This is one question Vice President Biden should ask Congressman Ryan Thursday night October 11.
The Wyden-Ryan plan, co-developed by Congressman Ryan, explicitly fixes the life-time limits problem in "Medicare as we know it," implies it might do something about the co-pays and deductibles problem, and the two authors alternately both say their reform will work like Parts C Medicare Advantage or Part D Prescription Drug Plans work today (when Wyden-Ryan begins in 2022 if ever passed).
So which is it, Mr. Ryan? Is your and Congressman Wyden's plan like Medicare Part C or Part D? The answer is both and the Patient Protection and Affordable Care Act (PPACA) as well.
Here's why:
1. It's better to compare Wyden-Ryan with Part C Medicare Advantage because Part D drug coverage is so unique to one type of product, drugs. Comparing C with A/B makes more sense because
- Part C Medicare Advantage is mostly an integrated-care/global-payment (also known as capitation) plan and that is same as the Wyden-Ryan proposal and
- Medicare Parts A/B are mostly uncoordinated-care/fee for service (FFS) plans.
2. As a result, it makes even more sense to compare what Wyden-Ryan proposes to do for seniors with what PPACA -- ObamaCare -- proposes to do for non-seniors. ObamaCare is all about coordinated care and global payments just like Wyden-Ryan. ObamaCare also was supposed to include long-term care insurance but the Obama administration has chosen not to implement that feature of Obamacare (maybe a question Congressman Ryan could ask VP Biden).
There is a side issue that is always ignored by the Democrats. Vice President Biden is always saying that Medicare is public and Wyden-Ryan is private. But all parts of Medicare (A, B, C, and D) are equally involved with and dependent on private insurers under contract to the Centers for Medicare/Medicaid Services (CMS). CMS also heavily regulates Medicare Supplement plans (better known as Medigap) although they ARE truly private.
I have not seen anything that indicates which approach the Wyden-Ryan plan proposes to take in terms of coordinating with Medigap plans or the most popular current form of supplementary insurance for retirees, former-employer plans. To the extent that Wyden-Ryan is like Medicare Part C, there is usually no need for a supplement because most Part C Medicare Advantage plans reduce co-pays/deductibles and add other services such as eyesight exam. More important all Part C Medicare Advantage plans must include the catastrophic coverage that is not provided by "Medicare as we know it."
But in some cases, a Part C Medicare Advantage plan will provide relatively high co-pays and deductibles like Original Medicare's and no extra services above Original Medicare but do so at a lower cost to the senior (even sometimes giving a Part B premium rebate). Currently a senilor who chooses this no-cost option cannot also buy a Medigap policy but can get insurance from a former employer. It is not known how this would work under Wyden-Ryan.
3. One thing Wyden-Ryan specifically states is that it will supply help for low income seniors just the way they receive such help today. In this case, Wyden-Ryan perhaps should be compared with Medicare Part D drug plans because under George Bush's drug plan -- opposed by Vice President Biden when it passed and now -- low income seniors face no deductibles or donut holes and receive the insurance free and get low or no co-pays. As for supplemental insurance, for those that cannot afford a supplemental plan in Massachusetts, the state runs about a dozen supplemental welfare programs. I believe there are similar programs in all states.
Everyone agrees that "Medicare as we know it" is totally inadequate.
-- Dennis Byron
