Later On

A blog written for those whose interests more or less match mine.

Health reform at last?

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Mike Lillis reports:

Earlier this month, during the fiery debate over how to preserve payments to Medicare doctors, scores of Republicans did the unthinkable: Bucking the White House, the insurance industry and even party ideology, they joined the thin Democratic majority to scale back funding for private plans operating under the federal health-care program.

To health-policy observers, the move was a stunner. Congressional conservatives have long sought to curtail government’s role in delivering health care by shifting more responsibility to the private sector. The GOP defections, which allowed Democrats their first major health policy-win in a decade, caused many commentators to suggest that Democrats’ plans for broader health reform might find unexpected legs in 2009.

“If the Democrats can win victories like this now,” New York Times columnist Paul Krugman wrote on July 11, “they should be able to put a definitive end to the privatization of Medicare next year, when they’re virtually certain to have a larger congressional majority and will probably hold the White House.”

A host of health policy-experts, however, have another message: Not so fast. Trimming some Medicare payments for the sake of preserving the program, they argue, is far easier to accomplish than the sweeping expansions of federal coverage that many Democrats have proposed.

“Medicare naturally makes for strange bedfellows,” Jacob Hacker, a political science professor a the University of California-Berkeley and the author of “The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream,” wrote in an email. “Both conservatives and liberals have an interest in keeping the program’s costs in line. The divisions are much deeper when it comes to expanding the role of government in health care — and the political fight will be that much fiercer.”

Others noted that the Democrats owe much to the looming elections for their Medicare victory. Faced with an enormous lobbying campaign from seniors and physician groups, they note, many Republicans voted largely to preserve their seats. This should not be mistaken for a change of heart on privatization, these experts say; rather, the Republicans’ support was simply a political calculation. With that in mind, the experts predict, the same partisan battle will likely resurface next year — making the Democrats’ major health-reform successes highly uncertain.

At issue is the five-year old Medicare Advantage program, which delivers Medicare services through private insurance companies. In recent years, it has become a leading symbol of the ideological differences between each party’s approach to health care. Republicans and other supporters argue that the private companies provide choice, treatments and efficiencies that Medicare cannot, while most Democrats and patient advocates say that removing the middle man would save Medicare much-needed resources.

The Congressional Budget Office has found that MA plans cost taxpayers roughly 12 percent more per beneficiary than traditional Medicare. For one particularly popular type of MA plan, called private fee for service, the divide is closer to 18 percent.

Continue reading.

Written by LeisureGuy

29 July 2008 at 10:50 am

Posted in Government, Medical

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