Wednesday, February 27, 2013

Fwd: qotd: Woolhandler, Himmelstein and Relman on the right path for Medicare

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Woolhandler, Himmelstein and Relman on the right path
for Medicare
Date: Wed, 27 Feb 2013 05:22:57 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

The New York Times
February 23, 2013
Sunday Dialogue: The Future of Medicare

Readers weigh in on problems with the health care program:

Canada's Medicare program — phased in at the same time as the American
version — shows how we can make Medicare simpler and thriftier, while
simultaneously upgrading its coverage. Canada's program covers all
Canadians (not just the elderly) under a single public program in each
province, and bans co-payments and deductibles.

Patients can choose any doctor and hospital. Cutting out private
insurers and the complexity and fragmentation they impose has simplified
paperwork for patients, doctors and hospitals. Administrative costs are
roughly half United States levels, saving more than $1,000 per capita.

Over all, Medicare spending on the elderly has grown three times faster
in the United States than in Canada since 1980, while life expectancy
(for the elderly, as for all age groups) has grown faster in Canada. If
American Medicare costs had risen at Canadian rates, we'd have saved
more than $2 trillion by now, and Medicare's trust fund would show a
healthy surplus.

New York, Feb. 20, 2013

The writers, internists and professors at the CUNY School of Public
Health at Hunter College, co-founded Physicians for a National Health


Medicare is headed for bankruptcy because it depends largely on
open-ended fee-for-service payment of almost any services providers
choose to deliver, at prices mainly determined by the providers.
Compounding the problem, most providers act like independent businesses
seeking to increase their income, regardless of whether they are
for-profit or investor-owned.

An effective Medicare fix would require a new payment system that
prospectively pays providers for comprehensive care at a rate set by a
single public payer. It would also need a not-for-profit medical care
system based on multispecialty doctor groups that pay physicians by
salary, thus minimizing incentives to deliver duplicative or unnecessary

The new system would have to be mandatory for all citizens, including
legislators, and it would have to be financed by a progressive,
earmarked health care tax.

Obviously, such reform would be slow and difficult, but so would any
other change that threatened vested interests. All reform will depend on
an aroused public opinion.

Tucson, Feb. 21, 2013

The writer is professor emeritus of medicine and social medicine at
Harvard Medical School and a former editor in chief of The New England
Journal of Medicine.

Comment: At a time when Congress and the Obama administration are
contemplating a reduction in Medicare spending as a means of paring down
our national budget deficit, it is important to remind the nation of the
beneficial changes that we could be making to the Medicare program that
would bring affordable, high quality care to everyone under a single
payer Medicare budget that we could afford. The messages of Steffie
Woolhandler, David Himmelstein and Arnold Relman need to drown out the
messages of those who would send Medicare down the wrong path.

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