Perhaps the most important debate on the future of Medicare since the program’s inception has now begun.
There is widespread agreement that the current Medicare program is unsustainable. We three former presidents of the American Medical Association have a combined experience of over 100 years of clinical practice and the passionate pursuit of health system reform that is pluralistic and accountable to a diverse array of patients. We have seen first-hand what works and what doesn’t, and we feel compelled to join the debate — not just because we’re doctors, but also because we’re Medicare beneficiaries.
To date, plans for controlling Medicare costs are primarily based on price controls and rationing. Reducing medical reimbursements to levels near or below the cost of delivering care will inevitably lead to a loss of access to care as doctors, clinics, and hospitals are invariably forced to turn seniors with Medicare away. Price controls sound good to some but they just do not work.
Fortunately, Congressman Paul Ryan of Wisconsin has clarified the debate by presenting a bold and serious proposal. He has created a foundation that can be developed into a viable alternative that allows patients to choose their physicians and health plans and injects individual responsibility and accountability into spending decisions. His suggestion would put patients in charge and make government, insurance companies, hospitals and doctors accountable to the beneficiaries, who would then be in a position to demand cost-effectiveness and quality through the marketplace, just as they now do so well with multiple other important goods and services.
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