Friday, October 20, 2000

The same senior citizen could get all of these services free of additional charge if they were enrolled in Medicare HMOs in New York, parts of Florida, and elsewhere.

The debate this season is about preserving Medicare in an environment that has lacked foresight, but they should also be talking about how to make it fair.

For years, there has been a huge urban/rural inequity in Medicare reimbursement to caregivers. The program has wrongly assumed that it costs less in a rural Iowa city like Storm Lake to care for a patient than it does to do so for a patient suffering the very same illness in a big city hospital.

The urban/rural differential has been pared down some in recent years, but still fails to adequately reflect the actual cost of providing services. When clinics and hospitals are shorted by Medicare, we all pay in the form of higher costs to other patients to make up for debt that has to be written off.

Now comes a study by the Health Care Financing Administration to look into the state of Medicare-funded care. It should make Iowans angry all over again.

The report shows that Iowa ranks eighth best out of the 52 U.S. states and territories in quality of care received.

In return, Iowa ranks 82nd out 92 national Medicare localities in payments per patient for those services.

"There's something wrong with this picture," says Sterling Laaveg MD, president of the Iowa Medical Society. "We provide high quality care, yet Iowans are at the bottom of a two-tiered federal reimbursement system."

In six areas studied specifically - heart attack, breast cancer, diabetes, heart failure, stroke and pneumonia, treatments delivered to Iowa patients resulted in the highest "quality indicator" in the nation.

Why is it that everyone who earns a paycheck pays the same federal Medicare payroll tax, and every Medicare beneficiary pays the same Medicare Part B premium - but Floridians receive an average $6,152 per beneficiary each year, while Iowa's average annual per patient benefit is $3,865?

Locally, older patients - Medicare patients - make up a very large percentage of hospital business. Bad policy compromises the health resources we all depend on.

It isn't that old argument over fluctuating cost of care. A study by the Minnesota Senior Federation indicates that actual cost of providing medical care varies no more than 15 percent from state to state.

Iowa health care is a matter of pride. It is that much harder to maintain that excellence when we are handicapped by inequity in our own government's health coverage program.

An Iowa senior citizen who has paid in their due through their years deserves prescription drugs, an eye exam and hearing services as much as a senior in New York or Florida does.

Our patients' patience has about run out.