Modernizing Medicare and Medicaid should be the highest domestic policy priority. These programs have an obligation to provide high-quality care to America's seniors and low-income beneficiaries, and they must be made financially sustainable.
The first priority is to improve the quality of care. It is now widely recognized that fee-for-service medicine promotes the inappropriate use of services. Both programs should be moved away from siloed payments to providers and toward coordinated care that incorporates prevention and rewards quality outcomes.
For Medicare, that means building on the success of the Medicare Advantage program and improving its associated star-rating program for health plans. In Medicaid, it means greater reliance on managed care in the near term, and, ultimately, a move to portable private coverage enabling beneficiaries to keep the same plan and provider network as their circumstances change.