February 03, 2012
3:57 pm
Earlier this week, I posted in this space about the need for Congress to take the issue of entitlement reform seriously, and to avoid undermining serious discussion about proposals to improve Medicare with glib 30-second sound bites and attack ads during the upcoming campaign season.
But I only addressed half of the equation that is instrumental to constructive discussion on this issue. As a group of physicians serving in Congress pointed out this week, organizations representing the interests of different population groups also have critical roles to play in this dialogue.
In an open letter to AARP, 18 doctors serving in the House and Senate point out, accurately, that “the American people deserve a mature, informed and thoughtful conversation about how to save the Medicare program and shore up its financing.” They add that, absent reform, “AARP members aged 50-56 today – as well as future members – will see the end of Medicare as we know it.”
The doctors, in the letter, invite AARP to participate in publicly urging all members of Congress, regardless of political party, to “acknowledge the approaching insolvency of the Medicare trust fund and the program’s structural financing challenges.”
They’re right. Structural change to Medicare, which is necessary if we’re to achieve long-term sustainability while maintaining quality and innovation for patients, will face a steep uphill battle if influential interest groups marshal their resources in opposition. To the contrary, progress relies not just on officeholders, but also powerful advocacy groups, acknowledging that the status quo cannot be maintained and that change is necessary.
All of us who are engaged in healthcare policy advocacy bear this responsibility.
January 30, 2012
3:33 pm
If you smoke tobacco, you’re not going to be hired for a job by the Baylor Health Care System. For that matter, you don’t need to waste time filling out an employment application form at the Cleveland Clinic either. Both healthcare providers have made it clear that they will not accept smokers within their respective workforces.
In its editorial today, USA Today says this type of policy is wrong. The newspaper argues that employers like Baylor CEO Joel Allison and Cleveland Clinic CEO Toby Cosgrove (both members of the Healthcare Leadership Council) have every right to offer smoking cessation programs to their employees and even to make smokers pay more out of pocket for their workplace-provided health insurance. But, USA Today says, it is improper to penalize a job applicant for practicing a legal habit on their own time.
According to the newspaper’s editorial, “A bit further down (this) road lies hiring based on genetics. In that world, inheriting that shows a predisposition to a costly disease could cost you a job.”
USA Today is wrong, and not just because of its nonsensical comparison of a voluntary activity like smoking to an individual’s genetic makeup.
Today’s healthcare providers are expected not only to provide excellent care for the patients, but also to encourage wellness, disease prevention and healthy behaviors among all individuals they have the ability to influence. As Dr. Paul Terpeluk of the Cleveland Clinic said in his “opposing view” in USA Today, “We have a unique perspective on the burden of chronic disease. We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach.”
There’s also a significant economic issue involved here. When an employer, particularly one who provides health coverage, hires an individual, they are assuming the burden of his or her healthcare costs. An individual may smoke on their own time, but the employer winds up footing much of the bill for the chronic illnesses associated with smoking. Should an employer be allowed to consider the increased health costs, absenteeism and loss of productivity associated with a voluntary, unhealthy behavior like smoking? It’s hard to argue that they shouldn’t.
And in an environment in which five percent of the population is responsible for 50 percent of our healthcare costs, this is a concern that goes well beyond Baylor and the Cleveland Clinic.
I know both Joel Allison and Toby Cosgrove. They are both gentlemen who have dedicated their lives and careers to providing better health to their fellow citizens. Their no-smoking policies are neither mean-spirited nor discriminatory. Rather, they are intended to make a vitally-needed statement about wellness and healthy living both within and outside the confines of their respective institutions.
December 15, 2011
9:46 am
If there ever seemed an issue, in today’s political environment, upon which Democrats and Republicans would never meet in the middle, it is Medicare reform. This is always particularly true in the months leading up to an election. It’s just too easy to portray any new idea to make the Medicare program more affordable or sustainable as a dangerous threat to vulnerable seniors.
That’s why it’s impossible to overstate the significance of Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) reaching across the aisle and joining together to offer a meaningful Medicare reform plan. This development has probably caused no small amount of heartburn in some political and campaign planning circles, but for taxpayers, future Medicare beneficiaries and the program itself, this is a very positive step.
We’re not going to try to comprehensively analyze the Wyden-Ryan plan right now in this space. Both lawmakers have, in fact, said that they won’t offer legislative language until after the 2012 elections. In broad strokes, though, the concept offers a sustainable path for Medicare’s future, offering beneficiaries a fixed federal contribution that can be used to acquire coverage from either conventional fee-for-service Medicare or a selection of competing private plans. As we’ve said at the Healthcare Leadership Council, in advocating this type of approach, competition will drive greater innovation, quality and value.
