Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients.
I have talked to doctors and other healthcare professionals who treat Medicare patients. Some of these have a patient load of 50% Medicare patients. I know of a few that treat nearly all Medicare patients because they have no place else to go. The majority of doctors say they can't afford to take on any new Medicare patients. The sad part of the situation is that with the right "tweaks" many doctors could take a few Medicare patients each. If a doctor is taking home $250,000 per year and took 10% Medicare patients, it wouldn't make him or her go broke, it would bring in extra money and it would help elderly people who need medical care. If he Medicare system could help devise a way where doctors got something out of treating Medicare patients and send out information about this to every doctor in the country, more doctors would be able to take a few Medicare patients and more elderly would be receiving continuous treatment. This would save money for the system because even if these doctors who took 10% of their caseload as Medicare patients and received a small bonus or other perk for doing so, the majority of patients would stay healthier longer and avoid costly trips to the emergency room or costly stays in the hospital or long term care. Medicare pays for these. If a doctor could help Medicare patients stay healthier and out of the hospital, perhaps he/she could receive a bonus which could come from a small percentage of what was saved for Medicare by keeping the patient healthy and at home. So the doctor gets $1,000 and Medicare saves $10,000 to $50,000. That sounds like smart finance and a win-win situation for everyone.
The elderly depend on Medicare. Some still have the means for private insurance, but even so, their Medcare benefits help defray other costs. There are ways to make sure that doctors can afford to treat Medicare patients and make enough money for it to work while at the same time actually saving Medicare money.
I am not privvy to the information being discussed in the battle over Medicare, Social Security and Healthcare by lawmakers on the hill in D.C. I just know that if I can think up something this basic, the leaders who are far more savvy than I am should be able to come up with a solution to keeping our elderly covered by Medicare and our doctors willing to take Medicare patients. There is enough time for these intelligent thinkers to come up with a plan that will work for everyone. This is not a maybe. This is a moral imperative.
Washington is trying to fix heath care and Medicare. Mark McClellan, a well respected think tank guru, said recently "It's a lot harder to come up with ways to implement reforms than it is to come up with ideas for reform," he said.
McClellan, 45, is an Austin native from a strongly political family. Brother Scott was President George W. Bush's press secretary. Their mother, former Texas Comptroller Carole Keeton Strayhorn, ran for governor in 2006.
Mark McClellan was a major policy figure in health care during the Bush administration. While most of his former colleagues are now in the political wilderness, McClellan is using his post at Washington's Brookings Institution to keep moving in the circle of implementers who want to "bend the curve" of rising health care costs.
Along with several other health care experts, McClellan is trying to persuade President Barack Obama's reform team and Congress to pay hospitals and doctors more if they can show they're improving treatment for Medicare patients while lowering costs.
McClellan argues that sharing savings could keep Medicare viable without bankrupting the federal government. "Right now, we are getting what we pay for – high-volume, high-intensity health care," he said. "Often, there's no support for preventive care."
White House Budget Director Peter Orszag says McClellan's approach is extremely closely aligned with the Obama administration's views on the need to change payment incentives.
"We have the same basic philosophy," Orszag said. "There are huge variations in health care costs across different regions of the country that can't be explained other than because of the intensity of care. ... We need to change the incentives so we get better care, not more care."
Medicare accounts for 20 percent of health care spending, pays providers on a fee-for-service model. Each visit, each test, each procedure a doctor performs pays a certain amount. The system creates an incentive to see lots of patients, lots of times.
For many years, reformers have argued in favor of payment systems based on performance rather than volume. Pay-for-performance advocates argue their approach gets patients the most effective type of care rather than an uncoordinated cascade of diagnostic tests, prescriptions and treatments.
Dr. Elliott Fisher of Dartmouth's Institute for Health Policy and Clinical Practice developed a pay-for-performance approach called Accountable Care Organizations that McClellan is now backing in Washington.
