Monday, June 08, 2009

Prove that you can fix Medicare first!

Virginia Postrel has a great post up that asked the question, "Why not fix Medicare first?" I would add to that all government healthcare operations that are controlled by government. On Medicare the Council of Economic Advisors' report says"Nearly 30 percent of Medicare’s costs could be saved without adverse health consequences."

OK, then "Show me the money!!!"Start with Medicare, Medicaid, government employees, the military, the Indian Health Service and the VA. If you can demonstrate a more efficient system, then and only then, we'll talk.

Postrel writes:

Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems,why not start with Medicare? Let's see what "better management" looks like applied to Medicare before we roll it out to the rest of the country.
This is not a completely cynical suggestion.

Medicare is, for instance, a logical place to start to design better electronic records systems and the incentives to use them. But you do have to wonder why a report that claims that Medicare is wasting 30 percent of its spending thinks it's making a case for making the rest of the health care system more like Medicare.

Peter Orszag at OMB contacted Virginia after her post circulated the blogosphere and related:

The administration does have big Medicare changes planned, both immediate cuts in reimbursements and "game changers" to impose more scientific management, potentially realizing savings down the road.

2) "I hope I’m not making anything sound like they’re painless." There are going to be "hard, CBO-scored cuts" in Medicare, "mostly involving provider payments." The administration is proposing cutbacks in home-health care and Medicare Advantage payments, for instance. It isn't expecting to get its initial savings from better management.

3) Medicare First--changing Medicare and waiting to see how it works before messing around with the rest of the health care system--won't work politically. "I don’t think you’re going to get these aggressive changes in Medicare unless you do some coverage expansion now."

You should understand that there are a lot of health service providers not taking any more Medicare patients now because of the reimbursement rates and the hassle of dealing with government bureaucracy.

I believe that the goal of "universal coverage" is really a massive price-fixing scam seeking to dictate what healthcare professionals get paid. That is where they think they will save money. Remember in HilaryCare they were going to control the number of specialists in each field? As the single (only) payor they can dictate what they pay.

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