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Bush proposes Medicare reform in “state of the union” address

BMJ 2003; 326 doi: (Published 08 February 2003) Cite this as: BMJ 2003;326:304
  1. Fred Charatan
  1. Florida

    President Bush in his annual address on the state of the union last week made health care his second goal after tax cuts.

    He said, “Instead of bureaucrats, and trial lawyers, and HMOs [health maintenance organisations], we must put doctors, and nurses, and patients back in charge of American medicine. Healthcare reform must begin with Medicare, because Medicare is the binding commitment of a caring society. We must renew that commitment by giving seniors access to the preventive medicine and new drugs that are transforming health care in America.”

    He offered a three point plan for Medicare:

    • Senior citizens who like the current system can keep their coverage just as it is

    • All senior citizens will be given a choice of a variety of health plans, including traditional fee for service coverage, with few restrictions on their choice of doctors, and preferred provider organisation plans

    • The president's budget will commit an additional $400bn (£240bn; ‡370bn) over the next 10 years to strengthen and improve Medicare.

    He ended his remarks on domestic health care by stating that one of the prime causes of higher costs was “the constant threat that physicians and hospitals will be unfairly sued. Because of excessive litigation, everybody pays more for health care, and many parts of America are losing fine doctors. No one has ever been healed by a frivolous lawsuit, and I urge the Congress to pass medical liability reform.”

    More than 85% of the 40 million Medicare beneficiaries are in the traditional Medicare programme for Americans aged over 65, which gives patients almost complete freedom to choose their doctors and hospitals, a privilege not enjoyed by subscribers to managed healthcare plans.

    Healthcare experts believe that Medicare reform is essential, because the traditional structure is too costly to be sustained when the “baby boomers” start to retire in 2011. The system would be cheaper if a greater proportion of people over 65 were members of managed care schemes, but Bush's speech did not make it clear how such a change would be achieved.

    Medicare does not reimburse people for the cost of their drugs except for certain anticancer drugs, an issue that has been taken up recently by Congress members, who have demanded a prescription drug benefit for all senior citizens.

    Representative Pete Stark of California, the senior Democrat on the Ways and Means Subcommittee on Health, said, “It is clear that President Bush intends to privatise Medicare. He's cleverly using the promise of a meagre drug benefit as a bribe to push Medicare beneficiaries into second rate, low quality health plans, putting seniors at the mercy of health maintenance organisations and the big drug companies.”

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