Dr. Tom Linden’s Health Blog

Medicare is heading toward financial meltdown.

That’s one inference you can draw from reading the March 2008 Report to Congress from the Medicare Payment Advisory Commission (MEDPAC).

Established through the Balanced Budget Act of 1997, MEDPAC advises Congress on issues affecting Medicare.

MEDPAC’s report is blunt. “The Medicare trustees and others warn of a serious mismatch between the benefits and payments the program currently provides and the financial resources available for the future. Projected levels of spending could also impose a significant financial liability on Medicare beneficiaries.�

Medicare is going broke with its hospital insurance trust fund projected to be exhausted by 2019.

The real kicker is that although the U.S. spends more per capita for health care than any other country, Americans are less healthy than people in many other industrialized countries.

MEDPAC’s report notes: “Despite spending more than other countries, the U.S. health care system does not consistently deliver higher quality care (Schoen et al. 2006). For example, the United States has a higher death rate for diseases that are amenable to medical care than the three leading industrialized nations. The United States also had a higher rate of medical errors than other industrialized countries. This disparity between spending and quality raises questions about the value for patients and health care payers of the higher level of spending in the United States.�

So what to do?

One health policy expert says Medicare can be fixed without raising Medicare taxes or cutting benefits seniors need.

Maggie Mahar, a fellow at the Century Foundation and author/editor of the highly respected The Health Care Blog, tells me in an interview that there are enough dollars in Medicare “to provide good care for everyone but Medicare can’t afford to provide care not based on good evidence.�

Medicare is spending millions of dollars on tests, drugs and medical procedures that don’t provide benefit and in many cases lead to unneeded or harmful care.

One example is overtreatment for the terminally ill in the last months of life.

As Mahar notes, “Many people don’t want to stay in the hospital and have more procedures… and they want to go home.�

This disjointed end-of-life care has many causes including lack of communication among specialists and a system that financially rewards doctors for doing procedures rather than talking with patients.

“People who practice cognitive medicine (talking to the patients and listening to the patients) get paid much less than a proceduralist who is operating or radiating,� says Mahar.

The reality that payment drives practice isn’t limited to end-of-life care or to Medicare. As Natasha Singer in The New York Times documented this week, many dermatologists in the country are offering two tiers of service… fast callbacks and personalized care for patients seeking beauty treatments like botox and cosmetic surgery and slower callbacks for patients needing exams for skin lesions that, in some cases, may herald skin cancer, including melanoma.

Mahar says Medicare pays for many procedures, drugs and treatments whose efficacies have never been documented.

“The country is running out of money.… the Medicare hospital trust fund pays out more than it takes in on tax revenues … 11 years from now it will be able cover only 78 percent of its obligations… it’s very much like Freddie Mac and Fanny Mae… on Wall Street years ago people knew…. The same thing with Medicare.�

To promote Medicare reform, Mahar and The Century Foundation are assembling a group of prominent physicians and health care experts to assess the state of Medicare and recommend reforms.

“This working group is composed primarily of physicians and public health officials, because they know better than anyone what’s wrong with the system and what’s needed to fix it,� Mahar says.

Members of the panel include John E. Wennberg, MD, MPH, Founder and Director Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice; Christine Cassel, MD, President and CEO of the American Board of Internal Medicine; and Elliott S. Fisher, MD, MPH, Director, Center for Health Policy Research.

For a complete list of panel members, go to:

http://www.healthbeatblog.org/2008/07/the-century-fou.html

Physician journalist Mike Magee writes on his Health Commentary blog that the U.S. is failing to live up to the promise of the Declaration of Independence “… that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” For without health, happiness is no more than an unattainable dream.

Dr. Magee asserts that our leaders are failing their people in not providing health care to the nation’s citizens. The Declaration of Independence states, “A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people” Dr. Magee asks, “… have not many of us felt those who denied our care were tyrants?”

Dr. Magee says we need to do better. How long will the people of the U.S. tolerate a system that denies care to millions as insurance companies and special interests control the levers of power in Washington? When will we reach the tipping point when a majority of Americans say “enough”?