Perhaps the most important debate on the future of Medicare since the program’s inception has now begun.
There is widespread agreement that the current Medicare program is unsustainable. We three former presidents of the American Medical Association have a combined experience of over 100 years of clinical practice and the passionate pursuit of health system reform that is pluralistic and accountable to a diverse array of patients. We have seen first-hand what works and what doesn’t, and we feel compelled to join the debate — not just because we’re doctors, but also because we’re Medicare beneficiaries.
To date, plans for controlling Medicare costs are primarily based on price controls and rationing. Reducing medical reimbursements to levels near or below the cost of delivering care will inevitably lead to a loss of access to care as doctors, clinics, and hospitals are invariably forced to turn seniors with Medicare away. Price controls sound good to some but they just do not work.
Fortunately, Congressman Paul Ryan of Wisconsin has clarified the debate by presenting a bold and serious proposal. He has created a foundation that can be developed into a viable alternative that allows patients to choose their physicians and health plans and injects individual responsibility and accountability into spending decisions. His suggestion would put patients in charge and make government, insurance companies, hospitals and doctors accountable to the beneficiaries, who would then be in a position to demand cost-effectiveness and quality through the marketplace, just as they now do so well with multiple other important goods and services.
Many current Medicare recipients are overwhelmed by the claims and counterclaims advanced by some in Congress and the media. Partisan attacks and fear-mongering by opponents of Congressman Ryan’s plan do not advance the debate. We believe that we need a vigorous and civil debate and we wish to offer serious but simple suggestions for improvements and enhancements to his plan.
1. Medicare beneficiaries should be allowed to stay in the current system. That is consistent with the Ryan plan. But, Mr. Ryan has proposed a better deal for future seniors than current seniors have now. He suggests that future Medicare beneficiaries who are now below the age of 55 should be given a choice of the equivalent of the Federal Employees Health Benefit Program (FEHBP), similar to what members of Congress and their staffs enjoy. FEHBP is in essence a defined contribution plan that allows extensive individual choice, is extremely popular and has proven more cost-effective than Medicare, Medicaid or the private sector for decades.
2. We believe that current Medicare recipients also should be given the opportunity to join the Ryan alternative, but this must be a voluntary choice with no coercion. Health Savings Accounts linked to catastrophic coverage insurance should be one of the options available to all beneficiaries.
3. The new Independent Payment Advisory Board (IPAB) must be prevented from making coercive mandates. The Board should be eliminated, but if retained, it must be advisory only and be responsible to Congress. The government has every right to set government payment levels for any service. However, government has no right to demand that physicians or anyone else accept this amount as payment in full. Regardless of what government pays, the patient and physician should have the right to discuss, determine, decide, and, if necessary, negotiate over costs for the treatment and care that a patient needs. That opportunity is currently illegal.
4. The Patient-Centered Outcomes Research Institute (PCORI) — created by the healthcare law — must remain as an advisory board, not morph into a coverage decision-making body. Recommendations from their research should be made available for use in establishing evidence-based appropriateness criteria designed to help physicians and patients know what works best in a given situation. It is imperative that PCORI not be allowed to become a rationing board. Medical care decisions must be made by an informed patient and the physician, and must be based solely upon the patient’s best interests. And, again, this newly created board must be responsible to Congress.
We welcome a serious debate but decry those who name-call and attack rather than advancing logical arguments based on facts. We believe that the best reform will be achieved by empowering patients not government. Individual freedom and empowerment are the founding principles of America. The scientific method brought us medical miracles and the greatest healthcare the world has seen. The FEHBP financing mechanism is a proven and popular success whereas the current Medicare price-control model, though also popular, already threatens to stifle patient access to care and bankrupt the country. The time has come for Congress to apply proven techniques rather than politics as usual.
Dr. Donald Palmisano, president of the American Medical Association from 2003-2004, is spokesman for the Coalition to Protect Patients’ Rights, a group of more than 10,000 physicians. Drs. William Plested and Daniel Johnson were presidents of the American Medical Association from 2006-2007 and 1996-1997, respectively.
