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A proposal for improving Medicare


A recent research paper recommends combining the various parts of Medicare as it now stands into plans that he calls "Unified Medicare" and "Unified Medicare +."

Outside of Medicare’s direct influence has been the tradition within healthcare that care is often delivered by individual physicians or by small groups of specialist physicians. "Increasingly, as medical knowledge has proliferated, it has become less and less possible for any single physician to master more than a small corner of the vast amount of medical knowledge," says Henry Aaron, senior fellow in economic studies at the Washington, D.C.-based Brookings Institute.

Henry AaronIn order to deliver the kind of care that patients need today, Aaron says that physicians and other healthcare providers need to collaborate more than they have ever have before. "Of course, physicians, like everyone else, tend to be resistant to change when it affects themselves. They’re used to doing things a certain way, they think they’re doing a good job; they’re trying to do a good job. But [collaboration] is necessary in the case of healthcare because of the compartmentalization of healthcare," he says.

One of Aaron’s recommendations for improving Medicare-which he argues should particularly help patients with complex conditions and those with multiple co-morbidities who can’t receive optimal care from a single physician-is covered in a research paper he co-wrote with Robert Reischauer called "Strengthening Medicare for 2030." Their recommendations include combining the various parts of Medicare as it now stands into plans that he calls "Unified Medicare" and "Unified Medicare +."

While he acknowledges that he and his co-author are not the first to advocate for combining the various parts of Medicare, he believes that doing so will improve the care of those served by the program. To illustrate this, he cites the example of a patient who can use a drug regimen that can reduce the likelihood that he will be hospitalized. As traditional Medicare is organized today, its payment system doesn’t allow the savings that will accrue elsewhere-in this example, a drug-to reap any financial gains that would accrue elsewhere in the financing system.

Susan Dentzer, senior policy adviser for the Princeton, New Jersey-based Robert Wood Johnson Foundation, agrees with Aaron that increased specialization has created problems for the overall healthcare system-not just Medicare.

She points to the inability to support a primary care structure that should have a vital role in helping to coordinate care for patients. The end result has been the creation of "an amazing sick care system, as everybody says; and a very bad health promotion system," she says.

The federal government delegated public health to states and local governments, says Dentzer. The end result? We don’t really have a strong primary care system in this country. "We take care of people who are already sick, with sophisticated hospitals and specialists, such as cardiologists, electrophysiologists, neurologists, and neurosurgeons. We have certain aspects of brain diseases that are treatable, yet we treat mental differently. We park that someplace else."


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