By Richard Propp
Albany (N.Y.) Times Union
Thursday, July 29, 2010
Friday marks the 45th birthday of Medicare, signed into law by President Lyndon Johnson, in the presence of former President Harry Truman, an early proponent.
Medicare has provided care to people 65 and older since 1966, and more recently to those who are disabled or who have end-stage kidney disease.
With the infusion of Medicare dollars, doctors, hospitals, drug companies, medical training and medical research have flourished. As a result, new diagnostic tests, treatments and procedures are available to about 50 million people who are on Medicare. These advances also are available to those whose private insurance allows access to quality care, and somewhat less so to those on Medicaid, a program originally for the poor.
In many ways, Medicare has been an outstanding success, and no doubt has saved millions of lives. But that success has brought with it charges of excessive spending, and the program is under scrutiny.
Five courses of action are available to make sure our money is being spent wisely:
Subject Medicare to the tender mercies of President Barack Obama’s deficit reduction commission. But in a June 30 statement to the commission, economist James Galbraith challenged its legitimacy and whether Social Security and Medicare fall within its mandate. He concluded that the deficit resulted from the financial crisis and warned that “if cuts are proposed in Social Security and Medicare, they will hurt millions, weaken the economy, and the deficits will not decline. It’s a lose-lose proposition.”
Save money by reducing fraud and abuse, a program at last in professional action through the management and policy skills of Health and Human Services Secretary Kathleen Sebelius.
Make more rational decisions in the practice of medicine by using the demonstrated skills of Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services. Berwick founded the Institute for Healthcare Improvement in 1989, working on patient safety and quality in scores of hospitals around the world and saving thousands of lives.
Restructure and improve Medicare and expand it to the entire population. Medicare has an overhead of about 4 percent, compared to 15 to 25 percent for private insurance companies. That translates into a projected $400 billion in savings that could easily pay for the 45 million uninsured. This would bring the cost control that the new health care reform law, the Patient Protection and Affordable Care Act, lacks.
Strengthen primary care. I recently interviewed four distinguished practicing physicians. Central to their critique of modern medical care were medical education and training, the culture of medical practices and the rationale for reimbursing primary care physicians.
They believe that primary care quality and time spent with patients are key elements in cost-effective, patient-centered care.
Total and per-patient costs have increased for many reasons, including increased utilization and longer life spans, but also because of ease of referral to large single-specialty groups and lack of access to primary care physicians.
Good primary care is essential to the care of seniors who often have many illnesses and take many medicines. But for a variety of reasons, including finances, doctors are not entering primary care.
To remedy this, we need to overhaul medical education, providing tuition to students who commit to four years of primary care practice where they are needed. This will allow entrance into medicine of talented, low-income students.
Then we must adequately compensate primary care. practitioners and their staffs to really provide in-depth, longitudinal care of challenging chronic illnesses.
As we remember and honor Lyndon Johnson and all those who advocated successfully for a system that has saved millions of lives, let us renew our efforts to provide a real system of care for all Americans.
What a great birthday present!
Richard Propp, M.D., of Albany is a member of the Capital District Alliance for Universal Healthcare.