The news today, though, is not the details of the plan, but the fact that Ron Wyden and Paul Ryan have opened up a crack in the previously impenetrable wall between the two parties on this issue. If this gradually moves us to a place where we have more substantive discussions about how to maintain a viable Medicare program, and fewer 30-second “Mediscare” TV ads, then these two have made an incredibly valuable contribution.
November 22, 2011
11:40 am
If hand-wringing and finger-pointing actually generated dollars, Washington, DC would probably be able to solve the federal deficit problem today. With ‘super committee’ negotiations collapsing and members of the Joint Select Committee on Deficit Reduction formally admitting that they won’t have recommendations to submit by the November 23 deadline, the Beltway blame game is in full swing. Kaiser Health News has a good summary of the news coverage taking place today – with links.
Worries about whether there will be meaningful spending cuts are premature. The November 23 date was an artificial deadline anyway. With the automatic sequestration cuts not taking place until 2013, Congress has an entire year to figure out $1.2 trillion in savings alternatives.
That’s not to say there aren’t serious missed opportunities in the ‘super committee’s’ failure to act. With the nation’s focus on their deliberations, this was an ideal time to launch a national debate on how to reform Medicare, make the program more cost-efficient and more sustainable for the long run. That public debate didn’t happen.
Sure, there were some ideas on the table for reforming entitlement programs. Some, like raising the Medicare eligibility age, warrant serious discussion. There were also reportedly discussions, though, focused on the tired, old approach of cutting payments to Medicare providers (and pretending this doesn’t affect beneficiaries’ access to quality care and medical innovations.)
What was lacking was a serious conversation about the issue raised by former Clinton budget director Alice Rivlin and former U.S. Senator Pete Domenici in their testimony to the Select Committee. Structural changes to the Medicare program, which the two experts said is essential in order to address the nation’s debt crisis, didn’t get off the launching pad.
It seems strange to me that there would be such political intransigence in some quarters to the concept of reforming Medicare to give beneficiaries a greater degree of choice in their health coverage. It’s a structure that has worked well with the Federal Employees Health Benefits Program and the Medicare Part D prescription drug benefit, and it’s going to be utilized in the Affordable Care Act’s state health insurance exchanges.
Yet, when it comes to Medicare, there is a greater willingness by some to simply cut dollars from the program, thus undermining both quality and access, than to create a role for the private sector in driving value and cost-efficiency.
The ‘super committee’s’ failure to take up the cause of Medicare reform was a missed opportunity. It will come back around again, though. As Dr. Rivlin and Senator Domenici accurately point out, you can’t fix America’s debt problem without it.
November 02, 2011
8:43 am
Former Clinton Administration Budget Director Alice Rivlin and retired U.S. Senator Pete Domenici (R-NM) testified yesterday before the congressional “supercommittee” charged with identifying $1.5 trillion in federal budget savings.
The members of the Select Committee would do well to listen to the Rivlin-Domenici advice on reforming the Medicare program.
The two experts, both members of the Bipartisan Policy Center’s deficit reduction efforts told the committee members that “simply put, there can be no lasting solution to the U.S. debt crisis without structural changes in the Medicare program to slow its cost growth.”
This structural reform approach contrasts with many of the news reports circulating which suggest committee members are considering straightforward cuts in Medicare payments to providers or requiring increased rebates from pharmaceutical manufacturers to the federal government. In either case, Medicare beneficiaries are going to pay the price either through reduced access to care or higher drug prices.
Instead, what Rivlin and Domenici have suggested is a bold yet sensible alternative to the idea of saving money from Medicare simply by taking an ax to it. They recommend providing Medicare beneficiaries with a choice of staying in the conventional fee-for-service program or entering a Medicare Exchange in which private plans would compete on the basis of cost, quality and value.
Some outlets that advocate maintaining the Medicare status quo have already gone on the attack, calling the Rivlin-Domenici concept partial privatization that will burden beneficiaries with higher costs.
The fact is, though, that leaving conventional Medicare as an option will incentivize private plans and providers to innovate new ways to provide high-quality care at lower costs. That incentive has been absent in traditional fee-for-service Medicare. As the Rivlin-Domenici testimony explains:
“The new Medicare Exchange will provide strong incentives for plans to manage care delivery efficiently and to offer the public evidence that their plans achieve quality outcomes at comparatively low cost – because low-bidding plans would be rewarded with increased enrollment.”
Giving the option between harming beneficiaries with cuts that will further limit the number of physicians taking Medicare patients and a new direction that will offer beneficiaries more choices and the prospect of improved, cost-effective care delivery, it seems that the supercommittee should be giving strong consideration to Alice Rivlin’s and Pete Domenici’s recommendations.
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