Newspaper article Sarasota Herald Tribune

Politics Colors Debate over the Future of Medicare

Newspaper article Sarasota Herald Tribune

Politics Colors Debate over the Future of Medicare

Article excerpt

If you've been paying the least bit of attention to the gradual unfolding of the 2010 Affordable Care Act, you know that Medicare has basically been in the driver's seat of this humongous health care reform vehicle, steering us into what we hope will be a sustainable future -- based on the best and most highly educated guesses available.

A lot of the law's calculated strategies -- intended to improve health care quality, make it more accessible and hold down costs -- are getting their start as Medicare initiatives. That's where the most measurable outcomes are, and it's also where the federal government can wield the most clout, since it's cutting all the checks.

So far, the new approaches seem to be chipping away at the health cost spiral: In February the Congressional Budget Office revised its 10-year projection for Medicare spending downward by about 2 percent, even with baby boomers streaming into the program. This was based on smaller-than-expected increases in the last three years.

The philosophical underpinnings for the Medicare strategy of tying reimbursements to better health outcomes (something that the health reform law will eventually apply to all Americans) came mostly from an influential study by the Dartmouth Institute for Health Policy. Over three decades, Dartmouth charted Medicare expenditures and found wide, unsupported variations from one community to the next.

Its conclusions, popularized in a memorable 2009 New Yorker piece by Dr. Atul Gawande, became the basis for the idea behind health care reform: that an unquestioned, for-profit approach to medical intervention needs to be tempered by a requirement that the results justify the expense. In other words, the patient should not only live, but have a better life.

That's the principle behind Medicare's move toward paying for the patient's overall care, instead of the current fee-for-service model -- which has unintended, built-in incentives for providers to tack on unneeded tests and procedures. …

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