The Podium

The attack on Medicare

The future of both Medicare and Medicaid — America’s solid promise to our seniors and most vulnerable citizens for almost a half-century — may well be at stake in this election. Everyone knows that there have to be reforms in order to make these programs stronger over time, but the two sides see the problem and the solution very differently.

Many Republicans are scaring seniors with false claims that they are about to lose the security they have; meanwhile they propose to turn Medicare into a voucher program, which shifts major costs onto seniors. They propose to change Medicaid into a program of block grants — stripping its core guarantees, cutting it, and shifting costs and risks to states and the most vulnerable Americans.


Republicans have made repeal of the new health care law the cornerstone of their health care plans. They claim that Obamacare cuts $700 billion from Medicare. As the former administrator of the Medicare program, I know that that claim is wrong.

Obamacare reduce costs, but it does so the right way. It targets waste, fraud, and abuse, reduces unnecessary subsidies to insurance companies, and provides redesigned payments and assistance to doctors and hospitals to make care safer, better coordinated, and more oriented to what patients and families want — better health. It helps all Americans, not just Medicare and Medicaid beneficiaries, by adding discipline to the insurance system with rate review and limits on administrative waste, and it invests in innovations to help providers improve the quality of health care. It wisely shifts Medicare payments away from volume (paying for how much is done) and toward value and quality (paying for how well patients are served). It is the Republican proposals, not Obamacare, that would take security away from our seniors and weaken protections for everyone.


President Obama’s health reforms do not cut any guaranteed Medicare benefits — in fact, the law expands those benefits in important ways. Thanks to Obamacare, seniors can now get a free annual wellness visit, preventive services like mammograms and colonoscopies without a copay, and more affordable prescription drugs because the reforms over time close the donut hole — a policy that has already saved Massachusetts seniors an average of about $610.

Medicare and Medicaid both face challenges today, but not because of Obamacare. The challenges exist throughout the health care system, mainly in the form of rising costs. And the primary culprit isn’t health benefits — it’s wasteful spending and poorly coordinated care.

Research shows that we are wasting one in every three dollars spent on health care, a finding confirmed yet again by a report from the highly respected, nonpartisan Institute of Medicine. That waste comes in many guises. For instance, overtreatment — when patients get tests, drugs, and even surgery that science shows won’t help them – cost taxpayers between $67 billion and $87 billion just last year. The costs that stem from fraud and abuse in the system are high, as well — between $30 billion to $98 billion in 2011 alone.

The right way to get health care costs under control is not by harming patients or taking care away from them; it is by reducing waste and spreading the better forms of integrated, patient-centered, safer care whose effectiveness has already been proven by pioneering health care providers. That’s the care that patients want to get, and, I can say as a physician, that’s also the care that doctors and nurses want to give — they don’t like waste any more than patients do.


Despite his attempts to distance himself from the Republican Party, in his short tenure Senator Scott Brown has not stood up for the improvements that Obamacare brings. He has repeated the Republican candidates’ misstatements about Medicare cuts. He has voted to repeal Obamacare, including the Medicare benefits it offers. And when Massachusetts was struggling to support the two-thirds of its nursing home residents who rely on Medicaid, Brown voted against half a billion dollars in emergency Medicaid support for our state.

We need leaders who are willing to stand up for seniors, disadvantaged Americans, and families — and who will not put them at risk. We need leaders who know that by better meeting the needs of patients and focusing on research and innovation to find even better ways to give care, we can control costs the right way, improve outcomes, and preserve and protect Medicare and Medicaid. Elizabeth Warren understands that.

I have devoted more than 30 years of my life to working toward fair and just access to continually better health care. In my view, Elizabeth Warren has the will, knowledge, and moral compass to protect the inspired promises our nation made in 1965. As a US senator, she will work for the right kind of change. I know she will fight for Medicare and Medicaid and the millions of our people who depend on them for peace of mind, health, and sometimes even life itself.


Dr. Donald M. Berwick is the former president of the Institute for Healthcare Improvement and the former administrator of the federal Centers for Medicare Fand Medicaid Services.