So close to a happy retirement


Austin’s almost got me convinced that throwing competitive bidding in there could be the answer.

I don’t care about convincing the rest of you, if I could only push Aaron into the “let’s give it a try” column, I’d retire a happy man. Let me try this approach:

  • Do you like the status quo Medicare, including Medicare Advantage, and its costs? (I know Aaron’s answer to this.)
  • Do you like to see private plans paid well above FFS costs? (No, health reform did not change that.)
  • Do you think we’ll achieve “perfection”? (I know Aaron’s answer to this too.)
  • If your perfect Medicare is unachievable, what’s your best approach to taking a reasonable step that at least improves things without disrupting too much?
  • What’s an approach that acknowledges the political equilibrium of a hybrid public/private Medicare? (If you reject that this is a political equilibrium, I’ve lost you. But then you have to explain the last two decades and the simultaneous appeal — to some — of Rep. Ryan’s plan along with the appeal — to others — of traditional Medicare.)
  • What’s an approach that is aligned with all of the above, protects beneficiaries from the risk of support not keeping up with health care costs, reduces taxpayer costs, and preserves both private plans and traditional Medicare options?

I think competitive bidding does the trick. Some might be concerned that it relies too heavily on risk adjustment. I’ll address that tomorrow. Even if you have reservations, come back to how Medicare Advantage is paid now. Do you like it? Why?

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