Brainstorming Medicare: Some Common Sense Ideas for Reducing Long-Term Medicare Costs

Require Medicare to negotiate drug prices.

This will save up to 45% of the cost of prescription drugs, leading to significant savings overall for Medicare. (Medicaid has negotiated discounts averaging 45% for the most widely used prescription drugs. There's no practical reason why Medicare could not do the same.)

This is such a no-brainer, it should be a bill in and of itself. Who could possibly vote against taking advantage of this huge free-market savings opportunity?

Intensify focus on prevention.

Example: Type 2 Diabetes, a significant and growing cost driver for Medicare, is largely preventable. NIH has already piloted a program that can prevent or delay the onset of diabetes in 58% of patients with pre-diabetes. Funding this program at $400 per patient can save up to $5,000 per successful patient annually down the road. Considering that 24% of current Medicare beneficiaries have Type 2 Diabetes, and this rate is growing, preventing new cases of the disease can be a "cost-curve bender."

Foster innovation at state and local level in programs that reduce healthcare costs while improving quality.

Accelerate Success: Develop mechanisms to identify successful programs and initiatives that reduce costs without sacrificing benefits, and accelerate wide-spread adoption of those programs. Invest in grants for implementation of proven programs.

Example: the Surgery Checklist promulgated by Dr. Atul Guwande, which has been shown to significantly reduce post-surgery complications, thereby reducing costs while improving patient outcomes.

Allow seniors aged 60 to 65 to buy into Medicare.

Private insurance for this population is exorbitant, often prohibitively expensive. Medicare could (likely) offer insurance at more affordable rates to this population that is statistically healthier than current Medicare population, yet not desirable to private insurers.

This population would cover its own costs, and the small profit would help offset overall Medicare costs.

Ensuring a good standard of care and prevention in this age group can result in a healthier population entering Medicare at age 65, resulting in further savings.

Explore ways to reduce the very high cost of dying in America.

There is no rocket science here, but there are some difficult conversations that need to be held. We need to determine, for each individual, what comprises the "best" end-of-life care, and implement those personal decisions. There is already a range of programs that can improve end-of-life care while reducing costs, by focusing on quality over quantity: quality of life and quality of care, over quantity of life and quantity of care. These programs can be more widely implemented as standard-of-care.

Improve education about, access to and delivery of palliative and hospice care as viable end-of-life options.

Make an Advanced Care Directive part of the standard of care for every Medicare recipient.

• Patient requirement: Since an Advanced Care Directive can specify any level of care, this document should be required within first year of entering Medicare. (Medical or social services to be reimbursed if needed by patient.)
• Primary care physician requirement: Maintain copy of Advanced Care Directive in patient's file, check in with patient annually regarding need to update.
• Hospital requirement: Document that patient's Advanced Care wishes have been followed.
• Hospital requirement: Document that patient and family have been made aware of available palliative and hospice care options. (Reimburse for this consultation - medical service and/or social service.)

Can common sense trump politics?

There you have it, five ideas that can significantly reduce the costs of Medicare over the long term, without sacrificing patient benefits. In fact, quality of care would improve. The big question is: can we muster the political will to enact these changes?

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