Medicare needs surgery, Minnesota docs told

Sep. 21--When Jon Christianson asked his question, the artwork he brought up drew a knowing chuckle from his audience of Minnesota doctors and medical residents at the Duluth Entertainment Convention Center.

"Who's responsible for saving this program?" the University of Minnesota health policy expert asked rhetorically.

As the Edvard Munch masterpiece "The Scream" appeared on twin screens, Christianson answered, "Legally, Congress is. And that's a scary thought."

The program Christianson was referring to is Medicare, and he's well-positioned to offer a diagnosis. A Washington insider as well as a Minnesota scholar, Christianson is vice chairman emeritus of the Medicare Payment Advisory Commission, a 17-member nonpartisan panel that advises Congress on the federal health insurance program for seniors.

Christianson's topic was as current as the presidential campaign. He spoke Friday on "Medicare for All -- or none?" at the annual conference of the Minnesota Medical Association, which brought about 120 doctors and medical residents to the DECC. The conference concludes on Saturday with an address from Gov. Tim Walz.

The overall conference theme was access to health care, an issue that concerns physicians, said Dr. Douglas Wood, a Mayo Clinic cardiovascular specialist who just completed his term as the Minnesota Medical Association's president.

"We are concerned, of course, about making sure Minnesotans are the healthiest people in the country," Wood said in an interview. "And a large determinant of that is the ability to access health care."

So the presentations during the day included such topics as the scarcity of physicians outside of larger metropolitan areas, the many communities without obstetrics care and a recent uptick in the percentage of Minnesotans without health insurance coverage, Wood said.

Medicare for All, the proposal that's dividing Democratic presidential candidates, was a natural fit for that conversation. Unlike political figures, the wonkish Christianson stayed away from sloganeering and sound bites -- although he did sprinkle in a few visual teasers, such as "The Scream."

Medicare for All, Christianson said, isn't really Medicare at all -- it's what used to be known as a single-payer health insurance in a more popular package. "Because people like it," he said of the Medicare program, producing survey results showing that 84% of Democrats and 83% of Republicans view Medicare favorably.

But Medicare for All, as proposed by Sen. Bernie Sanders, I-Vermont, "would eliminate Medicare as we know it," Christianson said.

It also would make a difference in the pocketbooks of the people he was addressing. "Will doctors make less money?" he asked rhetorically. "The answer is 'yes.' There's no question about that."

Christianson said he doesn't think the next Congress would muster the votes for Medicare for All, even with a President Sanders or a President Warren. The first concern, he suggested, should be fixing the existing Medicare program. He pointed out that 11,000 Baby Boomers turn 65 each day.

Showing a photo of two little boys attempting to row an out-of-kilter cardboard box held together by duct tape, Christianson said, "The boat's not big enough."

The Medicare system also looks like it was put together with duct tape, with the four parts -- A, B, C and D -- approved in different years and fitting together poorly, and the program as a whole failing to meet the needs of patients.

"What you have are a good number of Medicare beneficiaries that are exposed to a huge amount of financial risk because of very poorly designed coverage that hasn't been changed since 1964," Christianson said. "So that's one thing that absolutely needs to be addressed."

Christianson suggested the need for a commission to reform Medicare similar to the commission that recommended Social Security reforms in the 1980s. Such a commission could take on the hard issues and give Congress "cover," he said.

"I think everybody wants to see a healthy Medicare program in the long run," he said. "Nobody wants to make the tough decisions in the short run."

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