Putting Medicare on the Mend

"Putting Medicare on the Mend"

Pennsylvania knows better than most states in the union how important a strong, solvent, and effective Medicare program is to our elderly and disabled Americans. Our Commonwealth has the second highest number of Medicare beneficiaries in the United States with 17% of Pennsylvania's population enrolled in the program. The need for Medicare reform is made evident to individuals, hospitals, and health care professionals every day because of our state's particular demographics and because of our citizens' acute needs. Having just accomplished one of our most pressing congressional goals by reaching an agreement on the President's jobs and growth package, the Senate is now ready to tackle the long-postponed project of bringing Medicare into the 21st century.

More than 40 million people across the country rely on the federal government through Medicare as their main source of health insurance. Many of them are pleased with their coverage and the services available to them, but many more are suffering the physical and financial effects of a health care plan that cannot meet their needs. For America's elderly and disabled citizens, we have an obligation to do better and to remedy the significant problems that make Medicare, as it is today, an inefficient, costly program unable to keep up with the pace of advances in medical treatment.

The most egregious of these problems is the absence of a prescription drug benefit under the program, which means that there is no coverage for outpatient medications prescribed by physicians and needed by patients. In an age when drug therapies are routine for many illnesses and widely used to improve one's quality of life, it does not make sense for Medicare to be without prescription drug coverage. Another critical flaw in the Medicare program is its overall health care philosophy that reveals a reactive approach to treatment, not proactive or preventive treatment. The system has been, and continues to be, designed for episodic crisis management, not the kind of ongoing evaluative care that is a national standard. This situation does an incredible, sometimes fatal, disservice to Medicare beneficiaries and ultimately costs the government - unnecessarily - a lot of money. And finally, a disadvantage that puts Medicare far behind the myriad private and employer-sponsored health insurance programs nationwide is the lack of choices available to beneficiaries. In contrast to its present one-size-fits-all structure, Medicare must have options for its citizens such that medical care is convenient, patients are comfortable with the quality of their doctors, and they feel confident that the care they receive is accurate, effective, and tailored to their needs. It is no longer enough to offer such limited benefits to our seniors.

President Bush and Senate Republicans have a plan for strengthening and vastly improving Medicare so that current and future beneficiaries can enjoy affordable, first-rate health care coverage. Our goal is to address the major programmatic problems that leave millions of Americans unsatisfied and some inadequately cared for. Our vision for a stronger Medicare uses a three-part structure, somewhat based on the Federal Employees Health Benefit Program which provides coverage for the nation's federal workers and Members of Congress. The first of these three parts would be the traditional Medicare fee-for-service package as we know it, but with the additional voluntary benefit of prescription drug coverage that would protect patients from high out-of-pocket costs. Supplemental programs like those offered through employers or Medigap, for example, would remain available, and low-income beneficiaries would receive more-generous assistance with the costs of their health care.

The second option under a better Medicare would be voluntary enrollment in an "enhanced" program that gives its members a choice between several contracted health insurance companies, all of which would be required to provide certain standards of care, including: a prescription drug benefit, coverage of preventive care, protection against catastrophic medical expenses and pharmaceutical costs. A third option, known as "Medicare Advantage," would correct some of the flaws in today's Medicare+Choice program and offer more insurance choices at reasonable costs.

The immediate advantage that every Medicare recipient will have is the benefit of competition between health insurance companies to win their business. This is absolutely not a "privatization" of the Medicare program, but rather a public-private partnership between the federal government and willing companies to provide a larger range of more innovative, higher quality options. In this way, lawmakers are not relinquishing their responsibility to insure the nation's seniors; we are more assertively, more thoughtfully fulfilling our obligation.

It is far past time for Congress to emerge from the partisan shadow that has clouded our ability to enact meaningful reform legislation and build a Medicare program in line with contemporary needs and the realities of the current medicine. If we can accomplish this, we will be ensuring the health of our nation for generations to come.