Voices of Power: AARP's John Rother

Interview by Lois Romano
Thursday, November 12, 2009 8:06 AM

MS. ROMANO: Okay. Welcome, John Rother, Director of Policy for AARP, the world's largest organization for people over 50. Thanks for joining us today.

MR. ROTHER: It's my pleasure.

MS. ROMANO: You all made a decision to endorse the House version of the health care reform bill. What's in it for seniors? And be specific.

MR. ROTHER: Well, there are several things that are really important for both seniors and for older people between 50 and 64. For seniors, there's the "doughnut hole" goes away over time, saving people thousands of dollars. There's new prevention and screening benefits that are free. There's additional assistance to lower-income people and improves their situation, and there's also steps taken to build a better longterm care system for people who are disabled and need help staying independent.

MS. ROMANO: You've gotten a lot of pushback on this, though. You've lost some members on it. So, obviously, not everybody's in agreement.

MR. ROTHER: Well, first off, with 40 million members, we can hardly please everyone, and a very, very small fraction of our members have voiced any disapproval. And we've also gotten a very large number of people saying, you know, "Go for it. Hurray." So I think we'rewe're, you know, in the center of where our members want us to be in terms of advocating for things like the doughnut hole, lower costs, better access to physicians, that kind of thing.

MS. ROMANO: According to polls, in recent polls, seniors are more opposed to Obama's health care plan than any other demographic, and you've been under, you know, fire for months

MR. ROTHER: I think it's understandable, though, when people hear about savings out of Medicare that amount to a lot of money, over $400 billion. Then they have some anxiety about it.

On the other hand, when we asked people, our members and people at large, about the specific elements of health reform, there we see a lot more support. So what we experience in phone calls and letters and emails is more of tell us what this means, tell us how this would work, what is this likely to produce, as opposed to, you know, don't go there, we're unalterably opposed. So I think people are anxious. I think they want more information, and I think we feel like we've done the analysis. We can reassure them to a great extent.

MS. ROMANO: what do you tell your members that are very concerned that it's going to be 4 to 500 billion dollars, cuts in funding for Medicare, and they're very concerned that this means cuts in their benefits?

MR. ROTHER: Yeah. Well, first of all, the provider groups themselves have accepted this and said they could live with it, and it would not affect the services they offer, but, secondly, as a percent of the total Medicare expenditures over 10 years, these amount to only about 3percent reductions in what would otherwise be spent. So, surely, we can find savings and efficiencies that are equal to 3 percent of the program, in a big program like Medicare.

MS. ROMANO: As you know, one of the big fears everybody has, not just seniors, is that they're going to lose some benefits, that something is going to be taken away from them.

And one of the things that I read was about Medicare Advantage, that a number of those people, although they might be paying more, believe that they're getting some special things, like a gym membership

MR. ROTHER: I don't think Medicare was ever intended to pay for gym memberships. There was extra benefits that some of the Medicare Advantage plans are offering. Those are really over the long term not fiscally sustainable. We have to look for ways we can make Medicare more efficient, and overpaying some of the private insurers to provide those kinds of frills, it really is not what Medicare is supposed to do.

So I think for people who have enjoyed these plans, they should continue to enjoy them. They have a place in the program, but they should not be subject to the kind of, frankly, bribery to get them to enroll on the part of the private insurance industry. We've got to bring that down, so they're focused on actually providing good health care.

MS. ROMANO: Do you have your work cut out for you in communication in sort of tellingcan you tell me a little bit about how that's going to work?

MR. ROTHER: Yeah. I think that's one of our main challenges today is to try to keep the record set straight about what's actually in the bill, what it would do, and we are devoting a huge amount of resources and energy to that through our publications, through our website. We have operators standing by right now on the 1-800 lines. We have quite an effort, all designed to help people better understand what's in the bill, what it would mean to them.

MS. ROMANO: What is your budget for communications to your membership?

MR. ROTHER: You know, I don't have a number for you, but it's large. We probably put more resources into that than any other organization in the country.

MS. ROMANO: what don't you like about the Senate bill, and what do you like?

MR. ROTHER: Well, first of all, we don't have a Senate bill yet. We're hoping

MS. ROMANO: That's true.

MR. ROTHER: We're hoping that we might fairly soon. I think some of the concerns that we have, depending on what the specifics look like, are affordability; do people, especially moderate income people, have enough assistance. Whether there's discrimination based on age in the premiums, that can make a big difference in affordability, especially for people in their late fifties and early sixties; whether the "doughnut hole" in Medicare is completely closed over time, as it was in the House bill. So these are the things we're looking to in particular when the Senate bill finally is unveiled.

MS. ROMANO: You mentioned affordability, and, actually, a lot of economists and cost analysts have said that none of the bills so far are doing enough to bring down cost of medical care.

MR. ROTHER: Well, I think bringing down cost on medical care is probably going to be a life's work for most of us. We need to get started in a serious way, but the idea that we can do it all at once now is probably not realistic. We'd have to keep coming back and coming back as we learn more, as we see what works and what doesn't work. And I think the bill, both the House and the Senate really lay a foundation and give us some tools to do that, that we haven't had previously. So I'm not so harshly critical as some might be because I don't think it's possible to do it all at once.

