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Reclaim and Strengthen Medicare  -- From: Rekindling Reform
Undo the Damage to Health Care for All

(Editor's Note:   There is a concerted effort by the Bush Administration and Cohorts to destroy Medicare...Read this analysis.  It is very important.)

The traditional Medicare program, enacted in 1965, remains, despite its limitations, a fine example of social insurance, a system that is publicly instituted and publicly controlled. It is distinctly different from private insurance. As the National Academy of Social Insurance notes:

Certain risks we have agreed to confront as a society, rather than as individuals. Citizens have decided, through the political system, that we need financial protection against some of life's difficulties that are hard to face as individuals. These include old age, ill health, unemployment, disability that makes it impossible to work, injury on the job, and the death of a family breadwinner. For all these conditions, we rely on help from social insurance programs, which are financed by workers and employers.

In multiple ways, the Medicare Modernization Act of 2003 (MMA) has undermined the health insurance program that senior citizens and people with long-term disabilities have relied on for many years. That law strips away protections that people with Medicare continue to need. Moreover, as described below, if MMA’s provisions are allowed to remain in force, they will continue to erode traditional Medicare. Read More >>Download PDF

Reclaiming Medicare

June 7, 2007 • Volume 7, Issue 23

Medicare was created because, in the mid-20th century, older Americans faced a health care crisis. The Social Security system—created as an economic safety net for older Americans—was failing to protect them against the greatest single cause of economic dependency in old age: the high cost of medical care.

The 1950 census showed that the aged population had grown from 3 million in 1900 to 12 million in 1950, or from 4 to 8 percent of the U.S. population. Two-thirds of older Americans had incomes of less than $1,000 annually, and only 1 in 8 had health insurance.

Private insurers had long considered this illness-prone population a "bad risk," and even unions were generally unable to purchase coverage for retirees through employer-sponsored plans. Read More >>

Medical imaging equipment makers are lobbying to overturn Medicare cutbacks after weathering some of the worst sales numbers in recent memory.

The cuts took effect in January and reduce how much doctors are paid for running X-rays, medical resonance imaging and other tests on patients enrolled in the government-run health program for seniors.
For example, nationwide reimbursements for MRI scans, one of the most commonly performed procedures, dropped 38 percent on average, with payments varying by county.

The Medicare payment changes, which are expected to save $2.8 billion over five years, sent sales of scanners made by GE, Siemens AG, Toshiba Corp. and others tumbling more than 20 percent last quarter, according to data provided by an industry group.

Medicare officials say they are monitoring whether patients are having trouble getting access to imaging. And they point out that payment reductions don't affect hospitals, where the majority of imaging services are performed.

Washington's unresponsiveness may reflect a more troubling trend for these and other medical technology companies: Health-care experts that advise lawmakers are not convinced that more medical technology translates into better health care.

"We have communities with half as many scanners as those in other parts of the country, and their outcomes are just as good, and in some cases better, than communities spending twice as much on imaging," said Elliot Fisher, a professor at Dartmouth Medical School who consulted for government advisers on the imaging issue.

Research by Fisher and his colleagues found that patients live about the same length of time regardless of their access to imaging.

Imaging industry representatives counter that basing the technology's value on whether the patient lives or dies isn't valid.

http://www.azstarnet.com/allheadlines/189110

Comment: Currently the greatest increase in Medicare spending has been due to the increased use of medical imaging. Some of it is appropriate, and some of it is not. As stewards of our public funds, Medicare officials have an obligation to see that we are receiving appropriate value for our health care spending.

There have been some disturbing developments in medical imaging in recent years. There has been an increase in independent, entrepreneurial imaging centers which are not linked to hospitals.
Specialty groups that order many scans frequently purchase their own units, providing physicians with even more incentives to order scans.
This increased capacity has been demonstrated to increase the number of imaging procedures performed. Elliot Fisher and his Dartmouth colleagues have demonstrated that this increase in volume has not improved outcomes, yet it has decreased value of our Medicare purchasing. It is this over-utilization that is targeted by the reductions in Medicare rates for imaging services.

The opponents of government insurance programs will likely claim that Medicare's reduction in payments for imaging services will reduce incentives to develop new innovative technology. No. Medicare continues to adequately fund appropriate imaging services.

The message is that Medicare will pay for beneficial technology, but it will not waste taxpayer funds on expensive technology that fails to provide health care value. It is a message to the technology industry that they should continue to provide us with new technology that provides health care value, but don't sell us excesses that we don't need and really can no longer afford. The tech industry will not go away. They will still want their portion of the $2.2 trillion that we are already spending on health care.

This important oversight function is an advantage of having a single government program that can identify deficiencies in our financing of health care, and then put in place policies that correct them. The thousands of private plans with their fragmented proprietary information have very little capability of identifying these problems, much less having a credible basis for putting in place global policies that would increase health care value.

Just think of how much more effective we could be in value purchasing of health care if all of us were covered by our own single payer program of national health insurance. That would be so much better than being controlled by an industry that declares "whether the patient lives or dies isn't valid."

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