As I am sitting in a meeting discussing Medicare issues, I am reminded of a very real issue that impacts all of us, particularly our folks who are on Medicare: how are we going to pay for all of this?
We know about the advances in medical care and technology over the past years. CT scans, MRIs, PET scans, new chemotherapy drugs and targeted drugs are only a part of the equation. The result is that we can provide more and better care to our patients now than we ever have been able to do previously, and by some measures we provide higher quality care in the United States than elsewhere in the world.
We cannot and should not ignore the fact that we have millions of people in this country who are either uninsured or underinsured, or that by some basic measures of health we do not measure up as well as other countries. But this isn’t a debate about national health insurance; it’s a discussion about people getting the care they need and expect with the best technology available.
Some of the newer cancer treatments that have become available have increased the costs of treating some of the more common forms of cancer exponentially. We are talking about thousands and sometimes hundreds of thousands of dollars. And this isn’t for a serious, uncommon disease such as acute leukemia. It is now the price tag for the treatment of patients with colorectal cancer, breast cancer and lung cancer.
I don’t know how people can afford these treatments. If you are on Medicare and have a 20% co-pay, how do you meet the deductible when it can be 10, 20 or 30 thousand dollars a year and you are of limited means? Yes, some people have supplemental insurance, some are insured under Medicaid, and some people have employer-based health plans. And many drug companies have programs that provide coverage for those most in need.
But there have to be thousands of people who are struggling with the problem of paying their medical bills for cancer treatment every day.
The crux of the issue today, as I participate in this meeting, is that Medicare is probably the single largest payer for medical care in the United States. They have a budget for physician services and medications. That budget is basically fixed, or in Washington terms “budget neutral.” That means that if the cost of one component goes up, the reimbursements of the other components go down (at least for physician services and medications. Hospital costs are not constrained by budget neutrality, so that is a different discussion.).
The net result is that as we age as a country, as we need more screening mammograms and scans, and as the costs of drugs covered under Medicare Part B go up tremendously, other parts of the fee schedule go down to compensate for those increases.
Those of us who follow this budget-dictated interaction are aware that a crisis is on the horizon. The costs of care are rapidly increasing, and the seniors know it because their part B premiums are going to increase dramatically on January 1st of 2006.
The consequence is that on the same January 1st, physicians are going to find their fees reduced by 4.3%. That may not sound like much to you, and you may not be concerned for the doctors, but the reality is that for doctors who do a lot of the basic work caring for patients it is a significant decrease. Medicare has been paying below market rates for medical care for many years, and most doctors that I know have gone along and accepted that fact, as a reflection of their sense of responsibility to their patients.
Similar decreases are planned for each of the next several years. At what point will doctors decide they can no longer afford to care for Medicare patients and keep their doors open, or to provide all of the services their patients need?
Although there have been many similar situations that have been pulled out of the hat at the last minute in Washington, in the circumstances we find ourselves this year I am much less convinced that a solution will be found in Congress before 1/1/06.
The impact of these decreases is, in reality, uncertain. But we should be concerned about the decreased payments for the screening tests that patients need and the impact that may have on the availability of these important tests. We should be concerned that patients have access to the best treatment available for cancer. If these changes decrease that access, then we all will suffer.
These are problems that are not going to miraculously disappear. They have been with us for many years, and will be with us for many years to come. How we use our resources wisely—including the money available for health care—is everyone’s responsibility. I have been convinced for many years that we need to utilize our resources carefully to be certain that we get the right care to the right person at the right time. I am convinced that if we were wise consumers and providers of health care, we could extend the benefits of our medical care system to many more people.
I have always been optimistic that problems can be solved by the concerted efforts of concerned individuals and organizations. I am a bit pessimistic about the near-term situation, which is going to be difficult. But I remain hopeful that this potential crisis will bring forth the type of innovative thinking and discussion that, in my opinion, is long overdue, and of which we are very capable as a nation.