I spent a lot of time over on Maggie Mahar’s blog (and other places) wrestling (through comment streams in most cases) with the notion that very smart, very informed people believe that a federal health plan is the best step forward in our efforts to contain healthcare cost, increase access, and improve quality. This is what I learned.
1) The pro-plan crew will argue that Medicare in the past has done a poor job of managing the cost/quality balance because it had been handcuffed by the pro business Republican administration. Now that Obama is in charge, we will see big changes in the way reimbursement, quality/outcome measurement, and transparency into CMS activities are handled. If Medicare was managed poorly in the past, it won’t be anymore.
2) What is wrong with the nationalization of insurance if that happens as a byproduct? For-profit insurers by their very nature must put profit above policy holder needs. Their goal is to make money first, everything else second. The big non-profits don’t have an issue with a federal plan, why should you?
3) Medicare reimbursement will change to reflect pay for value. This will mean that medicare reimbursement will create incentives for better care, not more care as it does today. It also means that CMS will drive an agenda to collect outcome and cost data in order to make more informed policy decisions.
4) The bottom line with pro-plan camp is that they believe that the RIGHT government team (i.e. the Obama team) can drive change fast and effectively in a way that previous (even well intentioned) administrations could not. A public plan gives medicare even more power and thereby creates a better mechanism for driving unilateral change in the healthcare system.
Most seem to agree that reporting outcome data, improving price transparency, developing value based methods for evaluating care, and reforming payment schemes to incentivize better care, are all vital to success. A public plan would give CMS more power to get the job done. I can see the argument, but I dont agree with it. Medicare is a mess on almost every front and CMS has demonstrated very little ability to make progress. A multi-trillion dollar unfunded liability, poor coverage, poor reimbursement schemes, all contribute to an image of the stereotypical government bureaucracy. Is this the “insurer” you want coverage from…there aren’t any guarantees that they will be around to provide you with coverage when you actually need it in 30 years time. Before we go with Medicare for All, perhaps we should make Medicare Great for Some.