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The Ryan plan and changes to Medicare

There is a lot of fear and confusion over the proposal to change Medicare in Representative Ryan’s bill.  Is Medicare in trouble, yes.  But in the long run.  There are at least several major factors at work:  an aging population with many new beneficiaries needing care; the way Medicare pays for most services on fee for service basis (something managed care got away from years ago as a way to control costs through better care management); increasing expectations of what medical care can and should do to improve quality of life; and the general issues related to inability to control costs and quality within the US health care system as a whole.

Does Medicare need to fixed.  I would argue yes.  The current course is not sustainable.  Is the Ryan Plan ( privatizing Medicare by giving beneficiaries vouchers to purchase their own health insurance) the best response?  Not likely (for example, it underestimates cost of insurance for people with significant pre-existing conditions, and asks a vulnerable population to be savvy enough to make choices about medical care, something that is difficult to do even in the best of circumstances).  What are the other options?  The Affordable Care Act starts down a road to reform some of the way Medicare works (expanded coverage of preventive services and some quality improvement and attempts to control costs) but it could be argued that these changes will not fundamentally change the collision course Medicare is on with budget realities.  As the largest payer of medical services in the US, the next steps taken to reform the Medicare program will likely have significant impacts on the whole delivery system.  I would expect that we will see additional proposals being made during the run-up to the Presidential election.

Here is a recent reflection by the Kaiser News Network on what is being said in the media about the pros and cons of the Ryan Plan .