Fisher came to his model after sifting data that shows Medicare pays twice or even three times as much per patient in different parts of the country. The average enrollee in Medicare in Dallas, for example, consumes $10,103 a year in medical treatments, while Medicare enrollees in Salem, Ore., get by on half as much.
Fisher argues the regional cost disparities can be bent toward lower costs if physicians group together around hospital networks where each Medicare patient's care is coordinated and each treatment is evaluated for quality and effectiveness.
If the network can demonstrate its care regimen reduces average spending by 2 percent or more a year, the doctors and hospital would get bonuses amounting to 80 percent of the savings. If the network fails to meet either its quality or savings targets, its compensation would be penalized. "We need some big changes to address quality and regional disparities," McClellan said.
Len Nichols, a health care economist who worked on the Clinton administration's failed reform effort, said the reform emphasis now was less about ideas like pay-for-performance than ways to implement them. "None of these are new ideas," he said. "What we have is a sense of economic urgency driven both by the fiscal realities of our Medicare program and, obviously, the economic situation we're in right now. "We really shouldn't dither any longer about doing serious reconstructive surgery on our health system...We should start this afternoon. The longer we wait, the greater the costs."
This need to implement change is where Nichols and others see McClellan playing a role in the current debate. John Goodman, president of the Dallas-based, conservative National Center for Policy Analysis, said McClellan is "the single-most respected person in health care policy. He's both a medical doctor [Harvard Medical School] and a Ph.D. in economics [Massachusetts Institute of Technology]," Goodman said. "Most people in this debate are neither."
The health care debate is just getting started, and how much success McClellan will have is uncertain. For now, though, he's a busy man, shuttling between the White House, Congress and federal health care agencies. His phone directory includes the heads of major health centers across the nation, including Parkland and Baylor.
"We're gathering momentum," McClellan said. "I'm optimistic."
Some material reprinted from the Dallas Tribune
The new present and Congress are under a lot of pressure to clean up a lot of messes. The fact that most of these messes started long ago and far away under other administrations is somewhat irrelevant. The main issue is that right now, the economy is in a mess and it is affecting a lot of things, not the least of which is Medicare.
AIG has long been a staple in the financial area. The main problem is that as the government continues to try to shore up medicare, help it go further and help it assist more people who depend on Medicare benefits to stay healthy - or even stay alive - AIG has been finding ways to get money in sneaky and unscrupulous ways over and over. In addition, AIG has managed to get millions and milllions of dollars from the government to keep runing, because AIG is connected to tons of financial institutions that everyone seems to be worried will go under if AIG does, since AIG is the sugar mama.
The latest information on AIG after they have taken plenty of money to continue operating, they have been and continue to pass out millions in bonuses and "retention" money, as well as tell the overnment and everyone who will listen that this is someting they must do and that "legally" they can't get out of the situation.
Meanwhile, Medicare is struggling to take care of those other millions of people - you know, the ones wh depend on them to get o stay healthy. Lawmakers and the president are doing all they can to get Medicare on more stable fotting. The unfortunate thing is that this whole mess started in preious adminisrations and
for the most part, until this administration there has been little effort to really examine AIG or Medicare.
The Obama administration has made its share of mistakes and misjudgements, however, let's be fair - they inherited a miss that has been growing and growing, as well as getting messier. more complicated and more sinister over the previous years. Now it is up to the current administration to get this fixed. At least this administration is really trying to get it right. There are some lawmakers on both sides of the aisle that are trying to put bipartisanship aside and work on these urgent issues.
If the rest of the lawmakers could simply put their partisinship aside and worry aboutfixing the problems rather than blaming people, a lot coud be fixed faster. Things will get fixed, there will be mistakes and oversights along the way, and these, also, will be ixed.
It's time to continue trying to make Medicare run as it should and stop shoveling money to corporations who are - and have been - using it on unncessary luxuries while those who are struggling can't even get basic, decent medical care.
It will take some time, and at east for the first time in nearly a decade, there is a trye effort to fix these issues and put the oney where it should be. Now, if we could just get everyone to stop playing the blame game and clean up the mess, things would go faster and and definitely turn out better.
