Berwick defends healthcare reform from GOP attacks

Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), is fighting back this week against Republican attacks on the new healthcare law.

Responding to recent GOP claims that the Democrats' reforms are a threat to Medicare, Berwick said Friday that, on the contrary, the healthcare law has made the program "stronger than it has been in years."

"It's no illusion to the seniors and people with disabilities who will pay less for prescription drugs, to the millions of Medicare beneficiaries who will have preventive care and check-ups covered without paying co-pays, or to the people who will be protected from fraud and abuse," Berwick writes in a Washington Post op-ed. "Under the act, Medicare is stronger than it has been in years, and seniors will get new benefits. That's no illusion; that's progress."

The comments are a direct response to another opinion piece penned last week by Michael Leavitt, head of the Health and Human Services Department (HHS) under former President George W. Bush. Also writing in the Post, Leavitt charged that the new healthcare reform law "has weakened" Medicare. 

"Worse," Leavitt wrote, "its changes create the perception of progress, making it more difficult to pursue the reforms that would put Medicare on sound financial footing so future generations of seniors will benefit."

The "perception of progress" was a reference to a recent projection from Medicare's trustees that healthcare reform will extend Medicare's solvency through 2029 — 12 years longer than predicted last year before the law was passed. 

Critics, including many Republicans, say that the math is illegitimate because it "double-counts" the savings generated under the bill, applying those funds both to extending the program and to extending coverage to the uninsured.

Berwick this week says that charge is "inaccurate and oversimplifies what is really going on." 

Rather, he argues, new savings and revenues under the law will go toward extending Medicare's trust fund, and any funds not needed immediately will be invested in Treasury bonds.

"These dollars are used to help cover other investments, such as expanding health coverage to 34 million uninsured people," he writes. "Later, when the trust fund needs to cash in its Treasury bonds, they are repaid, with interest."

Those are rules, he noted, "that Republican and Democratic administrations have used for decades."

Berwick also takes on the critics who claim that cuts to the Medicare Advantage (MA) program — under which the government pays private insurers to cover Medicare patients — threaten patient care.

The CMS chief notes that the Medicare Payment Advisory Commission has for years found that Medicare spends much more on MA patients than those in the traditional program — "without yielding measurably better health outcomes."

A part of those subsidies go to cover the marketing, salaries and other administrative costs at the for-profit companies, leading critics to wonder why the MA program exists at all.

"The new law eliminates these unwarranted subsidies," Berwick writes, "and, for the first time, financially rewards Medicare Advantage health plans that do a better job of providing quality care."

Berwick ends with a final jab at his GOP critics.

"I share Michael Leavitt's belief in the seriousness of the challenges before us," he says, "but I do not share his pessimism."