Today's column in the News and Observer looks at the debate about the legitimacy of cuts to projected Medicare spending to finance subsidies for the uninsured to purchase insurance.
First, it is good policy to cut back payments to Medicare Advantage plans; cost is too high for small benefit increase. Here is a link to the study (by Austin Frakt @ Boston University, and others) referred to in the column. Here is general info about the history of Medicare Advantage and the earlier versions. More general info from HCFO, a program of the Robert Wood Johnson Foundation.
Second, Medicare is commonly used to find savings any time there is an attempt to pare back federal spending on finance a new initiative....for the same reason Willy Sutton robbed banks (that is where they keep the money).
Third, eventually reductions in payment rates to providers (docs and hospitals; not the Medicare Advantage cuts talked about in the article) can have an impact on access to care for Medicare beneficiaries. Medicare needs reforms in how it pays for care as well....but Congress certainly doesn't need to write this line by line. There are some fairly good provisions in Baucus to allow for experiments in payment that will eventually lead us away from fee for service, and toward a more capitated payment system. This both creates incentive to provide good care and shifts some of the high payment risk to providers.
Finally, the notion of inter-generational war pitting Medicare beneficiaries against younger people really misses the fact that we all live in the same country, and we are connected. the younger generations have a responsibility to maintain Medicare to pay for the care of our parents, grandparents, and great grandparents.....and Medicare beneficiaries, esp the coming baby boomers, should realize that there are better and worse ways to do this.....and that those coming after them are there children, grand children and great grandchildren.