In an op-ed piece for the New York Times, Ezekiel J. Emanuel and Jeffrey B. Liebman warn against “meat-cleaver” cuts and advocate for smart cuts to Medicare:
Medicare is going to be cut. That is inevitable. There is no way to solve the nation’s long-term debt problem without reducing the growth rate of federal health care spending. The only question is whether the cuts will be smart ones.
Smart cuts eliminate spending on medical tests, treatments and procedures that don’t work — or that cost significantly more than other treatments while delivering no better health outcomes. And they can be made without shortchanging patients. There are plenty of examples; here are three.
After listing the three examples among many, many more, they add another area to cut:
Smart cuts can also be achieved through better coordination of patient care. One program, at the University of Pennsylvania, sends a nurse to visit older adults at home immediately after they have been discharged from the hospital. By reducing readmissions, the program saves $5,000 per Medicare patient. It also improves health outcomes. By assigning a nurse case manager to high-cost Medicare patients, Massachusetts General Hospital has reduced spending on these patients by 4 to 5 percent and also reduced mortality.
They go on to warn against ill-conceived “meat-cleaver” cuts, which are currently en vogue in D.C., as well as cost-shifting cuts and penny-wise, pound-foolish cuts. Please read their entire article at the New York Times.
Ezekiel J. Emanuel, an oncologist and regular contributor to Op-Ed, will be a vice provost and professor of medical ethics and health policy at the University of Pennsylvania beginning in September. Jeffrey B. Liebman is a professor of public policy at Harvard. Both were White House advisers.
I am dismayed that the word “inevitable” is being used in connection with cuts to Medicare. It’s just defeatism. Medicare is cost effective, and ultimately it would be more effective to get people riled up and making a big noise about any cuts to medicare than to cave in and talk about “targeted” cuts. Even right wing Republicans like my mother would be angry about cutting medicare – this is one fight that actually can be won – unless we turn into weaklings and let it happen. Enough already! Just because the President and Democratic Congressmen/women we elected have no backbone doesn’t mean we have join them!
Thanks, Terry, for your thoughtful comment.
While I agree that Medicare is more cost effective that much of our medical system, it’s not good enough. Non-partisan estimates of the cost of providing Medicare for baby boomers under our current system start at 70 trillion dollars and go up from there. We’re not talking about folks already on Medicare – though the system could be improved for them – it’s the generation that just started going on Medicare this year.
Back when we started We Can Do Better as the Archimedes Movement, Gov. John Kitzhaber, then out of office, gave a talk which you can watch online. In it, he makes the case for tranforming the way we do health care and health so as to improve health outcomes, lower costs, and improve our interactions with the medical system. It’s long (44 minutes), but worth viewing when you have the time. You’ll find it here:
https://www.wecandobetter.org/2006/05/health-care-for-the-21st-century-a-call-to-action-2006/