Not all the way,
maybe. But partly.
On February 15, the
Bush administration proposed changes to Medicare that have made almost everyone
unhappy. Like most legislation, it’s a mixed bag. But two ideas in the plan,
already pronounced “dead on arrival,” are no-brainer necessities.
The first: raising
the premiums more affluent seniors (those with yearly incomes above $82,000 for
an individual, twice that for a couple) pay for Medicare Part D drug coverage.
The change would affect about 4.5% of all Medicare beneficiaries.
The second:
requiring doctors and hospitals to use electronic medical record systems. This
should have been done a long time ago, not only for cost and efficiency, but
because it can improve health care and reduce medical errors.
According to AP
reports, “The administration's proposal is part of a first-of-its-kind response
to a warning about Medicare's strain on the federal treasury.”
Democrat Pete Stark,
representative from California, says the proposal is part of “a political ploy
to foster a panic that Medicare is unsustainable.” Health and Human Services
Secretary Mike Leavitt says, "This is an emergency that grows by the
day."
Both are probably
right. Medicare is a fixable and incredibly successful program. But Medicare spending needs to be held in line, the costs of health care along with it. When Medicare was signed into law in 1965, the average life expectancy
was 67. Now that people live a decade longer, it’s become an entitlement to support an extended period of healthy “retirement,”
an idea that didn’t even exist before the 1950s. What's more, inflation-adjusted costs of medical care tripled between 1965 and 2005.
Too many budget
policies create a bitter balance, robbing from the poor to pay the rich, a
Republican notion; robbing the rich to pay the poor, a Democratic
notion; and robbing from children and the future to support older people and the past, a position supported
by both parties in their refusal to do the hard work of creating legislation that’s both
fair and sustainable.
Something has to
give.
Should means testing
enter the Medicare equation? Of course.
Should the proven efficiencies of electronic medical records be required practice? Of
course.
Now comes the tricky
part. The Bush proposal also includes more limits on financial and other
punitive measures for medical malpractice and other system abuses. There's plenty of evidence that the carrot doesn't work without a little help from a stick.
Worse, the Administration's cost reforms cut reimbursement from everything but the problem-fraught private Medicare Advantage
plans, which are clearly in need of reform. Rewarding what doesn’t work is just
bad practice.
Finally, the use of
medical records to track “quality” and reward “better” physicians and
hospitals, while a good idea, is subject to scary manipulation. I attended a
HRSA conference in Washington DC a few years ago. It was clear that Leavitt’s quality
measures for outcomes of medical training were all but impossible to
demonstrate. That seemed to be the point—not rewarding quality, but making it incredibly
difficult to get the money dangling at the end of the stick.
Here’s a Canadian slant on
the dilemma: "Democrats also have offered ways to slow Medicare spending. But
their preference is to trim payments to private insurers serving the elderly
through a program called Medicare Advantage. The administration has opposed any
substantial cuts to the insurers, so the two sides are basically at a
standstill over how to slow the program's growth."
To do it right, we need to draw on all the best ideas out there.
