Much has been stated about the potential bankruptcy of the Medicare trust fund ( ACP's take on Medicare and other health care reforms, March ACP Observer, p. 3). However, the solution is not to continue ratcheting down reimbursement levels for physicians and hospitals, but to explore other alternatives.
Delaying the point at which individuals are eligible for Medicare is one idea, but it will not produce enough savings by the time the trust fund goes broke in the year 2001. Other alternatives, which include rationing of care or limiting the amount of care that any one person might get after the age of 65, are also unacceptable.
Physicians and hospitals cannot work for free. In fact, beginning next year, some physicians may not be able to survive because of anticipated cuts. Someone needs to tell the public that there is no free lunch, and if it costs more to deliver health care, the public has to pay for it, either through increased premiums or higher Medicare taxes. Someone has to say it, and it might as well be us.
Brian D. Miller, FACP
Editor's note: Howard Shapiro, PhD, author of the ACP Observer article and ACP's Vice President of Public Policy, responds:
As an alternative to reimbursement cuts, which do nothing to change the spending growth curve, ACP has proposed program restructuring and initiatives to coordinate care and manage chronic illness. Summarized in a policy paper, "Reforming Medicare: Adapting a Successful Program to Meet New Challenges," ACP's proposals would save $65 billion over five years, according to an independent analysis.
With household income of 70% of the elderly below $25,000, increased cost sharing is a limited option, except perhaps for higher income beneficiaries. The average Medicare patient already pays for more than 20% of health costs out-of-pocket.
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