When Bush Comes To Shove

February 3, 2003
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GRAND RAPIDS — If nothing else, they welcome the coming debate and hope the final outcome will, in some way, begin to address the rapidly escalating cost of health care in America.

And that debate is likely to become a fierce one when President George W. Bush offers — and Congress considers — the details on Medicare reform, a prescription drug benefit for the elderly, and the creation of a national medical liability law.

“The kinds of things he’s talking about are not nickel and dime things,” Spectrum Health Chief Executive Officer Rick Breon said after meeting with Bush last week to discuss ideas for overhauling Medicare and reforming medical liability laws to cut down on frivolous lawsuits that contribute to escalating health care costs and insurance premiums.

“They are going to get a lot of debate,” Breon said. “It’s really a good start and a good start in the right direction.”

Breon was joined by a trio of physicians, a local small business owner and two elderly Grand Rapids area residents for a 45-minute private roundtable discussion with the president and Health and Human Services Secretary Tommy Thompson.

In coming to Grand Rapids the day after his annual State of the Union address, Bush touted the need for changing Medicare, the federal health plan for the elderly, and enacting a federal medical liability law.

While the specifics are still to come, Bush wants to commit another $400 billion over the next decade to Medicare in order to create a prescription drug benefit for senior citizens and overhaul the 38-year-old program that he said has not kept up with changes in the health care industry.

“I like to remind people, medicine has changed and Medicare hadn’t. It’s stuck in the past,” he said during an address at DeVos Hall. “A better America is one in which our health care systems work.”

Medicare spending in 2002 totaled an estimated $246 billion on behalf of nearly 40 million recipients, according to the Center for Medicare and Medicaid Services. Medicare expenditures are expected to rise to $260 billion in 2003, a CMS spokesman said.

Bush spoke of providing “choices” and “options” for senior citizens to consider for their health coverage and receive a prescription drug benefit, including enrolling in subsidized private insurers or staying in the current fee-for-service system. He quickly drew criticism from political opponents and interest groups who claimed he would force senior citizens into managed-care plans to get a drug benefit, limiting their choice of physicians.

The thrust behind the president’s idea is that steering senior citizens toward less costly private health plans would generate the cost savings needed for Medicare to absorb a prescription drug benefit, especially in the years ahead when millions of baby boomers hit retirement age and enroll in the system.

“Managed-care plans have the ability to squeeze efficiencies elsewhere so they can do that,” said Lody Zwarensteyn, president of the Alliance for Health in Grand Rapids.

Breon, Zwarensteyn and others say they’re happy to at least see health care and its complex problems moving into the national spotlight in Washington.

Bush has put health care “on the agenda, finally, and in a significant way that nobody can ignore,” Zwarensteyn said. His push politically “detoxifies” the issue for Republicans a decade after the debacle of the Clinton national health care plan and has great appeal to a constituency that votes in large numbers, Zwarensteyn said.

“We shall all welcome the president to the fray,” he said. “The president is really signaling that it’s really been detoxified and everybody can jump in. It’s open season.”

To the health care system, overhauling Medicare means more than simply raising reimbursements, or at least stemming reductions in payments of recent years, to care providers. Examining how and where Medicare money is spent, financially rewarding care providers that are the most efficient and produce the best outcomes, and keeping up with evolving medical technologies and procedures are among the issues that need addressing.

A recent American Medical Association survey found that 48 percent of responding physicians planned to limit or further limit the number of Medicare recipients they treat in 2003 because of a pending cut in payments to doctors. Sixty percent of the respondents said they had difficulties in 2002 referring Medicare patients to suitable physicians or surgeons, according to the AMA survey.

The results reflect the growing frustration and problems physicians have with declining Medicare payments, including a 4.4 percent reduction that takes effect March 1 unless Congress acts otherwise, in the face of rising costs to run their medical practices.

“How can you have costs going up, up, up and payments going down and continue to accept Medicare?” said Dave Silliven, executive director of the Physicians Organization of West Michigan, a group consisting of about 600 primary care and specialty physicians.

Medicare accounts for 25 percent to 30 percent of POWM patient revenues, Silliven said. At Spectrum Health, it’s about one-third of patient revenues, Breon said.

Adding prescription drug coverage to Medicare holds the simple benefit of prevention. The goal is to keep an elderly person’s condition from becoming chronic, ultimately driving up costs for the system, because they can’t afford their medication.

“Prescription drugs are a cost-effective benefit,” Silliven said. “They help thwart more expensive claims.”

Silliven likes what he’s hearing from the president, particularly ideas for a national medical liability law. Physicians groups across the country say skyrocketing liability premiums have created a crisis in many states, forcing doctors to stop performing high-risk procedures or simply leave the state.

Rising liability costs and concerns over possible lawsuits are reflected in increased utilization rates that are a major factor in double-digit increases in health premiums nationally in recent years. A national liability law, with caps on non-economic damages, could result in less medical tests ordered by physicians to confirm a diagnosis.

“There’s no question that there’s a lot of medicine that’s practiced based on the threat of potential lawsuits. I think anybody would tell you that anywhere,” Spectrum Health’s Breon said. “Clearly, I think, you would find that there would be less testing done, less procedures done because there isn’t a concern about that.”

While Bush’s decision to dive into the health care debate generally draws praise, some in the industry are looking at his ideas with skepticism. Like any major initiative, they say, the devil is in the details.

“He needs to put some legs into it,” said Dr. Dave Baumgartner, vice president of medical affairs at Saint Mary’s Mercy Medical Center in Grand Rapids.

Baumgartner wonders how the president is going to steer $400 billion more toward Medicare in the next decade while still cutting taxes. He’d also like to see the coming debate broadened to include the accessibility or affordability for everyone, not just senior citizens.

The number of people without health insurance is rising nationally. The uninsured population as of 2001 was an estimated 41 million Americans. Millions more are seeing their health benefits eroded as employers respond to rising health premiums.

Though hopeful, Baumgartner wants to see “more than political posturing.”

“When he talks about Medicare, that’s not all Americans. That’s an important share of Americans, but it’s not all,” Baumgartner said. “He has chosen a narrow debate here.”  

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