July 01, 2013
9:55 am
Even if we can’t find a way to eliminate ‘Mediscare’ political tactics altogether, shouldn’t we be able to at least limit retiree-scaring strategies to election years?
This weekend, Glenn Kessler, the Washington Post’s fact checker, pointed out that even odd-numbered years are open season for frightening seniors with outrageously misleading hyperbole. Kessler spotlighted a television ad sponsored by two political action committees, Patriot Majority USA and Senate Majority PAC, aimed at Congressman Tom Cotton (R-AR). The video accuses Cotton of supporting a plan that would “essentially end Medicare” and cost some seniors more than $6000 a year.
This ad is, of course, absolute nonsense that has been repeated — and discredited — many times before. Kessler, in fact, gave it his highest (or is it lowest) rating of “four pinocchios,” meaning it is highly deceptive messaging.
The two PAC groups are tying Cotton to an early iteration, since revised, of Congressman Paul Ryan’s (R-WI) Medicare reform plan. That plan, of course, wouldn’t end Medicare, but rather open the program up to participation by private health plans. And since the early Ryan version that the ad is referencing, the proposal has been revised to give seniors the option of remaining in conventional fee-for-service Medicare instead of opting for the private choice-and-competition plan.
Patriot Majority PAC and Senate Majority PAC know all of this, of course, but having a legitimate and necessary debate over Medicare’s future takes a back seat to using the program as a cudgel to pound down a political opponent’s approval numbers.
I don’t know if Congressman Cotton will be hurt by this ad but, regardless, he isn’t among the biggest losers here. Those would be the Arkansas voters who are being led to believe something that simply isn’t true, and current and future Medicare beneficiaries who need and deserve a genuine discussion over how to improve and sustain the program.
Mediscare tactics are deplorable enough in election years, but can’t we at least have one year out of every two in which we can have an honest conversation about the issue?
May 31, 2013
2:31 pm
Washington, D.C. has long had a tendency to avoid decisive action until crises make continued delays untenable. This being the case, there should be a great sense of joy and relief in the Nation’s Capitol over the Medicare Trustees pushing the projected date of Medicare insolvency two more years into the future, to 2026.
That would, of course, be the wrong way to look at this issue.
Whether it’s 2024 or 2026, the fact remains that Medicare insolvency is still where it shouldn’t be, on the foreseeable horizon. And with the number of retirees rapidly climbing and utilizing, on average, three dollars of healthcare services for every one dollar they paid in payroll taxes during their working years, the Medicare status quo is no more sustainable today than it was before the Trustees Report was issued.
(A side note here: Yes, there are those who will insist that insolvency is not really all that catastrophic, that there will still be sufficient revenues to pay 85 or 90 percent of benefit obligations and, anyway, Congress would never allow Medicare to fail in meeting beneficiary needs. I have no doubt this is true, but assurances like these gloss over the actions that would be necessary in order to make up for this financial shortfall – higher taxes, greater burdens on beneficiaries, further cuts in payments for Medicare services, or some combination of all of the above.)
Treasury Secretary Jack Lew was correct in saying today that we need to act sooner rather than later to address Medicare’s financial challenges. The longer we wait, the more draconian the remedies in trying to forestall insolvency.
And it remains true that solutions are right in front of us. The Medicare Part D program continues to be incredibly successful in keeping federal costs well below projections and in keeping medications highly affordable for seniors. Medicare Advantage plans are achieving health outcomes superior to the conventional Medicare fee-for-service program. What these two programs have in common are a reliance on consumer choice and competition to drive value, the same components that are central to the Affordable Care Act’s health insurance exchanges.
As we discuss Medicare’s future, it only makes sense to examine how the lessons learned from these already-existing success stories can be utilized to ensure healthcare security for future generations.
So, as we examine the 2013 Medicare Trustees Report, let’s focus not on the fact that insolvency is delayed by two years, but at the fact we’re still talking about insolvency at all. Then, let’s begin the discussion on how to remove that prospect from the imminent horizon.
April 04, 2013
10:13 am
A post by Sarah Kliff on the Washington Post’s Wonkblog site is getting a lot of attention this morning. She reported that cancer clinics across the country are turning away patients because sequester cuts.
Here’s the essence of this issue: Most pharmaceuticals are covered by the Medicare Part D program. That’s not the case with injectable drugs administered by a physician, such as those used for chemotherapy patients, which are covered under Medicare Part B.
Physicians are reimbursed for these drugs at the average sales price plus six percent – the six percent add-on is there to cover the costs of acquisition, storage and administering the medicines. For many physicians, particularly those in rural areas without the heavy patient volume to negotiate significant discounts, this reimbursement barely covers their costs, if it does at all.
So, when the sequester makes cuts in that Part B payment level, a story like Ms. Kliff’s results – that cancer centers aren’t seeing Medicare patients because the financial losses they would take on these drugs would force them out of business.
