There was no mistaking the message that two members of the Senate sent forth Sunday morning. In an interview on Fox News Sunday, two major players in the Medicare/deficit/entitlements debate—Sen. Bob Corker, Republican of Tennessee, and Sen. Dick Durbin of Illinois, a Democrat and the Senate majority whip—signaled there was a chance for a Democratic and Republican deal in the offing, at least for Medicare. Corker is an important figure in the Medicare debate, and his words to host Chris Wallace say a lot. Durbin is in a leadership position, and his words count for a lot, too.

Corker told Wallace:

We’ll know when the president is serious by virtue of a process that’s set up where he is actually at the table and whether he begins to say publicly to the American people, to all Americans, that he understands that Americans are only paying 1/3 of the costs of Medicare and that has to change for the program to be here down the road.

In other words, seniors don’t pay enough for their healthcare and should pay more, or, in wonkspeak, they should have “more skin in the game.” The one-third figure, which I had never heard before, may be emerging as a new talking point—or rationale—for requiring them to pay more. (Never mind that a few weeks ago advocates for seniors told a subcommittee of the House Ways and Means Committee that Medicare seniors pay about 15 percent of their income on healthcare, compared to about five percent for younger groups.)

Durbin told Wallace (presumably referring to the “more-skin-in-the-game” proposals out there):

We’ve said let’s put everything on the table, and I want to thank Bob for saying that. I think what Bob Corker just said from his side is a basic set of principles that both parties can rally around.

Wallace wanted to pin down Durbin: “Are you saying that you would accept structural changes—as you say, not doing away with Medicare—but structural changes and cuts to entitlements?” Durbin seemed to agree with Corker:

In 10, 12 years, Medicare goes broke. That’s unacceptable. We want to make sure that Medicare is there for generations to come. And, that means making some reforms and some constructive changes. The Paul Ryan voucher approach is destructive of Medicare. It will not survive. Millions of Americans will lose their benefits. But there are ways to approach it—to reduce the cost of medical care, and still keep our promise to seniors across America.

So Wallace got his “yes, there appears to be agreement” answer, and moved on. He did not probe what exactly are these new approaches and “constructive changes” that Durbin has in mind. But “structural changes” and “constructive changes” are the red meat in the debate over revamping Medicare, and so far Fox News Sunday and other news outlets have given us only the steak sauce. Precisely what Durbin and Corker have in mind would have been super interesting and illuminating for Fox News Sunday listeners, not to mention the rest of us.

We don’t know what Durbin’s “constructive changes” for Medicare are likely to be, but we do know what Corker has in mind, and it’s too bad Wallace didn’t ask him some questions about his Dollar-for- Dollar Act, introduced at the end of last year. It calls for $1 trillion in cuts to Medicare, Medicaid, and Social Security in exchange for lifting the debt ceiling by $1 trillion.

Among other things, that bill would radically change Medicare for its nearly 50 million beneficiaries. It’s important to note that Corker’s proposal will not cap Medicare spending on care—that’s one solution that’s been floating around. Instead, Corker’s plan would allow seniors and disabled people to get all the treatments they wanted—as long as they could pay for them. And it’s how they would pay for them that Corker would like to change. In a nutshell, they’d pay more.

The changes are complicated, but as we explained earlier this year, they would make seniors pay more out of pocket for their care. More skin in the game, which, the theory goes, would tend to lower healthcare expenditures because seniors would not over-use medical services. Another way to think of this change, though, is as a cost shift—from money out of the government’s purse to money out of beneficiaries’ wallets instead. And it raises a big question: Will seniors purchase the medical care they need, or postpone it to save money, possibly at a cost to both their health and, ultimately, to the healthcare system.

Corker’s bill would set up one deductible that covers hospital and medical services instead of separate deductibles for these services, which is currently the case. Right now, Medigap policies—which most seniors carry to protect themselves from large out-of-pocket expenses that Medicare doesn’t pay for—cover these separate deductibles, as well as coinsurance Medicare requires them to pay for medical services. (Coinsurance is not well understood. It is based on a percentage of what Medicare pays and is different from a copayment, which is a set dollar amount that you know in advance.)

Corker’s bill prohibits insurance carriers from covering the new deductible and a good chunk of the coinsurance. As we pointed out in that earlier piece, a senior or disabled person would have to pay the first $550 of their medical expenses (the deductible amount), $2,250 of their coinsurance, plus the premiums for both their Medigap policy—as well as the premiums for the parts of Medicare itself that cover medical services and drugs. In the February post, I wrote: “A couple without a Medigap policy would pay all of those out-of-pocket costs—$15,000. That could be quite tough for many seniors especially those whose only income is from Social Security.” In future years, Corker would like to prohibit seniors from buying Medigap insurance altogether. The hope is they won’t go to the doctor as often or use as many medical services, and the national medical bill will drop.

Wallace did not discuss any of this, but at the end of the interview he wanted to know how quickly the Dems and the GOP might strike a deal. “You know I am getting a kind of hopeful sense from both of you.” Thus Corker got another crack at his talking points:

When he [the president] begins to lay that out from his podium—I have been saying that for years, and Dick Durbin has been saying it for some time—but when the president uses the bully pulpit to explain to the American people the families are only paying 1/3 of the cost of Medicare, we will know that that we have begun the process of trying to solve this problem.

That one-third number again! Because Durbin and Corker have signaled the skin-in-the-game approach will be on the table, in a future post I will untangle the one-third figure that Corker seems so fond of using.


The Second Opinion, CJR’s healthcare desk, is part of our United States Project on the coverage of politics and policy. Follow @USProjectCJR for more posts from this author and the rest of the United States Project team. And follow Trudy Lieberman @Trudy_Lieberman.

Related stories:

Medicare Uncovered: What’s in a name?

Medicare Uncovered: the pain from skin in the game

 

More in The Second Opinion

Greedy Geezers, redux

Read More »

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.