A recent article in the New York Times illustrates the travails for one U.S. Senator as he finds himself between a health care reform rock and hard place.  The Senator is Florida’s Bill Nelson.  The rock is more than 1 million Florida senior citizens who enjoy spa-like services under Medicare Advantage.  The hard place is 50 million nonelderly uninsured individuals in the U.S., including more than 3.7 million in Florida. 

It’s a bit of a gut-check for Nelson, a Democrat, as he is forced to balance his loyalty to party and president against perhaps the most motivated voting bloc in the country.  And motivated they should be.  After all, Medicare spends an average of $8,794 a year on each Medicare enrollee (compared to $6,204 in Iowa) and an average monthly Medicare Advantage payment rate of $1,013 (compared to $752 in Iowa).  Clearly, Medicare Advantage has been a big hit in Florida, which is why it has a 28 percent market penetration, compared to barely 12 percent in Iowa. 

Just where Nelson is leaning is clear from the Times article, in which he declares, “It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare…I am offering an amendment to shield seniors from those benefit cuts.” 

Iowans, of course, have subsidized Medicare health benefits in Florida and other high-flying states for years, as Congress and the Centers for Medicare & Medicaid Services have allowed geographic disparity within Medicare to go unchecked, despite reams of data that show (1) it’s unnecessary and (2) it doesn’t benefit patients and, in fact, appears to detract from their quality of life, if not their overall health.  Speaking of “intolerable” – it’s doubtful that the Sunshine State Senator is aware that Florida is in the top 10 for Medicare spending and the bottom 10 for quality of care provided to Medicare beneficiaries. 

The good Senator gauges the situation by the e-mails and letters he has received, including, apparently, those coerced by Humana, one of Florida’s big Medicare Advantage insurers.  (Humana has since been taken to the CMS woodshed for using its Medicare Advantage database to further its political advocacy.)  What he should be looking at is why his state, home to the most expensive Medicare region in the country (Miami, at more than $16,000 per enrollee per year) is such a Medicare outlier.  That kind of guzzling at the public trough is bound to get you some well-deserved attention. 

It boils down to a basic question of equity.  Floridians are simply being asked to shoulder a small portion of what Iowans have hauled around since the Medicare Prospective Payment System was put in place.  Whether or not they choose to see the bigger picture and support a reformed national health care system that prioritizes patients – not just services – will depend a great deal on the words and actions of leaders like Senator Nelson and those who can, if necessary, neutralize him.