Medicare not the model for reform

“Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided …”

Those were the words written into law when Congress established our health insurance for seniors program — or Medicare — some 40 years ago. As a surgeon for nearly a quarter century, however, I can attest that there may be no greater negative impact on the “manner in which medical services are provided” than the federal government’s intrusion into health care, primarily through Medicare. Yet, many prominent Democrats dangerously see Medicare as the model for national healthcare reform.

Today, we are at a healthcare crossroads. Our broken medical delivery structure is in dire need of meaningful reform. There is no disagreement that a system with up to 47 million uninsured at some point annually requires fundamental change. The great debate will be how we achieve full access to quality healthcare in a way that ensures patients receive the treatment they believe best for themselves.

Having spent my career caring for patients and having to work with the federal healthcare system, it is clear to me and the vast majority of my former medical colleagues that Medicare must not be the model for our nation’s health system reform. Its fundamentally broken structure fails many seniors and requires its own patient-centered improvements, not broad expansion. Our focus for positive transformation must be cost of care, access to care, and quality of care. And Medicare comes up short on all three counts.  

Medicare was surely created with the greatest of intentions — a way to ensure that those often with the most challenging needs receive high quality healthcare — and that goal remains. The structure of the program, however, has led to dwindling access to doctors, a deteriorating standard of care and an uncontained cost structure.

When Medicare was created in 1965, the long-term budget estimate for 1990 (the furthest year predicted) was roughly $9 billion. In actuality, 1990 spending on Medicare Part A was nearly $67 billion. This year, we will spend more than $450 billion on the program, 12.3 percent of all federal revenue, with that percentage expected to double in the next 15 years.

Skyrocketing costs coupled with onerous regulations have led directly to shrinking access to care.

Patients are often told which doctors they may see and how frequently. Doctors, in turn, are told which procedures or tests they may — and may not — order or provide. It erodes the ability of patients and their doctors to make independent healthcare decisions — some of the most personal and important decisions we make. A once-sacrosanct institution, the doctor-patient relationship, is being trampled by coverage rules, inflexible regulations, one-size-fits-all policies and a flawed payment system.

The constant battle between government insurers and American doctors over permissible procedures and reimbursement levels is leading to a dangerous shortage of qualified new physicians. Most medical practices, including some of the largest and most respected institutions in the nation, find it necessary to limit the number of Medicare patients they see. This is not a healthy system.

To paint a responsible face on the damaging effects to care, Medicare tracks quality indicators that may have, in fact, nothing to do with quality healthcare. A punitive enforcement program creates perverse incentives leaving some of our sickest citizens without qualified providers. Put simply, federal healthcare policy has lost its vision of what quality healthcare means.

Thankfully, there is a positive alternative that would allow access to quality care for all Americans.

By restoring our focus to those most intimately affected by healthcare decisions — patients — we can transition to a financing and delivery system which will accomplish insurance coverage for all without sacrificing quality and access.

Using my experience as a physician, I have authored legislation, the Comprehensive Health CARE Act, H.R. 2626, to positively and fundamentally reform American healthcare. Two pillars are necessary to move us in the right direction. First, our tax policy should ensure that it makes financial sense for all Americans to be insured. Second, that insurance should be owned and controlled by the patient. Regardless of who is paying the bill — government, employer or individual — patients should be able to decide what coverage and care is best suited for their individual or their family’s needs.

Such a system will provide the accountability, responsiveness, and flexibility needed to ensure quality care, individual access, and contained cost.

Restoring the power of patients in our health care system is the best way to ensure we will have quality care throughout the 21st century. It will only occur if we remember and re-establish a process that best serves those most affected — patients!

Prior to being elected to Congress, Price practiced orthopaedic surgery for more than 20 years.