June 2nd, 2011
Let’s Stop Wasting Medicare Dollars

I think it’s clear to all of us that if you’re under 55 you won’t have your father’s Medicare when you turn 65. Medicare is growing at such an astronomical rate that if something isn’t done right now its costs will double in 20 years. One reason for this explosion in costs is our aging population; the fastest growing segment of our population is those over 80. Another reason is the way we pay for healthcare services and our mindsets that believe, more is better and newer is even better than that. And, what’s astounding is the government feeds into this mindset by approving medical devices without determining whether they improve our care.

[Editor’s Note: These changes are especially troubling for Latinos considering that, as we’ve reported before, that by 2050 20% of people over the age of 65 will be Latino. Thus, it’s imperative for Medicare not only to function well, but efficiently, if all of these Latino seniors are to receive care.]

For example, the FDA approves newer versions of existing devices without determining that it’s actually better than the older version. This is premarketing approval is called a 510(k).  A 510(k) is a premarket submission made to FDA to demonstrate that the device to be marketed is at least as safe and effective and substantially equivalent, to a legally marketed device. No scientific proof is required that the new machine actually improves healthcare. This type of approval is a big cause of  increased healthcare costs.

Here’s a good example where such an approval ratchets up costs without providing better care. There are currently three radiation treatments for prostate cancer. The first generation treatment, called three-dimensional radiation, costs $10,000; a newer treatment (called IMRT) costs $42,000; and the newest treatment called proton radiation costs $50,000. Which one do you think your doctor will recommend? Now, listen to this. There is no solid scientific evidence that the newer treatments provide better and safer care than the original three-dimensional radiation! NONE WHAT SO EVER. Yet, the FDA approves them and Medicare pays for them, no questions asked. What we do know for sure is that newer means more expensive.

We can do something about this now and not throw grandpa under the bus while we’re doing it. How about every new device introduced onto the market be allowed three years to prove it provides better results than cheaper treatments, or their reimbursement rates would be cut to that of the cheaper treatment? Makes perfect sense, don’t you think?

We know from discussions in Congress that our Medicare will be different from our Dad’s, but we don’t have to postpone saving money right now. Let’s pay for performance rather than procedure and not succumb to the allure of newer fancier machines that costs a fortune and provides little if any benefit to our care.

Jeff Kreisberg is a patient advocate, educator, scientist author of the book “Taking Control of Your Healthcare,” and, until his retirement, a professor at the University of Texas Health Science Center in San Antonio, Texas. Jeff also blogs regularly on health issues on his website, Taking Control of Your Healthcare. Follow him on Twitter @kreisberg.

[Photo By AnoLobb]

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