Marcia Angell on Health Care Reform:Why the House bill is inadequate

Marcia Angell former editor of the NEJM (New England Journal of Medicine) and thoughtful author on the health care mess has concerns about the house bill and several suggestions.

Her concerns are that the bill will do little to control excess spending and while “budget neutral” will:

  • “throw more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.”

She suggests:

  • “Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare.”
  • “Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists.”
  • “Medicare should monitor doctors’ practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty.”
  • “Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years.”
  • “Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices.”

Medicynical Note: Read the article for more detail.

To these suggestions Medicynic would add that we should also reform our patent system to reward responsible pricing of new advances and penalize companies that gouge.


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