THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, April 4, 1995 TAG: 9504040012
SECTION: FRONT PAGE: A14 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 55 lines
Medicare is one of those beasts that ate the budget, programs that have grown so uncontrollable that they threaten to bankrupt the government.
Republicans intent on balancing the budget realize the road to fiscal sanity runs through Medicare, as did President Clinton's ill-fated plan to fix health care. But cutting the program's cost won't be easy. Its senior-citizen constituency votes, is largely satisfied with the status quo and is touchy about changes.
The most frequently discussed solution is to effect cost savings by turning Medicare into a managed-care plan. In the private sector such plans have had some success in curbing the growth in health-care spending.
But even Newt Gingrich wonders about the cost of saving so much money. He has called for hearings on managed care because of claims that quality of care is sometimes traded for lower costs.
Anecdotal evidence certainly suggests that some managed-care plans operate more inexpensively by shifting costs to patients and doctors. They make primary-care physicians into gatekeepers, shift paperwork burdens and other administrative headaches onto physicians, patients and pharmacists. That may make fiscal sense but may not be the best use of medical talent.
Critics worry that medical decisions can end up in the hands of accountants rather than doctors and patients. They also claim that managed-care plans save a buck by refusing some treatment, curtailing hospital stays and otherwise squeezing the system.
If only the waste gets squeezed, that's fine. But who decides when medical care is suffering if much of the decision making is shifted to green eyeshade types? There's a real fear that managed care can lead to a situation where doctors are harried, patients are ill-treated and only the managers of the care are carefree.
And what if all the squeezing turns out not to be the answer? Dr. William Schwartz, writing in the journal Health Affairs, denies that costs can be contained by cutting waste alone. ``Neither managed care nor fee-for-service providers will be able to control the long-term rise in costs except by denying some patients access to certain types of expensive but useful services.'' That's another way of saying rationing.
Clearly, Medicare costs must be contained, but before leaping on the managed-care bandwagon Gingrich is right to investigate. There are no free lunches. If managed care is going to be adopted for seniors, they need to know if savings will come out of the quality of care they receive. Probably some sort of rationing is inevitable, but society needs to confront the issue head on rather than permit rationing to be practiced unacknowledged by health bureaucrats and managed-care gatekeepers. by CNB