Presidential candidates from the two major political parties have put forward schemes for solving Medicare's woes. The philosophical differences between the two parties over how to reshape Medicare are large and enduring. Health maintenance organizations and other managed care insurance plans are no longer viewed as an easy cure-all that can both control health care costs and deliver better care. States increase federal Medicaid payments by paying certain providers, such as nursing homes, more than they would normally receive and then having the providers return the bulk of the extra monies to the state. In testimony September 6 before the Senate Finance Committee, the General Accounting Office contends that this scheme violates federal law and urged the Committee to enact legislation to stop it.
Heart failure is a common chronic disease that leads to disability and death.
Treatments for heart failure slow, but do not stop, the progression of the disease. The successful management of chronic heart failure may require changes in patients' diet, alcohol intake, and smoking behavior and use of complex drug regimens. The limited available evidence suggests that, in some respects, quality of life is poor and often worse than that experienced by patients with other chronic conditions. Studies in the United States have shown that patients with chronic heart failure find it difficult to retain information and that patients may not appreciate the relevance of information provided by clinicians. Studies have also shown that although many patients believed that they were dying, few had been told this or discussed it with their doctors.