Divisions over future Medicare spending surface in house

"A week-old agreement among House Democrats to smooth out disparities in the way Medicare reimburses rural and urban health providers is in danger of crumbling, as disputes erupted Friday over what actually was agreed to," The Wall Street Journal reports.

"Some lawmakers from states with high health-care costs are also pressing House Democratic leaders for changes to the deal to ensure that their doctors and hospitals don't see too big of a bite. … Lawmakers from populous areas are questioning whether the deal on geographic disparities should be altered to allow more time for Medicare changes to take effect, since there is no longer the urgency of putting those changes into effect before the public option is rolled out. Another issue is for how long a period of time after changes go into effect urban hospitals should be 'held harmless,' meaning they won't see their Medicare reimbursements cut" (Vaughan, 8/2). 

The Des Moines Register reports from Marshalltown, Iowa, that "America's health care system would not be in such dire straits if everybody used medical care the way people here do. ... A national researcher found that Medicare, the giant federal insurance program for the elderly and disabled, spends substantially less on patients from Marshalltown than it spends on patients from most other Iowa areas. The program spent $4,169 in 2006 for each Medicare member in Marshalltown, compared with an Iowa average of $6,572 and a national average of $8,304, according to a study by Dartmouth College." Those low costs "might be due partly to a relatively small supply of doctors. According to figures compiled by the Iowa Medical Society, there is one physician for every 493 residents in the state. That puts Iowa in 44th place nationally. … Iowa's doctors also are more likely to be primary-care physicians, who health-cost experts say tend to practice relatively inexpensive medicine" (Leys, 8/2).

At the other end of the spectrum, Dallas, Texas, "ranks among top U.S. spenders for health care," The Dallas Morning News reports. "Faced with data showing Dallas doesn't give good value for money in health care, North Texas medical, insurance and other business leaders are discussing a transformation of one of the area's biggest industries to curb spending and improve quality. … Dartmouth research with Medicare data shows Dallas among the highest-spending areas of the country, and with some of the most rapidly escalating costs. If the area's doctors and hospitals practiced medicine as it's done in Waco, Dartmouth concluded that Dallas could save $1 billion a year just in Medicare spending" (Landers, 8/2).