Medicare premium support checklist

Austin Frakt has pulled lots of info on what a complete Medicare premium support proposal would have to address. In policy terms this looks like a great list to me.The policy is hard enough, but the politics are the hardest part.

I would favor moving ahead to replace the current Medicare Advantage program with something like what Austin outlines, so long as it came as part of a deal between the two sides to move ahead with the ACA in a way that gives both sides some credit, but most importantly, that gives both sides some responsibility to seeing to the hard work of health reform. That work will not be completed in my life time (it will never be fully done). We really don’t have a hope of developing a sustainable health care system so long as health policy is mostly a political football.

I don’t think both sides in the health reform debate are equally culpable in terms of favoring politics over policy in health reform over the past few years, but the debate could use more straight talk from everyone. As an aside, I was introduced to someone as a “health policy expert” a few weeks back and they had a fairly perceptive take of the policy and politics of the recent health reform debate. They said, “do I have this correct?”:

  • Gov. Romney passed a reform in Massachusetts that tried to increase competitive forces in expanding private health insurance in Massachusetts. It has worked reasonably well but needs to do more on costs.
  • Pres. Obama tried to copy this idea nationally for people under age 65, and the Republicans said it was the end of the Republic.
  • Republicans want to try this same idea, but only for people age 65 and over, and the Democrats says this is terribly dangerous

A reasonable take, though I did point out that about half of the insurance expansions in ACA are via Medicaid.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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