The Kaiser Family Foundation released an ambitious plan to reform Medicare. The 216 page document includes 150 cost-cutting policies that amount to $9.4 trillion in Medicare spending cuts over the next decade.
“We’ve had everyone from President Obama and Sen. John McCain to Alicia Keys in this room,” Kaiser Family Foundation president Drew Altman said to an audience of a few hundred health policy experts. “We’ve never had a forum with a Talmudic document like this one, featuring every Medicare expert I admire most.”
The document is available online.
The reform document put the cuts into five categories:
- Doctor payments
- Delivery system reform
- Program structure
Kaiser is said to have spent a year reviewing literature and interviewing health policy experts. The consensus: Medicare spending is a going to eat up a bigger chunk of the federal budget over the course of the next decade.
Finding agreement beyond the budget issue could prove elusive. Kaiser invited three former Medicare administrators to talk about the future of the healthcare program. They all agreed that it makes sense to pay doctors based on quality measures, rather than quantity. They were divided on how much impact this change would have on the budget, and whether seniors would need to be asked to spend a bit more, too.
Gail Wilensky, who headed the Medicare program under President George H.W. Bush, suggests an approach that makes patients more aware of the cost of their healthcare.
“Whether there are ways to involve people more in better use of clinical services, or involve them financially in the consequences of doing things, it is much more prevalent in the under 65 population,” she says. “It’s rarely used for those over 65.”
Bruce Vladeck, who took over the department after Wilensky, disagreed. He suggests that financial barriers reduce quality.
“We have 30 years of data going back to the RAND study: Out of pocket payments reduce utilization,” he said. “Most medicare beneficiaries are below median income and need more health care services than privately insured people.”
The variance in opinions between the experts highlights the political difference in America, and why making meaningful changes is so difficult.