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Health reform must tackle Medicare costs

Congress returns this week from a summer of discontent to stare down health care legislation – including Medicare reform – once again.

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State gets White House promise on Medicare
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WASHINGTON – The health care bill approved Sunday by the House of Representatives lays the groundwork to overhaul a Medicare reimbursement formula that has punished Washington state.
The bill also provides $800 million over two years to doctors and hospitals in Washington and other states until changes are made.
Rewriting the formula has been a top priority of the Washington congressional delegation, but in the end the effort was stymied by complicated budget rules. Instead, the delegation got a firm commitment from the White House that it will study the issue and implement changes within two years. To cushion the delay, the health care bill includes the $800 million, which lawmakers say doctors and hospitals throughout the state should benefit from.
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Federal health care reform will mean huge changes across the country, but demographics in Pierce County indicate that changes here might be even more dramatic than in many other places.
Pierce County tends to be poorer and more racially diverse than most Washington counties, and for decades public health officials have struggled, with limited success, to expand health care access to minorities and the poor.
Once insurance reform kicks in, local health officials say, Pierce County could begin to see significant changes in disease and mortality statistics.
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Consumers hoping for help from the national health-reform bill passed by Congress on Sunday must wait at least six months for some new benefits and until 2014 for the major benefits, state Insurance Commissioner Mike Kreidler said Monday.
Kreidler’s office has estimated that the number of uninsured in Washington is growing and might hit 1 million by year’s end, and President Barack Obama’s signature on a reform bill doesn’t change that trend line.
In fact, the reform’s creation of a national insurance exchange and a law against insurers rejecting coverage for pre-existing conditions don’t come into being for almost four years.
Health care reform changes kick in next month -- we tell you what to expect
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Individuals and businesses will start to see changes in health coverage in coming months as a result of the health care reform law enacted earlier this year.
Starting this month, new purchase options exist for people who have gone without insurance because of pre-existing conditions, and in September coverage will expand for young adults.
Also in September, people on new employer-sponsored health plans won't have to pay out of pocket expenses for preventive services, such as cancer or diabetes screenings. A corresponding provision for individual plans starts Jan. 1.
Gov't: Spending to rise under health care overhaul
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The nation's health care tab will go up - not down - as a result of President Barack Obama's sweeping overhaul. That's the conclusion of a government forecast released Thursday, which also finds the increase will be modest.
The average annual growth in health care spending will be just two-tenths of 1 percentage point higher through 2019 with Obama's remake, said the analysis. And that's with more than 32 million uninsured gaining coverage because of the new law.
"The impact is moderate," said economist Andrea Sisko of Medicare's Office of the Actuary, the nonpartisan unit that prepared the report.

THE NEWS TRIBUNE

Published: 09/07/0912:05 am

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Congress returns this week from a summer of discontent to stare down health care legislation – including Medicare reform – once again.

Fresh from their battering back home, Democrats will be trying to figure out how to salvage health care reform without setting themselves up for a fall in next year’s mid-term elections. President Obama is expected to lay out his must-haves in a Wednesday address to Congress that will likely be two parts “go get it done” and one part “I’m in this with you.”

The prospects for real change depend in part on what drives the legislation. Much of the talk emerging from within the Democratic party revolves around whether to public option or not to public option. That’s the wrong place to begin.

True health care reform is at its very core primarily about cost. The United States cannot afford to permit the the health care spending trajectory – on pace to eat up 40 percent of the gross domestic product by mid-century – to continue unabated.

Controlling costs is how this nation gets to a place where it can ensure universal coverage. Without curbs, health care will bankrupt the nation just as surely as it is bankrupting families today.

In the Senate, Democrats are said to be eyeing the idea of a trigger that would give private insurance companies benchmarks for insuring more Americans and reducing health care costs. If insurers failed to meet the target, the government would begin offering health insurance, presumably to achieve the same aims through competition.

The plan has promise, especially if it can win moderate Democrats’ and Republicans’ support and avoid bending the rules to get the bill out of the Senate on the barest of margins.

But the feds cannot try to put others’ house in order while neglecting their own. Unchecked growth in Medicare spending threatens to swamp the federal budget. No one will be pulling a trigger to expand government-run health care down the road if Congress can’t bring what it’s already got to heel.

Medicare now rewards volume and political clout. Doctor reimbursement rates are lower in states like Washington where doctors have historically been cost-conscious and the population relatively healthy. Meanwhile, Medicare beneficiaries in high-reimbursement areas receive 60 percent more services but aren’t any healthier.

The Congressional Budget Office estimated last year that the country spends nearly $700 billion a year, much of it in Medicare, on health care services that do not improve health.

A deal hammered out by Washington’s congressional delegation and other Medicare-disadvantaged states would help, at least in concept. The Institute of Medicine would issue recommendations to make reimbursement rates more fair, and a broader study would look at changing the Medicare system to reward value, not volume.

Some critics worry that the deal doesn’t go far enough to lock in savings now. That’s a healthy skepticism. But what will be ultimately unhealthy is to try to accomplish everything in one bill. Such legislation would die under its own weight.

Lawmakers can’t let the perfect become the enemy of the good. It’s crunch time on Capitol Hill.

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