NYT Readers Weigh in on the Future of Medicare

The New York Times
February 23, 2013
Sunday Dialogue: The Future of Medicare

Canada’s Medicare program — phased in at the same time as the American version — shows how we can make Medicare simpler and thriftier, while simultaneously upgrading its coverage. Canada’s program covers all Canadians (not just the elderly) under a single public program in each province, and bans co-payments and deductibles.

Patients can choose any doctor and hospital. Cutting out private insurers and the complexity and fragmentation they impose has simplified paperwork for patients, doctors and hospitals. Administrative costs are roughly half United States levels, saving more than $1,000 per capita.

Over all, Medicare spending on the elderly has grown three times faster in the United States than in Canada since 1980, while life expectancy (for the elderly, as for all age groups) has grown faster in Canada. If American Medicare costs had risen at Canadian rates, we’d have saved more than $2 trillion by now, and Medicare’s trust fund would show a healthy surplus.

STEFFIE WOOLHANDLER
DAVID U. HIMMELSTEIN
New York, Feb. 20, 2013

The writers, internists and professors at the CUNY School of Public Health at Hunter College, co-founded Physicians for a National Health Program.

***

Medicare is headed for bankruptcy because it depends largely on open-ended fee-for-service payment of almost any services providers choose to deliver, at prices mainly determined by the providers. Compounding the problem, most providers act like independent businesses seeking to increase their income, regardless of whether they are for-profit or investor-owned.

An effective Medicare fix would require a new payment system that prospectively pays providers for comprehensive care at a rate set by a single public payer. It would also need a not-for-profit medical care system based on multispecialty doctor groups that pay physicians by salary, thus minimizing incentives to deliver duplicative or unnecessary care.

The new system would have to be mandatory for all citizens, including legislators, and it would have to be financed by a progressive, earmarked health care tax.

Obviously, such reform would be slow and difficult, but so would any other change that threatened vested interests. All reform will depend on an aroused public opinion.

ARNOLD S. RELMAN
Tucson, Feb. 21, 2013

The writer is professor emeritus of medicine and social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.

http://www.nytimes.com/2013/02/24/opinion/sunday/sunday-dialogue-the-future-of-medicare.html?ref=opinion&pagewanted=all&_r=0


Comment by Don McCanne of the PNHP: At a time when Congress and the Obama administration are contemplating a reduction in Medicare spending as a means of paring down our national budget deficit, it is important to remind the nation of the beneficial changes that we could be making to the Medicare program that would bring affordable, high quality care to everyone under a single payer Medicare budget that we could afford. The messages of Steffie Woolhandler, David Himmelstein and Arnold Relman need to drown out the messages of those who would send Medicare down the wrong path.

What if we eliminated the huge financial "hole" that doctors start out with... Med school costs??? Could young doctors be convinced to charge less as a result?

A hugh expense for dr's is the insurance they have to carry because of LAWYERS pushing people to sue for every little tiny thing. The is a lawyer waiting to sue for the scar that's left from your knee replacement surgery or any other thing they can think of.

Jake, we need national tort reform. Without that, no health care program will be able to function over the long haul. If tort reform were enacted, the premium physicians, nurses, other health care professionals, hospitals and health care clinics pay for private insurance would probably go down considerably.

I don't know the answer to your question about med school costs, Eric. It seems the cost for a college education is becoming prohibitive for many people, not just doctors.

Some med students are opting for the programs that place them in under-served areas for a few years after they graduate. Under the terms of those programs, the cost for medical school would be heavily subsidized if not eliminated. If I'm not mistaken, some programs are private while some are government connected. I need to research that a bit more.

And Eric, rising health care costs can't be attributed to physicians only. What physicians charge pales in comparison to what hospitals - including non-profits - charge.

Again, tort reform is necessary if we are to change the state of health care in our country. Without that, nothing much will help.

Ah, bollocks. I deleted your post about the cost of Ambien, Eric. It was an accident. I was trying to add my input but it showed up as being posted by you. When I tried to fix it, the whole post went "poof."

We were talking about the cost of Ambien. As you wrote, Eric, it costs only around $2.00 for those who have insurance. For the uninsured, the brand name costs around $180.00 while the supposedly-affordable generic version costs around $120.00.

Sad commentary on the unnecessarily high cost of prescription drugs, eh?

PBulldog2 wrote:

Ah, bollocks. I deleted your post about the cost of Ambien, Eric. It was an accident. I was trying to add my input but it showed up as being posted by you. When I tried to fix it, the whole post went "poof."

We were talking about the cost of Ambien. As you wrote, Eric, it costs only around $2.00 for those who have insurance. For the uninsured, the brand name costs around $180.00 while the supposedly-affordable generic version costs around $120.00.

Sad commentary on the unnecessarily high cost of prescription drugs, eh?

No, I actually PAID for the whole prescription... $2 total. It was a generic... but $2 total for 30 pills.

Edit: Here's a quick link to a $12 prescription. http://www.fatwallet.com/forums/hot-deals/732883/

Another Edit: Poster #15 Anita on this thread http://www.prescriptiondrug-info.com/Discuss/Zolpidem-Generic-220783.htm says

Quote :

When I told the pharmacist that I wanted to fill the next prescription with name brand Ambien, she suggested I ask my doctor for a prescription specifying "no generics". That way I'd get a reduced price. And so, I filled the entire prescription of 30 pills with "real" Ambien for $60, rather than for about $300. (The generic cost me $3).

It works GREAT, just like it used to. I sleep for a full night, and it puts me to sleep quickly (as a matter of fact, I have to be careful that I don't have something important to do after taking the pill, because I'm out like a light).

Except for the money, I'm a happy camper. I can afford this (I don't use this often, only when critical), but I know it's more difficult for others, and I'm sorry for that.

I can now go on my trip to Haiti and not worry about a week of no sleep in questionable conditions.

I suggest more people ask for a "no generic" prescription and perhaps someone will investigate why the generics don't work for many people.