Entitlement reform is already law

I think I’ve established my bonafides on cost control measures here on this blog. I think we need them; I’d like stronger ones than we have in place.

But it’s odd not to regognize those we do have right now. A friend asked me this morning if I though President Obama would introduce some ideas about cost containment for Medicare in his speech on Wednesday. I’m baffled by that question, beause of course he will. They are already law; they’re in the PPACA. Here are the changes that will occur in 2012 alone, per the KFF:

  • Make Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care.
  • Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.
  • Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions.
  • Reduce annual market basket updates for home health agencies, skilled nursing facilities, hospices, and other Medicare providers.
  • Create the Medicare Independence at Home demonstration program.
  • Establish a hospital value-based purchasing program in Medicare and develop plans to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.
  • Provide bonus payments to high–quality Medicare Advantage plans.
  • Reduce rebates for Medicare Advantage plans.

Those are just for 2012. And those are just for Medicare.

Do I think all of them will work? I don’t know. But I don’t know if anything Rep. Ryan has proposed would hold either. But, unlike Rep. Ryan’s budget, they aren’t just “proposals”. They have also overcome the many, many hurdles that stop bills from passing, and are therefore the law of the land right now.

I do hope that President Obama articulates a competing vision for deficit reduction so that the media can acknowledge that a debate has begun in earnest. But, once again, let’s not pretend competing ideas don’t already exist and have for some time.



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