Rethinking Medicare

  • Article by: EDITORIAL , Los Angeles Times
  • Updated: January 22, 2013 - 7:26 PM

Let independent experts help rein in health-care costs. Ignore critics who argue it's a bad idea to put so much power in the hands of unelected bureaucrats.

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pumiceJan. 22, 13 5:37 PM

From the article: "There's no reward in the existing fee-for-service system for doctors who find ways to heal patients at lower cost; the board's role is to find ways to do so, and spread them rapidly.... If anything, the board [of independent experts] will push the system to focus less on the procedures done than on the results achieved." Is there any less effective way to reduce costs than fee-for-service? Is there any more effective way to improve health care than to focus on results?

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Mark27Jan. 22, 13 7:12 PM

Before we undertake too many exhaustive policy changes to cut Medicare costs, we need to inject a little honesty into the discussion of what really drives health care costs in this country as the conventional wisdom is effectively the diametric opposite of the actuarial reality. No matter how much we're told that a healthy lifestyle will reduce health care costs--and no matter how much one can benefit personally from a healthy lifestyle--the bottom line is that Medicare's financial insolvency is a direct result of more people living healthy lifestyles and extending their life expectancies than can be afforded. Much as we want to pretend that 25-year-old smokers run up higher health care costs than 85-year-old nursing home patients who were lifelong nonsmokers, the reality is the opposite. So instead of pretending that yet again more cigarette tax increases, already on the table here in Minnesota as a budget fix and inevitably sold to the public on fraudulent "health impact fee" grounds, is a good-faith effort to rein in health care costs, government needs to be honest with us about the consequences of living longer lives as we're constantly being told should be society's endgame. If life expectancy keeps on rising, the money runs out.

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gandalf48Jan. 23, 13 9:26 AM

I think the Mayo clinic has it correct, they just pay a doctor a standard salary so we don't need to even discuss how doctors get paid for doing unnecessary procedures or prescribing unnecessary drugs. Create a standard salary and add bonuses for results rather than for performing specific procedures.

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owatonnabillJan. 23, 1310:27 AM

Mark27 makes a very good point. Longer lives mean more dollars spent. But the answer is not to add more bureaucracy, or to tweak and meddle with the current system. Fact of the matter is that medical care is EXPENSIVE, and for a lot of reasons. Owatonnabill spent several days in the hospital last month and saw a total of four doctors, and with the exception of the guy in the ER, all told for a grand total of less than an hour. Yet when the itemizations for charges came the doctors' cut was nearly half of the total charges! Now owatonnabill understands that doctors make a huge investment in their educations and he has no problem with them getting paid what they do. But let's be realistic. This is a huge chunk of money. Perhaps a fundamental rethink is in order. There are systems in other countries where the government, when a promising young student is recognized who otherwise would not have the financial wherewithall to pay for his/her medical studies, will step in and fund the student's tuition and costs, in return for a contract where the student then works for the government for a set wage for "x" number of years after graduation. Many of these newly-minted doctors give the government their allotted hours of service during the day in local hospitals and clinics, and run their own private clinics evenings and weekends, until their obligation to the government is satisfied. It leads to pretty much a two-tier medical system but it DOES dramatically lower doctor costs for those who otherwise would not be able to pay the higher charges. Maybe we should be studying something similar here.

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hobie2Jan. 23, 1312:46 PM

We could fix Medicare by 1) removing the unfunded Bush Medicare addition from the FICA- and-premiums-funded Medicare of before the change, and put it under the US government as a stand-alone. Let the US government fund their part, not use the wage-earners and their employers monies... (Pre-Bush-add, the law said any shortfalls in FICA-plus-interest vs expense was to be made up by automatically increasing premiums)... 2) Remove the profit incentive to increase medical cost - with insurance companies and HMOs getting a straight percent cut of total expenditures for "handling" and profit, (now limited to 80 to 85% or total collected/paid by ACA) what do you expect? They let the reins go to grow the total and cut the admin costs on the 15% of the total to hold profit percentage - NOT to use the services more efficiently and effectively for the end users.

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