LET­TERS: Ryan’s Medi­care plan has strengths, weak­nesses, read­ers say

Modern Healthcare - - FRONT PAGE - Steve Bren­ton Pres­i­dent Wis­con­sin Hospi­tal As­so­ci­a­tion Madi­son

Re­gard­ing “Ryan: Plan is bi­par­ti­san” (Aug. 20, p. 8), Con­gress­man Paul Ryan’s call for trans­form­ing Medi­care from the bro­ken sta­tus-quo model to a de­fined con­tri­bu­tion model is wor­thy of se­ri­ous dis­cus­sion. Es­pe­cially in states such as Wis­con­sin with ad­vanced lev­els of de­liv­ery in­te­gra­tion, provider or­ga­ni­za­tions could be es­pe­cially well-po­si­tioned to mar­ket them­selves di­rectly to fu­ture Medi­care ben­e­fi­cia­ries.

The key will be to suc­cess­fully man­age risk by tak­ing a more pop­u­la­tion healthori­ented de­liv­ery ap­proach and bet­ter co­or­di­nat­ing care. Con­trast this to the al­ter­na­tive vi­sion of a 15-mem­ber In­de­pen­dent Pay­ment Ad­vi­sory Board em­pow­ered to ar­bi­trar­ily re­duce provider pay­ments (and only provider pay­ments) in or­der to re­duce Medi­care spend­ing.

But as with most com­plex mat­ters, the devil will be in the de­tails …

The next 80 days or so will see some, but prob­a­bly not enough, se­ri­ous dis­cus­sion about Medi­care’s fu­ture. But, un­for­tu­nately, we will hear way too much over-the-top rhetoric in­tended to scare se­niors ahead of the Nov. 6 elec­tion.

But con­sider this: 1) Medi­care is al­ready bro­ken and un­sus­tain­able. The sus­tain­able­growth rate is a case in point. 2) Ma­jor new Medi­care cuts are in­evitable … and an an­nual global spend­ing cap likely. 3) The choices as to how 1 and 2 will be ad­dressed make for a very short list.

The Novem­ber choice comes down to: The fee-for-ser­vice sta­tus quo run by IPAB, or Medi­care largely paid for and de­liv­ered via a de­fined con­tri­bu­tion. The lat­ter, if con­sis­tent with the bi­par­ti­san Ryan/Wy­den pro­posal, would in­clude a “tra­di­tional” Medi­care op­tion. The weak­est part of the Rom­ney/Ryan plan may prove to be the 10-year tran­si­tion to a de­fined con­tri­bu­tion op­tion. We don’t have that kind of time.

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