By Tom Still

Madison Correspondent


MADISON – As the U.S. Senate makes ready to debate the Medicare reform bill that was narrowly approved by the House of Representatives, Republicans and Democrats should ask themselves one question: If not this bill, what?


Very few people believe status quo is the answer. Medicare has been pretty much locked in a time capsule since its inception in 1965, when it created medical coverage for millions of elderly and disabled Americans. The social benefits were enormous as elderly Americans lived longer and better lives, but the law never evolved to reflect basic changes in the practice of medicine.


The surgical “fail and fix” basis for medicine in 1965 has long since given way to medicine that is more based on prevention, early diagnosis and outpatient treatment with life-saving pharmaceuticals. When Medicare was born in 1965, there was no need for an outpatient drug benefit because so few conditions were successfully treated with drugs. Today, outpatient drugs are a medical necessity for many seniors, and they’re paying for it out of their own pockets.


The bill passed by the House, estimated to cost $400 billion over 10 years, offers outpatient drug coverage for the first time to the 40 million Medicare beneficiaries. It also seeks to inject more competition and market forces into the program over time, which should lead to a higher quality of care for seniors as they gain choices. Finally, and perhaps most important to a state such as Wisconsin, the bill would spend about $25 billion over 10 years to increase payments to rural hospitals and doctors.


Over time, the provider reimbursement rates built into Medicare have tended to reward states with the most inefficient health care systems. States such as Wisconsin, which generally do more to guarantee good hospitals and care, have found themselves short-changed. Florida and New York, for example, have raked in federal dollars. One of the major reasons why Wisconsin ranks low in return on federal tax dollars is Medicare.


“This is very, very good for Wisconsin,” said Health and Human Services Secretary Tommy Thompson, the former governor who is leading the Bush administration’s efforts to pass the bill.


“This measure sets Medicare on the right track,” said U.S. Rep. Paul Ryan, a Republican who represents Wisconsin’s 1st District.  “It brings the program up to date with the option of prescription drug coverage, competition to hold down costs and give seniors the chance to choose the best plan for them, and e-prescribing to reduce medication mistakes.   It also helps equalize reimbursement rates for Wisconsin hospitals and doctors with the rest of the country.”

Others aren’t quite so sure. Democrats Russ Feingold and Herb Kohl are likely to vote against the bill when it reaches the Senate. If they vote “no” and Medicare reform dies this fall, they must defend the fact that an outmoded program has been retained – and Medicare insolvency within 10 years is a greater possibility.

In Wisconsin, groups such as the Medical Society have joined with AARP, the nation’s largest and most influential group for older Americans, in urging passage of the bill. The Medical Society calculated an extra $82 million in federal aid for Wisconsin’s Medicare program in 2004, in addition to the outpatient drug coverage.

“This would be one of the most significant health care victories for Wisconsin since the Medicare program was established in 1965,” said Dr. Paul Wertsch, president of the Wisconsin Medical Society. “Reimbursement rates that don’t even cover the cost of providing the care have forced Wisconsin clinics to limit, and in some cases, stop taking Medicare patients altogether.”

The Senate can and probably should improve the House-passed bill, but it cannot afford to kill it. For Medicare to survive, it must change and keep pace with the times.

Still is president of the Wisconsin Technology Council. He is the former associate editor of the Wisconsin State Journal in Madison.