Who is in charge of Medicare?

Monday, November 21, 2011

The wide-ranging debate over Medicare, a major factor in the presidential election next year, primarily focuses on whether future generations will benefit in the same way that the current 46 million recipients like me benefit. Politicians, critics and would-be-recipients express the illusion that the health care I receive from Medicare represents the ideal. I believe that the only way to save Medicare is to dramatically improve the way it is run today so that it remains a program worth saving.

The primary audience for this commentary is the men and women who provide DME other equipment necessary to sustain and maintain the quality of life. Recently, 87-year-old Lilian Hutchinson, who gets around on an unstable walker, fell and broke her elbow in an independent living facility for 90 elderly and disabled residents where I live in State College, Pa. I believe that if Lillian had access to a scooter or a power chair in her apartment, she would not have fallen. The tales of needless suffering you could tell resulting from a Medicare bureaucracy that increasingly limits access to mobility equipment and medical oxygen seem beside the point.

Durable medical equipment represents only a small fraction of the Medicare budget. The whole system for providing medical care for the elderly, disabled and poor is not working efficiently in large part because of the absence of leadership at CMS, an agency of the U.S. Department of Health and Human Services. My intention here is to answer the question: Who runs Medicare? In theory, Dr. Donald Berwick, a distinguished Harvard physician with an outstanding reputation as an advocate for efficient health care, runs CMS.

Last year, President Obama named Dr. Berwick to be administrator of CMS, a position one senator described as the nation's health czar since the job also includes putting in place much of the legislation passed last year, which, by one estimate, will extend health care to 32 million Americans who do not have coverage.

Sadly, the president had failed to appoint an administrator early on in his administration, when Senate confirmation would not have been a problem and when an adviser with the expertise and gravitas Dr. Berwick has in the medical community would have proven useful. The major flaw in the president's landmark legislation was how he intended to pay for it. He decided against raising taxes, which might have doomed passage.

Instead, half the estimated trillion dollars required to extend healthcare coverage was targeted to come from savings to the Medicare budget as a result of achieving cost savings, reducing fraud and abuse, and increasing efficiency. Anyone who has ever made a New Year's resolution to save money can tell you it is imprudent to spend it before the money is actually saved.

By the time Dr. Berwick arrived at Medicare, he was in the impossible situation of being required to save $500 billion, a requirement for which he had not been consulted and in a situation where the president had given him neither the time nor the authority to implement.

The political comedian Mark Russell observed, in a similar context, that exercising leadership without the necessary authority is equivalent to sending a eunuch to an orgy. Fearful of Republican reaction to Dr. Berwick's appointment and unsure of the allegiance of Democrats on the Senate Finance Committee, the president refused to fight for Berwick's confirmation or to find a replacement who would achieve bipartisan support.

Using the recess appointment mechanism, which allows a president to appoint an official on a temporary basis while Congress is not in session, Berwick currently serves as acting administrator and will be replaced next year by his deputy Marilyn Tavenner. Tavenner, while respected for her organizational skill, her background as a nurse and a hospital and state health care administer, does not have the stature required to lead what is in effect a cabinet level position.

Although CMS has a larger annual budget than the Pentagon, as I write this, there has not been a confirmed head of Medicare since 2006. For the purposes of comparison, if the Defense Department did not have a confirmed secretary for five years, there would be a national outcry.


Joel Solkoff was a political appointee in the Carter Administration, serving as special assistant to the Under Secretary of Labor. He believes a bipartisan solution to the problems of Medicare is achievable.



Of course powerchairs are a good cost mitigation tool for admittances to skilled nursing facilities, emergency rooms and physical therapy after falls. This is only common sense. But we are talking about the government so common sense will never enter the equation. It's all about what looks good on a CBO spreadsheet full of stilted assumptions. This kabuki dance would be funny if it were only happening to someone else instead of us.

The problem with Medicare is that for every dollar being paid in on your behalf, there will be 3 dollars spent to take care of you on the backend. We are all trying to make something work when the basic math is impossible. We either have to triple the tax levied or we need to raise the eligibility age or we need to drop the pretense that it is insurance and call it wellfare for old people and means test a big part of the population out of eligibility.<br />
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But it lieu of things that require common sense or courage, the politicians in charge will once again take the coward&#39;s way out and cut providers pay while simultaneouly demonizing us and saying we are the problem.<br />
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This is what happens when you put a bunch of lawyers in a room who are fixated on winning a bi-annual hiney kissing contest and tell them "fix healthcare".

A month ago my hip was hurting I could hardley walk so I went to Western Arizona Regional Medical Center in Bullhead City AZ.

I explained my problem they had me geting a ct scan with in 15 minutes then the doctor came in said all looks good I dont know why you hurt. I left I was really there not more then 25 minutes.

I recieved the bill my portion is only 139.04 they charged medicare or the governerment 11,573.12 .If they continue leting these hospitals throw these ungodly cost. when we all know it did not cost that much what the hell is going on here.it needs to be investigated I'm a dumb ass and I can figure that out.