Excerpts from a July weekly radio address by President Clinton highlighting the
preventive benefits improvements contained in his plan to strengthen and
modernize Medicare.  We at the frontlines in Primary Care have to promote
this and care it through.  The statistic that "75 percent of women in
their sixties are not tested for breast cancer as recommended" is appalling
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PREVENTIVE SERVICES ARE ESSENTIAL TO HEALTHY AGING.  Older Americans are
the fastest growing age group in the United States, and they carry the
greatest proportion of chronic disease burden and disability. For
example, 88 percent of those over age 65 have at least one chronic
health condition, many of which are preventable.  Early detection,
health screening programs, and appropriate follow-up care can
significantly reduce morbidity and possibly prevent or postpone
functional disability.  For example, studies indicate that if prostate
cancer is detected before it spreads, the survival rate is at least 99
percent.  If it is not, the survival rate is 31 percent.  Breast cancer
and colon cancer have similar rates of survival after early detection.

MEDICARE BENEFICIARIES HAVE DIFFICULTY ACCESSING CRITICAL PREVENTIVE
BENEFITS.  Medicare currently charges beneficiaries for 20 percent of
the cost of certain preventive services, and other such services count
towards the Medicare deductible.  However, studies have found that cost
sharing decreases use of preventive benefits for all age groups and that
Medicare preventive services are underutilized.  For example, research
indicates that 75 percent of women in their sixties are not tested as
recommended for breast cancer.

FINANCIAL BARRIERS ARE NOT THE ONLY REASON BENEFICIARIES DO NOT RECEIVE
PREVENTIVE CARE.   Eliminating cost sharing is important but not enough
to ensure that Medicare beneficiaries receive the recommended levels of
preventive care.  The vast majority of Medicare beneficiaries do not
know that Medicare covers preventive benefits; almost 70 percent of
beneficiaries who stated that they knew about the range of Medicare
services did not know about all the preventive benefits Medicare covers.

ELIMINATING COST SHARING AND IMPROVING PREVENTIVE BENEFITS.  The
President's proposal to modernize the Medicare benefits package would
address these barriers to preventive services.  It would invest about $3
billion over ten years to make preventive services more affordable,
educate beneficiaries about these services and their importance, and
evaluate new services to assess their scientific merit and cost
effectiveness.  Specifically, it would:

Eliminate all existing preventive services cost sharing to reduce
significantly and in some cases totally eliminate barriers to services.
To ensure that beneficiaries can access critical preventive services
that have the potential to prevent disability and death as well as
improve quality of life, this proposal would waive the Part B deductible
and 20 percent co-insurance rate for all preventive services not already
waived under current law. Co-payments would be waived for screening
mammographies and pelvic exams. Deductibles and co-payments would be
waived for hepatitis B vaccinations, colorectal cancer screening, bone
mass measurements, prostate cancer screening, and diabetes self
management benefits.

Create a new health promotion education campaign. The Department of
Health and Human Services (HHS) would launch a two-year, nationwide
education campaign beginning in 2001 to promote the use of preventive
health services by older Americans and people with disabilities. The
campaign would have three parts:

Educating all Americans over age 50 and people with disabilities about
the importance of preventive health care.  HHS, the Social Security
Administration (SSA) , and private sector partners would launch a public
education campaign to raise awareness of the value of prevention.  HHS
would distribute information on health promotion and disease prevention
through State Health Insurance Assistance Programs, Area Agencies on
Aging, and the Social Security Administration's 1,300 field offices.
SSA would include information on preventive health care on the Cost Of
Living Adjustment (COLA) notice, which is sent to approximately six
million people with disabilities, on the Personal Earnings and Benefit
Estimate Statement, and in brochures on retirement and survivors'
benefits.  Finally, SSA would expand the section in its Medicare
brochure to include a fuller discussion of the importance of health
promotion activities and Medicare benefits.

Encouraging Medicare beneficiaries to use its preventive benefits.  This
campaign would provide information about the importance of regularly
receiving preventive health care benefits, such as vaccinations and
mammograms, and would encourage individuals to access these benefits
under Medicare.  All 39 million beneficiaries would receive
comprehensive information on preventive benefits on the Medicare Summary
Notice statement, the Explanation of Medicare Benefits, and the Medicare
Part B benefits statement.  HHS would also develop a health status
assessment tool to help beneficiaries identify important health issues
that should be discussed with a health care provider.

Launching an education and awareness campaign to help the elderly avoid
falls.  HHS would launch a nationwide media campaign to educate older
Americans about how to avoid potentially harmful and debilitating falls,
including cost effective ways to modify their homes.  Among the elderly,
falls are the most common cause of injuries and hospital admissions for
trauma, accounting for 87 percent of all fractures among people aged 65
years or older.

U.S. Preventive Services Task Force study on new preventive services for
older Americans.  The Secretary of HHS would direct the U.S. Preventive
Services Task Force to conduct a series of new studies to identify
preventive interventions that can be delivered in the primary care
setting that are most valuable to older Americans.  In addition, studies
would include evaluation of services of particular relevance to older
Americans in the mission statement of the Task Force.  Despite the
potential for preventive services to improve the quality of life for
older Americans, few clinical guidelines focus on preventive care for
older Americans.

Launch a smoking cessation demonstration project.  HHS would launch a
demonstration project to evaluate the most successful and cost-effective
means of providing smoking cessation services to Medicare beneficiaries.
The four leading causes of death - heart disease, cancer,
cerebrovascular disease, and chronic obstructive pulmonary disease - are
strongly related to smoking.  Studies from the last three decades have
shown that when people stop smoking, their risk of tobacco-related
morbidity and mortality decreases significantly.  For example, the risk
of myocardial infarction diminishes by almost one-third after the first
year of smoking cessation and reaches the level of people who have never
smoked by the third or fourth year of quitting.

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