Bravo for Steve Brill! His appearance on ABC’s This Week was a rare example of a guest on a Sunday news program challenging the prevailing gestalt of the “expert” conversation stream these programs specialize in. It was refreshing to see Brill defend some of the themes in his Bitter Pill magnum opus on healthcare costs, which was recently published in Time (and which I will review shortly). Somehow I never thought of George Will and Steve Rattner as healthcare experts, and viewing this segment did not change that perception. Some highlights from the This Week interview:
On Medicare: Medicare is a big theme in Brill’s 36-pager, so the This Week conversation, which also included Kimberley Strassel, a member of The Wall Street Journal’s editorial board, focused a lot on it. Brill argued on air that Medicare was very efficient. (In fact, as CJR has reported, it controls costs better than the private sector does.)
He argued further that it could control them even better if the handcuffs came off and Medicare was allowed to negotiate the price of drugs, which it is forbidden to do. (That’s the last thing Big Pharma wants.) Medicare “buys healthcare really efficiently, which is a great irony because it’s supposed to be the big government bureaucracy,” Brill told viewers.
Is that true?, the host, George Stephanopoulos, wondered aloud. That was the signal for Rattner to jump in. He conceded that you could “get a fair amount” by negotiating drug prices. But he quickly added that he didn’t want “people to be confused”—negotiating drug prices will not be enough, he argued. His message: What is necessary are “fundamental reforms”—a prettied up phrase meaning large cuts in benefits—would be necessary. He passed along an argument from Medicare “reformers” that is floating around the Beltway—that today’s beneficiaries will get more in benefits than they paid in to the system during their working years. Eugene Steurle, a senior fellow at the Urban Institute, has advanced this value-for-dollar meme, a way of thinking that has often been used as a rationale for the idea of cutting Social Security benefits.
Stephanopoulos didn’t push for more explanation of the value-for-dollar thesis or offer any himself. If he had, viewers might have learned the reason seniors will get so much more in benefits is because of the growth in health spending. (I called Paul Van de Water, a Medicare expert at the Center for Budget and Policy Priorities, who said, “That’s a fact that we have to deal with, but it doesn’t necessarily justify cutting benefits.” And the incredible growth and cost escalation, which results in American healthcare providers being paid many times more than their counterparts in other countries, is the point of Brill’s Time piece.)
Brill pushed back, making the case for lowering—not raising—the age for Medicare eligibility, an idea long since dumped in the dust bin even by its liberal supporters. Brill’s reasoning: “You would put more people in the bucket of much more efficient healthcare,” he said. The president’s plan, Brill went on, will actually raise costs, because people in their early 60s who can’t afford health insurance premiums but must get them now will have to be subsidized by taxpayers—a less efficient mechanism than Medicare.
On making patients healthcare shoppers: Stephanopoulos turned to Will. “George, that becomes an argument for a single-payer system.” Will quickly argued against single-payer. He essentially argued that people are not paying enough for their healthcare, and that somebody else is paying the rest of their bills; that patients, aka consumers, don’t shop around for the lowest priced services the way they shop for cars and toothpaste. (That assumes, of course, that healthcare is a competitive marketplace, a notion that Brill and some health experts have debunked over the years, as CJR has discussed.)
I compliment Brill also for starting to have some guts in the public debate about US health insurance.
(If you do some real further research, you may actually uncover some real facts about the reasons for escalating health care costs, and not only within the Medicare program. The original Medicare plan itself is not causing cost escalation. The sub-contracts, and subsequent insurance companies contracts' costs are. The escalation in healthcare costs is not because of the initial phase of Federal governmental involvement within the public Medicare program.)
I am also reposting to this article, my comments in reference to your article: Medicare Uncovered.
Re your comments: "Currently, private insurers provide the prescription drug benefit for all beneficiaries, and they also provide all Medicare benefits for million or so Americans who have chosen Medicare Advantage plans."
Unfortunately, what you are stating is absolutely untrue.
You need to do more research on how Advantage and Prescriptions plans actually work in the real world. Advantage plans and the prescription plans are plans that establish private insurers as actually sub-contractors to the Federal Government for servicing of Medicare, primarily for processing payments. The sub-contractors have contracts with the Federal Government to provide varying plans based on fixed contracts with the Fed, for specific annual payments by the Fed to the private insurance companies. It is a complex and very profitable system, based on fees and profit/expense margins based on Medicare demand. The paybacks from the Fed are setup to private insurance companies based on actual medicare payouts per demographic makeup of varying counties, and regions within the US. The Medicare Program, and not the private insurance company is still paying the basic medicare costs of the insured individual.
Why perpetuate convenient and superficial dis-information that continues supporting ignorance in the general public debate platforms? How do you think a few individuals in Congress have made so much personal profit based on Medicare contracts between their private insurance corporations and the Fed? What do you think is the major contributing factor to escalating cost for health insurance in the US compared to a good number of European developed nations?
#1 Posted by lisa, CJR on Tue 5 Mar 2013 at 12:39 PM