McClellan Announces Goals, Pilot Programs for Medicare and Medicaid
CMS Administrator Mark McClellan, speaking Thursday at an event at the National Press Club to mark the 40th anniversary of Medicaid and Medicare, "struck a bipartisan theme, ... criticizing the programs in their current state as bloated with inefficiency" and setting "loftier" goals for them, CQ HealthBeat reports. McClellan credited President Lyndon Johnson with creating the program but said that "at 40 years old, Medicare needs to aim higher. ... We can keep the promise of dignity, but we aim higher in helping you get much better health."
He also announced a pilot program called Medicare Health Support that will educate beneficiaries with heart failure and diabetes about practicing preventive care, using reminders and making home visits to track their progress and using health care information technology to more efficiently manage their care. "It's important to note that heart failure and diabetes account for most Medicare costs," McClellan said. He added, "When 50% of our beneficiaries do not get recommended preventive care, and over 45% do not get proven effective care for their illnesses, we are spending much more than we should on preventable complications."
In addition, McClellan announced the Surgical Care Improvement Project, which aims to reduce preventable surgical complications by 25% over the next five years. He said, "Among the 42 million operations performed in the U.S. each year, up to 40% have complications after the operation. If we ... eliminate just 1% of inefficient care in overall Medicare spending over the next five years, we can improve patient access by increasing payment rates to physicians by 1.5% each year instead of cutting the rates" (CQ HealthBeat, 7/29).
The Atlanta Journal-Constitution on Sunday examined how Medicare might "be the greatest success story" of Johnson's Great Society, but 40 years after its creation, it is "facing a midlife financial crisis." According to the Journal-Constitution, the creation of Medicare provided health insurance for the nearly half of 18 million U.S. residents ages 65 and older who were uninsured in 1965. Today, Medicare covers about 42 million people. Financial "trouble lies ahead for the program" as annual double-digit increases in health care costs combine with the "onset of [baby] boomers' eligibility in 2011," the Journal-Constitution reports.
Under a requirement included in the 2003 Medicare law, if more than 45% of Medicare spending comes from federal general revenue for two consecutive years, the president will be required to submit a Medicare-reduction spending plan to Congress to keep that amount below 45%. The Journal-Constitution reports that that point could be reached as early as 2012. Gail Wilensky -- former administrator of CMS, then known as HCFA, and a senior fellow at Project Hope -- said, "My guess is whoever is president in 2012 will have major problems (with Medicare) on his or her hands during that term. That's when we may really face what we have done to ourselves."
Robert Moffit, director of health policy studies at the Heritage Foundation, said, "Congress is in a state of denial about Medicare," adding that by including a new prescription drug benefit in the program, lawmakers "basically poured gasoline on the fiscal fire" (Lipman, Atlanta Journal-Constitution, 7/31).
Passage of the law to create Medicare and Medicaid in 1965 required a "president who possessed not only energy and commitment, but also unparalleled legislative skills," David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, and James Morone, a professor of political science at Brown University, write in a New York Times opinion piece. Finding a solution to the U.S. health care system's current problems also will require "visionary and effective leadership from the highest reaches of our political system," they continue.
According to Blumenthal and Morone, Johnson likely would feel "pride" in what he accomplished if he could see Medicare today, but he also "would most likely be concerned by a program that is entering middle age burdened by growing infirmities." They note that "continuing gaps" in Medicare's health care coverage mean that beneficiaries "actually pay more for health care as a percent of their income now than they did before Medicare was enacted." Medicare's "history suggests that tough problems in health care can be solved," but such efforts will "require strong support from the American public and a president as committed and politically agile as ... Johnson," Blumenthal and Morone say. They conclude, "It would be tragic if we had to wait four more decades for this rare combination to emerge" (Blumenthal/Morone, New York Times, 7/30).
APM's "Marketplace Money" on Friday included an interview with economics editor Chris Farrell about the conclusion of "health week" in the House, including lawmakers' discussions on medical malpractice, legislation that would allow small businesses to form association health plans across state lines and Medicare's 40th anniversary (Farrell, "Marketplace Money," APM, 7/29). The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.