Transcript ch08x

Health Policy Issues
An Economic Perspective
Copyright © 2015 Foundation of the American College
of Healthcare Executives. Not for sale.
Chapter 8
Medicare
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of Healthcare Executives. Not for sale.
LEARNING OUTCOME
Investigate the current Medicare system,
its effects on physicians and patients,
concerns for its future, and proposals
for reform
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of Healthcare Executives. Not for sale.
LECTURE
The Current State of Medicare
Part A (HI)
• Exhibit 8.1
Part B (SMI)
• Exhibit 8.2
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of Healthcare Executives. Not for sale.
LECTURE (CONTINUED)
The Current State of Medicare
(continued)
Part C: Medicare Advantage Plans
Part D: Prescription Drug Coverage
• Exhibit 8.3
Medigap Supplementary Insurance
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of Healthcare Executives. Not for sale.
LECTURE (CONTINUED)
The ACA’s Changes to Medicare
Concerns About the Current Medicare
System
• Redistributive Aspects of Medicare
• Exhibit 8.4
• Efficiency Incentives in Medicare
• Exhibit 8.5
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of Healthcare Executives. Not for sale.
LECTURE (CONTINUED)
Concerns About the Current Medicare
System (continued)
• The Unsustainable Rise in Medicare
Expenditures
• Exhibit 8.6
• Exhibit 8.7
continue to discussion
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of Healthcare Executives. Not for sale.
LECTURE (CONTINUED)
Proposals for Medicare Reform
Politics of Medicare Reform
continue to discussion
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of Healthcare Executives. Not for sale.
Exhibit 8.1
Number of Medicare Beneficiaries, Fiscal
Years 1970–2030
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.2
Estimated
Medicare
Benefit
Payments, by
Type of Service,
Fiscal Year 2013
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.3
Medicare Prescription Drug Benefit
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.4
Two-Earner Couple Average Wage ($44,600
Each in 2012 Dollarsa)
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.5
Growth in Real Medicare Expenditures per
Enrollee, Part A, Part B, and Part D, 1966–2012
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.6
Population
Pyramid, United
States, 1960,
2013, and 2050
return to lecture
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of Healthcare Executives. Not for sale.
Exhibit 8.7
Cash Deficit of the Medicare Hospital
Insurance Trust Fund, 2012–2022
return to lecture
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of Healthcare Executives. Not for sale.
DISCUSSION
How difficult will it be politically for Congress to
enact Medicare reform? On what factors
do you base your opinion? Discuss the
political backdrop/climate that is interfering
with needed reforms to these programs.
What are the consequences of the two
changes Congress enacted in 1997 to keep
the HI Trust Fund solvent?
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of Healthcare Executives. Not for sale.
SUMMARY
To make Medicare an equitable and
efficient redistribution system, the
“entitlement” myth of Medicare must
be recognized and its large welfare
component acknowledged.
Government subsidies should be used
primarily to help the low-income
elderly.
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of Healthcare Executives. Not for sale.
SUMMARY (CONTINUED)
Health plans, including traditional
Medicare, should be able to compete
for beneficiaries on the basis of price,
quality, outcomes, and enrollee
satisfaction.
Health plans will then have incentives to
be efficient and responsive to
beneficiary preferences.
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of Healthcare Executives. Not for sale.
SUMMARY (CONTINUED)
The potential cost of suggesting dramatic
solutions to the problems of Medicare is
high to any one political party; whatever
the combination of approaches
selected, a vast redistribution of wealth
will result.
A bipartisan commission whose
recommendations are adopted by
Congress has, in the past, resolved such
highly visible redistributive problems.
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of Healthcare Executives. Not for sale.
SUMMARY (CONTINUED)
The National Bipartisan Commission on the
Future of Medicare (created by Congress
as part of the 1997 Balanced Budget Act)
was unable to reach agreement (by just
one vote) on reforming Medicare in 1999.
Whether and when a commission
approach will again be used for
reforming Medicare remains to be seen.
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of Healthcare Executives. Not for sale.