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The Good, the Bad and Now, the Ugly
Predictably, the health-reform debate has shifted to Medicare and our senior citizens. Now we are seeing the good, the bad and the ugly.
The "good" is that Medicare is popular with its beneficiaries. Medicare provides durable, widely accepted coverage. The premiums are affordable because they are heavily subsidized by the federal government.
The "bad" is that Medicare, in its present form, is financially unsustainable. Medicare was designed only as a "pay-as-you-go" financing mechanism. The program has neither the structure nor the power to provide cost-effective care. In fact, many Medicare patients enjoy richer benefits than they ever experienced with commercial insurance.
The "ugly" is that Medicare needs a major overhaul or it will devour the federal budget. Congress has known this for years but is afraid of voter backlash if it fiddles with this entitlement.
These volatile issues have been ignited by a major political blunder. Medicare cuts have been proposed as a funding source for universal coverage -- and the fireworks have begun. Senior citizens, already suspicious of the health-care reform agenda and the administration, now assume that they will be losers. Their grassroots fury has been obvious in town hall meeting confrontations with members of Congress.
The health-care crusaders urgently need a new plan to show that Medicare reform can work. We already have systems of care that provide high quality at reasonable cost for very satisfied Medicare patients. We should expand such models and empower Medicare to replicate them across the nation.
This is hard work and it will take time. It will also take leaders who see health reform as a mission, rather than a political hot potato.
By
Mark Kelley
|
August 12, 2009; 6:57 PM ET
| Category:
Health Care Reform
,
Medicare
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Posted by: MarkKelleyMD | August 18, 2009 9:31 AM
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Unfortunately, Dr. Kelley discusses this important issue in very vague terms. No ideas are profered or details given regarding how he would fix the heathcare system. Tell us something we don't already know. What we need are leaders expousing specific, well-conceived plans, not more vague-speaking politicians. And Dr. Kelley, the "reasonable cost" you speak of is to the Medicare recipient, not the ultimate payer (i.e., the taxpayer). As you state correctly, the current Medicare system is on a course that will bankrupt the nation.
Posted by: agivings | August 16, 2009 5:29 AM
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Thanks for the comment. There is a way to improve all this --but it is not a "quick fix". Group practices like Henry Ford Medical Group have taken much of the cost out of delivery systems, with enhanced quality. In our case, our Medicare costs and quality are significantly better than the others in the region. However, none of the proposed reform plans provides a payment system or incentives to replicate this model. The most successful models--Henry Ford, Mayo, Cleveland Clinic, Geisinger--align their doctors and their hospitals to work together--not fight over reimbursement. If Medicare took the bold step to bundled payments, as one example, things would change. However, too many constituencies want business as usual.