As partisans scuffle, Medicare surprises by reducing per-patient spending

Medicare-logo-650x250-300x115Critics may want to carve it up and make it tougher to join, while proponents would expand it and add more money to it. But what could the U.S. health system overall learn from real, rigorous research on Medicare, the major health coverage method for tens of millions of Americans age 65 and older?

Politico, the politics- and Beltway-focused news web site, has renewed attention on the work of Ph.D. economist Melinda B. Buntin, a professor who heads Vanderbilt University’s health policy department. She and her colleagues have spent years digging into the money flowing into Medicare, a program that in 2017 paid out $700 billion in benefits, compared with $425 billion in 2007.

As Politico reported, the research shows a surprise beneath the big, aggregate, and problematic Medicare cost: “One of the best-kept secrets in American health care might be that Medicare spending — in important ways — is going down.”

With 10,000 baby boomers every day turning 65, the traditional retirement age, the major headline about Medicare may be accurate — the program needs fixes, so it can keep paying benefits as Americans have come to expect, especially as they pay into program for their whole working lives.

But Buntin, without offering too easy or simplistic reasons why, has argued that health policy experts, lawmakers, and regulators also need to learn lessons from how Medicare works, especially, at the individual level, in holding or reducing medical costs.

How? Her research, for example, suggests that Medicare successfully has “coordinated care” for a tough group — chronically ill and debilitated seniors who qualify for both Medicare and Medicaid, so-called dual eligibles. These patients, with high needs and use of medical services, had racked up major costs with arrays of doctors, hospitals, and nursing homes.

But Medicare has made headway on a long-sought goal of the U.S. health care system, increasing efficiency by getting medical providers talking and working with each other to avoid repetitive tests, duplicated procedures, and failures to follow-up with patients to get them to adhere to treatments beneficial to them.

With financial incentives and penalties, the program also has advanced “value-based care,” efforts to reward and promote approaches that can cost less but produce better medical outcomes, Buntin has found. Studies with conclusive results are still coming in but, for example, by forcing hospitals, labs, surgeons, radiologists, and anesthesiologists to agree on one sum for, say, a knee or hip replacement — a “bundled” payment that the hospitals administer and share — Medicare and its experiments have shown it is possible to lower costs and keep quality high, while also saving patients from a flood of confusing medical bills.

Buntin’s work, by the way, reaches a finding offered in 2015 by Harlan Krumholz, a Yale health policy expert: Medicare holding or reducing individual costs cannot be attributed solely to wider price and expense doldrums due to the Great Recession, as some economists have contended. Krumholz, in his earlier study, also reported that older Americans who rely on Medicare live longer than they used to and spend less time in the hospital. Also, he earlier had found the cost of a typical hospital stay has decreased in the last 15 years.

In my practice, I see the harms that patients suffer while seeking medical care, and their struggles to access and afford safe, efficient, and excellent medical care, particularly as they age, develop more and complex and chronic health conditions, and rely on their retirement savings and programs, as well as government social supports like Medicare, Medicaid, and Social Security to sustain themselves and pay big ticket items like their health care.

It’s a sign of the political divide that, with Medicare in particular, partisans can’t seem to find a middle: Democrats have campaigned hard into the upcoming midterm elections on a “Medicare for all” slogan that lacks key details, especially about costs, while Republicans have vilified the program for its growing costs and for its putting government in any shape or way in Americans’ health care or individual lives. The GOP has promised to whack away at Medicare, if the party keeps power in the November vote that will help decide control of the House and Senate.

Can common sense and moderation apply to this important and valued program? With Medicare taking up 15 percent of federal spending and expected to increase to 18 percent by 2028, voters need to have their say: If you’re not registered, please do so. And please vote.

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