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Critical Condition

NRO’s health-care blog.


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Premium Support Will Be Good for Seniors

House Budget Committee chairman Paul Ryan is working to save Medicare with his proposal to begin modernizing the program through premium support.

Joseph A. Antos of the American Enterprise Institute took the lead in developing a letter sent to congressional leaders last week endorsing this concept, and the letter was signed by 30 of our colleagues in the policy community.

The key message: “The budget resolution that will soon be adopted by the House of Representatives is likely to include a call for Medicare reform. The key to that reform is premium support, which can restore fiscal health to the program by promoting more efficient and effective health care for America’s seniors.”

Premium support “is a new way of structuring the financing of Medicare benefits that gives beneficiaries more control over their health choices and spending. Medicare beneficiaries would be granted an annual subsidy that reflects the costs associated with their health status and their financial wherewithal,” the letter explained. 

It’s essential that we get on a new path to a more efficient design for Medicare that doesn’t continue to rely on an antiquated model of government officials making decisions about what benefits will or will not be available to seniors and what providers will be paid through a web of regulations and price controls.

The concept of premium assistance was endorsed in the 1990s by a majority of the members of the National Bipartisan Commission on the Future of Medicare and last year by the Bipartisan Policy Center’s Task Force on Debt Reduction.

Opponents of the proposal have charged that Ryan is planning to voucherize Medicare.  But that shows a misunderstanding of the proposal. In contrast with vouchers, premium support allows for more flexible subsidies that can be adjusted and targeted to seniors based upon financial status, age, health status, or other considerations.

Moving Medicare toward sustainability means modernizing the program. And that means giving seniors more choices in a market competing for their business, as Part D has successfully done in a program that is popular and that also is saving taxpayers money.

Premium support is a path to save Medicare over the long term without increasing taxes or further increasing deficit spending as it continues to chase an unsustainable fee-for-service model.  

We can choose rationing, higher taxes, and more deficit spending — or 21st-century reforms such as premium support that put Medicare and seniors on a better path. There will be a choice.

— Grace-Marie Turner is president of the Galen Institute and co-author of Why ObamaCare is Wrong for America: How the New Health Care Law Drives Up Costs, Puts Government in Charge of Your Decisions, and Threatens Your Constitutional Rights.

New on Critical Condition. . .


COMMENTS   1

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Chris Burns
   04/05/11 14:33

There appear to be only two ways this new model of Medicare could possibly save money:
1. Clock down the value of the "premium support" payments, independent of the actual costs of health insurance
2. Wait for the cost of health care to decrease on its own, presumably in response to the fact that insurers will supposedly compete for seniors' business

Case 1 simply means we're pushing costs onto the individual balance sheet and off of the government's, which amounts to an accounting trick, since the costs remain.

Case 2 is wishful thinking of the worst kind. It's simply a blind application of the most simplistic notion of market economics. The problem is, that it will absolutely not work in this case. Non-elderly individuals without employer provided health insurance live in exactly such a market, except without the vouchers to assist in the costs. This individual also happens to be the most dysfunctional part of our health care system, and yields the least benefit relative to its costs.

The basic problem is that insurers do not want every applicant's business - many people are simply not profitable customers when it comes to health care. No one who ever needs a triple bypass surgery will be profitable. Individuals with a high risk of cancer will *not* be profitable to insure at any reasonable price.

This is the central problem of market-provided health insurance - you cannot make a profitable business out of it unless you are very very selective in who you choose to insure, or you tap deep into the taxpayer's pocket. Market forces will not produce the desired result, and it is naive in the extreme to close your eyes and simply believe it will.

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