Attendees:

John Kotson—IBM Retiree; RMAC Chairman

Hazel Floyd—AUSWR CO/WY President; RMAC
Member

Barbara Wilcox—AUSWR Health Care
Specialist; RMAC Member

Pat Finley—AUSWR Retiree; RMAC Webmaster

Helen Domaratz—IBM Retiree; Member of
Congressman Jared Polis SAGE Council

John Rommelfanger—AUSWR Retiree; SAGE
Council Member

Joe Halpern—AUSWR Member

Guests:

Stuart Feinhor—Congressman Jared Polis
Staffer; SAGE Council Chairman

Taylor Hannegan—Polis Intern; SAGE
Council Member

Jerry Pifer—Congressman Ed Perlmutter’s
Community Liaison Staffer

Mike Wasserman, MD—Geriatrician, SAGE
Council Member

Harold Maletz—Guest Observer

National

Jerry
Pifer Comments;

1. On Medicare, mood in the House of Representatives is very polarized. Some Republicans are
   distancing themselves from the Ryan Medicare plan; being called “Republican
   Majority Plan”--it adds to the deficit. Citizens need to lobby the Republican
   House leadership on Medicare reform.
2. Another issue is cash breaks for the top 1% high income people.
3. Congressman Perlmutter wants the vote on the debt ceiling to be pure; no spending additions
   or deficit reduction initiatives.
4. Congresspersons get the same health and retirement benefits as other Federal employees get. Note:
   the Federal Employees Health Benefits (FEHB) cost insurance is subsidized
   by US taxpayers at 70% of premium costs.

Stuart
Feinhor Comments;

1. All amendments that Congressman Polis is proposing to reduce the national debt are voted down.
   He wanted to reduce the number of troops in Europe; each combat troop costs $1
   million per year.
2. Health care reform (the Affordable Care Act) was never intended to be Medicare reform.
   Medicare has grown and changed over time, like a Hydra.

Dr Wasserman Comments;

2005 Whitehouse Commission on Aging—Dr Wasserman attended. September 6^th 2006 final
report had 10 recommendations. Congress renewed the “Older Americans Act”,
other 9 recommendations not acted on. He feels the Democrats should take the
recommendations and bang the Republicans for failure to act upon them.

1. There are only 6,000 certified geriatricians (doctors specializing in senior citizen medicine)
   in the US and the number is decreasing.
2. In 1965 the American Medical Association (AMA) resisted Medicare, but agreed to sign off if
   the residency education of doctors is subsidized by Medicare. Medicare
   currently spends $9.5 billion per year subsidizing the residency education of
   doctors but there is no requirement for them to serve Medicare patients.
   Further, most enter specialty fields other than geriatrics. The American
   Geriatrics Society has been active promoting the use of this money to train
   health care providers in geritrics; they believe that 90% of this money should
   be used for this.
3. Dr Wasserman wants to reduce the pay of specialists, not increase the pay of primary care
   physicians. Many specialists have been trained with Medicare money but have no
   requirement to accept Medicare patients when they go into practice. Dr
   Wasserman’s one proposal is to insure that a significant amount of the Medicare
   money be used to train people in gerontology, including doctors, nurses,
   therapists and social workers.
4. The AMA determines how physicians get paid by Medicare. No geriatricians and only three primary
   care physicians are on the committee. Primary care gets only 5% of Medicare
   costs. Dr Wasserman drives to Cheyenne to see patients in a nursing home that couldn’t find a local doctor to do it.
5. Hospitals are regaining control of health care but they are the most dangerous place a person
   can be.
6. When Medicare D was established, we asked the wrong question; we should have asked, “Why are so
   many seniors on so many medications?” not “How can they pay for them?”

Discussion
of RMAC’s Position on Medicare Reform;

1. Jerry Pifer--no one likes the Republican plan; the Ryan plan is dead for now. The Democratic
   plan-- it was in the Affordable Care Act (ACA); eliminating waste, fraud and
   abuse plus reduced Medicare Advantage funding. Also there were a number of
   studies and trial programs aimed at reducing long term costs.
2. Action for Barbara Wilcox—Look up which health care costs are contributing most to the inflation of overall health care costs.
3. RMAC agreed to the following actions;
   1. Add the misuse of Medicare payments for doctor’s residency training to the 2011 RMAC agenda.
      Emphasis should be on doctors being paid for training in geriatric competency.
   2. 
      Revise the catastrophic white paper to include
      tiered deductibles by income levels in CBO Option 21. The composite average of
      all levels should equal the CBO recommended deductible of $550 for combined
      Medicare Part A and Part B annual deductible.
   3. 
      Determine if the
      Medicare trust fund report takes into account the savings claimed by the
      Affordable Care Act. The CBO has said the new law saves money.
   4. 
      We need to
      understand better the Accountable Care Organizations (ACO’s) that are formed
      under the Affordable Care Act. Does their charter include enabling Medicare
      savings through initiatives such as Medicare clinics and bundling of payments to
      replace fee-for-service? Are these ideas
      that RMAC should pursue at the grass roots level?

Review of
Comments on Social Security White Paper

1. 
   Joe Halpern---paper
   is too long, it should be two pages max. The introduction is good, but use
   bullet points for the background discussion. Our position on taxes should be to
   let the Bush tax cuts expire and reform corporate taxes by removing the
   loopholes and reducing the tax rates. This won’t stop outsourcing off-shore but
   would encourage corporations to do more business on-shore.
2. 
   Jerry Pifer agreed that the paper should be no
   more than two pages long; she looks for the solution first.
3. 
   John
   Rommelfanger—last paragraph about GE taxes is confusing.
4. 
   Barbara Wilcox will
   try to reduce the paper to two pages. After review by RMAC team, she will
   E-mail it to Jerry Pifer and Stuart Feinhor.
5. 
   John Kotson
   comment—it is important not to sacrifice content for brevity. The Medicare
   catastrophic coverage white paper is three pages long and has been widely read.
   No one has complained about the length.

Colorado/Wyoming

Teleconference
with Senator Mike Enzi’s Staff

1. 
   Three items were
   agreed for discussion; tiered deductibles for CBO Option 21, Social Security
   white paper when rewrite is complete and allowing Medicare to negotiate drug
   prices.
2. 
   Subsequent to the
   RMAC meeting, Enzi’s staff called to say the meeting would have to be
   rescheduled at a later date due to unavailability of some participants.

Health
Care for All Colorado (HCAC) efforts for a Colorado Health Care Cooperative—RMAC will support, but not actively. We will invite
Dr Irene Aguilar to the next RMAC meeting and assess our position

Meetings
with Colorado Representatives—during
the August recess, most Representatives are available for meetings. Each RMAC
assignee will be responsible to try to schedule a meeting;

1. 
   Representative
   Dianna DeGette—Barbara Wilcox
2. 
   Representative Ed
   Perlmutter—Pat Finley
3. 
   Representative
   Jared Polis—John Rommelfanger/HelenDomaratz
4. 
   Senator Michael
   Bennet—Hazel Floyd
5. 
   Senator Mark
   Udall—Hazel Floyd

General

RMAC Website Usage—Pat Finley will continue to work with Mike
Kotson to obtain statistical data. Subsequent to the meeting, some progress was
noted and will be reported on by Pat at the next meeting.

Next Meeting—Sept 16^th

Thanks to all for the great attendance and
exceptional discussions at this meeting. Let’s all do it again in September.

John Kotson; RMAC Chairman