Bloomberg is out with an article on Mediscare the week of September 3 basically saying “Can’t we all just play nice.” That Bloomberg is taking this stance tells me it is getting some indication the Democrats are losing the debate over when and how to reform Medicare (even Massachusetts seniors agree we can't keep "Medicare as we know it" for our children and grandchildren).
Remember though this is the same Bloomberg guy that claimed recently that the Patient Protection and Affordable Care Act (PPACA) included annual physical exams and then -- when informed he was wrong (apparently by his mother as well as by me) -- changed the post without notice and threw his own mother under the bus, saying something along the lines of "she can easily get a new doctor."
It looks like he's wrong again. Has his mom called him yet? Bloomberg says three things:
- 1. The "Ryan... budget adopted this year, (allows) Medicare benefits to grow much more quickly. Romney’s Medicare plan allows Medicare benefits to grow at GDP plus 0.5 percent per year after 2022, which is the same as the most recent House Republican budget and the same as Obama’s budget proposal."
- These spending caps both in PPACA and as proposed in Wyden-Ryan have nothing to do with whether or not Medicare benefits grow or contract. Both in the case of PPACA and the Wyden-Ryan plan they are fall-back formulas related to how much the government will spend if -- respectively -- cutting hospital/SNF reimbursements (PPACA) or competitive bidding (Wyden-Ryan) don't work.
- The caps relate to government spending, not to Medicare benefits.
- For example, Wyden-Ryan looks like it would foster some useful high-deductible, HSA-based Medicare policies with catastrophic coverage, policies that are increasingly popular among those under 55 today but not available to those of us on Medicare. Someone might say such policies have less benefits but that would not be because of GDP cap. (In fact, such policies might work to make sure the caps never came into play.)
- 2. We need to understand what role private insurers should play in the (Medicare) system? Does he mean...
- How much more than private insurers' 100% involvement currently? Private insurers currently are totally involved in all aspects of Medicare. Parts A, B, C and D are all equally administered by private insurers today. (Of course, how private insurers are involved varies depending on how the government writes its contract with them and what the different Parts of Medicare cover.).
- Or does he mean how private insurers would be involved providing something supplemental to whatever Medicare reform is finally decided on? In addition to the private insurer involvement today in all Parts of Medicare, private insuers have a very heavy involvement in private insurance from former employers and in individual Medigap policies.
- By my method of calculating, over 90% of seniors depend on private insurers today for their healthcare insurance. Democrats would say it's only 65% but it's still high
- (Note that the Bloomberg author correctly uses the word "insurers" and not insurance; only the supplemental policies are actually insurance.)
- 3. We need to know the pros and cons of reducing reimbursement rates and other price control-like measures? I think Nixon et al taught my generation the pros and cons of that in 1973 (as FDR taught my parents in the 1940s) but -- OK -- all you younger guys should get a dose of price control too. We'll actually already know the pros and cons of price control in healthcare by the time this debate gets underway from the then looming price control failure in Massachusetts.
-- Dennis Byron
(By the way PPACA cuts also apply to skilled nursing facilities as well as hospitals. That difference may seem trivial to the author but the difference is not trivial in the Medicare world. I hope the Bloomberg author's mom suggests he duck out of this subject until he catches up with rules.)