The New Health Dialogue

The Milwaukee paper had a little human interest story this morning about a man who was so determined to vote Republican that he didn’t even let a heart attack deter him. He went through all sorts of gymnastics to get a last-minute absentee ballot delivered to his hospital bed. The hospital bed being paid for by that big government run health care program -- Medicare.

The exit polls and analysts suggest that older voters went to the polls Tuesday in disproportionate numbers, as they often do in nonpresidential elections.  Fear that health reform was going to damage Medicare figured in their motivation.  The truth never got through the noise and fear-mongering. The truth is that Medicare spending will continue to grow, albeit a little bit more slowly. That health reform actually adds about a dozen years to the life of the Medicare trust fund, and, perhaps most salient to these voters, Medicare will add benefits aimed at better preventing, detecting and managing illness starting in January 2011. Less than two months from now.

Coincidentally -- or maybe not so coincidentally -- Medicare just released some of the new benefits that seniors can expect thanks to the Affordable Care Act. (There are also a bunch of more technical changes in Medicare payments and regulations, some of which will help Medicare patients in rural areas, and some of which will enhance primary care but we won’t get into those particular weeds right  now.)

Medicare beneficiaries won’t have to fulfill their Part B (outpatient) deductible for preventive services, and they will no longer have to pick up a fifth of the cost (the 20 percent co-pay) for specified preventive services. This applies to evidence-based preventive services recommended or strongly recommended by the U.S. Preventive Services Task Force (USPSTF). This includes, for instance, screening for colon cancer.

Medicare patients can all get an annual physical with no copay -- not just a single "welcome to Medicare physical." The annual visit will also enable doctors to do a bit of the care coordination that is so sorely lacking in the fragmented system, and it lets doctors and patients work together to come up with individualized health plans. CMS says the annual visit can:

• Establish or update the individual’s medical and family history.
• List the individual’s current medical providers and suppliers and all prescribed medications. (This is a huge problem today where people have multiple doctors providing all sorts of drugs, with no one tracking or coordinating.)
• Record measurements of height, weight, body mass index, blood pressure and other routine measurements.
• Detect any cognitive impairment.
• Establish or update a screening schedule for the next 5 to 10 years including screenings appropriate for the general population, and any additional screenings that may be appropriate because of the individual patient’s risk factors. (Note the emphasis on individual risk -- this is not "cookbook" medicine.)
• Furnish personalized health advice and appropriate referrals to health education or preventive services.

So to that voter in the hospital bed, we are tempted to say, “Be careful what you wish for.” The life health reform saves may be your own.