SOUND OFF: Addressing the health care crisis

Medicare, the federal health care program for older Americans, needs its own health care check up if Congress is going to maintain its commitment to our nation’s older Americans.

Seniors and health care providers delivered this basic message to me in a series of five town hall meetings and three health care roundtables I held in August 2001 and February 2002. Due to this direct input, I have developed a five point plan to address what I think is the number one health care priority facing our communities this decade: protecting Medicare and ensuring health care for older Americans.

The health care challenge Congress faces is clear. Washington state’s senior population grew 15 percent in the last decade and will represent 12 percent of the population in 2010. Seniors are living longer and more healthy lives as well.

Despite these clear facts, the Bush Administration budget shortchanges Medicare by nearly 20 percent over the next decade. The challenges facing our seniors are tough enough.

First, the current Medicare formula is unfair to Washington state seniors. Due to a basic formula that rewards inefficiency, the average Medicare reimbursement rates for physicians and Medicare+Choice plans in Washington are dramatically less than rates in other states. These dismal reimbursement rates lead not only to a decreasing choice of health care options, such as the diminishing Medicare+Choice plans in Washington, but also to a set of difficult choices for physicians: the decisions that lead to shutting off the practice to new Medicare patients.

The growing provider shortage is the second greatest health care related challenge facing seniors. Both physician networks in Bellingham have now stopped taking new Medicare patients because the cost of care is not even covered by the low Medicare reimbursements. As one doctor put it, Medicare is in danger of becoming charity care.

One hospital administrator told me that the low reimbursements would not be so bad if the regulations weren’t so onerous. Medicare regulations divert health care providers from providing health care. At one clinic in the area, 47 percent of staff time is spent on paperwork. Regulations are strangling seniors’ health care.

The combination of low reimbursements, lack of providers, and stifling regulations have led me to one conclusion: Medicare needs a serious health care checkup.

I propose five concrete steps to help protect Medicare.

FIRST: The Bush Administration unfortunately does not propose helping physicians whose Medicare payments were cut by 5.4 percent this year. These cuts will devastate doctors’ ability to provide quality care to seniors. Many in Congress are committed to fixing this problem, but the Administration’s budget leaves no room for any solution. Instead, the Bush Administration proposes taking money from other Medicare providers - simply shifting the problem not solving it. I will work closely with my colleagues here in Congress to restore this 5.4 percent cut to physicians.

SECOND: I have co-sponsored the bipartisan Medicare Access and Equity Act of 2001 to return long-term fairness to reimbursement rates. Passage of this important legislation will bring more money to Washington state and provide greater access for seniors to the health care services they need. I am also rejuvenating the Fairness Caucus to bring together the collective political muscle of counties that have chronically low reimbursement rates.

THIRD: Congress should recognize the regulatory burden under which physicians do their job by passing HR 868, the Medicare Education and Regulatory Fairness Act and HR 3391, the Medicare Regulatory and Contracting Reform Act. Both pieces of legislation will go a long way towards decreasing Medicare regulations and provide flexibility to Medicare administrators in helping hospitals and physicians to provide care to seniors.

FOURTH: The provider shortage extends beyond just physicians. The country faces a severe nursing shortage and gaps in the availability in other health care workers. Both chambers have passed a version of the Nursing Reinvestment Act, a bill designed to increase the number of nursing faculty and create scholarship incentives to bring more people into the nursing profession.

FIFTH: A prescription drug benefit for all seniors continues to be a priority. Seniors are choosing between paying for food and paying for medications. That is wrong. A prescription drug benefit in Medicare must be combined with the triple effort to make generic prescription drugs more available in the market, encourage research into the next generation of medications that help meet seniors’ health care needs, and speed the drug approval process.

Protecting Medicare requires that it get its own health plan so that this critical program is available in the future for seniors. Despite its problems, Medicare will continue to be the primary source of health care for older Americans. Congress must act to protect and strengthen Medicare to keep the country’s commitment to seniors’ health.

Rick Larsen, a Democrat, represents the Second Congressional District in the U.S. Congress.

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