But, here’s the rub. During congressional deliberations over budget reductions, cuts in Medicare Part B drug payments were proposed….well before the sequester went into effect. Congress was, in fact, considering reducing the average sales price-plus-six percent payment level to ASP-plus-3%.
So, while the sequester cuts are hurting some patients, they are also providing an object lesson to policymakers. We can’t make Medicare or our nation’s health system better by constantly chipping away at payments for healthcare goods and services. Such cuts may help meet short-term budget targets, but the reduced access to critically-needed care is both unconscionable and counterproductive because of the increased acute care and hospitalizations that will eventually be required by sick patients.
It has been difficult for the White House and Congress to start serious negotiations on structural Medicare reform. Wouldn’t it be far better, though, to focus on health-affirming ways to make Medicare more financially sustainable and cost-effective than to continue with the kind of reimbursement nibbling that results in severely ill patients being turned away by caregivers?
January 24, 2013
10:18 am
Some suggest the Independent Payment Advisory Board (IPAB) is a beast without teeth. After all, President Obama has yet to nominate any individuals to serve on the 15-member board, and lower-than-norm Medicare spending increases suggest that IPAB wouldn’t be triggered to act anyway to cut Medicare costs. That’s the benign view. By contrast, the American Association of Neurological Surgeons in its Neurosurgery Blog referred to IPAB yesterday as “No Good Rotten Very Bad News for Medicare.”
On the whole, we believe the neurosurgeons’ perspective is the correct one.
Yesterday, Congressman Phil Roe (R-TN) and a bipartisan list of cosponsors introduced the “Protecting Seniors’ Access to Medicare Act,” a measure that would repeal IPAB. It’s imperative that Congress act on this legislation this year and not put the issue on a back burner in the mistaken belief that is not a real threat to Medicare beneficiaries.
As to the matter of the President not yet nominating anyone to serve as IPAB members, Margot Sanger-Katz pointed out in yesterday’s National Journal that IPAB’s power does not disappear with a lack of appointees. The board’s power doesn’t disappear, but rather shifts to the Secretary of Health and Human Services, still leaving the executive branch with unprecedented powers over Medicare spending that are traditionally (and, we believe, constitutionally) reserved for Congress.
Also, leaving IPAB in place creates a false sense of security that reforming the Medicare program is not an urgent imperative, that a failsafe mechanism is there to keep spending increases from becoming excessive. But, as I pointed out in my letter to Congressman Roe yesterday, “”the bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers. This will affect patient access to care and innovative therapies.” Certainly, the number of health providers refusing to see new Medicare patients because of comparatively low reimbursement rates on the increase, arbitrary IPAB cuts that focus on numbers without regard to access, quality or value represent an ill-conceived solution to Medicare’s financial challenges.
IPAB may not look particularly dangerous to millions of Medicare beneficiaries at the current moment, but it inevitably will be. It needs to be defused before it can do serious damage.
August 23, 2012
10:57 am
For all of the criticisms of this year’s presidential campaign being overly negative and personalized, I actually believe one of the most important failures of the campaign thus far is spotlighted in the New York Times/CBS News poll published in today’s Times.
Despite (or perhaps, because of) the millions of dollars in advertising focused on the issue of Medicare, millions of Americans still don’t understand that the Medicare program as it currently exists can’t last. The campaign has failed, to this point, in educating voters that the status quo – or, as some politicians like to say, Medicare ‘as we know it’ – isn’t a viable option.
The NYT/CBS poll revealed that in three key swing states (Florida, Ohio, Wisconsin), approximately 60 percent of respondents said they preferred that Medicare should continue “as it is today.” Now, to be fair, the other option given in the poll question was a 28-word description of the Romney-Ryan premium support proposal, and we know from work with focus groups that premium support is not a concept that can be adequately explained in just a couple of sentences.
It’s clear, though, to anyone that watches the nonstop TV advertising from political campaigns both national and local that there is much more interest in demonizing opponents over the Medicare issue than there is in actually enlightening voters on the subject. Thus, it’s not surprising that majorities of voters would prefer the safe ground of the Medicare status quo when candidates aren’t emphasizing that:
• The Medicare Board of Trustees has said that the program, as it stands today, will be insolvent in a little over a decade – in 2024.
• 10,000 Americans per day are turning 65 and will receive approximately three dollars in healthcare benefits for every one dollar they paid in payroll taxes over the course of their working years
• It is a misnomer to say that any measure that doesn’t cut Medicare benefits to seniors, but that reduces payments to providers instead, protects beneficiaries. An American Medical Association survey from 2010 already warns that one of every three primary care doctors won’t take new Medicare patients because of low reimbursements.
What we need to hear more frequently on the campaign trail is that voters do have a choice, but it’s not between changing Medicare or keeping the program as it is. Rather, voters need to decide how they want political leaders to change a program that can’t be sustained in its current form.
We have approximately 75 days left in the campaign to see that realistic discussion take place. Fingers crossed.
CATEGORIES: