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With all the theatrics surrounding presidential politics, the rare media questions on health care tend to spotlight one issue: Are you for or against the Affordable Care Act? Left unasked is how to help the millions of Americans who suffer from chronic illnesses such as heart disease, cancer, diabetes, or stroke — which now make up an astounding 93 percent of Medicare spending.
Chronic illness is a personal issue for me: It was a challenge for both of my parents. My father, an acclaimed journalist of historical nonfiction, suffered from heart disease. My mother, who earned a master’s degree from Yale at a time when few women got master’s degrees, struggled with dementia in her later years. Watching the two of them try to navigate America’s non-system of managing chronic illnesses is something I will never forget.
I have been on the front lines helping older Americans make sense of their health care. When I was in my 20s, not long after the program got up and running, I was the co-director of the Oregon Gray Panthers, an advocacy and service organization for the elderly. I spent a lot of time visiting older people in their homes, helping them get through any number of issues — things like finances and health care. Back then, it was common to see a senior bring out a shoebox full of Medicare supplemental insurance policies that weren’t worth the paper they were written on.
The people who were victimized by these scams, older people who were a part of America’s greatest generation, would shamefully tell me they should have known better. They were ripped off by fast-talking health insurance hucksters; it was clear this was the health care challenge of the day for seniors. It was a lesson that complacency, when it came to the Medicare guarantee, was dangerous. While Medicare brought in a new era of comprehensive medical security to older Americans, it was clear to me the work would not stop there.
That experience, and that realization, was one of the reasons I ran for office, and throughout my time representing Oregonians in Congress I have been committed to updating Medicare to stay ahead of tomorrow’s health care challenges and do right by older Americans.
Why it's essential to update the Medicare guarantee
Ever since 1965, Medicare has been built around the guarantee to seniors of defined, secure, and high-quality health benefits. Now Medicare must be updated and modernized to meet the challenges of chronic illness, a task for lawmakers that has gone woefully unaddressed in today’s political debate. That means addressing the lack of coordinated, purposeful care, payments that encourage more, possibly unnecessary, services, and the singular focus on medical needs and not the underlying circumstances that lead to those health problems. At a time when 10,000 Americans enter the program every day, seniors have a right to know how the candidates plan to update the Medicare guarantee.
The crux of the chronic care challenge is this: Millions of American seniors who worked hard on factory lines, in classrooms, or in uniform on the beat now suffer from one or more chronic health conditions. These patients should not have to spend hour after hour of their own time struggling to navigate an overwhelming and byzantine health care system. That is not the true promise of the Medicare guarantee.
How the current system fails people with chronic illness
The struggles that people with chronic illness face are manifold. One problem is coordinating care. It’s hard enough for somebody who’s perfectly healthy to assemble medical records for a new doctor; consider how difficult it must be for an elderly woman who recently suffered a heart attack. Think about her journeying to a doctor appointment across town in the middle of the day. Or filling a hard-to-find prescription and adding it to an already-daunting battery of pills.
America’s health care system tells millions of seniors they’re on their own when it comes to managing their chronic illnesses. The result is a full-time job and far too many chances for dangerous errors and missteps.
Today, Medicare inexplicably charges older Americans a copay just to coordinate care among all their doctors. Doesn’t it defy common sense for seniors to pay extra for care coordination that holds costs down? In my view, this charge should be junked, and care coordination should begin right after seniors receive their free physical provided by the Affordable Care Act. This is one of many commonsense changes to Medicare that could improve the lives and health of seniors with chronic diseases, many of whom have stories all too familiar to every American family.
Another problem is the type of care that people with chronic illness have access to. Take a grandmother dealing with arthritis and the early onset of Alzheimer's. Perhaps she’s a cancer survivor, too. Instead of being driven to her doctor every two weeks, let that physician provide her care where she wants to be — at home — rather than in an unfamiliar and antiseptic hospital. Expanding an exciting pilot program, Independence at Home, will allow her to receive care in the comfort of her own home. Early results from this pilot show it saving Medicare $3,000 per beneficiary.
Or consider an elderly grandfather with diabetes and heart disease who’s shopping for a Medicare Advantage plan. In a lot of communities, all the options on the menu before him will look largely the same and often insufficient. It's time to make the rules more flexible so that he can get a Medicare Advantage plan tailored to his unique needs.
Or take the example of a favorite uncle suddenly hit by a stroke. In that moment, every second counts, and a minute saved can prevent irreparable brain damage. However, some hospitals may not have immediate access to a neurologist, delaying care exactly when it’s needed most. Access to telemedicine — innovative technology that connects doctors and patients even when they are miles away — must be expanded as part of an updated Medicare guarantee.
It’s not just the presidential race that has overlooked this chronic care challenge. Both parties in Congress have largely missed this dramatic health care transformation. During the congressional debate over the Affordable Care Act in 2009 and 2010, the focus centered on expanding access to health coverage, but there was virtually no mention of the burdens faced by seniors now that Medicare has been largely transformed into a program for treating chronic illnesses.
Why I'm hopeful about reform
The good news is there is growing, bipartisan interest in Congress in tackling chronic diseases in Medicare. In the Senate, Finance Committee Chair Orrin Hatch and I, along with Sens. Mark Warner and Johnny Isakson, are working on bipartisan chronic care reform. In the House, Congress members Peter Welch and Erik Paulsen have written legislation that updates the Medicare guarantee to cover chronic illness.
Heart disease, cancer, diabetes, stroke — these conditions are America's health care future. So the next time a presidential or congressional candidate is asked about health care, listen closely for one straightforward question: How would you update the Medicare guarantee?
Ron Wyden is the senior United States senator from Oregon.
