Medicare

Conservative healthcare analyst Avik Roy is rekindling debate over the virtues of government-run health insurance with a new post questioning Medicare's alleged efficiency over private healthcare. 

On his Forbes blog, Roy resurrects a 2009 Heritage Foundation study that throws into question the conventional wisdom that Medicare's administrative costs are much lower than those of private insurers. The conclusion matters greatly as lawmakers debate proposals to keep the nation's safety-net programs solvent.

"There needs to be an honest discussion of how well those programs perform as compared to the private sector," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

The Senate Finance Committee has dropped cuts to Medicare payments for medical imaging as a pay-for for trade legislation.

Instead, the revised chairman's mark would divert penalties from physicians who fail to adopt electronic healthcare records by 2015, as called for under the 2009 HITECH Act. The law requires the penalties to be diverted to the Medicare Improvement Fund after 2019, but Finance Committee Chairman Max Baucus (D-Mont.) is proposing to delay that by a year, freeing up the penalties to be used elsewhere.

Stakeholders immediately praised the decision.

Anti-tax activist Grover Norquist said Wednesday that he supports the Medicare plan released by Sens. Joe Lieberman (I-Conn.) and Tom Coburn (R-Okla.)

Norquist said “ideal” Medicare reform would look more like the proposal from Rep. Paul Ryan (R-Wis.), which would convert Medicare into a sort of voucher system. But Lieberman and Coburn’s proposal would improve the program without raising taxes, Norquist said.

The Lieberman plan would require higher-income beneficiaries to pay more out-of-pocket costs and raise the Medicare eligibility age to 67.

“The alternative would be raising taxes, cutting benefits for less affluent seniors, or going into unsustainable levels of debt,” Norquist wrote in a letter to Lieberman and Coburn.

Coburn broke with Norquist in April to support including some tax increases in a deficit-reduction agreement. Lieberman, however, said Tuesday that he dropped a proposed income tax hike from his Medicare plan in order to win Coburn’s support.

“Your outline gives a path forward for Medicare should fundamental reform not be achieved,” Norquist said in his letter to the senators. “Most importantly, and pending a full score, the Coburn-Lieberman outline appears to address Medicare’s problems without raising taxes.”

Secrets, secrets: The Obama administration abruptly canceled its plans to use "secret shoppers" to figure out how difficult it is for a person to find a doctor.

The initiative sparked a firestorm after The New York Times wrote about the plan on Monday; on Tuesday afternoon the Health and Human Services Department said it was pulling the plug. Doctors said the survey would only confirm what's already widely known: there is a shortage of primary-care doctors.

Healthwatch has the story.

Lead balloon: Sens. Joe Lieberman (I-Conn.) and Tom Coburn (R-Okla.) said they expected a negative reaction to the Medicare plan they released Tuesday. And they got it.

House Minority Leader Nancy Pelosi (D-Calif.) said the plan is “unacceptable” because it would roll back existing benefits. Senate Majority Leader Harry Reid (D-Nev.) called it a “bad idea,” while AARP, the nation’s largest seniors’ lobby, said it’s the wrong approach to reining in Medicare costs.

“Medicare represents the bedrock of health security for older Americans,” AARP said. “By relying on cost-shifting and reduced coverage for around 95 percent of the plan’s total savings, the proposal would threaten that security and risk putting Medicare out of reach for millions of seniors in the program."

The reason: Lieberman’s plan is unpopular with Democrats and their allies because its savings come from the very place Democratic leadership has insisted is off the table — benefit cuts. Party leaders are sure they have a political winner in the House GOP’s plan to dramatically overhaul Medicare and have tried to lock down that advantage by taking a hard line against any benefit cuts.

But the plan that Lieberman and Coburn outlined Tuesday includes plenty of benefit reductions and cost-shifting to seniors. It would extend Medicare benefits to fewer people and increase the cost of prescription drugs.

Healthwatch’s Sam Baker has the details.

Lieberman and Coburn's proposal includes several politically risky benefit changes.

More than 100 groups representing doctors said Monday that an agreement on the U.S. debt ceiling should include a permanent fix to the formula that Medicare uses to pay doctors.

Republican negotiators have poured cold water on the idea of using the debt-ceiling vote to tackle the "sustainable growth rate" formula (SGR). But the American Medical Association and other doctors groups say the two go hand-in-hand.

The SGR has become a perennial headache for doctors and Congress alike. The formula calls for a payment cut of nearly 30 percent in January 2012 — when the latest temporary fix is set to expire. Congress consistently blocks scheduled cuts from taking effect, and has to come up with new offsets each time.

According to the AMA, a permanent SGR repeal would have cost $48 billion in 2005 — compared with a price tag of nearly $300 billion to block the cuts that are scheduled for January.

"An agreement on the debt ceiling legislation provides the best — and perhaps only — opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner," the AMA and other organizations said Monday in a letter to President Obama.

The letter was signed by 112 medical groups.

The multimillion-dollar ad buy comes as lawmakers have been discussing deep cuts to healthcare spending

Congressional Republicans have had some success in shifting the healthcare debate back to the reform law, but speculation about health entitlement cuts in a debt-ceiling deal could thwart their momentum.

After weeks of dominating the healthcare headlines, Rep. Paul Ryan’s (R-Wis.) Medicare proposal has taken a backseat to heightened criticism of the Affordable Care Act. Republicans are renewing their assault on the law’s Independent Payment Advisory Board, which they say will "ration" care.

The GOP also seized on a report that up to 3 million middle-class families could become eligible for Medicaid because of the reform law.

But with negotiations over the debt ceiling and spending cuts reaching a critical phase, the focus is likely to shift away from the reform law and onto entitlements.

A private sector partnership between insurers, hospitals and physicians says federal regulators can learn from their model

Any chance of a bipartisan deal on the deficit faded quickly Thursday as the top Republican pulled out of bipartisan debt-ceiling talks, leaving the future of Medicare cuts up in the air.

During a Senate Finance Committee hearing on the healthcare entitlements, Chairman Max Baucus (D-Mont.) said he was "disappointed" with House Majority Leader Eric Cantor's (R-Va.) decision to quit the talks. Baucus went on to say that any Medicare cuts would have to be accompanied by revenue increases, raising questions about what exactly he had in mind.

"Senator Baucus continues to fight for Medicare, and made clear at the hearing that no changes in Medicare will be made unless Republicans agree to use revenue — in addition to spending reductions — to reduce the deficit," a Finance Committee aide told The Hill. "Any Medicare changes or savings would build on the type of efficiencies made in the Affordable Care Act, while protecting guaranteed benefits for seniors."