In growing fight over Medicare, honest language takes a beating

We are now in another war of words over health care, and the first casualty, as in any war, is always truth. And so it continues with Medicare.

A couple weeks ago when the nomination of Dr. Tom Price, an orthopedist by profession and likely to become the new secretary of the Department of Health and Human Services, seemed to be in trouble, the 45Committee, a conservative group, aired a TV commercial to help burnish the doctor’s image. Recall he had been in some trouble with members of Congress for his cozy business dealings with health care companies and possible conflicts of interest. The commercial was aimed at erasing any doubts about Price’s qualifications for the job, telling viewers, Price is “the right choice to protect Medicare for our seniors.”

The commercial was more than an attempt to drum up public support for Price. It once again resurrected a 20-year-old slogan Republicans have used to talk about Medicare. Back in the mid-1990s, GOP spinmeister Frank Luntz told his clients that when talking about Medicare, your number one priority is to “save Medicare.” He said “setting the right tone at the outset is critical” in the drive to privatize the program, adding that the words “saving, preserving, and strengthening Medicare” must be repeated. However, Luntz warned them not to talk about “improving” Medicare because seniors immediately think of new benefits like eyeglasses, hearing aids, lower deductibles, and free prescription drugs, which the GOP had no intention of providing. (In 2003 Congress did pass legislation authorizing a prescription drug benefit, but as part of the deal the law also took a big step toward privatizing the program.)

Those friendly-sounding words have served Republicans well, disguising their real intent to transform Medicare from a social insurance program to a privatized system using commercial insurers to provide all the coverage, much like Obamacare does. The underlying goal: shift more of the responsibility for paying seniors’ health care bills from the federal government to seniors themselves.

The Price commercial papered over Price’s business connections and his previous support for privatization.

This year brings more semantic confusion than I have ever seen. Combatants are using the same words, and when that happens, how is the public supposed to know who wants what? Tom Price, who would like to drastically change Medicare, is being cast as someone who will protect Medicare. The AARP, which has supported the kind of privatization that Price champions, also wants to protect Medicare. It has just launched a national, seven-figure ad campaign to pressure lawmakers into protecting Medicare and wants its 18 million members and others to “Tell Congress To Protect Medicare.”

Forgive me, but I am really confused. Tom Price, an ardent supporter of privatization now wants to protect Medicare? The AARP, which over the years has opposed steps for more privatization, wants to protect it, too? This all sounds like Alice in Wonderland stuff when Humpty Dumpty says words mean what he wants them to mean, with Alice replying, “The question is whether you can make words mean so many different things.” In today’s political zeitgeist, the answer is interest groups can and do, and there’s no better example than Medicare.

For Price, protecting Medicare means reducing the government’s long-standing obligation to provide benefits to current seniors in the program in order to “save” and “protect” it for future generations. It could also mean cutting benefits outright, such as raising the age of eligibility and making current beneficiaries pay higher deductibles. The question almost never discussed is what happens to those now on Medicare who cannot afford the added burden of paying higher costs for health care that results from the cuts. Half of them live on about $24,000 or less.

This all sounds like Alice in Wonderland stuff when Humpty Dumpty says words mean what he wants them to mean, with Alice replying, “The question is whether you can make words mean so many different things.” 

For the AARP, protecting Medicare can mean opposing full-fledged privatization, in which the government gives seniors a sum of money to buy an insurance policy in the commercial market. If the sum, called premium support these days, is not enough to cover the cost of the policy, Medicare beneficiaries would have to pay the rest out of pocket. “Protecting” Medicare could also mean other unwelcome changes such as making more seniors pay higher premiums for their drug benefits or for benefits that cover doctor visits, outpatient care, and drugs given in a physician’s office.  

Stacy Sanders, director of federal policy for the Medicare Rights Center, told me she is not worried about outright privatization happening at the moment. She’s more concerned about other changes that are also likely to be sold with the euphemistic vocabulary of Medicarespeak. “Price is a big champion of private contracting,” Sanders says. In that scenario, instead of taking payments from Medicare as payment in full, which is what most doctors do now, providers could enter into private contracts with beneficiaries who would pay the doctor’s fee. Doctors wouldn’t be obligated to submit claims to Medicare as they do now. In addition doctors could negotiate contracts with their patients and decide what to charge them.

“Effectively beneficiaries could pay wildly different cost-sharing amounts (which are standard now), depending on what doctors negotiate individually with patients,” she explained. Those changes would take away the protections seniors now have that give them predictability and prevent doctors from overcharging. This potential change is also being cast as protection for beneficiaries. Proponents of the change say it will “protect the doctor-patient relationship” and keep doctors in the program because they can charge beneficiaries more.

In a blog post, Jared Bernstein, a senior fellow at the Center for Budget and Policy Priorities and former chief economist to former Vice President Joe Biden, writes that other terms such as “reform,” “overhaul,” “change,” “revamp,” and “fix” are also euphemisms for “cut.” Like the word “protect,” they disguise changes policymakers want to enact while making the public think the changes are benign. A cut by any other name is still a cut.

Bernstein raises a different question. Why in these debates does “reforming” and “fixing” almost always mean cutting? Why don’t those words ever mean increasing benefits to address the looming shortfall in retirement income? Americans facing such shortfalls will likely have less money to pay the higher medical bills that many members of Congress want them to pay. It would be a shame if doublespeak kept Americans from grasping that reality. 

Veteran health care journalist Trudy Lieberman is contributing editor of the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care blog.