Saturday, May 22, 2010

Balancing Health Care Expectations Of Seniors with Reality: The Case of Hips and Knee Replacements

Everybody knows politics is a balancing act. One must balance promises against reality.

For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?

And how one do it without losing the vote of seniors, who hold the key to the balance of power?

The Obama administration and the Democrats hope to keep power by winning the senior vote for the next ten years through the following argument.

Medicare will keep Medicare intact be reducing fraud and abuse, which now consumes $60 billion, or 15% of Medicare payments. It will reduce regional variation, which varies by 30% from one Medicare region to another. It will save $136 billion by virtually eliminating Medicare Advantage plans, which offer such things as gym memberships, visual, and dental care, for which one quarter of Medicare recipients now pay extra. It will do it through 160 new government agencies and programs.

And it will slash another $200 billion out of Medicare by reducing payment increases to hospitals, doctors, nursing homes, home health agencies and other providers and basing those payments on performance and quality improvements. In senior circles, these cuts smack of rationing by another name.

And government will do it by adding only $1 trillion to the national debt over the next ten years, and another $2 trillion or so over the subsequent ten years.

Other than cutting out Medicare Advantage plans, most of these promises and projections are vague, lack specificity, and require unfunded mandates taking massive bureaucratic intervention to carry out. They also require trust in government, which is lacking at the moment in history.

So far national polls indicate about 60% of seniors oppose Obamacare and favor its repeal.

When it comes to the political balancing act, hip and knee replacements are a case in point. They have increased dramatically among older patients, statistics from the American Academy of Orthopaedic Surgeons show. Between 2002 and 2007, the 65- to 84-year-old population saw a 16 percent increase in hip replacements and an almost 44 percent rise in knee replacements. Among patients over 85, the increases were higher still: 21 percent for hips, 54 percent for knees.

Hip and knee procedures are generally successful among seniors. Mortality rates are low, and a return to a full pain-free existence is the rule rather than the exception.

Among seniors, word of mouth of these successes passes quickly. Seniors have come to expect quick access to these life-style savings joint procedures, which account for an increasing proportion of Medicare revenues.

How to deal with seniors’ rising Medicare expectations accompanied by skepticism about Medicare cuts and the skyrocketing national debt, will continue to be a political balancing act.


HaynesBE said...

Any idea what portion of the "fraud and abuse" of Medicare is actually providers attempting to circumvent the "fraud and abuse" of government price fixing?
Just a thought.

Richard L. Reece, MD said...

According to 60 Minutes, criminals stealing and hacking to steal Medicare ID cards and setting up false store fronts to harvest their take, not health care providers, constitute most fraud and abuse. To be sure, a few physicians and other provides participate, but they do not make up most of the Medicare and Medicaid fraud industry.

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