The New Health Care System

I have a piece about Medicare spending today on the Web site of the Center for Public Integrity, a nonpartisan investigative journalism organization. It’s the setup for an investigative series that will look at where Medicare is spending its money, and my piece looks at why we should care. (Answer: because its costs are going up so fast that we’re not going to be able to afford  it.)

It’s very hard to write a story like this without sounding like an anti-Medicare screed. I’m hoping the piece strikes the right balance, and that readers will get the point: Medicare has saved millions of people from hardship, it has to continue, but it can’t go on the way it’s going. Some of the issues are unique to Medicare, but for the most part, spending is rising too much for the same reasons all health care spending is rising too much.

Of course, bringing down spending in the right way — cutting out the fat, without hurting people along the way — is the biggest challenge of our time. The book covers the changes that the new law will make to Medicare (Chapter 9) and some of the experiments that will try to bring down health care costs (Chapter 14), but this piece should tie some of those themes together and explain why we’ll all have to have a grown-up conversation about what we can and can’t afford.

Take a look and let me know what you think. Nicely, of course.

During the August break, I had the chance to give a book talk to an audience at Querencia, my parents’ retirement community in Austin, Texas. It was a valuable chance to hear what seniors are concerned about — especially in Texas, where your typical audience isn’t exactly wild about the law in the first place. There has been a lot of discussion about why seniors are so convinced that the law will be bad for them, even though it gives them new Medicare benefits (Chapter 9: Medicare Changes) and creates stronger regulations to improve the quality of long-term care facilities (Chapter 11: Long-Term Care).

What I found is that there are a lot of valid concerns out there, and it’s not based on the misinformation we hear so much about, like the widely debunked claims that the law creates “death panels” and rationing. Nobody challenged the part of the speech where I shot those claims down. Instead, people at the Querencia audience worried about whether the health care workforce will be ready for the new demands it will face; whether providers can really take any more cuts in Medicare payments; and whether there will be any actual, practicing medical professionals — not just academics — guiding the research on what medical treatments and procedures work the best.

It was a lot easier to answer some questions than others. The whole experience proves that people are willing to listen to the facts of the law, but even when they’re able (mostly) to sort fact from fiction, there are a lot of legitimate questions out there. The administration has plenty of work ahead.

Special thanks to my lovely wife, Elissa Leif, for editing the video through her Web video business, MiniMatters (www.minimatters.tv). And to my sister, Wendy Nather, for shooting the footage in crowded, less-than-ideal circumstances.