NYT editorial: “What About Premium Support”

I may not have written it exactly the same way, but I think the New York Times editorial on premium support is quite fair and reasonably complete. Given its brief length, they did a good job, particularly here:

The best proposal for premium support is one that gives beneficiaries choice while protecting them from any added costs if competition does not keep prices down. Enrollees would be given a set amount of money to buy a plan comparable to what Medicare now provides. If they chose a plan that cost less, they could pocket the difference. If they wanted better benefits, they would have to pay the added premium themselves. But if market competition failed to restrain costs, the federal government would increase the support given. So far, this idea has found no support among leading politicians, who apparently have less confidence in market forces than they claim.

Still, I will quibble. The last sentence ignores Rep. Hensarling’s endorsement of the Domenici-Rivlin plan, which is of the type described in this paragraph.* Hensarling was a supercommittee co-chair. Can’t we call him a “leading politician”? Also, reading the paragraph strictly, it is indistinguishable from the current version of Medicare (Romney’s vision is similar), which is not a form of premium support I would call “the best proposal.”

The one thing I wish the NYT editors had mentioned, and it would have only taken a few words, is that there is no reason to exclude traditional Medicare and the payment reforms planned for it from any premium support program. Among the biggest misunderstandings out there are that “premium support” means “private plans only” and that it is the antithesis of the IPAB, ACOs, and other payment innovations. Wrong and wrong.

* Yes, it included a GDP + 1% cap on top of a premium support plan that is precisely as described in the quoted paragraph. But that cap was for CBO scoring purposes since that office apparently is unable to score competitive bidding. This, by the way, strikes me as a major problem going forward.

UPDATE: In my first reading, I inferred more than the NYT actually said in the quoted paragraph. The post has been updated to call them out on the vagueness.


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