MS. ROMANO: But you have a concern that costs are not going to come down very much at all, and so, therefore, insurance companies are just going to keep passing on these costs to consumers. So, yes, more people will be insured but they'll be paying more.

MR. ROTHER: No, we definitely want to bring the rate of growth in cost down much closer to the rate of growth in prices in the economy generally, but to do that is going to require some pretty basic changes, particularly in how we pay doctors and hospitals. That's really the core of this. And we need to move people to a more integrated way, more coordinated way of providing care and being paid for it. So we're not going to be paying for volume of, you know, services but rather for the value that's actually produced.

MS. ROMANO: What about on that topic, what about Medicare reimbursements? That seems to be a very sore spot with a lot of providers. Does the bill do anything to help level that out a little bit?

MR. ROTHER: Well, the bill does provide some improvements in pay for primary care physicians, which areit's very important because primary care is the best way for people to access the health care they need, and today we face a crisis in primary care. Beyond that, the companion bill in the House would eliminate the scheduled 21percent physician payment fee cut that would otherwise go into effect on January 1. We are hoping that the Senate also addresses that, but the controversy is whether those costs can be fully offset or not, and so I don't think we know yet what the Senate will do with the need to make sure that physicians are not cut by that 21 percent.

MS. ROMANO: Well, the Senate, I guess, seems to be more committed to helping out the physicians from what I've read. Is that accurate?

MR. ROTHER: We'll see. I don't know if I would make that judgment right now. The controversy isn't so much about whether the physicians should be protected from this automatic cut. It seems to be mostly focused on whether or notor to what extent the costs can be offset, through higher taxes or other cuts in the health care system.

MS. ROMANO: what do you think of the Stupak Amendment?

MR. ROTHER: We have no view on and no position on funding for abortion. The concern that I certainly have and many of our leadership has is that this is an issue that could unravel the entire bill. So that's what we're concerned about, not the merits one way or the other of the abortion issue.

MS. ROMANO: Welland that's actually what I'm interested in. As a measure that could unravel the entire bill, where do you come down on it? Does it belong in there or

MR. ROTHER: Yeah. We've had a pretty firm agreement for many years now about public policy and funding for abortions, and, probably, the best way to go forward, just in terms of allowing us to go forward, would be to find some language that continues our current policy. So I don't have that language in my pocket.

MS. ROMANO: Okay. 89 percent of Medicare patients have some form of supplemental plan. So your GOP opponents charge that, actually, AARP has a conflict of interest because you're supporting legislation that you might end up having a financial interest in receiving royalties from these supplements.

MR. ROTHER: These are the kinds of charges that have been made in every controversial fight over the years. I think the truth is that we don't pay attention to that. We simply don't put that into calculation. We only base our decisions on what makes sense in the best interest of our membership and of seniors, and whether or not it has an impact on us financially, we can always adjust to that. That's just not a factor. So these are allegations that

MS. ROMANO: But they're saying that it would be a positive effect on you financially.

MR. ROTHER: It might; it might not.

MS. ROMANO: Right.

MR. ROTHER: I haven't the faintest idea, actually. We do sponsor insurance to people under 65. Hopefully, if we're successful, that will no longer be necessary. So I have no idea whether or not it would be a net plus or net minus. It doesn't matter.

MS. ROMANO: That issue aside, the Republicans seem to be angry with AARP right now. Well, I guess their point is that it's supposed to be a nonpartisan, nonprofit organization, and that they view you as taking a decidedly partisan role in this process.

MR. ROTHER: We are nonpartisan. We are nonprofit. We do make decisions based on the merits. We call them like we see them, and I think the best evidence for that is just a few years ago, we supported a prescription drug benefit backed by President George W. Bush and most Republicans, opposedby the Democrats. Now we're backing health reform backed by President Obama and most Democrats, opposed by Republicans. So we call them as we see them. Our board is bipartisan. Our leadership at the staff level is bipartisan. We are not doing this to influence partisan wins or losses. We're doing this to try to get better health care for American people.

MS. ROMANO: Why have senior citizens...people over 65 been such a hard sell on this?

MR. ROTHER: Well, I think for two reasons. One is that this is a generation that perhaps feels like they've earned their Medicare benefit, and they don't want to see anything disrupt that. They don'tthey're naturally suspicious of change, and, particularly, when there are large numbers involved, that raises the anxiety level.

But the second thing is that the opponents of health reform have targeted this population and have, in my view, misrepresented the facts and have consciously tried to scare seniors who depend on health care really for their ability to live a normal, stable life, and so no surprise that they feel anxious because they're hearing messages every day designed to scare the bejesus out of them.

MS. ROMANO: Do you think they are a primary target for these scare tactics?

MR. ROTHER: Oh, absolutely. You look at the ads on the TV. It's mostly targeted at seniors.

Ms. ROMANO: Right. Okay. Well, great. Thank you very much for joining us.

MR. ROTHER: You're welcome.

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