Monday, November 28, 2011

Medicare Limits May Be Considered, Provider Preparations, CMS Follow Up

On the policy side, the "failure" of the Joint Committee -- let's face it, it's a failure of our politicians on both sides of the aisle, and not just with this Committee -- means that public awareness of funding issues related to pre-paid public benefits is higher than ever.  Indeed, policy makers already understand that some changes can be beneficial.  As a practical matter, preparation for the "mandatory" cuts now begins, and this scares providers, politicians, and consumers.  On the political side, it looks like there is no diminution from the inflexible Conservative Republicans of their anti-government stand.

A Shift In Basic Ground

"The supercommittee failed to strike a deficit deal, but the terrain still changed for entitlement reform.  And once Democrats -- starting with President Barack Obama -- gave ground on Medicare and other entitlements, it may be hard to take it back.  A year ago, Democrats dismissed as way too extreme ideas from the various deficit commissions about changing entitlements.  Democrats still vehemently oppose any move to radically restructure Medicare or Medicaid, as House Budget Committee Chairman Paul Ryan and other top Republicans propose.  But a lot of other ideas that were once taboo for Democrats are now part of the mainstream."

From that perspective, the Conservative Republicans have won a major victory.  They shifted the conversation to acceptance of (perhaps) severe changes to Medicare and Social Security.  However, we need to remember that they basically bullied their way into this winning position.  Now more than ever before, politics is HARDball.

A Dangerous Idea to Damage Medicare

"Though it reached no agreement, the special Congressional committee on deficit reduction built a case for major structural changes in Medicare that would limit the government’s open-ended financial commitment to the program, lawmakers and health policy experts say.  Members of both parties told the panel that Medicare should offer a fixed amount of money to each beneficiary to buy coverage from competing private plans, whose costs and benefits would be tightly regulated by the government."

"The idea faces opposition from many Democrats, who say it would shift costs to beneficiaries and eliminate the guarantee of affordable health insurance for older Americans.  But some Democrats say that -- if carefully designed, with enough protections for beneficiaries --it might [emphasis added] work."

This DOES sound like rationing -- of the worst kind -- a fixed and irrational dollar amount regardless of medical need.  But it has far too many unknowns.  I for one am not willing to take such high risks which can cause irreparable harm to the aged and disabled and be impossible to correct when proven tragically wrong.  Our pre-paid public benefits can change, but our commitment to the common good cannot.

Providers Ready To Take Offensive

"Automatic Medicare cuts triggered by the congressional supercommittee’s failure would hit hospitals harder than any other health industry, according to an analysis from Avalere Health.  The report puts hard numbers to across-the-board cuts that stakeholders have mostly viewed in broad, general terms.  But Avalere chief executive Dan Mendelson cautioned that the figures also assume the automatic cuts will actually happen -- an assumption he’s not ready to make.  The supercommittee’s cuts, if it had agreed on a deal, likely would have started next year.  But sequestration isn’t scheduled to begin until 2013.  'It gives the providers a chance to fight another day,' Mendelson said."

And EVERYONE will be fighting for another day.  This political season from now until the Presidential election and then beyond promises to be a mess for those who would rather see good sense carry the day.

Follow Up

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