Spring 2001; Volume 2, Number 1
Features: Medicare Symposium
Bruce Vladeck, Ph.D.
I thank Marsha Gold for her thoughtful and informative comments, and especially for emphasizing the needs of Medicare beneficiaries for greater financial protections than the program now affords. Her suggestions on ways to help meet those needs seem to be very much on point.
I also agree with Harry Cain that efforts to control fraud and abuse in Medicare - which were developed to address a very real and very malignant problem - have gotten out of hand, especially in their application to individual physician practices. There are ways to address that problem, however, without throwing out the baby with the bath water. My own particular preference would be to change the law to make clear that the False Claims Act does not apply to Medicare claims. That would eliminate the bounty hunters and whistle blowers, and the propensity for regulation by intimidation that some of the law enforcement agencies have demonstrated.
On the other hand, I'm not really sure how Cain would propose to solve the other problems he identifies with Medicare - which seem to consist primarily of the fact that it is complicated and subject to detailed Congressional oversight. Welcome to the twenty-first century! Should we amend the Constitution to limit Congress's prerogatives over 15% of the federal budget? Or simply give the money back to beneficiaries in the form of vouchers - something that we know will not work, and that beneficiaries don't want?
Cain, like others, advances the model of the Federal Employees Health Benefits Program as a potential alternative to the existing design of Medicare. Like many advocating such a position, he distorts the facts concerning FEHBP, especially the level of cost increases it has experienced in the last decade and the continuing withdrawal of plans.
As Gold notes - and as I noted in my article - there are many things wrong with Medicare that should be fixed. Most importantly, the benefits have to be improved, and coordination with supplemental policies strengthened. But if Cain's alternative is a hypothetical private market of a kind that has never existed and never can exist, I, and most beneficiaries, would prefer to keep what we now have.
about us | links | contact us | subscribe | epihc