(image: stopmedicarefraudla.org)

Amid the loud political din about health reform, it’s refreshing to read serious health policy stories. By luck, there were three interesting stories about Medicare this past weekend:

Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, wrote an op-ed for the Los Angeles Times, in which he lays out three principles to guide Medicare: 1) It should not bankrupt our children; 2) It should not waste money on low-yield medicine; 3) It should recognize the value of having patients talk to their doctors.

I want to talk about aging gracefully. My Medicare would be really good at this. It would help patients understand the trade-offs between the length of life and the quality of life. It would help patients understand why the side effects of early detection — overdiagnosis and overtreatment — are even more pronounced as they age (simply because there is less time for abnormalities to become important problems). And it would help patients understand the futility and the suffering caused by aggressive interventions at the end of life.

Jane Gross has a piece in Sunday’s New York Times on how Medicare “fails the elderly.”

This mismatch between what is covered and what is actually useful is the central flaw in Medicare today, a shock to families who have no clue, until they’re smack in the middle of it, about how this system works.

This mismatch tortures our elderly, drains the Medicare trust fund and leaves adult children with depleted retirement reserves. Yet in all the debate about the national debt, medical inflation and the need to pare Medicare costs by such means as raising the eligibility age, why is nobody, outside the insular community of long-term care providers, even mentioning the difference between acute and chronic care and how each is paid for (or not)?

Why is nobody enraged that our taxes are paying for hip replacements, for example, for people with advanced Alzheimer’s disease, who are incapable of physical therapy? Why is nobody saying out loud, like it or not, that one of our great challenges is figuring out what to do about our elderly people, our fastest growing-population cohort, which will grow exponentially when 76 million baby boomers join the ranks?

Finally, Paul Starr, Professor of Sociology and Public Affairs at Princeton University, has a lengthy, pretty wonky piece about Medicare’s past, present and future in the American Prospect. In “The Medicare Bind,” offers a history of Medicare, a discussion of the Affordable Care Act and the Ryan Plan. He writes:

No matter how Congress resolves the immediate budget issue, the long-term problem will remain. Medicare’s share of the federal budget, which rose from 8.5 percent in 1990 to 15.1 percent in 2010, is projected to hit 17.4 percent in 2020—a percentage that will almost certainly increase because of implausible cuts in doctors’ fees written into current law and will rise higher still if budget cuts fall disproportionately on other programs. The way out of the Medicare bind cannot involve changes only to Medicare itself; the cost of caring for seniors reflects the overall costs of the health-care system, and spending on Medicare will become manageable only through measures that bring total costs under control.

Medicare is clearly in the crosshairs and major changes may be inevitable, during the Super Committee or down the line. These pieces offer useful perspectives.