A recent Kaiser Family Foundation survey illustrates a huge problem facing seniors who stand to be profoundly affected by the outcome of America's Medicare prescription drug debate: Too many know far too little about it.[1]

The Kaiser survey also reveals that seniors don't understand what the bills recently passed by the House and Senate will mean for Medicare.

Among congressional offices, however, a preliminary survey by Heritage Foundation staff shows a profound unwillingness even to comment on key issues, as well as evident confusion or logically conflicting views on broader Medicare policy objectives.

What Seniors Don't Know About the Medicare Bills

Among the key findings of the survey:

• 68 percent of seniors surveyed by the Kaiser Family Foundation didn't know whether there were any differences between the House and Senate bills, though there are significant differences.[2]
• Only 34 percent of seniors have a favorable impression of the current Medicare proposals in Congress.
• Even though such a high percentage of seniors admit to having too little knowledge of these bills, 54 percent of them think Congress should enact this legislation this year.
• 63 percent were either very or somewhat worried that a Medicare prescription drug bill would change Medicare too much. Yet 68 percent are either very or somewhat worried that the bill will not go far enough in reforming Medicare.
• 64 percent of seniors were very or somewhat worried that the bill would be too costly to taxpayers, and 55 percent answered they were concerned that the bill would expand the role of government too much.

The Role of Government
It is ironic that a majority of seniors are concerned about an excessive expansion of the role of government. While still not a central issue in the House-Senate conference, where Members are haggling over the details of a massive entitlement expansion, the role of government is in fact a key issue facing the Medicare program.

The governance question, how Medicare actually works and would work in the future, is a key issue in Medicare reform. As policy analysts of every political persuasion know, Medicare is heavily micromanaged by both the Congress and the Centers for Medicare and Medicaid Services, the agency that runs the program. The problems of bureaucratic complexity, centralized planning, and excessive red tape are indeed creating a managerial crisis in Medicare and discouraging both doctors and other medical professionals. These growing managerial problems are also a contributing cause of the increasing difficulties that some newly retired Americans encounter in even getting an appointment to see a doctor. For example:

• In 2001, 40 percent of seniors reported having to wait more than a week to see a doctor when they were sick.[3]
• Also in 2001, only 71.1 percent of doctors were accepting new Medicare patients, down from 74.6 percent in 1997.[4]

What Congress Won't Say About the Medicare Bills
While seniors are evidently confused and unsure about the pending Medicare legislation, most Members of Congress, based on a survey of their offices, aren't even talking about it.

The staff of the Center for Health Policy Studies at The Heritage Foundation conducted an anonymous survey among members of four important committees involved in federal health policy or the drafting and amending the Medicare legislation now in a House-Senate conference committee. The Heritage staff agreed to keep the names of respondents and their responses to the questions on the legislation confidential. The universe of Members were those on the following committees: the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; the House Ways and Means Committee; and the House Energy and Commerce Committee. The offices of 139 Members were contacted three times each between July 25 and August 11. There were 12 questions on key policy issues facing the House-Senate Medicare conference. Only 40 of 139 offices responded: 14 of 60 Democrats (23 percent); 26 of 78 Republicans (33 percent); and 0 of 1 Independent. In other words, only 28 percent of congressional offices contacted responded to the survey.

While the low response rate made a valid survey impossible, some revealing insights can still be gleaned from the limited data that were collected. Take just two key issues:

1. The displacement of private coverage, and
2. The government standardization of private health insurance options.

Patients Being Dumped Out of Private Drug Coverage
A central issue in the current Medicare drug debate is whether the creation of a universal drug entitlement will lead to "a crowd out" of existing private drug coverage, particularly the coverage now provided by employers to retirees. The congressional office responses to this issue were instructive.

Of the responding Democrats:

• 86 percent opposed seniors being dumped from their employer-provided coverage into a new Medicare entitlement,
• Yet 36 percent of them said they favor the federal government supplanting private-sector coverage for retirees.

Of the respondents who favored the government supplanting private-sector financing and delivery of prescription drugs for seniors:

• All opposed private companies dropping covered retirees, and
• 80 percent favored providing new taxpayer subsidies to companies to prevent them from dumping,
• The remaining 20 percent were unsure.

Of the responding Republicans:

• 12 percent support the idea of the government supplanting the private sector in the financing and delivery of drugs, and
• All of them also support subsidies to private companies in hopes of preventing the dumping of retirees.
• 15 percent of responding Republicans do not oppose seniors being dumped by their private-sector retiree drug coverage,
• Yet 75 percent favor providing subsidies to companies to maintain the private insurance that they don't oppose seniors losing.

Essentially, these members favor having government be the only entity that provides any form of prescription drug benefit to seniors but also oppose letting companies stop providing that coverage because the government is willing to pay for it. They are also willing to provide these companies with tax dollars or other forms of relief to prevent them from doing something they say they essentially support.

Government Regulation of Private Benefit Packages
Responding Members were asked whether they supported a provision in the Senate bill (S. 1) that would require the standardization of the benefits offered to seniors, essentially the same benefit for everyone. They were also asked whether they believed seniors had a right to choose their own private plan.

• While no Republican respondents favored the government standardizing benefits for seniors as would be the case under S. 1, 58 percent of Democrat respondents did. Of those who stated their support for standardized benefits, 87 percent of these responding Democrats supported seniors' right to choose their own private plans. (Presumably, in other words, one would have a right to choose a private health plan as long as the benefits were the same as the private health plan one did not choose.) On the Republican side, 12 percent of congressional offices said that their Members supported the government supplanting all private coverage for prescription drugs for seniors, but these same congressional respondents also said they supported seniors' right to choose their own private health plan.

Seniors Confused, Congress Mute
As the recent Kaiser Family Foundation survey reveals, many seniors are indeed confused about the proposed Medicare legislation now in a House-Senate conference committee. As the more limited Heritage staff survey of congressional offices reveals, many Members of Congress are simply not talking about the most important issues emerging from the Medicare debate. These issues will affect the lives of millions of Americans. Moreover, those that do respond seem profoundly conflicted on some of the major issues in the current Medicare debate.

The author thanks interns John Dayton and Ian Ellis for conducting and organizing the data of The Heritage Foundation survey.

[1]Kaiser Family Foundation and Harvard School of Public Health, "Medicare Prescription Drug Survey," August 2003, at http://www.kff.org/content/2003/20030903a/3374chartpack.pdf.