Medicare

We've all done a lot of looking back to the lessons of 1993-94, and the long list of reasons the highly complex, ill-timed and politically-polarizing Clinton health care plan failed. But today the journal Health Affairs published an essay looking back not just at the failures of the Clinton plan but at the successful passage of two major health reform initiatives--the truly bipartisan State Children's Health Insurance Program (SCHIP) and the Medicare Modernization Act, which added prescription drug coverage for seniors.

 This Sunday we honor the 83 million moms in America on Mother’s Day.  We owe our Moms our lives and our thanks.  Mother’s Day also turns our attention to our children and the need for more focus on them.  Unfortunately, families with children receive a dwindling share for federal expenditures. Scholars Eugene Steuerle and Adam Carasso have found that between 1960 and 2005, federal spending on children declined from 20.1 percent of the domestic budget to just 15.4 percent, while non-child Social Security, Medicare, and Medicaid spending soared from 22.1 percent to 45.9 percent.  This is not good for the development of our future generation.

It is within families that many Americans find the support and love to live their lives with joy.  Many Americans work increasingly hard and it is within families that they experience unconditional love and support in times of trouble.  For couples that do not have children, nuclear and extended families provide critical emotional support.  In a variety of emotional and psychological ways, families enhance the lives of millions of Americans.  And through children, mothers help ensure our future.

Let’s thank our mothers for all they do to make our families what they are.

Let’s let Mother’s Day be a wake-up call for us to invest more in our children.  

Rev. Gray directs the New America Foundation’s Workforce and Family Program. 

You know those signs in gift shops, "You break, You pay?" Medicare has adopted that philosophy in refusing to pay hospitals for "never events"—things that just shouldn't happen to patients. Now the agency has proposed adding to its list.

Last year Medicare announced it would not pay for certain medical errors and conditions acquired in hospitals. Starting October 1, several private insurers followed suit. Now Medicare wants to add nine more avoidable conditions and complications, if acquired in the hospital. The goal, which we like, is to put some financial teeth in efforts to improve care of patients, including infection control. Hospitals should not be dangerous to our health.

According to the AP, the new list includes deep vein thrombosis, or a blood clot within the vascular system, which occurred in 140,010 cases for the fiscal year ending September 30, ventilator-associated pneumonia, which occurred in 30,867 cases, bloodstream infections with the staph aureus bacteria, 27,737 cases, and Legionnaire's disease, which occurred in 351 cases.

When we saw Monday's New York Times report on how Medicare's experiment in disease management was not cutting costs, we asked Robert Berenson MD, Senior Fellow at The Urban Institute, to comment. Here's what he had to say:

Disease management for patients with chronic conditions is supposed to pick off the "low hanging fruit" of cost containment, both in Medicare as well as among self-funded private employers and commercial health insurers. In each of these settings, about 5 percent of subscribers/beneficiaries are responsible for more than 40 percent of the health costs, and 20 percent of the patients run up 80 percent of the costs. Many of these patients have one or more underlying chronic conditions, such as congestive heart failure (CHF) or diabetes.

This past Sunday, Jacob Hacker, Yale Professor and New America Fellow (and like all Fellows, not affiliated with our Health Policy Program), published an Outlook piece in the Washington Post about the government’s role in covering all Americans. I have a great deal of respect for Jacob and am thankful for his many contributions to the health reform conversation. Nonetheless I do feel compelled to offer my own perspective on the most salient points in his essay.

I applaud Jacob for taking on the “socialized medicine” rhetoric. Such language was invoked to oppose Medicare in 1965 and is still used as a scare tactic in today's health care legislative debates. Just this year, identical exaggerated claims damaged the debate on expanding SCHIP, the State Children's Health Insurance Program. The same rhetoric threatens the effort to build bipartisan consensus on a sustainable system of coverage for all Americans. Indeed, those who use the phrase "socialized medicine" want to stop us from covering everyone. As the ranking member of the Senate Finance Committee, Charles Grassley (R-IA), said during the children's health debate, “Shouting socialized medicine during a health care debate is like shouting fire in a crowded theatre. It is intended to cause hysteria that diverts people from reading the bill, looking at the facts.” As we approach the next great national conversation about covering all Americans in a high-quality, high-value health system, it is my sincere hope and belief that we can maintain a fact-based dialogue. Jacob Hacker has, and will continue to, help us do just that.

When Boston-based Fidelity Investments began calculating retirees' likely health costs in 2002, the figure was a pretty hefty $160,000 in savings for a couple. Just six years later, the necessary nest egg has swelled to $225,000. And this is for the segment of our population covered by Medicare as well as a new prescription drug benefit enacted after this annual survey began. [slideshow]Many experts believe the out-of-pocket expenses for the elderly will continue rising unless we come up with an effective national strategy of cost containment.

A similar study by the Center For Retirement Research at Boston College put the savings goal for a couple at about $206,000 – and it concluded that six in 10 older workers are "at risk" of being unable to maintain their standard of living in retirement. The findings appeared in the Boston Globe. The rising price tag stems from higher medical bills, more use of health services, the boom of costly new medical technology and higher rates of such chronic conditions as diabetes.