Posted At Washingtontimes.com

BY : Robert Goldberg

Over the last several weeks there has been an insurgency against the Medicare reform and the new Medicare drug benefit. Like most insurgencies, it is run by a handful of people with little popular support designed to demoralize political elites by creating images of chaos and defeat in the mainstream media. In turn, the media creates an echo chamber of like-minded talking heads who agree that both President Bush and democratic capitalism are immoral and unable to overcome the challenge the insurgency defines as unwinnable.
In the case of Medicare, the insurgency was successful -- perhaps at the expense of people's health and very lives -- in discouraging them from signing up for free drugs and cash along with drug discount cards. Now that the Medicare insurgency is spreading fear about confusion and being over charged, insurgent leaders such as Henry Waxman, Families USA and AARP are using the echo chamber to spread disinformation about how useless Medicare reform is and how seniors should wait until the Revolution, when all drugs will be imported from Canada and a single-payer system is in place.
Sadly, Republicans have reacted to the insurgency by retreating and revising. The echo chamber now resonates with the statements of former Council of Economic Adviser Chair Glenn Hubbard telling the Wall Street Journal "expansion [of Medicare] without substantial reform of the system was unwise fiscal policy." Most recently Fed Chairman Alan Greenspan's statements on Medicare have been mischaracterized as an attack on the new drug benefit and new technologies in general.
Republicans (as well as Mr. Hubbard) know full well that the original Bush plan limited the drug benefit to seniors choosing from among managed-care plans where prescriptions could be integrated with other health services rather than purchased on a stand-alone basis. It was congressional Republicans who rushed to the media in a panic to assert that not offering drug coverage to all seniors was "inhumane." This bit of history is important since it is all but missing in the Republican reaction the Medicare insurgency. Rather than seeking to promoting health care freedom, congressional Republicans are responding to the echo chamber's disinformation campaign about cost and confusion and regulating programs they once pledged to democratize.
Republicans are looking to the cerebral cortex of the insurgency, the New York Times, for health care policy ideas. For example, the New York Times has been running a series of above the fold front-page articles claiming that surgeons currently choose medical devices in exchange for money without regard to cost or outcomes. The articles claim hospitals should make the decision since they, by banding together, could buy devices in ways that would save money with no concomitant erosion of outcomes.
The NYT initiative gainsharing has been championed by Rep. Nancy Johnson, who is usually thoughtful on health-care matters. Despite warnings that gainsharing might actually undermine a doctor's role as a patient's advocate, Mrs. Johnson plans to introduce a bill.
As one observer of the device industry noted: "Surgeons would be able to garner a bigger payday by significantly reducing the level of implant technology utilized. If, for example, a surgeon chose to switch from a modern design to an older design, or one with fewer features and lesser technology, the savings -- and the resulting surgeon reward -- might escalate dramatically." Not all devices are alike or work the same in all patients. Indeed, one-government-size-fits-all flies in the face of mounting evidence that individual differences in responses to drugs and devices are of great clinical importance.
Gainsharing means patients could be given used devices without exception and without their consent. (Why stop at recycled hip replacements or pacemakers? Why not re-used toothbrushes and leftovers?) Republicans are eager to embrace "pay for performance" approaches in Medicare without looking at how it would affect consumer choice and health care quality. Ideally, doctors and hospitals that deliver better care would receive more money, which is not the case now. For example, nearly 25 percent of Medicare patients who are hospitalized with heart failure are readmitted within a month. Half of these readmissions are preventable. Medicare's price controls do not encourage physicians to reduce readmissions. Yet, Republicans want to impose price controls on doctors and force them to spend time reporting on what they do rather then reward them for finding ways to improve the quality of care. For that matter, there is a disconnect between gainsharing proposals that would give surgeons bonuses for using cheaper and older devices and policies that would supposedly reward cardiologists for reducing hospital admissions by improving care.
We should reform Medicare. Gainsharing and physician regulation is nothing more than a retreat on that goal. Further, while it's important to raise the retirement age and limit benefits to wealthy seniors, continuous transformation of Medicare is critical. Our capacity to live longer and healthier lives depends on stopping the insurgency and creating a market-driven Medicare that promotes competition, compassion and innovation.