The Day: Medicare, rationing and costs

Filed Under: Costs, Health plans, Patients

“Much has been said about the growing gap between [Medicare’s] spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered.” Squandering Medicare’s Money – NYTimes.com, by Dr. Rita Redberg.

What is health-care rationing, really? Ezra Klein defines it in The Washington Post.

“Medical performance tends to follow a bell curve, with a wide gap between the best and the worst results for a given condition, depending on where people go for care. The costs follow a bell curve, as well, varying for similar patients by thirty to fifty per cent. But the interesting thing is: the curves do not match. The places that get the best results are not the most expensive places. Indeed, many are among the least expensive.” Atul Gawande, the New Yorker writer, delivered the graduation address at Harvard Medical School on May 26.

“When a heart attack patient was admitted to South Shore Hospital in Weymouth in 2009, insurers paid $9,684 on average for the hospital stay. But for patients who got similar care at UMass Memorial Medical Center in Worcester, that price tag was nearly twice as high, $19,059.” More about wide disparities in hospital payments, with interactive graphic, from Liz Kowalczyk on boston.com.

“Preventive care — a long list of services including mammograms, childhood vaccines and tobacco cessation counseling — for patients covered by private insurance is, in most cases, supposed to be covered without co-pays or coinsurance, thanks to the Patient Protection and Affordable Care Act.” But often no one knows if a co-pay is due. The AMA reports.

“America desperately needs a new strategy — one that takes on rising costs across the public and private sectors and is driven by verified data and evidence about why and how our national spending is growing.  … We need a serious national effort to collect accurate data about cost drivers and price trends, medical decision making and quality of care. This data, collected across all 50 states, could guide policy, give consumers understandable ways to compare health care outcomes and options and create a foundation for a more fair, responsible and sustainable health care system.” Ralph Neas on politico.com.