A question came from a colleague about the Paul Ryan’s plan to balance the budget Medicare. Specifically, the question was whether someone on the Democratic side would ALSO be able to balance the budget and maintain the Medicare benefits to which Americans have become accustomed. In case you are also wondering, my answer is as follows:

If the question is whether or not there is the ability to maintain the provision of the services provided by CMS with a decreased cost, the answer is that the PPACA actually has provisions for this. Within the Affordable Care Act are provisions, which if enacted, will reduce Medicare liability (or revenue if you are a health care entity) both for the elderly (found here) and for the dual eligibles (found here) but at the price of taking some control away from the system and a reduction of dollars in the system. If ACOs work as intended, there will be less of a loss in primary care than there will be in specialty care (as evidenced here) but as of yet there are none in Alabama.
If the question is whether there is anyone who can provide services under the fee-for-service model and protect Medicare, the answer is no. Ryan’s 2011 plan doesn’t accomplish this. As outlined in 2011, it would cap “premium support” at $8,000 (roughly $2,000 less than 2009 US per capita spending though only $1,700 less than Alabama per capita spending (found here)). So, there would be less money in the system, no controls over product quality, and someone would still be liable for the additional costs once the beneficiary either was unable to get “insurance” because of cost or went beyond policy limits.
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