PHILADELPHIA 鈥斅燗 day after President Barack Obama proposed聽strengthening an independent commission to control Medicare鈥檚 costs, the program鈥檚 administrator said such oversight won鈥檛 be necessary because new efforts to reduce waste should slow down spending and even improve the quality of care.
鈥淲e don鈥檛 have to get to that point,鈥� Medicare chief Donald Berwick told Kaiser Health News Thursday in Philadelphia, where he was addressing a conference of health care journalists. Medicare, the government鈥檚 health insurance program for 48 million older and disabled Americans, spent about $509 billion last year.
Under the deficit reduction 聽Obama unveiled Wednesday, if Medicare spending grows faster than聽 gross domestic product plus 0.5 percentage point, it would trigger cost reduction recommendations from Medicare鈥檚 Independent Payment Advisory Board. The board鈥檚 proposals would then go to Congress. If Congress declined to approve those cuts or make equivalent cuts of its own, the secretary of Health and Human Services would be required to enforce them. The 15-member board was created by the federal health care overhaul law, which set the trigger point slightly higher: a rise in per capita gross domestic product plus 1 percentage point.
Berwick called Obama鈥檚 proposal 鈥渁 very wise default system 聳 a Plan B,鈥� adding that 鈥渉e is right to hold our feet to the fire.鈥�
But he said that improving the quality of care and reducing waste will avoid the trigger and yield big savings by keeping people healthy and avoiding medical complications.
鈥淭here are two ways to save money,鈥� Berwick told the journalists meeting. 鈥淥ne is to cut and the other is to improve.鈥� He cited hospitals that have dramatically reduced patients鈥� bed sores and another that adopted efficiency steps from Toyota to save millions of dollars while also delivering better care.
鈥淭he aim is to make the best the norm,鈥� he said.
Berwick said the health law provides other tools to improve health care quality and delivery. These include accountable care organizations, in which doctors and hospitals coordinate patient care, and the newly created Center for Medicare and Medicaid Innovation to 鈥渘urture invention鈥� that will lower costs and raise quality.
He also pointed to a the Obama administration this week to reduce preventable hospital-acquired infections and complications. It could save 60,000 lives and cut Medicare costs by an estimated $50 billion over 10 years, officials estimated.
In contrast, Berwick said the Republican proposal聽to refashion Medicare by giving vouchers to seniors to buy private insurance would reduce health benefits. Such vouchers would eventually cut access to health care, because they would not keep pace with the rate of health care inflation and would not cover seniors鈥� medical bills.
It would abandon people 鈥渨ho need us to be there, the elderly, the disadvantaged, the disabled,鈥� he said. 鈥淚t is a withdrawal of support from people who badly need our help and who will end up worse off.鈥�
Contact Susan Jaffe at jaffe.khn@gmail.com.