Improve-Don’t Destroy-Medicare

The recently passed House of Representatives “doc fix” is a warning and should serve as an inspiration to forge ahead in improving and expanding Medicare for all.  Instead of sticking with the necessary goal of repealing the Sustainable Growth Rate (SGR) the Republican lead House has started on its quest to privatize (cost-shift back to out-of-pocket expensing) Medicare and cut back on Medigap benefits. Those of us who are concerned about the health care of everyone in our country need to get serious about the job of improving Medicare even before we move into universal coverage. We could start with proposals for quickly eliminating the donut hole in drug coverage. That, combined with eliminating the proscription against negotiating prices with the pharmaceutical industry, would offer affordable availability of even the specialty drugs for cancer, hepatitis C, multiple sclerosis, rheumatoid diseases, etc.  A quick fix should be made to the physician payment system until workable substitutes for our present volume based system can be developed under a single payer plan. That fix could be a simple up-adjustment of evaluation and management codes and down-adjustment of procedural codes with a budget neutral end point. And we could stop wasting time, money and other resources on the present catch-word pay-for-performance and pay-for-value experiments. Attention could be focused on mental health and long term care needs. Expandable systems could be developed for these areas even before Medicare moves to universal coverage. We should also be making the necessary changes to eliminate the need for Medigap policies, Part D coverage, and Medicare Advantage Plans. Not solely related to Medicare but open to immediate action would be improvement in the recruitment and financing of the primary care pipeline from first year medical students through residency training programs. We could also take a few steps back to re-think the present electronic medical records push and its Meaningful Use regulations. This has been a poorly thought out, expensive, provider exhausting  effort with a huge disconnect between the stated goals and the existing technology and financing resources.

We should be improving Medicare, not destroying it. We should all be putting pressure on our Congressmen and administration to eschew any actions that disregard the above goals.

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