Regarding “Ryan: Plan is bipartisan," Congressman Paul Ryan's call for transforming Medicare from the broken status-quo model to a defined contribution model is worthy of serious discussion. Especially in states such as Wisconsin with advanced levels of delivery integration, provider organizations could be especially well-positioned to market themselves directly to future Medicare beneficiaries. The key will be to successfully manage risk by taking a more population health-oriented delivery approach and better coordinating care. Contrast this to the alternative vision of a 15-member Independent Payment Advisory Board empowered to arbitrarily reduce provider payments (and only provider payments) in order to reduce Medicare spending. But as with most complex matters, the devil will be in the details … The next 80 days or so will see some, but probably not enough, serious discussion about Medicare's future. But, unfortunately, we will hear way too much over-the-top rhetoric intended to scare seniors ahead of the Nov. 6 election. But consider this: 1) Medicare is already broken and unsustainable. The sustainable-growth rate is a case in point. 2) Major new Medicare cuts are inevitable … and an annual global spending cap likely. 3) The choices as to how 1 and 2 will be addressed make for a very short list. The November choice comes down to: The fee-for-service status quo run by IPAB, or Medicare largely paid for and delivered via a defined contribution. The latter, if consistent with the bipartisan Ryan/Wyden proposal, would include a “traditional” Medicare option. The weakest part of the Romney/Ryan plan may prove to be the 10-year transition to a defined contribution option. We don't have that kind of time.
Steve BrentonPresidentWisconsin Hospital AssociationMadison