The Democratization of Health Care: The Seniors Question

There is much talk these days about seniors. There are just so doggone many of them, proliferating and living long lives in Medicare. It is estimated that by 2030, one-third of our population (80 million) will be on Medicare, with a life expectancy of 20 years in the program. The concern is that, by their numbers and longevity, seniors will bankrupt Medicare and damage our economy as we struggle to save the program.

How can Medicare afford to cover our seniors? One answer to that question is Medicare’s recent effort to move away from paying fees for services and toward paying for value. Value is a pleasant-sounding word. Who could be against getting value for a dollar? But this shift raises questions of its own: How can value save Medicare from bankruptcy? What do the proponents of a value-based health care system mean by the term value?

As it turns out, the shift toward value-based Medicare means transfer of the program’s financial risks to physicians through a mixture of capitation, bundled, and performance payments. It means reduction in reimbursements to product manufacturers. It means diversion of consumers to lower-cost, older therapies. Aside from these dubious effects, there is nothing transformative about this value-based system. Its purpose is to balance the books by denying access to quality care. Masquerading as a system to provide quality medical care, it hides rationing behind the word value. It holds out no vision of a 21st-century health care system capable of meeting the challenges of providing optimal care to seniors. It does not regard seniors as its customers, nor does it recognize that meeting their demands is the sine qua non of Medicare. Read More