BEYOND MEDICARE FOR ALL: CRACKING THE CODE OF THE HEALTHCARE AFFORDABILITY CRISIS, the latest book by veteran healthcare journalist Ken Terry, explains what is driving rapid cost growth and offers an innovative solution that could provide affordable, comprehensive healthcare for all. Based on a bifurcated approach to healthcare financing, this approach places physicians in charge of care delivery.
Terry, whose previous AAPL book, Physician-Led Healthcare Reform: A New Approach to Medicare For All, was published in 2020, builds on that foundation with a new financing framework that splits healthcare costs into two distinct parts. Competing primary care groups would take financial responsibility for basic care through a subscription model, while health insurers would cover hospital care, post-acute care, and higher-cost outpatient services such as ambulatory surgery and cancer care. Employer and government subsidies for basic care subscriptions and major medical insurance would ensure universal access.
“In the wake of last fall’s government shutdown and the ongoing debate over Obamacare subsidies, it has become clear that our healthcare system is experiencing an existential crisis with implications for all of us,” Terry writes. “Beyond Medicare for All, unlike our major political parties, outlines a clear solution that could make first-rate healthcare affordable for everyone.”
Healthcare consultant and thought leader David W. Johnson, in his foreword to the book, says this about its message: “Ken Terry’s book does not offer easy solutions, but it nails the essential dilemmas confounding the policy debate for how best to reform America’s broken healthcare system. As such, Terry challenges readers to reconsider fundamental assumptions about how healthcare should operate. His proposal to shift greater financial responsibility to physicians raises important questions about incentives, governance, and professional responsibility.”
Recent 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.