More Medicare changes coming, McLaughlin Group members say

WASHINGTON — Change is coming to the U.S. health care system, and the Washington insiders who make up TV’s McLaughlin Group gave attendees here a taste of what may be to come.

Members of Congress are already talking about changes to the Medicare Modernization Act, which was made law only 2 years ago. And the newly appointed head of the Centers for Medicare and Medicaid Services said he envisions changes in the mission of that agency, according to commentator John McLaughlin.

Mr. McLaughlin and other members of the McLaughlin Group debated health care, Medicare and economic issues in a lively session here at the American Society of Cataract and Refractive Surgery meeting. The participants, in addition to Mr. McLaughlin, were Eleanor Clift, Lawrence O’Donnell, Tony Blankley and Pat Buchanan.

Much of the debate centered on possible changes in the Medicare program. The talk in Washington is that Medicare reform is necessary, but reform could mean cuts that would be painful for physicians and patients, said Ms. Clift.

She said that Sen. Bill Frist, MD, R-Tenn., and Sen. Ted Kennedy, D-Mass., have both said they are interested in relieving bureaucracy in the health care system. She also said that the Medicare Modernization Act of 2003, which introduced prescription drug discount cards and the prescription drug benefit slated to begin next year, may be revisited by Congress. It may be that the Department of Health and Human Services will be given the authority to negotiate better drug prices with manufacturers, a provision that was not included in the original plan, she said.

According to Mr. McLaughlin, the new administrator of the CMS, Mark McClellan, MD, PhD, foresees a different focus for Medicare in the future. Mr. McLaughlin said that in an interview he conducted with Dr. McClellan, the CMS administrator said that the government insurance program should focus on prevention of disease and promotion of health care, rather than curing disease.

“It’s hard to see how cost-containment will be part of [coming reforms],” Dr. McLaughlin said.

Mr. McLaughlin discussed some of the concerns that ASCRS has expressed in lobbying efforts in Washington, including the flawed formula for updating physician reimbursement.

“If the fee schedule remains as is, [physicians face a] 33% decrease [in reimbursement,] which is indefensible,” he said.

Also discussed was the Medicare pharmaceutical benefit scheduled to take effect next year. Mr. McLaughlin noted that the drug benefit, which may cost the government as much as $1.2 trillion over the next decade, according to one estimate -- more than double the amount originally estimated -- has recently dominated discussions of Medicare reform.

Panelist Lawrence O’Donnell, who was a congressional staffer during President Bill Clinton’s attempt to reform health care in the 1990s, referred to that period several times in his remarks. He said current attempts at Medicare cost-containment are similar in many ways to the efforts undertaken in the ‘90s.

Ms. Clift said that, although the Clintons’ attempt to reform health care failed, it may be that pressure from the aging baby boomer generation will produce a better result from current efforts.

“Democracy has trouble reacting unless there’s a crisis,” she said.

The baby boomer generation’s large population will be a problem for Medicare, Mr. McLaughlin said.