Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors
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A longstanding complaint from health plans is the differential treatment of private plans as compared to fee-for-service Medicare. The executive order proposes leveling this playing field with multiple opportunities for positive change in not only program administration but also in rulemaking and legislative activity.
To capitalize on the budgetary and care coordination benefits of MA for both beneficiaries and government, CMS could modify the enrollment process to promote auto-enrollment into high-performing MA plans. This would likely require additional legislative authority and could prompt objections by progressive Democrats. However, it would help shift the balance from an open-ended financial commitment—fee-for-service Medicare—to a risk-adjusted capitated-plan product—MA—thus facilitating long-term budgetary control over the Medicare program.
Further changes in payment rates are also proposed, which is likely to bring vigorous, or even rancorous debate. Increasing Medicare fee-for-service rates to commercial rates as specified in the executive order would likely be financially unsustainable, stressing the already strained financial footing of the Medicare program—the latest Medicare Trustees Report estimating depletion of the Hospital Insurance Trust in 2026.
Comment by Don McCanne of PNHP: Congress and both Republican and Democratic administrations have periodically introduced policies that benefit the private Medicare Advantage (MA) plans while neglecting much needed reform in the traditional fee-for-service Medicare program. The goal has been to convert Medicare into a private, market-based program by giving the private MA plans a competitive advantage over traditional Medicare. The current Presidential Executive Order seems to be an effort to abandon, for the present, the goal of “shrinking Medicare and drowning it in a bathtub” to one of converting traditional Medicare into a market-based program which then would have to compete with the private plans, or perhaps be assimilated by them.
The Executive Order calls for specific actions to move the process forward. But this is not new; it has been going on for decades.
As an example, Gail Wilensky – coauthor of the Health Affairs article above – has been fighting for years to prohibit supplemental Medigap plans from covering the deductibles under Medicare. A point that is dear to the pro-market advocates in health care is that people who need medical care must feel the pain of “having skin in the game” by requiring out-of-pocket payment as a condition of receiving health care services. Wilensky won. Next month insurers will be prohibited from issuing new Medigap plans that protect beneficiaries from exposure to deductibles (grandfathered plans will be phased out by attrition).
Another example is that each year Democratic legislators have joined their Republican colleagues in pressuring CMS to ensure that the private MA plans receive very generous taxpayer contributions which has resulted in their stellar performance on Wall Street. (Do campaign contributions constitute a quid pro quo?)
As Miller and Wilensky state, “The Medicare executive order represents a vision for a market-based Medicare program.” The transformation is almost complete. Our vision of health care justice for all through a single payer model of reform will be much more difficult to achieve if we not only have to enact and implement an improved Medicare for all but we also have to drain the swamp created by the medical-industrial complex and their market-based approach to health care. Keep in mind that the insurers and the venture capitalists and their brethren are taking over and becoming the health care delivery system. If you check the smoke signals, they are already well positioned to dictate the terms of reform.
Our inertia has been quite effective in letting us get to this appalling state of reform. Miller and Wilensky state, “Now is the time to try something different.” Well, yes. The single payer model of an improved Medicare for All. But continued inertia won’t get us there.
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction
December 13, 2019 at 8:46 AM #237957rampartParticipant
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“protecting and improving” my azz. do they really think people are doing unnecessary medical procedures because someone else pays the deductible?
ok, i’m sure there are such people (or, more likely, such doctors) but most people want as little health care as possible, and should be incentivized to detect problems as early as possible.
December 13, 2019 at 9:06 AM #237959algernonParticipant
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End that bafflegab! Elect a gov’t with the brains to bring in an universal system of healthcare, of a standard that can hold up as ‘civilized’ in this world.
Is the USA too stupid to do that?
December 13, 2019 at 2:36 PM #238009snotParticipant
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“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
– Upton Sinclair, Oakland Tribune 1934-12-11, “I, Candidate for Governor and How I Got Licked” by Upton Sinclair, Quote Page 19, Column 3, Oakland, California. (Newspapers_com) ↩
Destruction is easy; creation is hard, but more interesting.
December 13, 2019 at 3:35 PM #238033D503Participant
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Short answer: most likely.
"Violence is the last refuge of the incompetent." - Asimov; "If you push something hard enough, it will fall over." - Fud's First Law of Opposition
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