• JAMA Forum – Outcome of 2012 Election Will Likely Affect Medicaid Far More Than Medicare

    Last week, following President Clinton’s mention of Medicaid at the convention, I went on a tear blogging about Medicaid. Now that I’ve calmed down, I explain over at the JAMA Forum why this really is what we should be talking about as a difference between the two candidates.

    Go read!


    • I realize you wanted to write a piece emphasizing the fact that the differences in Medicaid under the two parties dwarf the differences in Medicare – and you’re right – but those first few paragraphs were really sloppy.

      “Republicans want to focus on consumer-level changes like premium support (a subsidy toward a health insurance plan) and competitive shopping. But if health care stays below GDP plus 0.5%, then neither really matters.”

      Although per enrollee Medicare spending is projected to decrease, I believe overall spending is projected to increase at greater than GDP plus 0.5% due to increased enrollment even uder current law. So, which approach is used will likely matter.

      And it will likely matter anyway – for the reasons you note. Unfortunately by framing it as democratic “claims” vs. republican “claims”, you make it seem like it’s all rhetoric.

      Under the republican plan, nearly all the increased cost and risk is borne by the beneficiaries – and the most at risk beneficiaries will suffer the most. Under the democratic plan, the majority of the cost and risk is borne by payers and providers – mostly hospitals.

      The whole point of ACO’s is to provide equivalent or better outcomes at similar or lower cost. The point of the IPAB is to allocate scarce resources to the most beneficial procedures if costs rise too fast. There are no equivalent devices in the republican plans.

      But you know all this. Still, you choose to present it as if it was all semantics.

      The real tragedy is that you easily could have made your point without doing this. You could have said that while there are significant difference in the way democrats and republicans would handle Medicare – and a lot of debate about those real differences – the differences in their medicaid programs are even greater but hardly discussed. and left it at that. If you had augmented your 5th paragraph and dropped paragraphs 2-4, the article would have been so much better.

    • Unfortunately, the perception is that Medicaid recipients are the undeserving poor, not our parents, peers and neighbors.