WORRYING ABOUT HEALTH CARE RATIONING IS NOT IRRATIONAL

Robert Pear, NY Times - White House officials and Democrats in Congress say the fears of older Americans about possible rationing of health care are based on myths and falsehoods. But Medicare beneficiaries and insurance counselors say the concerns are not entirely irrational. Bills now in Congress would squeeze savings out of Medicare, a lifeline for the elderly, on the assumption that doctors and hospitals can be more efficient.

President Obama has sold health care legislation to Congress and the country as a way to slow the growth of federal health spending, no less than as a way to regulate the insurance market and cover the uninsured.

Mr. Obama has also said Medicare and private insurers could improve care and save money by following advice from a new federal panel of medical experts on "what treatments work best."

The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life. . .

An independent federal panel, the Medicare Payment Advisory Commission, conducts annual surveys of beneficiaries and says they generally have good access to care. But, it said, some beneficiaries have difficulty finding new doctors, especially primary care physicians, and blacks and Hispanics are more likely than whites to report problems.

Mr. Obama has repeatedly said, "Nobody is talking about cutting Medicare benefits." At the same time, he wants to eliminate what he describes as "unwarranted subsidies" and giveaways to private Medicare Advantage plans, which use some of the money to provide extra benefits.

More than one-fifth of the 45 million Medicare beneficiaries are in Medicare Advantage plans operated by insurance companies like Aetna, Humana and UnitedHealth. The House bill would cut payments to private plans by more than $160 billion over 10 years. Mr. Obama says those payments "boost insurance company profits, but don"™t make you any healthier."

In the past, insurers reacted to such cuts by increasing premiums, reducing benefits or pulling out of the Medicare market, and beneficiaries complained loudly. . .

In effect, Mr. Obama says he can cut bloated Medicare payments to inefficient health care providers without adversely affecting any beneficiaries. Many doctors are dubious.

Medicare officials recently proposed changes that could increase payments for some primary care services but reduce payments to many specialists. Cardiologists would be especially hard hit, with cuts of more than 20 percent in payments for electrocardiograms and 12 percent for heart stent procedures.

"Cuts of this magnitude could cripple cardiology practices and threaten access to services for millions of patients," said Dr. John C. Lewin, chief executive of the American College of Cardiology. . .

Moreover, if a bill becomes law, no one can say for sure how it may be applied or extended. The 1965 law that created Medicare prohibited "any federal interference" in "the practice of medicine or the manner in which medical services are provided," or in the operation of any institution providing health care.

Sara Rosenbaum, a professor of health law and policy at George Washington University, called this "a majestic message from Congress about how it expected the Medicare program to be run."

But the meaning of that guarantee has shrunk as Medicare officials and Congress have set more detailed standards for doctors, hospitals, nursing homes and others in Medicare.