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Medicare and Tax Reform Are the Answers
The current, seemingly permanent, extraordinary growth in domestic health-care spending is a predictable result of our tax policies and the many federal rules forced upon Medicare. If we are going to be serious about making health care more responsible and effective, we need to address these issues first.
Our tax system provides ever larger federal subsidies for ever-more-generous insurance policies. Thus, it is not surprising that we buy the most insurance we can afford -- or get our employers to pay for. As predictable, we then allow insurance design and coverage to dictate what health care we need. In the absence of evidence about the effectiveness of new technologies, we find ourselves willing to "buy" the latest and greatest tools, irrespective of known value, confident that someone else will pay.
As important, our federal Medicare program, though less than 20 percent of national health expenditures, affects a disproportionately large amount of health-care delivery. Hospitals, physicians and numerous other providers receive reimbursement that is variably influenced by Medicare policy. Health plans mostly follow Medicare coverage decisions even when there is little evidence that it will be a true improvement in health for their members. Physicians, in an almost vicious circle, chase the latest technology, as long as it is covered by Medicare; then proceed to apply it to ever broader populations, even when evidence for positive effect is lacking.
However difficult it may be to transition to outcome- and health-based reimbursement, we must make that effort. However challenging it may seem to revise our tax code, in order to reduce the distorting effects, we must make that stride. Through these and other reforms, we can curtail cost growth and bend the curve back!
By
Howard Forman
|
July 22, 2009; 10:20 AM ET
| Category:
Doctors
,
Health Care Reform
,
Health costs
,
Insurance
,
Medicare
,
Public policy
,
Taxes
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Posted by: lensch | July 24, 2009 2:27 PM
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The cost of Medicare is rising at a slower rate than that of provate insurance. Your concerns are misplaced.
As my daughter says we are rearranging the band aids on the TB patient while the rest of the world is using antibiotics.
You omit one of what should be the easiest and most effective ways to get quality health care to all. A well run for profit corporation has one and only one goal--to make money for share holders. In the case of health insurers this conflicts with the goal of quality effective health care. They waste $400 Billion each and every year on high overhead and compliance costs designed to raise their stock price by lowering their medical cost ratios.
The reason we have so many different and complicated proposals is because the first principle of all of these proposals is to preserve the riches going to insurance company executive and shareholders. These proposals run 1,000 pages. HR676, Medicare for All, is 70 pages long. It gives quality health care to everyone. It solves problems like pre-existing condition and like lose job=>lose insurance and since it picks up the $400 Billion mentioned above, it will cost no more than we are now spending, probably less.