As I was preparing to sit down and write this editorial, I was feeling immense pressure to come up with a laundry list of reasons why I should oppose President Bush's Medicare reform plan. The problem is, I like it. I like it because I understand it. I understand it because it mirrors the coverage choices that I, and millions of others with employer-based private health insurance, have to make every year.
The administration's proposal essentially offers seniors the same three options many employers offer their employees. Seniors would have a choice of traditional indemnity, PPO or HMO coverage. To better control Medicare spending, the proposal would create financial incentives to entice seniors into the cheaper PPO or HMO plans, with the strongest incentive being prescription drug coverage under the HMO option.
As readers of this magazine know, we like competition. We think competition between hospitals, between physicians, between insurers, between vendors, between suppliers and across all sectors of the healthcare industry helps control costs and expand and improve services to patients. The Bush Medicare reform proposal would inject a needed dose of competition into the 38-year-old program.
But the proposal won't pass Congress in its current form or anything even close to it. The problem with the plan is, it may match my expectations of what reasonable health insurance options should be, but it doesn't match the expectations of the 40 million people currently enrolled in the Medicare program. Those folks-with an average age of 75-expect to have unlimited access to high-quality healthcare services of their choice for free whenever they want it. Sounds silly, doesn't it? But just ask any Medicare enrollee what they think they deserve from the program and you'll see what I mean.
I'm sure a number of well-meaning people within HHS crafted the Bush Medicare reform plan. My guess is, most are between the ages of 30 and 50, and many have worked in the private sector where multiple insurance options are common. The proposal mirrors their experiences and expectations with and about health insurance in this country, not the experiences and expectations of those seniors currently enrolled in the program. Consequently, seniors will oppose the proposal and so will their constituency-sensitive lawmakers in Washington.
All-payer advocates will oppose the proposal because it would perpetuate a separate payment system for the elderly. Sectors of the healthcare industry that financially benefit from the current payment system will oppose the Bush proposal because it wouldn't perpetuate the status quo. So the proposal's chances of passage are slim to none, which means business as usual for providers.
One idea that may save the proposal is maintaining the same two-pronged coverage system for anyone currently enrolled in Medicare, and then offering the three-pronged approach to new enrollees only as they qualify for the program. Most new enrollees would better understand the expanded coverage options because many would have recently left the workforce.
Meanwhile, the grand political experiment that had Janet Rehnquist posing as HHS inspector general mercifully came to an end last week with word of her pending resignation. For 19 years under tough guy Richard Kusserow and then the no-nonsense June Gibbs Brown, the agency ably policed the Medicare and Medicaid programs for fraudulent activity. In her 19 months in the post, the inexperienced Rehnquist turned the agency into a candy store. If Medicare does add a third coverage option for enrollees, it's going to take someone who takes the job more seriously than Rehnquist did to ferret out the suspect activity that often comes with a new program.
What do you think?
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