As part of the Garrison Institute on Aging’s Healthy Aging Lecture Series, I am giving a talk to about 100 seniors at 4 p.m. tomorrow,  (Wednesday, Sept. 25).  Of course, I am honored to have been asked to do so; but confess some trepidation if I can adequately explain the topic: “Medicare — Past, Present and Future.” It’s not the first two that bother me — the past and present.  Those are a piece of cake. It is the future part where the challenge lies — looking into the old crystal ball.

When I was in graduate school in health care administration, we carefully studied how Medicare came to be — we talked about President Lyndon Baines Johnson and Sen. Wilbur Mills, who, among others, made the backroom deals and compromises necessary to produce what we have come to know as Medicare. Now that I am thinking about it — we even went back to President Harry Truman who originally proposed universal coverage in 1945, which, at the time, did not go anywhere.

Medicare’s present is not a problem either. I can talk all day (I won’t) about how Medicare provides coverage for more than 50 million Americans, including adults over age 65 and younger individuals living with permanent disabilities. I can tell them Medicare covers health care services, including, but not limited to, hospitalizations, physician services, medical devices and prescription drugs. And, of course, I can throw in some facts and figures like saying in 2013, average per capita Medicare spending is projected to exceed $12,000. I could tell them that today more than half of Medicare beneficiaries have an annual income of $22,500 or less and that these Medicare beneficiaries spend about 15 percent of their household budgets on health expenses; by comparison, younger households spend about 5 percent.

But, I know that all of that is not what they want to hear — no, that is mere predicate. An appetizer, if you will.  What they want to hear about is the future of Medicare.  And, that is the thing that is tricky to know and explain.

Oh, I certainly think Medicare has a future.  And, as a person whose next birthday will be my 60^th, I have more than just an academic interest in the matter. But, a simple Google search tells me that many seniors are confused by the massive media blitz regarding insurance exchanges and, no doubt, by all of the rhetoric in Washington D.C. about the Affordable Care Act. The fact is a Medicare beneficiary doesn’t have to do anything — the Affordable Care Act doesn’t directly affect them. They are already covered, their benefits aren't changing, and the exchanges don't require them to do anything different. That is the truth. But, one might say that it might indirectly affect them in the future — maybe fewer doctors, limitations, cutbacks and end of life care restrictions. All conjecture that would unnecessarily alarm them.  No, I will try to speak the truth of what we know today and to allay fears.  I am sure I will see figuratively my own late parents in the room and I would want someone to be honest, factual and gentle in explaining the situation to them.