US attempts to keep Medicare solvent

BMJ 1997; 314 doi: (Published 21 June 1997) Cite this as: BMJ 1997;314:1781
  1. Fred B Charatan
  1. Florida

    The ways and means committee of the United States House of Representatives has voted to cut Medicare spending by $115bn (£72bn) or 8.5% of the amount that would otherwise be spent in the next five years.

    That is the largest reduction in the programme's history. Most of the savings would be extracted from hospitals, doctors, nursing homes, and other healthcare providers. The biggest change in the bill is to open Medicare to more health maintenance organisations and other forms of managed care, including health plans established and owned by doctors and hospitals.

    A controversial proposal is the provision for tax free medical savings accounts, under which 500 000 elderly people would be able to open accounts to help pay their medical expenses. The Democrats have criticised this as designed for “the wealthy and healthy.” The bill would also limit the amount of damages to be recovered in lawsuits by patients injured as a result of medical malpractice. Damages for “pain and suffering” could not exceed $250 000.

    The American Medical Association and other doctors' groups have lobbied congress to limit damages, but consumer groups have strongly opposed such limits, saying that they would eliminate important protections for patients. The executive director of the American Association for Retired Persons, Horace B Deets, said: “Right now we're reserving final judgment. This is only a framework, not a bill. A lot can go wrong as it moves through the various committees.”

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