Here's the big picture:
And before Klein fudges the numbers, as is obvious from the absolute numbers shown in the 2001-2011 comparison above, managed care has become the fastest growing type of service in Medicare. What is not so obvious from looking at the absolutes (but is obvious if you look at the data book), inpatient care and MD fees have plummeted as a percent of the much bigger total.
Of course -- the biggest parts of managed care are MD fees and inpatient hospital. So MedPAC's mixing of type of service with payment/insurance method gives a false view of the Medicare population and time-series trends.
[It would be important to understand if "managed care" means Medicare Part C only and -- if so -- which parts of Medicare Part C?. Arielle Mir, MedPAC assistant director, says via phone that she is "pretty sure (the term) managed care" is used interchangeably with the term Medicare Part C, and does not break out Part C further. This is unfortunate for doing meaningful research, especially because other MedPAC reports claim the non-managed-care in Part C FFS is the biggest problem area in terms of Medicare Part C costing too much in relation to its benefits. I fear without a meaningful view of the different components of Part C, the government is throwing out the baby -- Medicare Part C HMOs -- with the bath water -- Medicare Part C FFS.]
That's part of my major criticism of the data book. With all this work (over 200 chart-filled pages), all this time (most of the data is three or more years old), and all this money and the government statisticians can neither combine nor "compare and contrast"
- Medicare Parts A and B Fee for Service (FFS) data with
- Medicare Part C (Medicare Advantage) data
Maybe the Feds don't want us to know how the two approaches compare1 and what the real benefits and drawbacks of one approach vs. the other are? Such a comparison against a meaningful total is THE burning question in the premium-support/voucher debate.
Will a system such as
- the Part C Medicare (Advantage) HMO-dominant "choice" approach -- which is what Wyden/Ryan proposes -- work better than
- the traditional Medicare Parts A and B FFS "one size fits all" approach so admired by most of the Democratic Party and President Obama2
To help in such a comparison it would be really good to separate Medicare Part C FFS data from the rest of the Medicare Part C data and combine it with Medicare Parts A and B FFS data.
-- Dennis Byron
1 The Medicare Trustees and MedPAC do talk about these subjects independently in other reports, just not in the Data Book. And my complaint is the failure to look at the issue in a mututally exclusive, collectively exhaustive manner typical of good research. It IS clear where MedPAC stand on the issue from its recommendations; it is just not clear what data backs up its opinions and recommendations
2"One-size-fits-all" Medicare FFS is sort of what the Democrats admire in Medicare; however and ironically the Patient Protection and Affordable Care Act -- PPACA -- actually wants to change Medicare Part C and Medicare FFS as follows:
- Move all 11,000,000 Medicare beneficiaries on Part C Medicare (Advantage), which is mostly made up of beneficiaries in HMOs (CBO thinks half of us will do it)
- Back into traditional FFS Medicare Parts A and B and then
- Move those 11,000,000 seniors and the 38,000,000 seniors already on traditional FFS Medicare Parts A and B into Accountable Care Organizations (ACOs), which are really HMOs
The Democratic-party attack on the mostly HMO-based Medicare Part C is doubly ironic because PPACA also wants to move all non-seniors into ACOs, which are really HMOs.