December 2009 Archives

Would the leading Demcoratic health care reform proposals result in a better or worse Medicare?

One of Republicans' major criticisms of the Democratic plans under consideration is that they would take a chunk of money out of Medicare. Reducing payments to Medicare Advantage insurers, they say, would result in sliced benefits for seniors. In addition, the bills raise revenue by limiting spending increases for medical providers.

Democrats, along with some consumer groups, counter that the legislation would help Medicare beneficiaries, citing examples of closing the gap in prescription drug coverage called the "donut hole."

Would Democratic health care reform proposals hammer Medicare or help it? And would any negative hit be to beneficiaries, to medical providers or to both? On the whole, would Medicare be fiscally stronger or weaker as a result of Medicare changes? What kind of Medicare commission would help, and what's a waste of time?

5 responses: James P. Gelfand, Karen Davis, Stuart Butler, Gail Wilensky, Uwe Reinhardt

Is a Medicare buy-in for pre-retirees a good idea, and would it really make a difference?

When Senate Democrats last week began considering a proposal to let people ages 55 to 64 buy into Medicare, medical providers complained that they had already made concessions on health care reform, and that subjecting them to Medicare payment rates for this new population would further hit them in the pocketbook. Indeed, Medicare pays doctors less than do private insurers.

This is a very difficult population to cover with insurance. These people do not yet qualify for Medicare, and if they aren't working, then they don't have access to employer-sponsored coverage. Moreover, they are considered a poor risk for insurers, who often don't take them on a walk-in basis, or charge them high premiums. About 35 percent of adults in this age group were uninsured in 2008, accounting for 12.5 percent of all uninsured Americans, according to the Kaiser Family Foundation.

How much would a Medicare buy-in help this population, and would it have a positive or negative effect on the health care system?

7 responses: Grace-Marie Turner, Michael F. Cannon, John C. Goodman, Rich Umbdenstock, Newt Gingrich, Ron Pollack, Paul B. Ginsburg

When, and in what capacity, should President Obama escalate his role in the health care reform debate?

Unlike President Clinton, who presented Congress with a detailed health care reform proposal, Obama has mostly laid out principles and stayed away from taking positions on many controversial decisions. Indeed, Obama spent much of November in Asia, working on other issues.

While Obama's staff is engaged behind the scenes, what is the right time for Obama to assert his leadership, if at all? And how should he do it?

3 responses: Marilyn Werber Serafini, John C. Goodman, Drew Altman