Medicare

The Republican stance on Medicare has Paul Krugman tearing his hair out. Or maybe he wants to tear their hair out. In a column titled "The Politics of Spite," he writes:

At this point, the guiding principle of one of our nation's two great political parties is spite pure and simple. If Republicans think something might be good for the president, they're against it -- whether or not it's good for America.

Now, it's understandable that many Republicans oppose Democratic plans to extend insurance coverage -- just as most Democrats opposed President Bush's attempt to convert Social Security into a sort of giant 401(k). The two parties do, after all, have different philosophies about the appropriate role of government.

But he argues that when Democrats opposed President Bush's plan to privatize Social Security, they did it in an ideologically consistent way. Not so the Republican assault on health reform. 

Security was tight as NPR's David Kestenbaum entered the inner sanctum. Six staffers hovered around him.

It wasn't the CIA. Or a secret air base. Or Fort Knox. Not even the Playboy mansion. It was the closely-guarded Medicare databank in Baltimore.

The databank is enormous, petabytes of data (a petabyte is a 1 with 15 zeros after it, Kestenbaum explains). The rows and rows of shelves, a half-million cassettes of computer data, so vast that a robot is required to navigate it. The library holds medical records of decades of Medicare patients. And their doctors. It could potentially tell us much about quality and performance and efficiency of just about every physician in the United States.

Except it's a secret. Some researchers and consumer advocacy groups have fought to open it up (not the patient records, but the doctor data). And doctors have fought to keep it closed.

Arnold Milstein, a physician and researcher who has advised the White House on health care economics, wants it open. Doctors don't even know how they stack up against their peers, against standards. The database could tell them.

Day three of the Senate Finance Committee mark up of the America's Healthy Future Act is underway. Highlights from the morning session include a definition of perspicacious from Senator Jon Kyl as well as Senator Chuck Grassley advising Senator Chuck Schumer to look into red yeast rice and omega-3 pills as an alternative to Lipitor.

As for amendments, progress is a slow, but steady, with Democrats and Republicans sticking close to party lines.

Republicans introduced several amendments relating to Medicare Advantage. Democrats want to lower government subsidies to these private plans and introduce competitive bidding to promote competition and choice while reducing costs. Republicans claim this will lead to a loss of benefits, especially in rural regions. Neither side seems willing to budge.

When Vice President Biden went home to Delaware a few weekends ago, the first thing his 92-year-old mother said to him was, "Joey, what about these death panels?"

"It's hokum," Biden said, "It's bunch of malarkey."

No one, no panel, is going to sit down and tell your doctor or you how to make these decisions, he explained. Health reform is about "giving you more power and your doctor more power" to make the decisions that are best for you.

If the Vice-President's own mother is hearing rumors about death panels, it's no wonder seniors, as a group, are among those most skeptical of health reform.

Helping to dispel these fears and sell the benefits of reform, the Vice President spoke Wednesday at a retirement community in Montgomery County, Maryland. Assisted by Secretary of Health and Human Services Kathleen Sebelius and White House Director of Health Reform Nancy-Ann DeParle, the Vice President laid out how reforms will protect and strengthen senior's Medicare.

Many of the key points from the discussion are outlined in a new report from the White House on Health Insurance Reform and Medicare. The report tackles questions seniors may have such as:

We are not quite sure what Lyndon Johnson would have done had he lived in the age of YouTube (the mind boggles), but his daughter, Linda Bird Johnson Robb, jumped in to make a video with the Alliance for Retired Americans that aims to reassure U.S. seniors that health reform is in their interest, and in the interest of a  healthy sustainable Medicare program.

Robb, who reached Medicare eligibility age herself this year, recalled the achievements of  Presidents Roosevelt, Truman, Kennedy and Johnson -- "Social Security, Medicare, Medicaid and more."

After The Speech -- and the Outburst -- and some of the usual political chatter, ABC‘s Nightline went inside the Mayo Clinic to show Americans what President Obama is talking about when he says we'll have "delivery system reform" and integrated care. It's one of at least three in-depth television pieces we've seen recently (more below on PBS and CBS) that illustrate how we can get high quality, patient-centered care at a lower cost.

Mayo is a household word. People know it's world-class care. What they may not know, and what Nightline showed, is that Mayo isn't excessively expensive. It isn't inaccessible to ordinary Americans. And it isn't built around the most esoteric and exotic and high tech specialist solutions. Yes they have them there, state of the art, best in class, and all that. But Mayo is built on primary care. On teamwork. On care coordination. On health information technology. On putting patients first.

One of the great ironies of the health reform debate is that one of the groups that is most apprehensive about the drive to cover all Americans is the group that is already covered -- America's seniors. The AARP is gearing up its efforts to soothe their fears.

Another great irony is that the Republicans now casting themselves as the defenders of Medicare have for years pursued one version after another of radically changing the very nature of Medicare -- most recently, as Ron Brownstein in the National Journal pointed out, by voting for a House GOP budget this year that would have replaced Medicare's guarantees of coverage for the elderly and disabled with a voucher. 

Here's the real story that the AARP wants to get out: All Americans age 65 and up are covered by Medicare, and that won't change under health reform.

We realize that a lot of Americans are still confused by the Gumby-esque phrase "bending the cost curve."  They probably don't even see a curve.They see a straight  line going up and up and up. Or maybe a hole getting deeper and deeper and deeper.  (Wait until they see what insurance is going to cost next year -- two recent industry reports forecast 10 percent hikes at a time when a lot of us have less money to spend.)

A few new reports and articles take another stab at explaining what curve-bending means, and how to achieve it. Bending the curve means that health spending will keep growing -- but not as fast as it would without reform. We'll spend more as our population grows and ages -- but we'll spend smarter and slower.

NPR began a two-part series, reminding us that doctors get paid for doing lots of stuff to us, a perverse incentive that rewards volume over quality of care. The piece also asks whether the pending health reform legislation does enough to change how we deliver and finance care. It quoted Rep. Jim Cooper (D-TN),

The message of our medical system has been to 'sell, sell, sell, buy, buy, buy,' " Cooper says. "And the real message should be, 'What's really going to help me live longer and healthier?' "

I fear two things as a young health policy researcher: health care costs that grow faster than the economy and the flashing red light on my phone.

"You've got voicemail" triggers a series responses in my brain: "You've got work," quickly followed by the gut fear of "You screwed up," topped off with a dash of "Why weren't you at your desk," anxiety.

The last time I entered the last two digits from the years the Cleveland Indians won the World Series into my phone, I was expecting a request for PowerPoints. What I got was "Chris."

Chris is a nurse in middle America. She'd seen slides from an event my boss participated in about health reform, and wanted to talk. She was worried about Medicare financing. And she had some thoughts about who the uninsured really were, and hoped I'd call her back to discuss.

Given the tone of the health care debate this summer, I called Chris half-expecting to be told I was some sort of actuarial anti-Christ -- a faceless bureaucrat bent on killing her Grandma or cutting Medicare.

Instead I was a reminded of why we're doing this.

Republican Chairman Michael Steele wrote an op-ed earlier this week supposedly about protecting our seniors. We were half-way through writing our response, but Wonk Room's Igor Volsky was quicker. He has an excellent response, pointing out some of the inconsistencies of current Republican rhetoric and past Republican policies. Remember that most Republicans opposed creation of Medicare in the first place (Socialized Medicine!! Now where have we heard that before?). Here's some of what Igor had to say:

Steele is on a tight rope. He wants to "prohibit government from getting between seniors and doctors" -- i.e. limit the government's role in the Medicare program -- but "protect [government sponsored] Medicare" -- including the $500 billion in waste that's already in the system.