Cardiac Surgery to "Fix" Medicare

Dr. Angell, former editor of the New England Journal of Medicine, is concerned that Frist has a significant conflict of interest that will have a prejudicial effect on his handling of Medicare legislation.

The conflict is that his family is in the for-profit health-care business (Hospital Corpora-tion of America, known as HCA, was founded by Frist's father and is now headed by his brother). Although he has put his large interest in the business into a blind trust, it is still true that whatever is good for HCA is good for Bill Frist.

Dr. Angell says that it's astonishing that this obvious conflict of interest has been so little noted. It is? Not to me.

I thought that was the way things were now meant to be with our "honorable" legislators, although perhaps somewhat less obviously. Incidentally, HCA has paid $1.7 billion in fines for massively defrauding Medicare and other insurers.

Dr. Angell believes that Frist is President Bush's choice to lead the move to change ("fix") Medicare by making it more like our fragmented, for-profit insurance system that people under 65 find increasingly unreliable, inadequate, and arbitrary.

Medicare was developed in the 1960s and has changed little since then. In those days the focus was on acute diseases. There were not many effective drugs and they were cheap. That Medicare needs "fixing" seems certain, and Dr. Angell suggests changes in benefits and funding.

Nowadays, the matters of long-term care and medically necessary but expensive prescription drugs must be addressed. Fees should be adjusted to reward high-tech medicine less and time spent with patients more. A mechanism for discouraging physicians from providing unnecessary services is needed. Her suggestions for resolving these issues are discussed in some detail in the article.

According to Dr. Angell, Medicare is the only part of our health-care system that works even reasonably well. Therefore, it makes no sense to "fix" it by duplicating the private market's arbitrariness, cost shifting, and inefficiency.

She notes the irony of putting the future of Medicare in the hands of someone whose family business is paying enormous fines to settle charges of defrauding that very same program.

peniston@mcn.org

For those interested, the complete article by Dr. Angell is available at http://www.prospect.org/print/V14/2/angell-m.html.