John Goodman on Reforming Medicare "What Medicare is trying to do is impossible," writes John C. Goodman in The Wall Street Journal. Medicare pays physicians for about 7,500 tasks, he writes, but it varies the prices according to factors including location so that it is actually setting about 6 billion prices. When Medicare inevitably fails to set appropriate prices for every transaction, it creates "perverse incentives" that, for instance, give doctors far more money to perform a cataract removal than provide primary care. "A more sensible approach is to quit asking for the impossible. Instead, let's begin the process of allowing medical fees to be determined the way prices are determined everywhere else in our economy--in the marketplace." All over the country, walk-in emergency care clinics post prices, determined outside the insurance industry based on experience. Medicare should authorize enrollees to go to these places and it should pay the posted prices. Second, Medicare should allow enrollees to use commercial telephone health care services, which often have much lower costs than a visit with a nurse. "Finally, Medicare should encourage physicians to repackage and reprice their services in ways that are good for the doctor, good for the patient, and good for Medicare."
Roscoe Bartlett on Apes and Testing Representative Roscoe Bartlett of Maryland invented a respiratory device that helped the first chimpanzee survive a trip to space and back while he was a physiologist at the Navy's School of Aviation Medicine. He also notes that another ape on that flight died from an allergic reaction to anesthesia. He once believed those sacrifices were necessary, he writes in The New York Times, but now "I no longer believe such experiments make sense--scientifically, financially or ethically. That's why I have introduced bipartisan legislation to phase out invasive research on great apes in the United States." Methods such as computer modeling, testing in small doses on humans, and growing human tissues for biomedical studies now often prove "cheaper, faster and more effective," he says. This decline means about 500 federally-owned chimpanzees now sit idle in warehouses. Because chimpanzees are stronger than humans, simple tests often require extreme methods such as "knock-downs" with tranquilizers. "There is no question that chimpanzees experience pain, stress and social isolation in ways strikingly similar to the way humans do." He writes of studies that show chimps kept in captivity communicating dismay through sign language and displaying symptoms of post-traumatic stress disorder. He concludes: "Continuing innovations in alternatives to the use of invasive research on great apes is the civilized way forward in the 21st century."