Among the blizzard of markups to the U.S. Senate Finance Committee’s health care legislation, also known as the Baucus bill, are a couple of amendments offered by U.S. Sen. Maria Cantwell, D-Wash., that would go a long way toward controlling Medicare costs, which, in turn, should help control the overall price tag for health care.
Without cost containment, reforms won’t have the necessary staying power, because health care inflation is projected to double current costs in 10 years. Plus, savings from Medicare are supposed to help pay for coverage for the uninsured.
Enter Cantwell’s amendments, which take aim at Medicare’s dysfunctional and inefficient fee-for-service model that values quantity over quality. As Cantwell told fellow senators, the current model is like a restaurant bringing everything on the menu to your table. It doesn’t matter if you don’t want it or can’t eat it, because somebody else is picking up the check. To extend the metaphor, everybody involved in the preparation and the delivery of those meals would be paid separately, so there is an incentive for all of the kitchen workers to make a portion of this feast.
Long-term research at Dartmouth University backs Cantwell’s contention, noting that about 30 percent of health care spending goes for unnecessary tests and procedures. Rather than continue with this gluttony, her amendments serve up incentives for high quality, coordinated care. They also seek to reward those parts of the country that are doing the right thing and punish those who are mindlessly billing the government. In 2006, the average Medicare cost per patient in Washington state was $7,110. Nationwide, it was $8,304. In McAllen, Texas, it was $14,946, because of gross overutilization.
As it stands, Medicare’s payment system encourages waste by paying for each test and procedure regardless of patient outcomes. A primary care physician who works hard to coordinate an effective treatment plan is punished, because Medicare doesn’t value that work. In addition, some health care providers are reimbursed more than others for identical procedures, because Medicare hasn’t determined whether the wide disparity in spending from region to region is warranted. According to the Dartmouth research, the higher spending is not justified.
Nonetheless, Congress has ignored such evidence and has continued to reward inefficiencies. The result is lower reimbursements for our relatively efficient region, which makes it more difficult for our doctors to take on new Medicare patients.
Cantwell and U.S. Sen. Amy Klobuchar, D-Minn., are spearheading these common-sense reforms and thus far 26 senators have signed on. However, politics cannot be discounted, because high-spending regions would have to surrender Medicare money. It won’t be an easy sell, but if Congress is serious about controlling the nation’s health care bill, these amendments will remain in the final product.
Local journalism is essential.
Give directly to The Spokesman-Review's Northwest Passages community forums series -- which helps to offset the costs of several reporter and editor positions at the newspaper -- by using the easy options below. Gifts processed in this system are not tax deductible, but are predominately used to help meet the local financial requirements needed to receive national matching-grant funds.
Subscribe to the Coronavirus newsletter
Get the day’s latest Coronavirus news delivered to your inbox by subscribing to our newsletter.