Michael Fumento

Medicare is speeding toward insolvency , and only major fundamental changes can save it. But beware the "tweakers" - those who say that little things can add up to a lot. Usually what they're pushing is of little benefit to Medicare, but of much benefit to them.Medicare's problems won't be solved by tweaks.

As I write at Forbes. com, we that in a new study, paid for by the American Association of Nurse Anesthetists and seemingly applauded without dissent in the media - maybe because most of the articles are clearly rehashes of the accompanying press release.

The report in the August issue of Health Affairs says complications and deaths during surgery are equally low regardless of whether certified registered nurse anesthetists (CRNAs) or physician anesthesiologists are used. It also says there was no difference whether or not the nurse anesthesiologist was supervised by a surgeon.

Therefore we can safely drop the Medicare rule requiring either an anesthesiologist or physician supervision of a CRNA when anesthesia is administered, it concluded. And though CRNAs are among the best-paid nurses, their time is still cheaper than a doctor's. So while Medicare currently reimburses at the same rate regardless of who's doing the administering, we could change that and save money.

But as the study's own data show - sans spin - we could also lose lives.