You can tell it’s almost summer because the Legislative Session has finally come and gone in Minnesota (well, not exactly) and there still are many unanswered questions regarding healthcare. The trendy idea of demanding accountability from HMOs who gobble up $3 billion dollars in tax money every biennium and only belch up self-serving, non-informational reports, is but a memory. Fiscal hawks from both sides of the aisle who, as recently as 30 days ago, were demanding that HMOs show us their expenditures “clearly and concisely,” now seem content to have just mouthed the demand in the first place. Talk about your staying power. What does it take to right a wrong that has gone on for nearly three decades? To me that’s some really weak tea.
On the national scene there’s still a lot of talking, but little action. So far, one thing seems certain; any significant change proposed to alter Medicare will most assuredly trigger a “gray-nami” wave of action. Seniors really like their Medicare and any attempt to significantly change this most successful program will be met with powerful protests and strong resistance. Case in point:
Rep. Paul Ryan of Wisconsin has submitted a Medicare redesign plan, and *Peter Orszag writing in the Washington Post offered his analysis… ”At the heart of the Ryan plan is a shift within Medicare toward consumer-directed health care (vouchers) — which in turn is predicated on increasing beneficiaries’ ‘skin in the game’ to make the health system more efficient. While more consumer cost-sharing would help reduce unnecessary care, the plan would not live up to its billing in cutting health costs for America. According to the nonpartisan Congressional Budget Office, it would do the opposite. That’s right: The CBO found that the Ryan Medicare proposal (vouchers) would substantially increase total health-care spending… By 2030, health spending on the typical beneficiary would be more than 40 percent higher under the Ryan plan than under existing Medicare, according to the CBO report.”
I sometimes chuckle (or is it grumble?) when I hear healthcare “experts” stress the need for seniors to have more “skin in the game” in order for them to be better consumers. Who has more “skin in the game” right now than seniors? Most of them have paid into the Medicare system their whole lives in confidence and believing that the program they helped fund would be there when they needed it most. Those folks in Congress who want to throw the Medicare program up in the air and just grab a few pieces of it as it falls are in for quite a shock; seniors and seniors-to-be are in love with their single-payer (Medicare) system and won’t stand for a total restructuring. They will revolt with their precious dollars and with their votes.
Another chuckle(?) I get is when I hear the folks in the Minnesota legislature talk about the revolutionary new idea they have for reshaping the healthcare system with “Accountable Care Organizations,” or ACOs for short. The short version of what the new ACOs will do is simply shift a large part of the financial risk from the (current) insurance companies and HMOs, directly onto the backs of the direct care providers (hospitals, clinics, doctors, etc). It does not reduce cost, it will not improve access, and it certainly won’t improve quality of care (talk about lose-lose-lose). The only change that occurs is that direct care providers would then have more “skin in the game” for delivering services. Seems like I’ve heard that phrase somewhere before. It’s just the newest iteration of the HMOs with a brand new name, but with the same old issues that have made them undesirable and unworkable. The only change is shifting the party at risk; from HMOs onto the backs of the direct-care providers.
My suggestion is that when your hear the words “ACO” or “voucher” or “skin-in-the-game” used in a healthcare proposal, simply repeat to yourself “re-run.” Or, better yet, scream it out if you’re in a crowded room and you want to make the point of calling someone’s bluff. It’s repackaged floor sweepings and nothing more, and if allowed to become part of this broken system will only make it worse, not better. Be wary and vigilant.
*Peter R. Orszag, is vice chairman of global banking at Citigroup and an adjunct senior fellow at the Council on Foreign Relation and was the director of the Office of Management and Budget.