Everybody knows that if you don’t pay to maintain and repair your car, you limit its life. The same is true with human beings. We need medical care to avoid becoming clunkers — disabled, worn out, parked in wheelchairs and nursing homes.
For nearly a half century, Medicare has enabled seniors to get that care. But the Obama administration is changing that by launching a new “efficiency” measure that will discourage hospitals from expending resources on older patients. The measure was announced this week.
Hospitals will be evaluated based on “spending per Medicare beneficiary.” Hospitals that spend more than average on a patient with a particular diagnosis get whacked with demerits, starting July 1.
Financial penalties will follow in October 2012. Unfortunately, patients will feel the effects much sooner.
The Obama administration claims the new initiative will reward “efficiency, ” but hospitals will earn points for spending less, regardless of what happens to the patient. That could mean rewarding skimpy care.
A new study in the May 25 issue of the Journal of the American Medical Association shows that in regions of the U.S. where primary care doctors are in plentiful supply and spending per Medicare beneficiary is higher than average, patients are more likely to survive their illness. Spending more is associated with lower mortality.
President Obama has said he could cut 30 percent from what Medicare spends on a patient without doing harm. But research suggests the dangers.
Examining patients with heart failure at six California teaching hospitals, doctors found that the hospitals giving more care saved more lives (Circulation, Oct. 13, 2009). The low-spending hospitals had higher mortality rates. That’s the opposite of what President Barack Obama's cost-cutting program is doing.
In the early 1990s, HMOs tried a similar cost-cutting method, withholding payments from doctors and hospitals who failed to meet targets for lowering cost per patient. It set up a conflict of interest between medical professionals and their patients. As the medical tragedies accumulated, state lawmakers deemed the “withhold” too dangerous to patients and outlawed it.
Now the Obama administration is reviving this dangerous tool and using it against the most vulnerable patients, the elderly.
Patients won’t know what they might have gotten or how much less they might have suffered. Rationing is invisible. Only the consequences are felt.
When Medicare started in 1965, the law forbade the federal government from interfering in treatment decisions. Doctors decided what patients needed, and Medicare paid for each treatment on a fee-for-service basis. Though this protection from government interference has been whittled away a bit, the new Obama initiatives are drastic. They destroy Medicare as we’ve known it.
The Obama health law also severely cuts payment rates to hospitals and doctors across the board, leading the chief actuary of Medicare, Richard Foster, to warn that some hospitals may stopping taking Medicare. In addition, the new law installs an independent Payment Advisory Board to determine what treatments for seniors are "unnecessary." I'd prefer my doctor to make that decision.
Americans know Medicare is running out of money in a decade. It’s better to have an honest conversation about how to extend its financial solvency (including raising the eligiblity age, and enlisting competition among private insurers) rather than impose hidden rationing while dishonestly claiming to “save Medicare as we known it" We don’t want to treat our seniors like clunkers.
Betsy McCaughey, Ph.D., is a patient advocate and former lieutenant governor of New York state.
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