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Medicare reform benefits for New Hampshire
by Denis Paiste, THE UNION LEADER
Apr. 4, 2000

CONCORD -- Under the current federal Medicare health insurance program for seniors, New Hampshire loses money while states like Florida gain, but the Granite State would stand to gain from reform of the program, Dr.  John Wennberg of Dartmouth Medical School told a health forum yesterday. "Health care is geography, and what you get depends on where you live, on the average," Wennberg said at the Holiday Inn in Concord.  The forum was sponsored by U.S.  Rep.  Charles Bass, R-N.H., and the Public Forum Institute.

For 1997, Medicare spending averaged $ 8,700 per person in Miami, Fla., versus $ 3,800 per person in Lebanon, New Hampshire.

But what that money buys is more, not better, medical care, he said.

What seniors are getting in Miami is a lot more intensive care in hospitals and a lot more visits to doctors and specialists in the last six months of life, he said.

Wennberg, director of Dartmouth Medical School's Center for the Evaluative Clinical Sciences, has done extensive work in the field of resource allocation and utilization.  If Congress has the courage to spend less money in high cost areas like Miami and other urban and suburban areas and redistribute the money across the country, it could create a prescription drug benefit program for all Medicare beneficiaries without spending more money, he said. Under Wennberg's plan, 65 percent of the nation's seniors, including New Hampshire's, would benefit, he said.

The forum also featured panel discussions on the Challenge of the Uninsured, Rural Health and Prescription Drugs.  It was the second in a series conducted by the Public Forum Institute.  The first was in Oklahoma City, Okla.

Congressman Bass said afterwards he felt the session could lead to constructive change.  "Getting all of the players together in one room, hearing what each other's problems are" would make a significant contribution to the whole health care debate, Bass said.

Wennberg said urban areas with greater concentrations of doctors see greater intensity of medical care.  But there is "no evidence greater care intensity produces better outcomes," he said.

A person in Miami is 10 times more likely to see a doctor in the last six months of life than a person in New Hampshire, he said.

Yet the occurrence of major surgery is only slightly higher in Miami than in New Hampshire, he said.

At the same time, measurements showed drugs called beta blockers for heart attack patients were used more often in Manchester than in Miami.

"Beta blockers are done here better than in Miami," he said.

Beta blockers are proven to help prevent heart attacks in patients who have already had one, he said.

"(By) reallocating those resources to the things we know work and people want, we would be better off," he said.

"The money that's going to Miami is coming out of our pockets," he said.

"We're in a position to gain if we have equity and fairness in Medicare," he said.

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