Medicare and malpractice liability reform topped President Bush's healthcare agenda as outlined in his State of the Union address Tuesday night.
"Instead of bureaucrats and trial lawyers and HMOs, we must put doctors and nurses and patients back in charge of American medicine," Bush said.
Bush wants to add a prescription drug benefit to Medicare and in his 2004 budget will propose $400 billion over the next 10 years to strengthen and reform the program, which serves 40 million seniors, he said.
He also said excessive litigation over claims of medical malpractice is a prime cause of increased health costs. Bush is urging Congress to pass medical liability reform that would put a $250,000 cap on damages.
Sitting in the audience next to First Lady Laura Bush were two physicians who had moved to another state or stopped practicing because of high malpractice insurance costs.
"The rising price of medical liability insurance premiums is squeezing physicians and hurting their ability to provide health care," says James Martin, M.D., president of the American Academy of Family Physicians, in a statement. "We support legislation that contains medical liability tort reforms that have been proven effective. These reforms balance the need to appropriately compensate patients who have been wrongfully harmed against the need for all Americans to continue to access medical care."
The AMA and the American College of Obstetricians and Gynecologists also avidly endorse tort reform.
Some Democrats, however, argue that tort reform won't work to lower premiums and say rising costs are due to insurance industry practices that reflect the state of the economy, not lawsuits.
Although not explicitly outlined in his speech, it is expected that Bush's Medicare strategy would offer drug coverage through managed care plans, not through traditional fee-for-service care.
About 5 million Medicare beneficiaries are enrolled in managed care plans today through the Medicare+Choice program. That number has dropped over the last three years as HMOs leave the program complaining that federal reimbursement is inadequate. Some 85% of those in Medicare receive traditional fee-for-service delivery.
"Seniors happy with the current Medicare system should be able to keep their coverage just the way it is," he said during the address.
Bush will provide more details of his Medicare plan in a speech in Grand Rapids, Mich., today.
But in the Democratic response, Washington Gov. Gary Locke says the "fine print" of Bush's plan only helps Medicare beneficiaries who leave traditional Medicare. He says, "Democrats will insist on a Medicare prescription drug benefit for all seniors."
"Our parents shouldn't be forced to give up their doctor or join an HMO to get the medicine they need," Locke says. "That wouldn't save Medicare; it would privatize it."
Robert Hayes, president of the Medicare Rights Center, a not-for-profit consumer-service organization based in New York City, says Medicare isn't broken and calls Bush's plan "a cruel hoax."
"The problem is not Medicare's structure, which works better than any private marketplace structure to ensure universal coverage and access to healthcare people need," Hayes says in a written statement. "The problem is Medicare needs a prescription drug benefit."
Other healthcare highlights of Bush's domestic and foreign agendas include:
- $15 billion over five years, including $10 billion in new money, to prevent and treat AIDS in Africa and the Caribbean. Called the Emergency Plan for AIDS Relief, Bush says his strategy would prevent 7 million new AIDS infections and treat at least 2 million people with anti-retroviral drugs.
- $6 billion for Project BioShield to fund research and production of vaccines for potential bioterrorism weapons such as anthrax, botulinum toxin, ebola and plague.
- $600 million over three years to help 300,000 people seek treatment for drug addiction.
- A ban on all human cloning.
- A ban on "partial birth" abortions.