Ryan: Plan is bi­par­ti­san

The ‘time has come’ for pre­mium sup­port, he says

Modern Healthcare - - THE WEEK IN HEALTHCARE - An­dis Robeznieks

Wis­con­sin Rep. Paul Ryan’s se­lec­tion as the Repub­li­can vice pres­i­den­tial nom­i­nee has put Medi­care re­form back in the na­tional spot­light, as Ryan’s plans for trans­form­ing Medi­care into a “pre­mium sup­port” sys­tem gain re­newed at­ten­tion.

Of par­tic­u­lar sig­nif­i­cance is how Ryan’s plan to of­fer ben­e­fi­cia­ries fed­eral pay­ments to pick the health plan of their choice goes over with vot­ers in Florida and Penn­syl­va­nia— two pres­i­den­tial bat­tle­ground states with large Medi­care-ben­e­fi­ciary pop­u­la­tions.

Ryan, who fin­ished first last year on Mod­ern Health­care’s 100 Most In­flu­en­tial Peo­ple in Health­care list, was in­ter­viewed Aug. 2 by Mod­ern Health­care for an up­com­ing story, just nine days be­fore pre­sump­tive GOP pres­i­den­tial nom­i­nee Mitt Rom­ney an­nounced that Ryan would be his run­ning mate.

“We be­lieve con­sumer-driven, mar­ket­based re­forms do more to al­ter the cost curve of health­care in­fla­tion.”

— Rep. Paul Ryan

In the in­ter­view, Ryan em­pha­sized that pre­mium sup­port wasn’t only his idea or a Repub­li­can idea. He pointed out that he pro­posed last year’s Medi­care-re­form plan jointly with Ore­gon Demo­crat Sen. Ron Wy­den. Pre­mium sup­port’s ori­gins, he added, can be traced to for­mer Pres­i­dent Bill Clin­ton’s 1999 Bi­par­ti­san Com­mis­sion on the Fu­ture of Medi­care and its Demo­cratic co-chair, Rep. John Breaux of Louisiana.

“This is an idea whose time has come,” Ryan said. “And it’s a bi­par­ti­san idea.”

Ryan ac­knowl­edged that the idea takes some get­ting used to and said he knew that Congress would not pass last year’s pro­posal. “What Ron Wy­den and I tried to do was to plant the seeds of a bi­par­ti­san con­sen­sus,” Ryan said. “We knew we weren’t go­ing to pass it be­cause of the pol­i­tics. We did this to­gether to get the con­sen­sus­build­ing started.”

To that end, Ryan said the plan’s chances for ap­proval will greatly im­prove next year. “I’m ac­tu­ally pretty op­ti­mistic,” he said. Ryan said he heard from some of his “doc­tor friends” at the Wis­con­sin Med­i­cal So­ci­ety that his plan was the sub­ject of heated

de­bate at the an­nual Amer­i­can Med­i­cal As­so­ci­a­tion House of Del­e­gates meet­ing in June and that he has had “years of con­ver­sa­tions” about pre­mium sup­port with physi­cians in his state.

“I think it’s a good de­bate,” he said. Medi­care, Ryan said, can go in two direc­tions: to­ward gov­ern­ment-di­rected price con­trols as dic­tated by the In­de­pen­dent Pay­ment Ad­vi­sory Board or to­ward pre­mium sup­port, which he said “keeps the pa­tient­doc­tor re­la­tion­ship in­tact.”

“That to me is the best way to deal with costs and save this pro­gram,” Ryan said. “Com­pe­ti­tion does work.”

Ryan said he en­vi­sions a risk-ad­justed pro­gram in which ben­e­fi­cia­ries who need more sup­port get it and said that risk ad­just­ment is “some­thing CMS knows how to do.”

“Physi­cians are also in­volved in get­ting proper in­cen­tive align­ment fo­cused on qual­ity and cost,” Ryan said.

“This will help ev­ery­one: sick or healthy, wealthy and poor,” he added. “We can put so­ci­ety’s as­sets where they need to go and emerge from that with a sys­tem that is in keep­ing with our goals of in­no­va­tion, com­pe­ti­tion and qual­ity im­prove­ment.”

Ryan also said the U.S. should un­der­take health­care re­form on its own and “fix this on our terms” in­stead of bor­row­ing ideas from Europe.

“We be­lieve there are far su­pe­rior ways to get back to a pa­tient-cen­tered health­care sys­tem, the nu­cleus of which is the pa­tient and her doc­tor—and not the gov­ern­ment,” Ryan said. “We be­lieve con­sumer-driven, mar­ket-based re­forms do more to al­ter the cost curve of health­care in­fla­tion.”

Ryan said price con­trols won’t bend the health­care in­fla­tion cost curve and would lead to ra­tioning of ser­vices.

Ryan cred­ited his se­lec­tion last year as the most in­flu­en­tial per­son in health­care to his hav­ing had a seat on the House Ways and Means Com­mit­tee since 2001 and used that po­si­tion to fo­cus on the health­care sys­tem’s im­pact on health out­comes and eco­nomic and so­cial is­sues.

“It’s just some­thing I’ve im­mersed my­self in,” Ryan said. “What a lot of pol­i­cy­mak­ers have failed to grasp is how im­por­tant health­care is to our econ­omy and to our fu­ture.”

Ryan also pre­dicted that Congress would ap­prove an­other tem­po­rary post­pone­ment of a physi­cian Medi­care pay­ment cut in Jan­uary of around 30% un­der the sus­tain­able growthrate for­mula used to cal­cu­late re­im­burse­ment.

“I think the SGR is ridicu­lous and should have been re­placed long ago,” Ryan said, adding that he hopes to re­place the SGR next year with a for­mula that fur­nishes doc­tors with some­thing pre­dictable and ac­count­able so “we don’t have this can-kick­ing ex­er­cise ev­ery six months.”

While the SGR has not worked, Ryan said some­thing worse lurks ahead.

“I al­ways say to the doc­tors, ‘If you don’t like the SGR, just wait un­til you see what the IPAB has in store,’” Ryan said.

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