Notice that there is no question mark after that headline. The New York Times on August 22 is supposedly comparing the Obama plan for Medicare (which is actually current law) with the Wyden/Ryan/Romney plan for Medicare reform. Right from the beginning it makes a totally stupid mistake. The Times says Obama:
"maintains the fee-for-service structure in... Medicare...
But The Times says Wyden/Ryan/Romney:
"Would move to a premium support system.."
Fee for service (FFS) refers to how providers get paid, not just in Medicare but in any type of insurance. But premium support has nothing to do with FFS or providers.
Only about 75% of Medicare is FFS today, the rest is capitated (per-person) and usually managed care. Why Obama is so for FFS for seniors when he is against it for everyone under 65 -- as demonstrated in many "managed care" provisions of the Patient Protection and Affordable Care Act (PPACA) -- is not explained by the Times. The Times apparently thinks it is setting the right (make that left) tone of pro-Obama political propaganda by comparing FFS payments with premium support.
But premium support has nothing to do with FFS or providers. It is the way insurers sometimes get paid. It is the way almost everyone in America gets their health-care insurance today.
- You pay some today; your employer supports the premium payment and pays some (usually most).
- In Medicare today, seniors pay a little more than half (counting the 40 years of Medicare payroll taxes deducted from their pay checks); the government pays some
(Note that for most large employers and for most Medicare -- or all Medicare depending on definitions, self insurance is involved so that the insurers are really just administrators. The "published" premium -- the total of your share and the government/employer share -- is implicit rather than an actual attempt on the insurer's part to determine healthcare-service costs ahead of time and build reserves and invest so as to cover costs and make a profit.)
-- Dennis Byron