Getting serious about excessive Medicare spending: a purchasing model.

It is now well documented that Medicare spending varies widely across the country and that higher spending does not produce differences in quality, access, or even patient satisfaction. Yet for various reasons, policy analysts have tended to minimize the importance of the fact that as much as 30 percent of Medicare spending might be excessive and unnecessary. There is an imperative to transform the traditional Medicare program from that of a claims payer to that of a strategic purchaser, able to adopt a broad array of approaches and to use a comprehensive set of tools used by private plans, but in a more transparent and accountable way.