Thousands of calls are taken at centers that offer comfort and information.

NEW YORK – She’s been the love of his life for most of his life. He was 21 when they met; she was 16.

Now, after 63 years of marriage, she’s in a Long Island rehabilitation facility, recovering from a bad fall and disabled by Parkinson’s disease.

Anthony wants his wife to come home. The son believes that’s unrealistic. Mom should go to a nursing home, he insists, and Dad, 87, should let go.

Madeline Augonnet, 56, is listening to the old man tell his story over the phone in a cracked voice. He didn’t know where to turn, he says. So he called this hot line.

All morning, the phones at the Medicare Rights Center, a counseling program in the heart of Times Square, have been ringing:

“The insurance company hasn’t paid my bill. Can you help me figure out why?”

“My mother needs home health care, but we can’t get an agency to send anyone over.”

“How can I afford Medicare’s new premiums?”

“My doctor is leaving my HMO. Can I go back to traditional Medicare?”

All morning, three hot line volunteers have a close-up view of the problems that politicians say they want to fix as they work on legislation to overhaul Medicare.

The government announced last week that 2004 monthly payments for doctors’ care would rise 13.5 percent to $66.60, one of the largest increases in Medicare’s history. The deductible for hospital care is going up as well. Also last week, lawmakers failed to agree on compromise legislation, missing one of the many deadlines Congress has set to reform Medicare before next year’s elections.

It’s extraordinarily hard to agree on what to do about this vast government program for 40 million elderly and disabled Americans. But here, on the front lines of the health-care crisis, there is a sense of urgency. Many people who call this hot line – the official Medicare help-line in New York – are sick and vulnerable. Like Anthony, many are desperate as they face the prospect of abandoning or losing those they love.

Anthony’s son is advising his father to spend the $40,000 he’s saved so that he and his wife can qualify for Medicaid, the government health program for the poor. Medicaid will pay for nursing home care, but you have to be impoverished to qualify. Medicare, which all Americans get when they turn 65, doesn’t cover long-term care.

“I don’t want to spend my money,” says Anthony, who emigrated from Italy when he was young. “I saved all my life to get this money.”

Augonnet, a retired elementary school teacher who volunteers on the hot line one day a week, listens sympathetically. But Anthony is so hard of hearing he can barely understand her compassionate responses to his many questions.

All over the country, phones at senior health-insurance counseling centers are ringing with similar queries. People are confused about Medicare. People can’t afford soaring medical bills. People need to buy prescription drugs, but don’t have enough money.

‘No stability’

At the Medicare Rights Center in New York, more than 70,000 calls came in last year. Every state has a similar effort to guide older people through a $220 billion program that has become far more complicated and confusing – not to mention expensive – over the last decade.

“There is no stability to the system,” says Deane Beebe, communications director for the New York center. “Drugs are dropping off formularies all the time. Doctors are closing their practices to Medicare patients. HMOs decide to leave the program. People have to pay more, even if they’re living on a fixed income. The rules of the game keep changing.

“How can we expect someone in their 80s who’s sick and frightened to keep up?”

Augonnet, 56, began volunteering here a year ago, after she stopped teaching and realized a schedule of going to art galleries and lunching with friends left her feeling empty. At first, she says, “I cried after every call. There are so many needy older people who are surviving, I don’t know how, on not enough money, not enough health care, not enough attention.”

None of her callers had any idea there were government programs to help lower-income elderly pay monthly Medicare premiums for doctors’ care. Most had no idea there was a New York state program to help pay for prescription drugs, or drug company programs that would offer a hand.

There is no better way to find out about this patchwork of programs and services than by calling state hot lines. Medicare mails handbooks to every member, but they aren’t localized and many older people don’t understand the terms used. Information is available on the Internet, but large numbers of elderly people don’t have computers.

In the end, many older people seem to be looking for a human voice, anyway.

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