About 10 years ago, a new radiation treatment for prostate cancer came on line. A single course of “intensity-modulated radiation therapy” cost Medicare about $42,000. The older radiation therapy cost $10,000. Hospitals bought the new machines and stopped using the traditional method. This tacked another $1.5 billion per year to Medicare spending on prostate cancer alone.
Did the fancy new machines do a better job than the old ones? Medicare did not inquire. It just paid. Amazing.
A new McClatchy/Marist poll has 80 percent of Americans opposing cuts in Medicare and Medicaid spending to reduce deficits. Well, 80 percent of Americans don't quite understand Medicare's reimbursement system and how crazy it is.
Forget the Republican plan to squeeze Medicare spending by moving to a voucher system. First, look at the existing setup. For most any treatment deemed “reasonable and necessary,” Medicare pays the cost plus some profit. This has turned the program into a brainless check-writing machine for the medical-industrial complex.
Not long ago, an article in Health Affairs used the above prostate cancer example to show the ludicrous way Medicare pays for things. “Coverage is determined without any requirement for evidence demonstrating that the service in question is equally or more effective than other available options,” write Steven Pearson, president of the Institute for Technology Assessment in Boston, and Peter Bach, a critical-care physician at Memorial Sloan-Kettering Cancer Center in New York.
Enter “comparative effectiveness research” — perhaps the most boring term in public policy today, but essential to containing the explosively rising costs of Medicare, Medicaid and private health coverage. (I suggest “best for less” as a catchier name.)
Comparative effectiveness research studies different treatments for the same condition and identifies those that do the job with the fewest side effects. Medical economists generally agree that our system groans with pricy treatments that provide outcomes no better — and sometimes worse — than less-expensive alternatives.
The 2009 stimulus bill and the health-reform legislation contained spending for this research, which Republicans and some Democrats fought tooth and nail. They expressed concern that it would discourage medical innovation. Their unstated worry was that taxpayers would become resistant to sending big checks to equipment makers and other medical providers for bells, whistles and exotic names that add nothing to the quality of care. Much of political Washington has a vested interest in the vested interests.
Pearson and Bach have come up with an intriguing way to use comparative effectiveness research without stifling the development of improved technology. They would use this research to have Medicare pay the same thing for services that provide equivalent results. But it would reimburse new technologies at the higher rates for, say, three years. If they prove to be superior, then Medicare continues to pay more for them.
What the 80 percent of Americans who oppose spending cuts on the government health plans really want is the assurance that they can get state-of-the-art medical care when they need it. Responsible leaders must impress upon them that enormous savings can be found in Medicare without reducing quality one iota. Furthermore, the perverse incentives in our reimbursement system encourage too much care, which itself can hurt patients.
There's no need for a radical voucher plan that saves money by sending the elderly to private insurers, then curbing payments to the insurers. The government can continue picking up the bills if Medicare starts considering value received for the checks it writes.
Patients would be happy. Taxpayers would be happy. Some vested interests would not be happy, and they have lots to spend on scaring the public. The question at the end of the day is: Who matters more to our politicians?
We’re not backing down in the face of Trump’s threats.
As Donald Trump is inaugurated a second time, independent media organizations are faced with urgent mandates: Tell the truth more loudly than ever before. Do that work even as our standard modes of distribution (such as social media platforms) are being manipulated and curtailed by forces of fascist repression and ruthless capitalism. Do that work even as journalism and journalists face targeted attacks, including from the government itself. And do that work in community, never forgetting that we’re not shouting into a faceless void – we’re reaching out to real people amid a life-threatening political climate.
Our task is formidable, and it requires us to ground ourselves in our principles, remind ourselves of our utility, dig in and commit.
As a dizzying number of corporate news organizations – either through need or greed – rush to implement new ways to further monetize their content, and others acquiesce to Trump’s wishes, now is a time for movement media-makers to double down on community-first models.
At Truthout, we are reaffirming our commitments on this front: We won’t run ads or have a paywall because we believe that everyone should have access to information, and that access should exist without barriers and free of distractions from craven corporate interests. We recognize the implications for democracy when information-seekers click a link only to find the article trapped behind a paywall or buried on a page with dozens of invasive ads. The laws of capitalism dictate an unending increase in monetization, and much of the media simply follows those laws. Truthout and many of our peers are dedicating ourselves to following other paths – a commitment which feels vital in a moment when corporations are evermore overtly embedded in government.
Over 80 percent of Truthout‘s funding comes from small individual donations from our community of readers, and the remaining 20 percent comes from a handful of social justice-oriented foundations. Over a third of our total budget is supported by recurring monthly donors, many of whom give because they want to help us keep Truthout barrier-free for everyone.
You can help by giving today. Whether you can make a small monthly donation or a larger gift, Truthout only works with your support.