The Medicare-Based Health Care Deal: Rough Water Ahead

NYT:

The Senate majority leader, Harry Reid, said Tuesday night that he and a group of 10 Democratic senators had reached “a broad agreement” to resolve a dispute over a proposed government-run health insurance plan, which has posed the biggest obstacle to passage of sweeping health care legislation.

Under the agreement, people ages 55 to 64 could “buy in” to Medicare. And a federal agency, the Office of Personnel Management, would negotiate with insurance companies to offer national health benefit plans, similar to those offered to federal employees, including members of Congress.

One is reminded of Barry Goldwater's crack about Medicare:

Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.

Fair question, eh?

On a more serious note, how does expanding a program that's already in serious trouble help? As the WaPo reported last summer:

Expanding access to Medicare will not solve the nation's health-care cost problem. That's the message of a report yesterday by a commission that advises Congress on the federal medical program for older Americans. ...

[The Medicare Payment Advisory Commission (MedPAC) report states that] "If current spending and utilization trends continue, the Medicare program is fiscally unsustainable. . . . Part of the problem is that Medicare's fee-for-service payment systems reward more care -- and more complex care -- without regard to the quality or value of that care."

And then there's another problem:

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle. ...

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

So here's a quick look at the future: Expanded Medicare will do nothing to constrain costs, government spending will go up, and we'll be told by the Democrats that solving the problem will require transforming Medicare into a single payer system from which doctors can't opt out.

Comments

[Don B]

One is reminded of Barry Goldwater's crack about Medicare:
Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.
Fair question, eh?

Actually - no. It is not a fair question, it is a stupid one and is the exact same point that Limbaugh made the other night on Shatner's show. If you cannot understand the difference between health care and a can of beer then you are not a serious commenter on health care at all.

Really, I read this blog to get insights into law and economics from a very smart conservative. Not silly rhetoric that could be better delivered by the garbage heads like Beck and Limbaugh.

[save_the_rustbelt]

The current system is not working well and the do-nothing crowd has few alternatives.

(Please do not tell me the GOP has a plan, my GOP is an intellectual and ethical wasteland.)

The stuff really hits the fan when private employers have to make severe cuts in coverage because of accelerating costs.

The Democrats do no have a great plan, although we dodged the single payer radicals for now. The GOP is worthless. Not a good situation.