Voice of the Mid-Columbia | Kennewick, Pasco and Richland, Wash. |
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closeSen. Maria Cantwell is on the right track with her push to reform Medicare.
The Washington Democrat has played a key role in keeping the issue in play, despite all the contention over health care.
It'll be a shame if the anger and division that currently define the health care debate end up killing this sorely needed fix in the way Medicare payments are calculated.
The devil is in the details, and it's possible that the precise language that survives the legislative process will fail to produce the desired results.
But Congress is closer than ever to repairing decades-old flaws in the Medicare reimbursement system that punish doctors and hospitals for making good decisions about the use of public money.
Even worse, the existing system encourages waste.
The trouble is a fee-for-services formula that pays health care providers based on raw numbers rather than results or even medical need.
See more patients, order more tests, perform more surgeries -- and get a bigger government check.
After the New Yorker magazine published a detailed look this summer at the way Medicare dollars are spent in McAllen, Texas, that town became the poster child for the problems inherent in the system.
In 2006, Medicare spent $15,000 per enrollee in McAllen, almost twice the national average.
"The income per capita is $12,000, the magazine reported. "In other words, Medicare spends $3,000 more per person here than the average person earns."
And yet the physician who wrote and researched the article, Harvard professor Atul Gawande, couldn't find any evidence that patients in McAllen got better care than their counterparts in other cities.
They saw more specialists, had more medical tests and underwent more operations, but it's clear that when it comes to health care, more isn't better.
You can't blame doctors and hospitals for reacting to the financial incentives built into Medicare's reimbursement formulas, but you can change the system.
Where the focus is on the quality of care rather than the number of medical procedures -- the result isn't only lower Medicare costs, it's also better outcomes for patients.
That's not conjecture. Plenty of models exist that prove the concept. The most famous is probably the Mayo Clinic in Rochester, Minn.
Physicians at the nonprofit hospital are paid a salary. There is no financial incentive to order an additional CAT scan or to take out more gall bladders.
Health care professionals there focus on what's best for the patient, Medicare costs average thousands of dollars less per patient than in McAllen, and the quality of care is among the best in the world.
In Washington and other states, where hospitals and doctors operate on a model closer to the Mayo Clinic than McAllen, Texas, Medicare reimbursements are seen as a hardship, not a profit center.
Some doctors in the Tri-Cities refuse to see Medicare patients altogether, and others set a limit on the number they'll allow in their practices.
There's a growing push for reform in Congress. More than a quarter of the Senate -- 28 members -- wrote President Obama, urging for Medicare reform to be included in any health care legislation.
The system is broken, and billions of dollars are wasted because of excessive Medicare reimbursements.
If the battle over health care does nothing else, it needs to fix the Medicare problem.
Editorials are the consensus of the Tri-City Herald editorial board.
Editorial board members are Rufus Friday, publisher; Chris Sivula, editorial page editor; Ken Robertson, executive editor; Matt Taylor, contributing editor; Lori Lancaster, editorial writer; Shelly Norman, editorial writer and Jack Briggs, retired publisher
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