Medicare Muddle

President Bush has fulfilled his promise of proposing much-needed changes to the Medicare program, but the delay in providing details unfortunately has put the White House on the defensive as the debate begins on this first-tier issue.

Political opponents and newspaper columnists around the country have filled the void with criticism of what is known about the plan – charging it will force seniors to lose their doctors and drive them into HMOs. It’s not true, of course, but what does that matter in politics?

The president’s vision is solid: Give seniors the choice of staying with traditional Medicare or selecting a new option that would allow them to join a competing health plan with drug coverage as part of the policy. The new plans would look more like Preferred Provider Organizations in which seniors could select a plan that has their doctor or doctors in the network.

The White House is struggling to keep domestic issues like health care in the spotlight, but it’s extraordinarily difficult with the Columbia tragedy, the threat of war with Iraq, and North Korea dominating the news. The difficulty was evident the day after the president’s State of the Union address when he gave another speech that was billed as a major Medicare presentation, but the president devoted only three minutes to the topic.

The president also has been criticized for not mentioning the uninsured in either speech, even though he devotes $89 billion over 10 years to refundable tax credits for health insurance in his budget. And the budget is full of other provisions that cheer a free-market heart, like unshackling Medical Savings Accounts and making them permanent, giving states much more flexibility with Medicaid, and ending the use-it-or-lose-it provision for Flexible Spending Accounts so employees can rollover up to $500 a year.

There are a lot of good ideas out there, both inside and outside government, to fuel a substantive debate over health care. For example, Tom Miller of the Cato Institute has a thoughtful piece called “Can Medicare Ever Graduate from Reform School?” with ideas to link Medicare payments to market prices and provide full cash rebates to seniors who choose plans that cost less.

But the debate is off to a rocky start, not what was needed for the White House or congressional leaders to take the offense on this important issue.

On a brighter note, as many of you know, the Galen Institute facilitates a group called the Health Policy Consensus Group that has been meeting since 1993. It’s made up of the best minds in the market-based policy community and has been crucial in generating the ideas to put consumers in the driver’s seat in the health sector.

And now there is a new Health Policy Consensus Group formed in the United Kingdom and chaired by our friend Dr. David Green, director of the Institute for the Study of Civil Society in London. Like ours, the UK Consensus Group is diverse; it includes a mix of experts from prominent Labour party members to representatives of market-oriented think tanks.

The UK group has developed a statement with six principles to guide reform, including advocating that “Patients should have a choice among a range of competing health care providers.” As different as our systems are, we are both struggling to achieve the same goals.

Congratulations and all success to this new Consensus Group. (Background: I traveled to London in 2000 to talk about the success of the US Consensus Group and to explain how productive it can be to get the best minds on health policy thinking together about big changes instead of arguing over policy details.)

And finally: Greg Scandlen’s new newsletter, Consumer Choice Matters, has been a big hit. There’s no better single source of information on cutting edge papers and developments on consumer driven health care. If you’d like to subscribe, please send us an e-mail at galen@galen.org.


Grace-Marie Turner

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President Bush has fulfilled his promise of proposing much-needed changes to the Medicare program, but the delay in providing details unfortunately has put the White House on the defensive as the debate begins on this first-tier issue.

Political opponents and newspaper columnists around the country have filled the void with criticism of what is known about the plan – charging it will force seniors to lose their doctors and drive them into HMOs. It’s not true, of course, but what does that matter in politics?

The president’s vision is solid: Give seniors the choice of staying with traditional Medicare or selecting a new option that would allow them to join a competing health plan with drug coverage as part of the policy. The new plans would look more like Preferred Provider Organizations in which seniors could select a plan that has their doctor or doctors in the network.

The White House is struggling to keep domestic issues like health care in the spotlight, but it’s extraordinarily difficult with the Columbia tragedy, the threat of war with Iraq, and North Korea dominating the news. The difficulty was evident the day after the president’s State of the Union address when he gave another speech that was billed as a major Medicare presentation, but the president devoted only three minutes to the topic.

The president also has been criticized for not mentioning the uninsured in either speech, even though he devotes $89 billion over 10 years to refundable tax credits for health insurance in his budget. And the budget is full of other provisions that cheer a free-market heart, like unshackling Medical Savings Accounts and making them permanent, giving states much more flexibility with Medicaid, and ending the use-it-or-lose-it provision for Flexible Spending Accounts so employees can rollover up to $500 a year.

There are a lot of good ideas out there, both inside and outside government, to fuel a substantive debate over health care. For example, Tom Miller of the Cato Institute has a thoughtful piece called “Can Medicare Ever Graduate from Reform School?” with ideas to link Medicare payments to market prices and provide full cash rebates to seniors who choose plans that cost less.

But the debate is off to a rocky start, not what was needed for the White House or congressional leaders to take the offense on this important issue.

On a brighter note, as many of you know, the Galen Institute facilitates a group called the Health Policy Consensus Group that has been meeting since 1993. It’s made up of the best minds in the market-based policy community and has been crucial in generating the ideas to put consumers in the driver’s seat in the health sector.

And now there is a new Health Policy Consensus Group formed in the United Kingdom and chaired by our friend Dr. David Green, director of the Institute for the Study of Civil Society in London. Like ours, the UK Consensus Group is diverse; it includes a mix of experts from prominent Labour party members to representatives of market-oriented think tanks.

The UK group has developed a statement with six principles to guide reform, including advocating that “Patients should have a choice among a range of competing health care providers.” As different as our systems are, we are both struggling to achieve the same goals.

Congratulations and all success to this new Consensus Group. (Background: I traveled to London in 2000 to talk about the success of the US Consensus Group and to explain how productive it can be to get the best minds on health policy thinking together about big changes instead of arguing over policy details.)

And finally: Greg Scandlen’s new newsletter, Consumer Choice Matters, has been a big hit. There’s no better single source of information on cutting edge papers and developments on consumer driven health care. If you’d like to subscribe, please send us an e-mail at galen@galen.org.


Grace-Marie Turner

SHARE THIS ARTICLE

About the author