MEDICARE DEFENDER NEEDED

Sometimes it's smart to learn from other people's experience. At this time when the coming congressional attack on Medicaid is the most serious group problem affecting all of us seniors, I think it's appropriate we look at the experience of other groups in defending their rights to government-provided or financed health care.

To be specific, I'm thinking of the nation's veterans and the health care they're provided through the Department of Veterans Affairs, or, as most of us remember it, through the Veterans Administration which I always think of as the VA.

Earlier this year a House committee proposed cutting about $206 million from the VA's spending, a small fraction of the almost $40 billion it will spend this year. You would have thought there was a political earthquake. Washington was full of protest meetings, and President Clinton spoke at one of them assuring the veterans that as far as he was concerned the VA could get all the money it wanted. The upshot was that the House committee retreated fully, restored the proposed cut, and the VA walked away unscratched.

Now, mind you, I have nothing against veterans or the VA. I am myself a veteran in fact. And I think veterans who have suffered bodily harm in the service of our country deserve the best of medical care for as long as they need it.

But, of course, that's not the issue. Most of the people in VA hospitals were never injured in active service. For the most part they are simply senior citizens like the rest of us, who are poor, and who prefer VA care in government hospitals to Medicare in ordinary hospitals. That's their right, of course.

There are many more of us senior citizens than there are veterans, most of whom are men. Yet when an attack was unloosed against the VA, a whole multitude of organizations went on the offensive: the Veterans of Foreign Wars, the American Legion, Disabled Veterans of America. And within a matter of days, they had the attack defeated and reversed.

But when it comes to an attack on Medicare, we have essentially just one organization to look to for help, the American Association of Retired Persons. And the AARP is just not in the same league as any of the veterans organizations. The reason is simple. It's profit-making business whose prime concern is getting dollars from us. It makes money by selling us pharmaceuticals, through its magazines which advertise stockbrokers, cars and tours. When I joined the AARP years ago it was primarily to get discounts at certain hotels. It wasn't until must later that I discovered it was by far the largest organization of seniors in the country.

Moreover the record is clear that AARP doesn't regard defending Medicare as its primary task. That was proved over the past two years during all the debate about the Clinton health reform bill. The AARP looked kindly on the bill which most Americans justifiably didn't like. And in particular the AARP defended the president's plan to cut billions out of the Medicare budget to provide us with supposedly extra goodies such as cut-price drugs. Never forget the AARP is in the mail order drug business.

Ideally, of course, we ought to have an organization -- perhaps something called the Committee to Defend Medicare for Senior Citizens, supported by our dues and having a full-time obligation to see we get the best medical care possible in the light of what doctors and hospitals know.

But the fate of Medicare against the current challenges wil be decided by what exists. Fortunately millions of us senior citizens exist. What we can do above all is to write our congressmen and senators and let them know we like what we have and that we will vote in 1996 on the basis of how our representatives in Congress vote with respect to the Medicare budget. We can also write to AARP demanding that they adopt a firm and unyielding stance in defense of Medicare.

Oh, yes, let's not forget to protest against cuts in the Medicare budget. Medicare can be killed if the fees it pays doctors and hospitals are made so small they won't be able to afford to serve us. And it can be killed too if we are forced to join Medicare HMOs where HMO gatekeepers have the right to decide what medical care we get if any. There gatekeepers, remember, get rewarded on how little they spend on medical attention for HMO members. If we get very sick, the most profitable thing they can do is to let us die. Ugh!

Harry Schwartz is a former member of the New York Times editorial board, an author of more than 20 books and a frequent contributor to the Southeast Missourian.