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OPINION

What's at Stake in the Medicare Showdown

By SCOTT GOTTLIEB
June 24, 2008; Page A19
http://online.wsj.com/article/SB1214...googlenews_wsj

A friend recently asked me for advice on how to protect her father. He wants to stay in his own apartment as he recuperates from hip surgery. But the Medicare program that covers him requires that he head off to a costly nursing home. My friend was so desperate that she has also consulted a health-care lobbyist for advice.

At stake in the presidential election is whether we will all need to consult lobbyists to have our medical issues heard by a remote, bureaucratic Medicare program. Medicare's staff, members of Congress and Barack Obama are all moving to expand government influence over the medical choices we make. As early as today, the House will vote on legislation that aims to cut Medicare Advantage – a program that allows millions of seniors to use federal dollars to buy private health insurance..

Democrats hate Medicare Advantage and have been trying to cut it for quite some time, because they don't like health-care markets. Sen. Obama promises to cut $150 billion out of it in the coming years. The Senate has been haggling over cuts to the program for weeks.

Why cut? For all the talk about finding health-care savings with painless "reforms" like better information technology or disease management, the only way to really control costs under our current health-care model is to control access to drugs, devices and services.

The crucial question is where the controls should be – with patients working through private plans or with government agencies. While private health insurance is imperfect, there's a misguided faith in Medicare's superiority that rests on flawed assumptions.

First, there's a mistaken belief that Medicare is better staffed than private plans, and can therefore make better decisions about patients' clinical circumstances and the access to new therapies they should have. Yet at any time, Medicare has about 20 doctors and 40 total clinicians (including nurses) inside the coverage office, and fewer than a dozen in the office that sets the rates that doctors are reimbursed for the care they provide. Private insurers employ thousands of doctors, nurses and pharmacists, many experts in new technologies.

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