The NYTimes reports today that a compromise on the health care bill may swap a public option for expanded Medicare, while noting in another piece that states have drastically cut their anti-smoking programs. These programs are actually fully funded out of a combination of settlement funds from the tobacco companies and direct taxes on cigarette sales.
Expanding Medicare is problematic for physicians, and in particular primary care physicians that are the bedrock of our system. Since Medicare under-reimburses these providers it seems likely that were a significant number of people to enroll, that some primary care physicians would drop out of the system. This would then increase the burden on other providers still accepting Medicare patients as well as emergency rooms. Minus payment reform (which also seems unlikely), its possible that this will have a paradoxical effect on primary care and prevention, while leaving tertiary and sub-specialty care unfettered.
Likewise, shifting money away from smoking cessation and prevention and to acute needs (such as acute health care) may seem prudent in the short term, but in the long term simply means more health care costs from cardiovascular, cancer and pulmonary disease.
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