Filed Under:Health Care
Seniors are squeaky wheels in the political system. They complain, they vote, and they're growing in number. If they seem querulous and wary about health reform, let's face it: This group, with its very own single-payer government health care program, has a lot of turf worth protecting.
We've had our summer of unhinged talk about death panels and sniping over which party is a bigger threat to Medicare. But now the major congressional health bills from the House and from the Senate are finally on the table, and it's time for a reality check.
There are 43 million people on Medicare and it looks to me like they are going to fare pretty well. By which I mean, they'll have to endure no more inconvenience and dislocation than what the rest of us put up with under the current "system," and probably less.
Let's first look at some of the upside for seniors (a group that includes my parents and, in three years, will include my husband):
-- Help with prescription drug costs. One-quarter of those in the Medicare prescription drug program end up falling into a coverage gap -- the infamous doughnut hole -- and must spend nearly $4,000 of their own money before coverage kicks in again. The Senate bill would cut the price of brand-name drugs 50 percent for people in the gap, while the House bill would phase out the gap entirely.
-- Both bills cancel a 22 percent cut in reimbursements to doctors that is scheduled to take effect next year. That will make doctors more likely to continue to accept Medicare patients, so people can keep their doctors. Primary care doctors, in short supply, would get bonuses.
-- Both bills improve preventive care and wellness benefits. Seniors would get free annual check-ups. Deductibles and co-pays would be waived for preventive services. Vaccines would be added to Medicare coverage.
-- The House bill would reimburse doctors for talking to patients about end-of-life care – voluntary discussions of what patients want to happen and how to make sure their wishes are known and followed. This is what exploded into the death-panel frenzy – "an extraordinary lie," as President Obama said. But it disturbed some rational people too. It is not in the Senate bill, though it seems like a benefit some patients would value.
-- Both bills have incentives and pilot programs designed to bring about patient-centered care that is better coordinated and more efficient. That's a huge deal, given that older people often are seeing multiple doctors and taking multiple medications. "Too many people receive fragmented care," says David Certner, legislative director for AARP. "This can save them money and, more importantly, improve the quality of the care they're getting."
Now for the downsides. Whenever you mention Medicare and saving money in the same sentence, beneficiaries get nervous and political rivals get pumped. So what are we talking about here?
-- Both bills would cut subsidies for Medicare Advantage, private plans that cover one in five Medicare beneficiaries. The Advantage plans now cost 14 percent more than regular Medicare, according to the independent Medicare Payment Advisory Commission. MedPAC says half of the overpayment goes to profits, marketing and administrative costs. This is the opposite of the cheaper, more efficient model Medicare Advantage was advertised to be.
The subsidy cuts are designed to make the plans more competitive, but some insurance companies probably will drop policies or services instead. That would upset Medicare Advantage participants. But the 80 percent of people in traditional Medicare would no longer have to pay higher premiums to subsidize Medicare Advantage. The feds would save $156 billion over 10 years and Medicare overall would be more sustainable.
-- To improve care and get a handle on rising costs, Obama wants to strengthen or replace MedPAC and make it more like the base closing commission. The idea is to insulate members of Congress from political pressure. Recommendations, mostly in the area of payment rates and incentives for doctors and hospitals, would go into effect unless Congress vetoed the whole package on a yes or no vote.
The Senate would not let such a commission ration care, raise taxes or change benefits or eligibility standards. Would services improve and become more efficient? Would doctors and hospitals leave Medicare? Unclear. But deficit hawks say an independent commission with teeth is the only serious way to make Medicare fiscally sustainable over time.
-- The House bill creates a research center, much promoted by the administration, to study the comparative effectiveness of different treatments and drugs. Whatever the findings, the center and a new commission overseeing it would not be allowed to mandate policies on coverage, reimbursement or anything else to private insurance companies or Medicare.
Even with all the cautions and restrictions, there are bound to be changes in Medicare. There have to be, in order for the system to survive over the long term, and surely that's in the interest of every person who relies on Medicare. There may be some disruptions as the changes are made. But how different is that from what other Americans are dealing with?
If Medicare beneficiaries get to keep their longtime doctors, they'll be doing a lot better than many of us. If they have to make just one switch -- from Medicare Advantage to traditional Medicare -- they're doing better than those who are tossed around from employer to employer, insurance company to insurance company, in a churning economy.
They're also more likely than the rest of us to be heard by the deciders in Washington. Seriously, who's got more influence -- people with coverage from private companies accountable to Wall Street, or people with a government plan overseen by elected officials? No politician or party wants to tick off 43 million people.
Speaking of which, Vice President Joe Biden, 66, is heading this week to a retirement community near Washington to talk health reform. Think of him as the administration's new health reassurance czar. Obama can only hope this diplomatic mission goes better than Biden's summer outreach to Russia.