• Burr and Coburn intro Seniors’ Choice Act

    Senator Richard Burr (R-NC) and Tom Coburn (R-OK) today will announce their Medicare reform bill, The Seniors’ Choice Act. Avik Roy gave me the text and has a lengthy post up and he is a fan.

    The devil is in the details, and with any premium support approach to allow Medicare beneficiaries to purchase private insurance, the most important detail is how the premium support amount will be set. The TIE FAQ entry on competitive bidding is required reading for anyone interested in this type of policy. The broad outline of the plan:

    • Maintain traditional FFS Medicare, but introduce a premium support approach designed to get traditional and private Medicare to compete. Again, the details are the key
    • Raise the Medicare eligibility age. TIE FAQ on that
    • New out of pocket cost maximum, unified across all parts of Medicare, with higher cost sharing for high income persons
    • Creation of a voluntary care coordination benefit
    • Repeal the IPAB. This one is particularly ironic given Burr and Coburn’s Patients’ Choice Act (introduced in May 2009), which I argue has similar boards with far more power than IPAB

    Politically speaking, this further reinforces that Republicans realize the plan to move to eventually do away with FFS Medicare altogether is a non starter. It brings about the move toward a new premium support approach sooner (2016) than does the Wyden-Ryan plan. As said now three times in this post, the details are the key for any premium support/competitive bidding approach, although I suspect that if there ever is a deal on Medicare it will be called premium support/competitive bidding. I need to look more closely at what is written, but the maximum out of pocket cost benefit and the means testing of this is worth a closer look. More later


    • Does the IPAB apply to Medicare Advantage plans?

    • The “National Health Expenditure Accounts” team reported in the January HEALTH AFFAIRS edition on their accounting of the 2010 cost of our nation’s healthcare industry: $2.6 trillion at $8,400 per citizen, representing 17.9% of the GDP. Using 13.4% of GDP as a benchmark for an efficient nation’s healthcare industry, the excess cost in 2010 represented an potentially excess cost of $650 billion in 2010 alone. We might quibble about the benchmark for a nation’s best performance GDP cost. But, the over-ridding issue for our nation’s healthcare reform is not insurance benefits, whether for medicare eligible citizens or for the citizens who lack health insurance. The over-ridding issue should be the development of uniformly available and equitably accessible Primary Health Care for each citizen, preferably a development process that is promoted by locally sponsored collaborative efforts. Improving financial access to healthcare will only drive-up costs if is not accessible or available. Please realize that our nation’s healthcare industry is not only highly inefficient, but it also has major gaps in the effectiveness. Our nation’s maternal mortality rate ranks 41st worst among the world’s 43 developed countries ( see “trends in MATERNAL MORTALITY: 1990 to 2008,” World Health Organization 2010).

      Basically, the preoccupation with insurance benefits is really only a manifestation of the paradigm paralysis that has engulfed our nation’s healthcare. Improving our nation’s Primary Health Care, neighborhood by neighborhood and community by community, is the linchpin for the achieving the future economic and social vitality of our nation. Without a reduction of 25% in the annual cost of our nation’s healthcare by 2020, our nation’s finances will soon achieve the disaster level currently being experienced by Greece.