Medicare users should embrace reform

By Bill Leaver

During the last few weeks, I've spent a lot of time talking with Dad about health care reform. He is a Medicare senior and takes care of Mom, who is suffering with Alzheimer's disease. He's a thoughtful and intelligent man.

And he's scared.

He's scared their Medicare benefits will be cut as our government looks for ways to pay for health care reform. That fear comes from the unknown. No one knows exactly how their Medicare benefits will change with reform. And that fear has led many Iowans to resolve that we should just forget about health reform.

What I fear most is what will happen to the Medicare system soon if we don't pass health care reform legislation. Medicare costs are the largest single funding obligation of our country - and the cost is increasing at approximately 7 percent each year. Every day, 10,000 more seniors become eligible for Medicare benefits. If we keep spending taxpayers' money at this rate, Medicare spending will break the bank of the federal government. The current system is unsustainable.

One of the most contentious proposals to contain costs is scaling back the Medicare Advantage program. Medicare Advantage has been a big hit in states like Florida, where 1 million Florida seniors enjoy spalike services under the Medicare Advantage program. Iowans have been paying the Cadillac cost of health care for Floridians and other high-flying states for years while Iowa seniors use the system in a much less expensive fashion.

Florida is in the top 10 for Medicare spending and the bottom 10 for quality of care provided to Medicare beneficiaries. Iowa is in the top 10 for quality of care provided to Medicare beneficiaries and the bottom 10 for Medicare spending. Medicare spends an average of $8,794 a year ($9,379 in Florida) on each Medicare patient, compared with $6,204 in Iowa.

Proposals to cut the fat out of states like Florida should not scare Iowans. In fact, the proposed health reform bills include rational ways to cut costs and improve the quality of care that have been developed with a large influence by Iowa's own congressional delegation. As leaders in the House and Senate work to merge the different health proposals, they should include important reforms such as:

l Rewarding health care providers for the quality of care they deliver, rather than for the volume of services they render. In Iowa, we already do a good job of that.

l Rewarding health care providers who work together to coordinate the care of their patients. Care is better when your family doctor, specialist, hospital staff, home health care provider and long-term care provider work as a team. Iowa providers are already developing these coordinated care models and using electronic health information to orchestrate care coordination.

l Paying providers more to offer preventive care to patients - more time caring for you and keeping you well.

l Reducing geographic disparities in the formulas used to pay hospitals and physicians under Medicare that have traditionally disadvantaged states like Iowa.

These proposed reforms may be the best chance Iowa has to get a fair shake from the Medicare system. This means Iowans can stop footing the bill for people in other states.

We all know reform won't be perfect, and there are legitimate questions about its expense, its impact, the unintended consequences and what could happen with sweeping legislation.

But we have to change the way health care is delivered and financed. Iowans should embrace the passage of a health care reform bill this year - a good beginning to a long-term effort to fix our system to ensure my Dad's fears and those of so many Iowans don't come true.

Bill Leaver is president and CEO of Iowa Health System, composed of 26 hospitals in rural and urban communities and more than 140 group practices of physicians and clinics.