Thank you Senator Lieberman

There have been some good ideas and some horrendous ideas appear this year as part of the health insurance debate. Expanding Medicare was probably the worst apple that has fallen from the idea tree. It now appears we were one Senate vote away from significantly expanding the wasteful, bankrupt pyramid scheme that is Medicare. Senator Lieberman has shown real political courage this week and done the country a great service by halting the nonsense.

Medicare a "pyramid scheme"? This may sound harsh, but the fit is too tight to ignore. In a pyramid scheme, current benefits are paid to previous investors out of funds provided by current investors. That works fine until the number of new investors becomes insufficient to pay the current benefits at which point the scheme collapses. Hmmm...sounds like Medicare today to me. As the baby-boomers age and retire, the cost of their healthcare expands as the number of workers paying into the system declines. It would be hard to call this a pyramid scheme if it were just bad luck or circumstances, but we've known for decades that the demographics of the U.S. would lead to this. We just chose to do nothing about it.

We have a moral contract with our seniors to provide them with accessible, quality healthcare. Medicare is our very flawed attempt to honor that contract. The problem is that Medicare, like most health insurance, is procedure driven. Doctors and hospitals get paid more for doing than thinking, more for testing than listening, and much more for treating than preventing. The evidence is found in answers to simple questions: Is it easier to find a surgeon who accepts Medicare or a primary care doctor who accepts Medicare? Is it easier to see a nutritionist and have Medicare cover the $100 fee or have Medicare cover the thousands of dollars of cost when the preventable heart attack occurs? Does Medicare pay doctors for outcomes like the health of their patients or inputs like the tests and procedures performed? The answers to all of these questions are disappointing.

Expanding Medicare in its current form would quicken the already alarming reduction in access to quality primary care in this country. Doctors are leaving and avoiding primary care in droves. The administrative trivia imposed on primary care by the byzantine system of coding, justifying, and compartmentalizing care has made primary care a particularly unappealing professional choice. We need to create and finance a system that reverses the current incentives and priorities. Adding millions of people to a collapsing system looked for a week like a way to pass a bill, but the approach made zero sense if the goal is to actually reform the system.