Strengthening and Improving Medicare: Hearing Before the Subcommittee on Health of the Committee on Energy and Commerce, House of Representatives, One Hundred Eighth Congress, First Session, April 9, 2003U.S. Government Printing Office, 2003 - Broj stranica: 77 |
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administrative Aetna afford Barbara Kennelly believe BERENSON billion BUYER CAPPS Chairman Bilirakis choice committee competition CONGRES CONGRESS THE LIBRARY coordination costs cover deficit durable medical equipment employees enrollees Federal budget fee for service FEHBP ficiaries Foster future going gram GREALY growth health care healthcare improve Medicare income increase innovations KENNELLY LIBRA LIBRARY OF CONGRESS look managed care Medi Medicaid Medicare beneficiaries Medicare benefits Medicare's Medicare+Choice plans Medicare+Choice program MOON NGRESS offer options PALLONE patients payment payroll taxes percent physician preferred provider organizations premiums PREPARED STATEMENT prescription drug benefit prescription drug coverage private health insurance private health plans private insurance private plans private sector projected RARY rates RAWLINGS reform RESS retirees revenues savings seniors SHADEGG share SMI expenditures Social Security spending STUPAK subcommittee tax cuts Thank tion traditional Medicare program trust fund workers
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Stranica 35 - Thus, the most vulnerable may stay in plans that become inordinately expensive. Further, private plans by design are interested in satisfying their own customers and generating profits for stockholders. They cannot be expected to meet larger social goals such as making sure that the sickest beneficiaries get high quality care; and to the extent that such goals remain important, reforms in Medicare will have to incorporate additional protections to balance these concerns as described below. Ultimately,...
Stranica 34 - Medicare from increased competition and the flexibility that the private sector enjoys. Further, the effort necessary to create, in a private plan environment, all the protections needed to compensate for moving away from traditional Medicare seems too great and too uncertain. Claims for savings from options that shift Medicare more to a system of private insurance usually rest on two basic arguments: first, it is commonly claimed that the private sector is more efficient than Medicare, and second,...
Stranica 34 - In addition, there is the question of how private insurers will respond. (If new enrollees go into such plans each year, some savings will be achieved, but these are the least costly beneficiaries, and may lead to further problems as discussed below.) Will they seek to improve service or instead focus on marketing and other techniques to attract a desirable, healthy patient base? It simply isn't known if the competition will really do what it is supposed to do. In fact, undesirable outcomes may be...
Stranica 15 - ... that consideration of further reforms should occur in the relatively near future. Today's relatively favorable conditions could change, accelerating the expected return to deficits in the HI trust fund. Moreover, the earlier solutions are enacted, the more flexible and gradual they can be. Finally, the Trustees note that early action increases the time available for affected individuals and organizations — including health care providers, beneficiaries, and taxpayers — to adjust their expectations....
Stranica 34 - I completed with Cristina Boccuti found that Medicare's cost-containment performance has been better than that of private insurance even after controlling for coverage of comparable services. Starting in the 1970s, Medicare and private insurance plans initially grew very much in tandem, showing few discernible differences (See Figure 4). By the 1980s, per capita spending had more than doubled in both sectors. But Medicare became more cost-conscious than private health insurance in the 1980s, and...
Stranica 34 - Often this includes allowing the premiums paid by beneficiaries to vary such that those choosing higher cost plans pay substantially higher premiums. The theory is that beneficiaries will become more price conscious and choose lower cost plans. This in turn will reward those private insurers able to hold down costs.
Stranica 34 - Technological change and improvement represents a major factor driving high rates of expenditure growth. To date, most of the cost savings generated by all payers of care has come from slowing growth in the prices paid for services and making only preliminary inroads in reducing the use of services or addressing the issue of technology. Reining in use of services will constitute a major challenge for...
Stranica 11 - SMI enrollees pay monthly premiums ($45.50 in 1999) that cover about 25 percent of program costs. The balance is paid by general revenue of the Federal government and a small amount of interest income. The HI tax rate is specified in the Social Security Act and is not scheduled to change at any time in the future under present law. Thus, program financing cannot be modified to match variations in program costs except through new legislation. In contrast, SMI premiums and general revenue payments...
Stranica 35 - Private plans can play an important role and may develop some innovations on their own, but in much the same way that we view basic research on medicine as requiring a public component, innovations in health delivery also need such support. Further, innovations in treatment and coordination of care should focus on those with substantial health problems — exactly the population that many private plans seek to avoid. Some private plans might be willing to specialize in individuals with specific needs,...
Stranica 12 - ... in the HI payroll tax rate, payable by employees and employers, each. (The projected deficit could also be eliminated by many other revenue increases and/or expenditure reductions.) Note, however, that such a change would only correct the deficit "on average." Initially, HI revenue would be significantly in excess of expenditures, but by the end of the period, only about one-fourth of the projected deficit would be eliminated. The effect of the baby boom's retirement on Social Security and Medicare...