Stephen Parente’s grand bargain, ctd.

Presuming you’ve read Don’s post and Parente’s column, my two key points are:

  1. It matters a great deal how defined contribution levels are set and how they grow. Would they erode relative to premiums? Relative to incomes? See competitive pricing posts. (Yes, I need to do a FAQ on this.)
  2. It matters a great deal how federal contributions to state Medicaid programs are set. Would they be tied to local economic conditions so that states are able to handle increased Medicaid demand during times of reduced state revenue?

Finally, somewhat related to this, I tweeted the half-baked idea of allowing 55-64 year olds to enroll in a “defined contribution” like Medicare program. Then, at age 65, individuals choose to either remain in that program or to enter a CER/IPAB/ACO-driven “traditional” (neo-traditional?) public Medicare option. The question is, would this be viewed as a step down the slippery slope toward Medicare for all or would it be viewed as a step down the slope toward dismantling Medicare as we know it? Is it Medicare expansion or destruction? Tricky one!

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