- Greater savings
- Increased quality health care
- Greater control for us, our families, and our doctors and less for insurance companies
- Continued strength and solvency of Medicare
- No change in existing Medicare benefits
- New Medicare benefits
- New cost savings
- Increased focus on quality to ensure we get the care we need
- She promises to keep us up-to-date on any changes
- She promises to keep our information safe
This message surprised me because I thought that the new law was funded in large part by a big cutback in Medicare spending of about $450B, and I was thinking that cut must surely require some reductions in Medicare coverage, especially since the number of citizens covered by Medicare is increasing annually.
So I had figured that, in order for this new legislation to work, we Medicare recipients were going to be asked to share by giving up some of our benefits, maybe resulting in less frequent physicals and colonoscopies and mammograms, etc., so that those who haven’t had any insurance coverage would get some of their medical expenses paid for.
Now let me be clear. I don’t mind sharing. My parents taught me from an early age to share. I was disappointed that this cowardly and unimaginative way of approaching improvement in health care was chosen rather than a more market based and process re-engineering approach, but I was fully prepared to go along with it and do my part. So, you can imagine how surprised I was to get this letter basically telling me that I don’t have to share…that I am going to get more for less.
I still can’t help wondering how this can be true. There are only so many doctors, and while the new law, as explained in the message from Ms. Sebelius, supposedly, “increases the number of primary care doctors, nurses, and physician assistants…through expanded training opportunities, student loan forgiveness, and bonus payments,” such changes are unlikely to have any immediate effect and, while certainly expensive, may or may not eventually entice more talented folks into what is shaping up to be a very different profession. So, it seems to me that, given the number of doctors we have, and with no plans for fundamental free-market reforms and process improvements, the only way some can get more care is for others to get less or for the doctors to decide to work a lot more hours than they are already working. I don’t believe that is likely. Nor is it likely that we will get more doctors and just pay each of them a little less.
It just made me wonder if this message from Ms. Sebelius is exaggerated somewhat and is really a political campaign tool designed to keep those who voted for the new legislation from losing elections this fall. I don’t believe they are allowed to send out political campaign material at public expense, so surely that is not the case.
I also can’t help wondering if all the various constituencies such as business owners, large company employees, students, unemployed folks, self-employed folks, chronically ill folks, etc., are being given similar messages, telling them not to worry because they are going to be getting more for less. I think it is possible, through fundamental process re-engineering and free market reforms, for us all to get more for less, but this new legislation is not going to do that.
Anyway, in the interest of fairness and openness, I just wanted to share with all of you who are not on Medicare this promise we have been made because apparently you are the ones who are going to have to pay the bills and I just thought you should have a chance to raise your objections. It’s kind of a transparency issue I think. And, if you are getting similar promises, let’s agree that, in the absence of major process changes, such promises are certain to be broken. Then we won’t be facing major disappointment a few years down the road.
I don’t usually share personal correspondence, but in the interest of fairness, I am going to let you see just the front page of this message from Ms. Sebelius to Medicare folks. Click on it for a better view. I wouldn’t want you think I’m exaggerating.