Old People Vote. Go After Them!

By Alec Pruchnicki, MD

Photo by Bob Cooley.

It’s kind of late to be giving advice to Democrats about the upcoming election, but what I say here can be used in many future contests. Just as I complained about Democrats not going after the votes of working-class whites and middle-class suburbanites this will focus on the population where I have the most expertise — old people.

As a geriatrician who has always cared for elderly patients, I have not just been aware of their medical problems but also their social and financial fears and there are plenty of them. Here, I am just going to focus on medical problems of the elderly that Kamala Harris has addressed with specific policy proposals.

First, what they have already done. Under the Biden/Harris administration Medicare finally has the power to negotiate drug prices and put a cap on total drug costs within a calendar year. When the Republicans passed the Medicare Modernization Act, they did it in the worst way possible. Negotiations and price setting were banned and the entire program was turned over to the private sector leading to the creation of Pharmacy Benefits Managers (PBMs). As someone who must deal with these PBMs, I can tell you they cause nothing but trouble and only save money by rationing expensive drugs. A recent NY Times article highlights some of the problems with them driving out small pharmacies, skimming off billions of dollars in middleman fees, and not controlling overall costs. Local pharmacy New York Chemists had to close because of under-reimbursement by PBMs.

Giving Medicare the power to negotiate prices is the first step in replacing PBMs with a federal system, although Big Pharma and the Republicans will do everything to stop this. Democrats often mention these successes in passing but not as much as they can. Every old person knows that drugs are expensive and any price control by the Democrats should be celebrated and publicized.

New proposals for Medicare expansion are mentioned by Harris at some rallies but more is needed. Allowing Medicare to pay for durable medical equipment like dentures, hearing aids, glasses, walkers, and wheelchairs, etc., would be a major advance for Medicare enrollees. One of the major reasons people sign up for Medicare Managed Care contracts is to get these benefits and putting them into Medicare eliminates the need for yet another private form of unnecessary medical insurance.

Potentially, the biggest proposal Harris has made is to add long term care coverage into Medicare. Right now, the average annual cost of nursing home care in the U.S. is about $150,000 to $200,000 with specialized care costing much more. This can drain the resources of most families if the loved one is in the nursing home for several years, which is often the case. If patients have Medicaid, it will pay for most care, but to get onto Medicaid people must be virtually impoverished or spending down whatever assets they have. This is a cruel and frightening system. I have seen old persons themselves request “Do Not Resuscitate” status so that they don’t have to go to a nursing home, become impoverished, and leave nothing for their children. The fear of poverty in your last years is a major concern to many old people and coverage of this type would be a significant relief.

These proposals can make a major difference in the financial burdens of medical care for the elderly. But I don’t hear a lot about it from the Democrats. As of this writing (Oct. 21) there have been a few vague TV ads about protecting Social Security and Medicare but none go into the details that older people worry about. We should brag about these initiatives as much as possible. When the Republicans come out with some alternative plan, or maybe just a “concept,” we should point out that all Republican plans involve privatization so that Big Pharma, insurance companies, profit making chains of hospitals and nursing homes become even richer at the expense of Medicare, Medicaid, and the people they serve.

Old people vote a lot, and often they vote Republican. They shouldn’t. But the plans outlined here, although excellent, are not self-evident. We need to publicize them whenever possible, and get Democrats elected to implement them. If we can’t do this, then my last piece of advice is just don’t get old.