So Much For People To Learn About Medicare Reform

There is so much more for people to learn about the various Medicare proposals out there. Many people I talked to were surprised to learn that both the Ryan and the Obama Medicare proposals reduce the growth of federal outlays on Medicare by very large amounts compared with current law, as Dan Kessler and I pointed out in our article in the Wall Street Journal this week. In commenting on our article Arik Roy emphasizes this little known fact (he had pointed it out earlier), suggesting that “an excellent reform plan for a GOP Presidential candidate to take up: the Ryan plan, tweaked to adhere exactly to the Medicare target growth rates advocated by the President…Such an approach would completely neutralize the charge that Republicans (or Democrats, for that matter) were unfairly cutting Medicare, and allow the candidates and the country to have a more substantive debate.”

Some commenters on our article were surprised to hear that President Obama even had a Medicare proposal, assuming that reform was part of Obamacare passed last year. But the Obama Medicare reform proposal was just put forth in an April 13, 2011 speech. Here is the fact sheet from that speech which calls for "setting a more ambitious target of holding Medicare cost growth per beneficiary to GDP per capita plus 0.5 percent beginning in 2018, through strengthening the Independent Payment Advisory Board (IPAB).”

Some commenters said that people could learn more about the proposals with a numerical side-by-side comparison of federal outlays under the two proposals going out into the future. Well I agree, and CBO has prepared such a comparison of current law versus the Ryan plan, but they said they could not estimate the impact of the April 13 proposal because the Administration did not provide enough information in the proposal. Here is a video of CBO Director, Doug Elmendorf, explaining that “We don’t estimate speeches. We need much more specificity than was provided in that speech for us to do our analysis.”

Some questioned our claim that physicians have begun requesting additional fees—‘concierge’ or ‘retainer’ payments—from Medicare beneficiaries to remain part of their practices, saying that they are illegal. But such fees are legal if the doctors accept Medicare and charge on top of this for services uncovered by Medicare, such as telephone or email consultations, though one can see fuzzy lines between this and billing extra for a covered service, which is illegal.

Some were surprised to hear that the Ryan reform proposal is much like the already existing Medicare Part D, which benefitted many at much less cost than experts predicted. This should help remove doubts—which obviously still exist in some quarters—that markets and competition can be a positive force to create better services for each dollar spent.