In an ungated NEJM Perspectives piece worth a full read, Marsha Gold summarizes the lessons from Medicare Advantage:
- Neither the private sector (Medicare Advantage) nor government (traditional Medicare) has a magic solution for controlling health care costs.
- Studies comparing Medicare Advantage plans with traditional Medicare in terms of quality of care are limited, but their results do not justify a large differential in payment based on quality.
- Medicare Advantage has increasingly attracted beneficiaries who seek to lower supplemental premiums, limit cost sharing, and consolidate their benefits, but cost sharing in the program can still be substantial.
- The highly skewed distribution of health care spending and the selection patterns of Medicare Advantage enrollees have meant that risk-adjusted payments are essential to an equitable private-plan offering.
- In the absence of strong oversight, Medicare beneficiaries are vulnerable to unscrupulous insurers who may use questionable marketing practices and offer products that may not meet expected performance standards.
It’s interesting to observe the extent to which these lessons are applied in premium support proposals or recognized by those promoting them. I hate to say it, but I detect some disconnect between researchers and policymakers on this front.
UPDATE: The other just-released NEJM Perspectives piece on Medicare Advantage, by Jeet Guram and Robert Moffit, includes a nice summary of how the plans are paid, as well as a defense of the program.