No matter how the U.S. Supreme Court rules on the constitutionality of the Patient Protection and Health Care Affordability Act, the plain, non-legal truth is Americans pay too much for health care and get too little in return.
By so many measures of medical outcomes, from infant mortality to life expectancy, the United States performs dismally, somewhere around 35th among all countries. Yet the U.S. devotes 18 percent of its gross domestic product to medical care, far more than other industrialized nations.
Much of the bill is picked up by the federal and state governments, which are bending under the burden. Washington’s Basic Health plan, once a model, has been eviscerated. Medicare will soon run out of money.
Although many recognize these truths, the solutions are elusive, or spurned.
Take the recommendations made by the Medicare Payment Advisory Council, or MedPAC, a panel formed in 1997 to review Medicare payment issues and recommend changes to Congress. Lawmakers have usually chosen to ignore its advice, allowing billions in wasteful spending to continue.
Medicare’s fundamental problem, says a commission report released this month: “Providers are paid more when they deliver more services without regard to the quality or value. … High-use regions are not clearly associated with better outcomes.”
Despite concerns doctors are turning away new patients, the report found Medicare beneficiaries had about the same access to doctors as those age 50-64, although that was less the case for primary care providers.
A sample MedPAC recommendation for 2013: Pay doctors who see their patients in hospitals an amount equal to what they would charge in their offices. Medicare pays 80 percent more for the hospital appointment. The change, phased in over three years to soften the blow to doctors, would save Medicare $1 billion annually.
The report looks at each segment of the health care market – doctors, hospitals, nursing homes, etc. – to determine who might be enjoying too much of a good thing at the expense of taxpayers and how some companies game the system to fatten profits. While hospitals do not fully recover costs from Medicare, for example, skilled nursing facilities thrive on a margin of 18.5 percent.
Unfortunately, MedPAC has no teeth, but a similar body authorized by the Health Care Act would. The Independent Payment Advisory Board could reward good practitioners and punish the bad, unless Congress steps in. IPAB has become a punching bag for Republicans opposed to reform.
Rep. Cathy McMorris Rodgers, for one, says “IPAB is just a Band-Aid for the true reforms that Congress needs to make to save Medicare for our future retirees.”
Last week, House Republicans voted to kill the board. But in misrepresenting IPAB as a body that would ration care, they tacitly accept the open-ended, runaway costs of Medicare as it is now. IPAB would impose the discipline representatives and senators beholden to special-interest money have not.
Used properly, IPAB would be not a Band-Aid but a tourniquet.