Senate supports women’s health, Medicare benefits

In the first U.S. Senate vote on the substance of health care reform legislation, 61 senators, including Montana’s Max Baucus and Jon Tester, backed an amendment to make mammograms and other preventive health screenings available to all insured women over age 40.

Three Republicans (two of them women) joined Democrats in voting for the women’s health amendment. Two Democrats voted against it, as did Wyoming Republicans John Barrasso and Mike Enzi.

Coverage for mammography became a hot political issue last month when a federal advisory panel of scientists questioned the benefits of routine annual screening mammograms for women under age 50. Politics aside, more consistent and appropriate use of preventive health care is absolutely essential to reforming the U.S. system.

One Democrat who opposed the mammogram amendment Thursday complained that the cost should have been paid for before the vote. According to the Washington Post, all the screenings (for breast, cervical, ovarian and lung cancer, heart disease, diabetes, postpartum depression and domestic violence) that the amendment would make available at no out-of-pocket cost to women would cost $940 million over 10 years. Yes, that’s a lot of money, but consider: Medicare is expected to pay out $477 billion in benefits for 2009 — $477 billion for just one year. Among the 45 million Americans covered by Medicare, 38 percent have more than three chronic conditions, according to data compiled by the Kaiser Family Foundation.

Like other health programs, Medicare spends most of its money caring for a small fraction of enrollees who are the sickest. In 2005, 10 percent of Medicare enrollees accounted for 63 percent of all spending with the top 10 percent using an average of $44,220 each in health care. The average expenditure for the other 90 percent was $2,934 per person, according to Kaiser Family Foundation.

Keeping people healthier significantly reduces care costs. For example, research has shown that consistent, timely provision of certain tests and screenings for people with diabetes helps reduce the risk of serious complications (such as loss of eyesight or kidney failure). Prevention makes life better for individuals and saves money overall.

The second Senate vote in the health care debate rejected Republican Sen. John McCain’s proposal to remove $460 billion in Medicare savings. His proposal would have effectively killed the bill because it would no longer be paid for by congressional standards. While McCain and other Republicans warned that the bill would endanger Medicare benefits, there was little media discussion of exactly what these “cuts” are.

Here are some examples:

• Premiums paid to most private insurers in the Medicare Advantage program would be reduced. Medicare currently pays these private insurers an average of 14 percent more per beneficiary than what the regular, government-run Medicare program spends to care for the other 80 percent of Medicare beneficiaries.
• Hospitals would be penalized for unnecessary readmissions to discourage them from discharging patients too soon.
• Hospitals would see payment reductions for treatment of hospital-acquired problems, such as infections.
• Hospitals that receive Medicare disproportionate share payments because they care for a relatively high proportion of indigent patients would see that payment reduced as the proportion of uninsured people and uncompensated care is reduced by insurance system reforms.

Some of the Medicare savings proposals probably wouldn’t work exactly as proponents hope, but, if passed into law, most wouldn’t take effect until 2012 or later, so adjustments could be made before full implementation.

After McCain’s proposal was defeated, the Senate voted 100 to 0 to adopt an amendment by Sen. Michael Bennet, D-Colo, making it clear that guaranteed Medicare benefits would not be taken away as a result of the legislation.

“Our bill does nothing to reduce guaranteed Medicare benefits,” said Baucus, the principle author of the Senate Finance Committee bill that was melded with another committee bill to produce the legislation now being debated in the Senate. AARP, the powerful senior lobbying group, agrees with him.

The first votes in this arduous debate are encouraging: On bipartisan votes, the Senate affirmed that prevention is a priority and unanimously pledged to protect Medicare benefits.