Medicare Plan Looks for Cure in Prevention

WASHINGTON — At a time when the Medicare program is fast going broke, both Democrats and Republicans in Congress are now moving toward consensus on adding a new package of benefits to the program for the first time since 1989.

The unexpected development, which is supported by the Clinton administration, is based on a calculated financial gamble: that by offering more preventive care now, Medicare can head off costly treatments in the future. Currently, Medicare covers no preventive measures except for flu shots and mammograms every other year for women 65 and over.

The proposal sends Congress and the administration back to one of the bloodiest political battlefields of the last election year, when Clinton mercilessly accused congressional Republicans of seeking to gut the program.

But this year, it appears likely the two sides will agree that the program should pick up the tab for the management of diabetes and for tests designed to provide early diagnosis of cancers of the breast, cervix, colon and prostate.

Although those measures would cost money in the short term, Rep. Bill Thomas (R-Bakersfield) said they could save Medicare large sums in the long run by cutting back on costly treatments for advanced diabetes and cancer.

“While we are fighting the larger battles of balancing the budget and finding a long-term solution to Medicare’s problems, we do not want to be an impediment to appropriate and necessary legislation,” Thomas said in an interview. “There are some serious legislators who decided not to hold up serious legislation.”

Thomas, chairman of the House Ways and Means subcommittee on health, introduced the legislation along with Rep. Michael Bilirakis (R-Fla.) and Benjamin L. Cardin (D-Md.).

“This proposal would result in large cost savings in the long run, as well as saving lives,” Cardin said.

Ellen Dadisman, spokeswoman for Democrats on the Ways and Means Committee, added: “Democrats are as ready as Republicans are to take on Medicare, especially these consumer issues.”

Both parties supported the diabetes and cancer proposals last year as part of legislation to rescue Medicare’s hospital trust fund, which is expected to run out of money in the year 2001 unless something is done. But the proposals died when Congress failed to agree on a formula to rescue the trust fund.

This year, Thomas said, the diabetes and cancer provisions will be handled separately from the Medicare rescue.

Under the legislative proposal, Medicare for the first time would cover several preventive measures that many doctors have recommended for years:

* Annual mammography screenings for women to detect breast cancer.

* Pap smears and pelvic examinations every three years for women to detect cervical cancer. High-risk women, such as those with a family history of cancer, would have the tests annually.

* Annual prostate cancer screenings for men, including a blood test for prostate cancer and a digital rectal exam.

* Colorectal screenings for colon cancer, with blood tests every year, and a flexible sigmoidoscopy every four years. High-risk individuals with colitis, ulcers and a family history of cancer, would get a colonoscopy every two years.

* Diabetes management and training programs. People already diagnosed with the disease need to take courses in nutrition, exercise and methods for monitoring their condition. The expense of these programs would be covered by Medicare for the first time. The cost of blood-testing strips used by diabetics to check their blood sugar would also be paid by Medicare.

Medicare beneficiaries pay the first $100 in doctor charges each year and then 20% of approved charges. Under Thomas’ legislative proposal, the screening tests would not be subject to the annual deductible.

“Basic coverage now will save us money later,” said Thomas. If the tests are adopted by Medicare for no extra charges, they will establish a “pattern for the private sector,” he said.

Increasing preventive services would “definitely be an improvement” for Medicare beneficiaries, said Dr. Jeffrey Newman, medical director for California Medical Review Inc., which oversees health-quality issues for California’s 4 million Medicare enrollees.