Bush proposes Medicare reform

BMJ 2003; 326 doi: (Published 15 March 2003) Cite this as: BMJ 2003;326:570
  1. Fred Charatan
  1. Florida

    All Americans should have a good health insurance policy, so that they can choose their own doctor, rather than just rely on the state to dictate the coverage they are eligible for, President Bush told the American Medical Association earlier this month.

    He was outlining proposals to reform the Medicare system for less well off people, including a new higher level of provision for those who wanted it. In doing so, he contrasted his vision with what he described as “government run healthcare ideas, the ideas in which the federal government decides care … rations care … dictates coverage.” Such a system, he said, would “stifle innovation, stifle quality, and run up the costs on the patients of America.”

    Mr Bush said that under his scheme, which has yet to go through the House of Representatives and Senate, elderly people who were happy with the current Medicare system would be able to stay in the system and get help for prescription drugs. They would be given a discount card that would reduce the cost of prescription drugs by 10% to 25% Elderly people on a low income would receive an annual subsidy of $600 (£375;€545) to pay for prescription drugs.

    But, he said, there would be an option to go for a higher level of cover for those who wanted it.

    “Seniors who want more coverage will be able to choose an enhanced form of Medicare. This option will include full coverage for preventative care, a comprehensive prescription drug benefit, protection against high out of pocket costs, and extra help for low income seniors to be able to get the drug benefit.”

    Competing healthcare plans would provide this additional coverage, he suggested.

    “Seniors who want the kind of benefits available in managed care plans, including prescription drug coverage, will have that choice as well. This option would place seniors in an affordable network of doctors, provide drug coverage, and allow seniors to keep their out of pocket costs to a minimum,” he said.

    Mr Bush also outlined additional payments for doctors operating under the Medicare system: “Effective this past Saturday, instead of a 4.4% reduction in Medicare payments, docs will receive a 1.6% increase. This increase is a sign of confidence in our doctors. And I hope that all of you will show your confidence in Medicare by staying in the system. Medicare needs you. Our seniors need you.”

    American Medical Association president Dr Yank Coble said, “The AMA agrees with President Bush on the need to modernise and improve Medicare so that America's seniors have more options and enhanced benefits in regard to their health care. The AMA supports the administration's desire to make prescription drugs more affordable for low income seniors and believes a prescription drug benefit for all seniors is long overdue.”

    The American Association of Health Plans, representing more than a thousand health maintenance organisations, and the Health Insurance Association of America have backed Bush's Medicare reform proposals. But many Democrats and Republicans in Congress have criticised the prescription drug benefits as inadequate.

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    President Bush at the American Medical Association conference


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