PHYSICIAN-LED HEALTHCARE REFORM: A NEW APPROACH TO MEDICARE FOR ALL, the latest book by veteran healthcare journalist Ken Terry, explains why Medicare for All won’t work unless the U.S. healthcare delivery system is restructured to lower costs – and lays out a blueprint for how to do it.
Ken Terry, the author of two previous books on health care policy and practice, has been writing about the health care field for more than 25 years… (Continue reading)
“This is the only book that makes the explicit connection between the need for clinicians to reduce healthcare waste and the ability to reallocate these resources to improve health. Terry makes the important point that only clinicians, acting with the best available evidence to reduce unexplained clinical variation, can reduce said waste.” —David Nash, MD, founding dean of the Jefferson College of Population Health at Thomas Jefferson University, Philadelphia
“Physician-Led Healthcare Reform: A New Approach to Medicare for All offers an encyclopedia of knowledge on the U.S. healthcare system, written in an engaging, popular style.”—Thomas Bodenheimer, MD, professor emeritus of family community medicine at the University of California San Francisco
“Ken Terry has produced a tour de force analysis of the current state of American health care. In a world filled with ‘alternative facts,’ Ken’s encyclopedic reliance on research evidence, instructive interviews, and clear writing makes for compelling reading, whether or not you agree with his prescriptions for reform. An essential resource.”—Robert Berenson, MD, senior fellow at the Urban Institute
Current musings
Jan. 30, 2024
The percentage of seniors in Medicare Advantage plans continues to increase, and there has even been speculation that all beneficiaries will eventually have no other choice than to join these private plans. Many seniors would not join an MA plan voluntarily, even though these plans have low or no premiums, low copayments and some coverage for services that traditional Medicare doesn’t cover, such as vision and dental benefits. These beneficiaries prefer to remain in the fee for service program, where they have access to all providers who accept Medicare. The MA plans, in contrast, have narrow networks and restrict coverage for many services through prior authorization and other methods.
However, when the majority of Medicare beneficiaries are in MA plans, those remaining in traditional Medicare will tend to be the sicker people who value having a wider choice of physicians and hospitals and who don’t want restrictions on the care they can receive. Theoretically, the government could continue to subsidize the cost of care for this sicker population; but eventually, Medicare would have no choice but to raise their premiums, and supplemental plans would follow suit. This would prompt more seniors to join MA plans, leaving the pool remaining in traditional Medicare even sicker and more expensive to care for.
Of course, Republicans applaud this transformation of the government program into private insurance. Many Democrats also support the MA program because it is so popular. The Department of Health and Human Services views the transition to MA as part of its goal of having all beneficiaries in “value-based care” by 2030.
But there are reasons to question whether Medicare Advantage provides value. After all, MA plans have cost Medicare $353 billion more in the past five years than it would have spent on the beneficiaries who enrolled in those plans–and they are anticipated to cost taxpayers $88 billion extra in 2024. Michael Chernew, the chair of the Medicare Payment Advisory Commission (MedPAC), points out that MA plans have restrained utilization of resources. But if they cost Medicare more than its fee-for-service program, MA plans are simply generating profits for corporations without cutting the growth of health costs for society.
The goal of the original Medicare program was to provide good healthcare to seniors when they could least afford it. The idea was for people to pay into the program when they were younger and for Congress to cover hospital care with appropriated funds. But gradually, beneficiaries had to pay higher and higher Part B premiums, and healthcare became so expensive that people in traditional Medicare had to protect themselves with private supplemental plans. Hence, the door was opened to Medicare Advantage plans that reduce this expense for seniors but also offer them more limited coverage when they get sick.
Clearly, the time has come for our country to stop ignoring the continuing disaster of rising healthcare costs and to stop pretending that shifting insurance from the public to the private sector will solve the problem. The costs are still coming out of taxpayers’ pockets, and the profits are going to rich corporations. The only solution is real healthcare reform that changes how we deliver and finance care.
Physician-Led Healthcare Reform 