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<<   作成日時 : 2009/08/22 19:08   >>

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管理者なきメディケアが混乱を増幅
 メディケア・メディケイド・サービスセンターは米国で最大の医療購買者である。医療制度改革の核心をなすものである。その管理者がいれば、議会で立法のために働くだろうし、拡大する役割を準備するだろう。
 医療モデルとしてしばしばホワイトハウスによって引用されたメイヨ・クリニックのデニスA.コルテーゼ会長は、「その不在はいたんだ親指のように目立つ」と言った。コルテーゼ博士は、「事実上、メディケア(高齢者公的医療保険)は米国最大の保険会社である」と言う。社長と議会は取締役会として役目を果たすはずだ。「強力な管理者の下、医療配給システムを大きく変革すれば、より低いコストで良い結果と良いサービスを提供できるだろう」
 7,000億ドルの年間予算で9,800万人に健康保険を提供し、年に12億の請求に対し支払っている。広範な医療に影響を及ぼし、病院、医師、保健計画、研究所、医療事業者を制御している。
 メディケア管理者なしで医療制度を改造しようとすることは、将軍なしで戦争をするようなものである。Dr. Mark B. McClellanが辞めてから、2006年10月以来正式に上院で承認された管理者がいない。その最高経営執行者、Charlene M. Frizzeraは1月以来ずっと代理の管理者である。
 病院保険信託基金が2017年に底をつき、メディケアは本当の問題に突き当たる。メディケアは「自動操縦」で動いており、詐欺と乱用についての深刻な問題を先送りしているとも言われている。
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オバマ次期大統領 メディケア改革を言明/米国医療事情
http://kurie.at.webry.info/200901/article_13.html
メディケアの破綻/米国医療事情
http://kurie.at.webry.info/200905/article_23.html
医療改革プランの財源はどこに?/米国医療事情 議会予算局
http://kurie.at.webry.info/200812/article_38.html
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Lack of Medicare Appointee Puzzles Congress
http://www.nytimes.com/2009/08/18/health/policy/18health.html
By ROBERT PEAR
Published: August 17, 2009

WASHINGTON ― President Obama has made health care his top priority. He says the cost of Medicare and Medicaid is “the biggest threat” to the nation’s fiscal future. But to the puzzlement of Congress and health care experts around the country, Mr. Obama has not named anyone to lead the agency that runs the two giant programs.

The agency, the Centers for Medicare and Medicaid Services, is the largest buyer of health care in the United States. Its programs are at the heart of efforts to overhaul the health care system. If it had an administrator, that person would be working with Congress on legislation and could be preparing the agency for a new, expanded role.

“The vacancy stands out like a sore thumb,” said Dr. Denis A. Cortese, president of the Mayo Clinic, often cited by the White House as a health care model.

“In effect,” Dr. Cortese said, “Medicare is the nation’s largest insurance company. The president and Congress function as the board of directors.

“Under a strong administrator, it could take the lead in making major changes in the health care delivery system, so we’d get better outcomes and better service at lower cost.”

The agency provides health insurance to 98 million people, pays 1.2 billion claims a year and has an annual budget of more than $700 billion. It has a pervasive influence on medical care, regulating hospitals, doctors, health plans, laboratories and almost every other type of health care provider. When Medicare decides to cover a new treatment or adopts a new payment policy, private insurers often follow its lead.

Trying to remake the health care system without a Medicare administrator is like fighting a war without a general.

“You need a general,” said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the health subcommittee of the Finance Committee. Of the job vacancy, Mr. Rockefeller said: “It’s a big problem. I can’t explain it.”

Administration officials said they were searching for someone with the right mix of managerial experience and clinical expertise.

“We’re working hard to find the best fit to steer C.M.S. during this critical period,” said Reid H. Cherlin, a White House spokesman. “We look forward to nominating an administrator soon.”

The agency has not had a regular Senate-confirmed administrator since October 2006, when Dr. Mark B. McClellan stepped down. Its chief operating officer, Charlene M. Frizzera, has been the acting administrator since January.

Mr. Cherlin said the agency was “running at 100 percent capacity” and continued to provide vital services.

But Dr. John C. Lewin, chief executive of the American College of Cardiology, said that, in the absence of an administrator, many decisions were being made by “a beleaguered bureaucracy.”

Since Mr. Obama took office, more than a half-dozen people have been seriously considered for the top job running Medicare and Medicaid. Some have been interviewed by White House officials, but the names sank from view as fast as they bubbled to the surface.

Among those who have been considered are Dr. Donald M. Berwick, president of the Institute for Healthcare Improvement, a nonprofit group in Cambridge, Mass.; Dr. Glenn D. Steele Jr., president of the Geisinger Health System, in Pennsylvania; and Dr. Nicholas J. Wolter, chief executive of the Billings Clinic in Montana.

Some insiders suggest that the president is waiting for Congress to finish work on health care legislation, so he could pluck an administrator from Capitol Hill ― someone like Elizabeth J. Fowler, chief health counsel for the Senate Finance Committee, or Jack C. Ebeler, a top aide at the House Committee on Energy and Commerce.

“It’s an extremely important position,” said Senator Ron Wyden, Democrat of Oregon, “and it’s extremely important to have a talented person in that post for health reform.”

Senator Orrin G. Hatch of Utah, a senior Republican member of the Finance Committee, said the delay in naming a Medicare administrator was “of great concern.”

“Medicare is in real trouble,” Mr. Hatch said, noting that its hospital insurance trust fund was expected to run out of money in 2017.

The delay in choosing a health secretary, after former Senator Tom Daschle withdrew from consideration because of tax problems, may have delayed the selection of a Medicare administrator. Some candidates have been reluctant to sell financial holdings in the health care industry. Some apparently wanted more authority than they could have in an administration where health policy is directed from the White House.

Thomas S. Crane, a health lawyer who used to work at the Department of Health and Human Services, said the Medicare agency was “running on autopilot.” For example, he said, “officials are deferring decisions on serious policy questions involving Medicare fraud and abuse.”

To help finance coverage for the uninsured, Mr. Obama and Democrats in Congress propose to squeeze more than $400 billion in savings from Medicare over the next 10 years. They want doctors, hospitals and nursing homes to work together in teams, with Medicare payments eventually based on the quality of care.

They also contemplate huge changes in Medicaid, the program for low-income people, financed jointly by the federal government and the states.

All the major health care bills moving through Congress would use Medicaid as a vehicle for expanding coverage, adding perhaps 11 million people to the rolls, an increase of about 20 percent.

Vernon K. Smith, a former Medicaid director in Michigan who is now a consultant to many states, said the Centers for Medicare and Medicaid Services desperately needed an administrator to address “the future fiscal stability of the Medicaid program.”

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