With the nation’s debt crisis looming large, much attention is on cutting Medicare spending. Medicare shoulders the highest expenses in the U.S. healthcare system, and tax dollars pay for most of the annual increase in the cost of care for the elderly and disabled.
The Medicare cut proposal is causing a lot of concern. President Obama and Congressman Paul Ryan are taking opposite approaches to the Medicare dilemma, though their goals are the same – to rein in Medicare costs and to limit the amount of taxpayer money going into Medicare. However, the proposals that both the President and the Republicans are making to tackle long-term Medicare debt have come under fire.
President Obama says he is determined not to leave “seniors at the mercy of private insurance with shrinking benefits to pay for rising cost”. Physicians express the fear that the various committees and federal agencies that President Obama visualizes to set up, to look into the matter, will decrease the services that doctors can order for their patients. The Independent Medical Advisory Board that will kick off by 2018 will decide whether too much is being spent on medical services, and will decide whether one service or treatment is better than another. This has come in for much criticism:
• First, it places the onus of judgment in the hands of a few bureaucrats and vested interests.
• Doctors feel that such judgments on the ‘comparative effectiveness’ of treatments or services are not wise, as they could affect the physician-patient relationship, especially when a patient needs a particular treatment. There is a view that way too much is being spent on seniors aged 65-70. Individuals in this age group are much healthier than they used to be. Some doctors feel that a better alternative to saving money that is being spent on medical services would be to cut Medicare benefits for those in the 65-70 age group so that there is enough to pay for a life saving operation when they reach, say, age 80.
As for Congressman Paul Ryan’s suggestions, doctors think that they could work well for younger people but not the elderly. Paul Ryan recommends that health insurance companies should be brought in for people who have a serious illness. His long-term “budget-cutting plan” proposes a drastic restructuring of Medicare that includes the creation of health insurance exchanges, which he claims would drive down prices through free market competition.
Doctors also came out in criticism of Paul Ryan’s views, especially when it comes to dealing with older patients. As a result, the House GOP plan, to replace Medicare with a voucher-like system, has been rejected. Some of the issues raised are:
• The general feeling was that it does not make sense to give a voucher to an 80 year old with medical problems and tell him to buy private insurance, as it is tough to get private health insurance companies to pay for patients who are very old and very sick.
• President Obama points out that this plan will leave old and sick people at the mercy of private insurance companies.
• Private insurance works better for patients who are young and have less medical issues. It is pointed out that Medical Advantage has not worked well for older patients even in the past.
Suggestions Put Forward to Cut Medicare Spending:
• Medicare access should be cut down. For instance, people shouldn’t be using Medicare or Medicaid to treat issues like a common cold. Treatment should be restricted to high tech solutions that work.
• There is too much money being wasted internally in the Medicare system. This should be dealt with and such waste should be cut.
• Obama care talks about ‘preventive medicine’. Doctors feel that lifestyle changes like diet, and exercise are the crux of preventive measures. Federal medical spending should address such measures to ensure that seniors stay healthy. This would contribute to lowering the nation’s overall health bill.
• Reassessing the retirement age can also help. With greater awareness about health issues and improved medication, today’s senior citizens are quite healthy even at age 65. Reassessing the retirement age can bring down the number of people becoming eligible for Medicare.
• The use of electronic medical records can bring down health care costs and improve the efficiency of hospitals and practices. Computerized medical records will help prevent waste and reduce the time needed to repeat expensive medical procedures and tests. Doctors are now eligible to get more than $40,000 in extra Medicare payments, if they upgrade to electronic records. They would face reduced Medicare payments and even a penalty if they don’t do so by 2015.
To sum up, there is no doubt that Medicare must operate more efficiently, especially as the generation of baby boomers is all set to enter its rolls. Additional revenue must be found. The government should take care to prevent false billings and ensure that Medicare reimbursements are made only for authentic claims.
There is general consensus on an enforceable limit. Such a limit would see a future with less Medicare payments for healthcare service providers like hospitals, doctors, drug companies and others, more out-of-pocket expenses for many senior citizens, and smaller role for tax dollars in Medicare payments.
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