If Medicare is turned into a voucher program one way to save big bucks is to let its benefits erode. But that’s dodging an awful lot. What do we mean by “let its benefits erode”? There’s no “letting” with Medicare. Every single millimeter of movement in the program is fought tooth and nail by armies of advocates for providers, insurers, and beneficiaries. Benefits will not simply be “let” to erode.
If there’s to be any change in benefits, it will have to be, at a minimum, justified on air-tight scientific grounds. As in, “No, we won’t pay for XYZ anymore because 15 clinical trials all showed that it doesn’t do anybody any good.” Even then, it will be darn hard to get the XYZ lobby to back off, to say nothing of the political party in the minority who will suddenly find a reason to defend XYZ as “Medicare as we know it” or to attack the party of anti-XYZ as secret lovers of rationing and death panels.
So, what if we tied Medicare to the rest of the health insurance system? What if everyone was in the same voucherized program? Call it the expansion of the ACA to the Medicare population or call it the expansion of Medicare to the rest of us. Either way, if the program is voucherized, should we worry about benefits erosion?
No! We should not. It only makes it less likely, not more so, that benefits would erode. With the entire population in the same boat, the pressure to keep the goodies flowing would be immense. If anything, there is a greater risk that we’ll explode the budget, not tighten it.
So, I’m really not that worried about benefits erosion. It doesn’t seem like a good reason to oppose voucherizing Medicare. Now, I do think there are good reasons to not voucherize Medicare in certain ways. I wrote all about it earlier. But I’m not seeing an erosion angle. Am I missing something?