The Congressional debate over the future of Medicare reminds me of that iconic electronic board game "Operation," where the goal is to carefully remove a toxic organ without killing the patient.
The pundits recently decreed that the issue of Medicare will decide the 2012 presidential election, based upon polling results in the upset victory of a Democrat over a Republican in New York's 26th Congressional District. This revelation strikes me as the moment when you've got those "Operation" tweezers around the toxic organ and oops, you touch the sides of the incision and the poor patient's red nose lights up.
Why? Because politics alone can't and won't save or cure Medicare. Politics today is all about furthering the many goals of politics, not health insurance. Politics, fix Medicare? The analogy would be inviting a hospital's bookkeeper – or heck, even the janitorial department – into the OR to perform a triple bypass.
A recent New York Times guest column by Rita F. Redberg, a cardiologist and professor of medicine at the University of California, San Francisco helps bring the debate back "within normal limits," as your doctor would put it.
To wit: Medicare is in trouble because it is wrapped in the crazy-tape way we overprescribe expensive medical procedures that in many cases are not needed.
Redberg notes that the chief actuary for Medicare estimates that 15 percent to 30 percent of health care expenditures are flat-out wasteful. In dollar figures, that suggests that $75 billion to $150 billion of the $500-plus billion Medicare expenditures in 2010 could be "removed" without setting off its glowing red nose.
She takes particular aim at needless colonoscopies for 220,000 patients over 75, which cost Medicare more than $100 million in 2009. She also notes that eliminating two popular procedures for vertebral fractures that have been shown to be ineffective could save about $1 billion annually.
But Medicare's problems run deeper than funding. Redberg says Medicare's reimbursement procedures are not sufficiently sophisticated to track the appropriateness of care, contractors have little incentive to watch the dollars paid out and doctors tend to over-test.
"Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test," she writes.
You want toxic conditions? Combine medical inefficiency with our current polarized politics.
"Changing the system would require a commitment to determining whether tests and procedures benefit patients before performing them. Unfortunately, in an environment in which doctors provide end-of-life counseling are called death panels, and in which powerful constituencies seek to preserve an increasing array of procedures and device sales, this solution remains hidden in plain view."
Make no mistake, Medicare is sick. Its trustees now estimate that the program could move into the red by 2024, five years earlier than previously estimated.
It's going to take a steady, bipartisan hand on the tweezers instead of what I expect will be the usual election-year knife fight to keep Medicare's big red nose from lighting up.
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