HCR -- CMS is in Trouble

By John Ballard

I was elated last year when the president appointed Dr. Donald Berwick to head the Center for Medicare and Medicaid Services. As a recess appointment he was doing an end run around knuckle-dragging Congressional opponents of health care reform, but under other circumstances Berwick would have been approved with little discussion.

Berwick Targeted By Lynch Mob; CMS Director �Abandoned� by the Administration?  by Maggie Mahar inflames me too much to write about it. The headline says it all. Readers can go to the link for the whole piece but this part  needs to be disseminated as far as possible.

Why Medicare Reform is Essential to Health Care Reform

The consensus among healthcare reformers is that one-third of Medicare dollars are squandered on procedures and products that provide little or no benefit for the patient. In our hospitals, preventable medical errors and accidents add to the waste. And it doesn't matter whether Medicare or a private insurers is paying the bills: health care spending in the private sector is no more efficient. The cost of care has been spiraling at roughly the same rate, both in the public sector and in the private sector for the past twenty years. Medicare desperately needs to change how it pays for care and what it pays for. If CMS takes the lead, and provides political cover, private sector insurers have said that they will follow. This is the only way that we, as a nation, can hope to make health care affordable.

Government now covers well over 50 percent of all doctors� bills, hospital charges, prescription drugs and other health care expenses in this country. As a result, only the Centers for Medicare and Medicaid (CMS) enjoy the market clout to insist on value for our health care dollars. Even the largest private insurer does not possess comparable power.

No hospital could stay open without Medicare patients. No drug company could turn a profit without reimbursements from CMS. A relatively small number of doctors might be able to refuse Medicare and thrive by offering concierge medicine to affluent younger patients. But what would happen when their patients needed to be admitted to the hospital?

Without reform, a concierge doctor�s patients would be exposed to the same high rates of errors, infections and accidents that threaten all hospital patients today. As one specialist who cares for the very wealthy (and does not accept insurance), said to me not too long ago: �It doesn�t matter who you are�or how much money you have�you don�t want to be in any of Manhattan�s hospitals.�

Nevertheless, conservatives are dead set against reining in health care inflation by excising waste and errors from our health care system because that would mean cutting into the incomes of the many industry lobbyists who feed at the trough of overtreatment. They argue that �more care is always better care. We can�t spend too much on health care. If we trim spending, we�ll stifle innovation.�

Rather than cutting Medicare spending, conservatives would prefer to shift the cost of Medicare to seniors, raising their co-pays and deductibles, while continuing to over-pay for diagnostic tests, surgeries and treatments that put patients at risk without benefit. This would means that many middle-class Medicare patients who live on roughly $20,000 a year (median income for seniors, including Social Security and all other sources of income), wouldn't be able to use Medicare: they couldn�t afford to cover the out-of-pocket payments.

In the end, many of Berwick�s opponents would like to simply privatize Medicare, turning it over to private-sector insurers who would offer �bait and switch policies� as they have in the past. Then, for-profit insurance companies would decide how much care seniors deserve and how much they should pay, while they made their own side deals with drug-makers, device-makers, medical equipment makers, and brand-name hospitals, agreeing to pay many of them lavishly, without regard to quality, just as they do today.