Where Medicare Reform Should Really be Focused

Representative Paul Ryan’s recent Medicare spending proposal has greatly stirred the political pot going into next year’s congressional and presidential elections. Not only has the proposal been blamed for the recent Republican loss of the staunchly conservative New York 26th district, it has also continued to feed into the larger debate on government spending. Due to the nature of the Ryan plan, discourse surrounding Medicare focuses almost exclusively on spending while ignoring other important aspects of the program such as quality of care and wasteful spending. Both parties seem to be willing to concentrate political discussion solely on who is going to foot the bill rather than focusing on where the money is actually being spent and whether our health care system is prepared to support tens of millions of new people.
So far the Republicans have been content to converge the debate on healthcare as well as their defense of the Ryan plan around the issue of how the government is going to afford the monumental costs of healthcare in the future. Democrats are delighted to debate in this political arena and rightly so. It is hard to find many American families that emerged from the past two years economically unscathed; in difficult economic times, “the last thing [older Americans will] countenance right now is any suggestion that one of the last remaining federal life preservers is being withdrawn.”
A focus on spending is necessary to any discussion involving Medicare because the program has recently been projected to become insolvent by 2024, and because of the Damoclean federal deficit and national debt. However, there are ways to reduce the cost of Medicare without reducing coverage or level of treatment that are being ignored. Medicare currently covers dozens of procedures that are largely not beneficial or redundant which lead to excess costs that run in the billions of dollars. Just a few examples of ineffective procedures that are covered include surgical procedures such as kyphoplasty (cost: $1 billion) which were shown to be just as effective as a sham procedure as well as billions spent on cardiac stents which have been repeatedly demonstrated to be just as effective as drugs in reducing the risk of heart attack.
The amount of waste in the Medicare system is almost impossible to quantify but the chief actuary for Medicare estimates that about 15-30% of Medicare expenditures are superfluous translating to about $75-100 billion dollars that can be cut without reducing needed services or general patient outcomes. This wasteful spending is able to persist despite clinical evidence clearly demonstrating procedural ineffectiveness due to political sensitivities surrounding the issues of limiting Medicare coverage as well as the prevailing medical culture in the U.S.
Although there are rarely any simple solutions to almost any political issues, there seems to be one in this case: making sure clinical evidence is in agreement with Medicare coverage. However, there are many powerful constituencies that have a vested interest in making sure these procedures continue to be covered. While the solution seems simple: having a dedicated administrative panel committed to ensuring that all procedures covered by Medicare are proven to be clinically effective, fighting the political battle in implementing this while avoiding loaded, political terms such as “death panels” and negative spin involved with “cutting” program coverage is another story.
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