The birth of the United Seniors Consumer Cooperative this week could mark the start of a genuinely constructive approach to the confusing and often tragic muddle health care for the elderly has become.
Combining management techniques from business, the latest in computer technology and old-time trade union solidarity, USCC, if it catches on in the metropolitan area, could do what the government, the medical establishment and elderly advocacy groups have so far been unable to do: Start using the $1.2 billion spent each year on health care by the Washington area's over-65 population as a bargaining chip, a potent tool.
Nationally, the figure is almost $117 billion a year.
"My feeling is the power is there for the taking," James Firman, USCC's chief executive officer, said in the group's spare offices in downtown Washington. "That money can be a major force in the economy if it is directed. So it is really a question not of seizing the power, because it's already there; people just have to learn how to wield it."
Here's how USCC is expected to work. Members (of any age) join for a modest annual fee -- less than $20 for individuals, less than $30 per couple. In return they get: Individualized access to health care providers -- mainly doctors, hospitals and dentists.
USCC will maintain lists of providers with whom they have negotiated group discounts, an agreement to accept Medicare fees and an agreement to bill Medicare and supplemental carriers directly. In return, these providers will be recommended by USCC as long as they maintain high-quality care.
A member, said Firman, "will be able to call up and ask for 'a board-certified ophthalmologist in Alexandria near the Metro, with handicapped accessible parking, who agrees to take Medicare assignment.' We can go through our computer and find, say, four doctors meeting those qualifications. We don't say, 'Here's a directory of 7,000 doctors with all the information. Go through it and find what you need.' Even four or five years ago, this would have been too expensive an operation."
*Access to improved hospital care. USCC has negotiated four hospital contracts and has nearly completed four more with area hospitals which have agreed to work with the organization to improve discharge planning, providing patients with proper information about billing and about their rights under the complicated Medicare payment system.
Said Firman: "The pressure on hospitals is very clearly to get the people out, and most hospitals don't even have a way of knowing what happens to them when they do get out. We think we can influence the system in a positive way.
"We're not an adversarial organization; we're not suing people," Firman said. "We're working with these hospital groups and saying 'Let's work out arrangements that are mutually beneficial.'"
*A review of an individual's eligibility for various services and payment programs.
"This," said Firman, "is one of our neatest services." It is designed to help individuals or couples discover what benefit programs they may be eligibile for, whether federal, state or private.
There are some 30 programs in this area, including public utility assistance programs, state programs like Maryland Pharmacy Assistance, home repair for the elderly, plus an assortment of relatively obscure federal programs providing benefits for senior citizens. It is estimated that even for such a well-known program as Supplemental Security Income (SSI), the federal subsistence program, there are some 3 million people who are eligible but not taking advantage of it.
Ordinarily, just to determine which programs they are eligible for, applicants must file at 30 different agencies or offices, stand in innumerable lines, fill out reams of forms and, as often as not, find out some vital piece of information was missing or, after all that, discover that the individual wasn't eligible after all. Federal agencies, noted Firman, are not all that eager to give away money.
But new members of USCC are given a single form developed by the organization, which, said Firman, takes about 15 minutes to fill out. The information is then fed into the USCC computers, which contain all the requirements for all the programs.
Without having to stand in a single line or spend frustrating hours on the phone being transferred from clerk to clerk, members will be given a personal, confidential report that states their eligibility for different programs. "We can't certify that anyone is definitely eligible for any specific program," said Firman, "but we can say, for example: 'Based on the information you've given us, we strongly urge you to apply for these four programs and here is information on how to apply, what specific information is needed and where to go.'"
*"Medigap" checkups. Medigap is the term used to describe a growing jungle of insurance programs designed to pick up payments where Medicare and Medicaid leave off. Firman said: "It is almost impossible for an individual to intelligently assess how one policy comes in or how one plan compares to another -- Marlin Perkins versus Lorne Green or Harry Morgan or Glenn Ford -- or whether these plans, many of which play on the fears of the elderly, are needed at all."
"Medigap policies are now an $8 billion a year industry, of which about a billion is estimated to be worthless coverage," Firman said.
"We have a panel of lawyers and insurance experts analyzing these policies, and it's not easy for them. It's difficult even for the experts.
"We can help them compare them. Say a member has Prudential, plan six, and is considering Mutual of Maryland. We can give them a printout that says, okay, these clauses are the same; these are different. We don't make decisions for people or even recommendations. Our job is to provide people with the information they need to be better consumers."
The USCC's board includes such well-known consumer and senior advocates as Esther Peterson, President Carter's consumer affairs chief; Maggie Kuhn, National Convenor of the Gray Panthers; Dr. Roger Egeberg, President Nixon's maverick assistant secretary of health; Joseph Eaglin, executive director of the Congress of National Black Churches; Arthur Flemming, President Eisenhower's secretary of Health Education and Welfare; and Dr. T. Franklin Williams, director of the National Institute on Aging.
"It is an imaginative and desirable direction to try to move in," Williams said. "It is in the best tradition of cooperative efforts and it seems to make so much sense that I would think that a lot of people would wonder why no one had thought of it before."
"It is," said Peterson, USCC board member and currently an advocate at the United Nations for international consumer activism, "the kind of professionalism the senior consumer movement has needed for a long time. Here is knowledge about how to operate, and that's what appealed to me." More Information
People who want more information or wish to join should write to USCC, 1334 G St. NW, Suite 500, Washington, D.C. 20005; or call: 393-6222.