Medicare Costs - the Biggest Leadership Challenge

Today the Bush administration confirmed the prediction made one year ago: the Medicare hospital fund will be exhausted in 2019.

The looming collapse of Medicare is probably the best test of the mettle of John McCain and whoever becomes the Democratic nominee. Politics as usual will dictate a wishful thinking approach. Republicans will invoke market solutions. Unfortunately, as powerful as markets are, the evidence that market forces will solve the health care cost dilemma is on a par with evidence for the tooth fairy. Democrats will invoke preventive care and chronic disease management, sprinkled with attacks on corporate greed. As valuable as prevention and disease management are, and as egregious as some corporate behavior has been, the likelihood that these will make Medicare solvent is south of nil.

There is no pain-free way to solve runaway health care costs. In addition to using markets wisely and managing disease well, by 2019 we will have to learn to make do with less. Sometimes less is better (even though we don't believe it, as shown by the recent study demonstrating that expensive placebos are more effective than cheap ones). But sometimes less is worse, a very unpalatable political message.

A real national leader will help us come to grips with painful truths. In the 32 weeks between today and election day we the people should press those who want to be our leaders to talk turkey about Medicare. I don't think we can expect a candidate to talk explicitly about rationing, but we should harry them to get beyond wishful thinking, smoke, and mirrors. Eleven years isn't a lot of time for us to accomplish the needed learning.