MISSOURI COMMENTARY: SELF-INDUCED MYTHS ON HEALTH CARE

Last week, the New York Times conducted a very interesting series of interviews of elderly retirees. Many of these seniors were of limited means and living in trailer courts in and around Bradenton, Fla. Some were somewhat more affluent residents of retirement villages in the area. The Bradenton area has one of the largest concentrations of senior citizens in the country.

The common theme of the interviews graphically demonstrates why it is so terribly difficult for politicians to deal with Social Security and Medicare. Most retirees, it appears, have firm convictions as to what they want to believe. Statistics, figures, projections are mostly irrelevant. It all tracks with the old adage: "My mind is made up. Don't bother me with the facts."

Here are the opinions expressed in Bradenton.

-- "I'm just getting back what I've paid in." I had an aunt who lived to the age of 97. She had two convictions expressed daily at breakfast. (1) I shouldn't have "given away" her Panama Canal. She seemed to think she helped dig it with Theodore Roosevelt in his white suit. (2) Social Security "gives back to me just what I paid in. They have been holding my money all these years, and it's time to pay me back."

When I pointed out to her that she received many, many times over what she had put in, she put up her hand and said, "You simply don't know what you are talking about."

Most of the senior citizens in Bradenton will receive far, far more than they paid into Social Security. Current benefits are actually funded by those people who are presently employed and paying the payroll taxes that fund the system. Similarly, the payroll taxes of today's retirees funded the benefits for the Social Security recipients of yesteryear. They were not "saved" to pay today's benefits.

When our nation has an avalanche of baby-boom retirees early on in the next century, the Social Security system will experience considerable difficulty, because there will be a much smaller ratio of younger workers to pay the taxes to fund tomorrow's pensions. In fact, around 2012, Social Security will likely be in red ink.

Some say don't worry about it. Things will work out. It's too early to get excited. Others like Sen. Bob Kerrey and former Sen. John Danforth argue that we had better make palatable, sensible corrections now and not wait to go over the cliff. The advice falls on deaf ears in Bradenton.

-- "We spend more on foreign aid than we do on Medicare." Poppycock. By a ratio of 10 or 12 to one, Medicare outruns what we will spend on foreign aid this year.

-- "Medicare won't be bankrupt in 2002." There is a wide disbelief in government numbers and projections. Seniors are unwilling to believe that a system on which they rely so heavily is headed towards disaster. The easiest way to ignore the storm warnings is to pretend that it is all a government-invented hoax.

-- "The budget can be balanced without touching the retirement and health programs." False. The budget can never be balanced without dealing with the retirement and health programs. Once you put aside the retirement programs, the health programs, defense and interest on the debt, there simply aren't enough dollars to cut from the budget to bring it into balance.

-- "The trouble with Medicare is the doctors and hospitals, but don't change the program." The notion is that doctors and hospitals "milk" the system. However, the premise is that, despite whatever problems there may be in the program, do not change its basic structure because any change will provide less benefits.

-- "We don't want HMOs. We want to pick our own doctor." An essential part of any Medicare reform is to discourage and eventually eliminate fee-for-service medicine paid for out of government funds. Any reform of the government portion of a health care reform system has to contain a form of managed care.

In a democracy, the political leaders have to be able to persuade the people as to the wisdom of public policy in areas of great philosophical controversy. If America's senior citizens tenaciously cling to their self-induced myths, reform will remain extraordinarily difficult to accomplish. It's akin to the S&L crisis. You have to get deep into a mess before people are willing to admit there is a mess.

~Tom Eagleton is a former U.S. senator from Missouri and a columnist for the Pulitzer Publishing Co.