Healthcare leaders on Medicare and Medicaid's legacy and future

Dr. Glenn Steele recently stepped down as CEO of Danville, Pa.-based Geisinger Health System and continues to serve as chairman of xG Health Solutions, a spinoff that markets Geisinger innovations. "Medicaid and Medicare were two of the most transformative programs that have ever occurred in healthcare in this country. That said, I believe they helped to freeze us in an anachronistic fee-for-service environment."

After founding and leading the Institute for Healthcare Improvement, Dr. Don Berwick was tapped by the Obama administration to serve as CMS administrator.
"Medicare and Medicaid can help set goals for the country and lay out a pathway for us on patient safety, on patient-centered care, and on making sure the care aligns with the best possible science."

Thomas Scully, now a partner in private equity firm Welsh, Carson, Anderson & Stowe, was a CMS administrator during the George W. Bush administration and played a key role in the passage of the Medicare Part D prescription drug program. "I think Medicare and Medicaid are both fabulous programs. But I would compare them to an old Scottish golf club. They're ancient and way out-of-date as far as how they run."

Dr. Louis Sullivan served as HHS secretary from 1989 to 1993 and was president of Morehouse School of Medicine for more than 20 years."One-third of our population benefits from these programs, and in a larger sense, all of us benefit from the programs by seeing that all of our citizens are receiving needed healthcare."

Sister Carol Keehan is CEO of the Catholic Health Association, which represents more than 600 Catholic hospitals and 1,400 other healthcare facilities. "Medicare and Medicaid represent American compassion and creativity at its best, both in the people who initiated them and in the thousands who have stewarded them for the benefit of the people they serve."

For the past 22 years Karen Ignagni was CEO of America's Health Insurance Plans and one of two predecessors that merged to form the trade group in 2003. After this interview was recorded, she announced she would leave AHIP to join insurer EmblemHealth.

Henry Aaron is a senior fellow of the Brookings Institution who focuses on Medicare, Medicaid and healthcare reform. "To the extent that we can bring the growth of healthcare spending under control overall, we will simultaneously improve the prospects of the Medicare trust fund and reduce the burdens that healthcare spending imposes on taxpayers."

John Bluford retired this year as CEO of Truman Medical Centers, the safety net system in Kansas City. He dedicated all of his years in healthcare to organizations serving vulnerable patient populations. "I've seen the roller coaster ride that especially Medicaid has been on because so much of it is controlled by the individual states. The challenge has been to keep up with the change."

Sandra Bruce is CEO of Presence Health, an 11-hospital Catholic system in the Chicago area. "I witnessed the transformation of healthcare in the 1960s due to Medicare and Medicaid as the elderly population and the poorest of the poor, in almost what felt like an overnight sensation, suddenly were walking around with cards that gave them entitlement and access to healthcare services."

Mario Molina's father started the company that's now Molina Healthcare as a network of clinics serving low-income patients. The health insurance company now has 3 million members in 11 states and Puerto Rico, predominantly in Medicaid managed care. "As a result of these programs, our most vulnerable members of the society don't have to fear that they will lack for healthcare."

Princeton University professor Uwe Reinhardt is a leading expert on U.S. healthcare policy. "People say traditional Medicare and Medicaid are broken. But people from Europe say the U.S. system is broken when if you lose your job you also lose your family's health insurance. That's a broken system."

Ruth Brinkley is CEO of KentuckyOne, a large health system in one of the few southern states that expanded Medicaid under the Affordable Care Act.

"I hope to see greater collaboration between Medicare and Medicaid, particularly to align their goals, contracts, and administrative programs to improve care management, particularly in dual-eligible populations."

Chip Kahn is CEO of the Federation of American Hospitals, a trade group representing more than 1,000 investor-owned hospitals and health systems. "Medicare's administration and payment policies have made it difficult for those who serve its patients to bring the most effective and efficient services to bear. On Medicaid, insufficient resources sometimes inhibit access for those who need that care the most."