The federal government’s responsibility to provide access to health care for the nation’s 41 million Medicare beneficiaries implies another obligation: to spend taxpayer dollars wisely. This means assuring that the $250 billion+ spent for Medicare goes for services that are safe, timely and effective.
A worldwide discussion is under way on the role of evidence-based medicine in evaluating the relative effectiveness of prescription drugs. Publicly funded health programs, large employers and managed care plans all are working to learn more about how the costs and benefits of one drug compare with those of another. At the same time, these payers of health care want to make sure that their beneficiaries have access to new pharmaceuticals that offer measurable improvements over older products.
President Bush’s FY 2006 budget could have long-lasting effects on several health programs. If enacted as is, the budget would trim $60 billion in the growth in Medicaid spending over the next 10 years. At the same time, the budget offers $11 billion in new money to enroll children in Medicaid and the State Children’s Health Insurance Program. It would provide $74 billion in tax incentives to help the uninsured buy coverage. Some congressional budget leaders have signaled their intention to find budget savings in another entitlement program – Medicare.
The budget season is upon us. The Congressional Budget Office’s January 2005 “Budget and Economic Outlook” provides an overview of where Congress will start, and the President’s budget request will arrive next week. The journey down the sometimes bumpy, sometimes difficult-to-understand road to a federal budget for FY 2006 is beginning.
Health care didn’t prove to be a make-or-break issue in most races during the 2004 election. But post-election polls showed the public still thought our health care system had major problems, and a substantial number of people wanted action from Congress on health issues – especially costs, access and affordable drugs.
Congress made major changes in the Medicare managed care program, now named “Medicare Advantage,” affecting plans and beneficiaries in 2005 and 2006. The Department of Health and Human Services (HHS) has proposed regulations to implement this part of the new law, and comments on the draft regulations are due by October 4, 2004.
Congressional interest in prescription drugs was by no means exhausted once the Medicare drug bill passed in December 2003. A continuing focus on the Hill is whether to encourage reimportation of drugs to the U.S. from other countries, notably Canada. The secretary of Health and Human Services has had the right to authorize reimportation since the Clinton administration, but no secretary has yet exercised the right, citing safety concerns.
Some market-oriented economists have long contended that the best way to get a handle on rising health care costs is to give patients more control over the type of services they consume and the prices they pay for them. There are increasing signs that the market is gravitating in this direction. In the last several years employers have been setting up so-called “consumer-directed” plans, which put more responsibility for selecting the appropriate provider at the right price in the hands of employees—in exchange for potential financial gains.
More than 43 million U.S. residents lacked health coverage in 2002 and unless private or public coverage programs expand, the number of uninsured could continue to rise over the next decade. To address this growing problem, the Institute of Medicine (IOM), with support from The Robert Wood Johnson Foundation, has been conducting a three-year study of the uninsured to assess and consolidate evidence about the health, economic and social consequences of uninsurance for those without insurance, their families, health care systems and institutions, and communities as a whole.
National polls and opinion surveys consistently show that health care is an important issue for voters. In a June 2003 survey by Harris Interactive, health care ranked third after economy/jobs and war/defense as an issue needing government action. A Gallup poll in September 2003 found that 85 percent of respondents considered presidential candidates’ positions on health care issues to be either extremely important or very important in influencing their votes.
Although less well known than Medicare, Medicaid covers even more people. In fact, about 47 million people were expected to have been covered by the program for at least part of last year, including more than one in four children across the country. Medicaid, which is financed by both states and the federal government, also pays for nearly half of all long-term care services.
The drivers of health care costs, federal spending, consumer spending, and industry consolidation.