Journal Sentinel. 11 Aug 2009.
Trysla, Tim. Executive Director, Access to Medical Imaging Coalition. Interview with FactCheck.org. 11 Aug 2009.
U.S. Government Accountability Office. "Medicare Part B Imaging Services." GPO. Jun 2008.
U.S. Government Accountability Office. Letter to the Hon. Gordon H. Smith and the Hon. John D. Rockefeller IV. 26 Sep 2008.
Lubell, Jennifer. "Amendment to HELP bill would require Congress to use public plan." ModernHealthcare.com. Posted 14 July 2009.
Mathews, Anna Wilde. "More Answers to Your Health Reform Questions." WSJ.com. 6 Aug 2009.