The Medicare Patient Empowerment Act (MPAE)

While the Ryan Plan has insurance vouchers, how about payment vouchers?  That's how the Disease Management Care Blog thinks about the Medicare Patient Empowerment Act (MPAE).

Right now, doctors that "participate" in Medicare must take "assignment" for all patients and accept its payment in full and not balance bill.  There is a good discussion of how it all works here.  The two page MPEA would change that, allowing docs and patients to directly "contract" for service costs over and beyond the Medicare rates, while the physician could still be reimbursed for the amount amount that Medicare would have otherwise paid.  The proposed legislation requires that the arrangement be spelled out in a formal written contract and protects the patient from being billed for additional payments that are explicitly spelled out in the contract.  The patient would have to agree to things ahead of time and presumably be fully apprised of the out of pocket costs. It also can't be implemented during emergent or urgent care.

The AMA and other MPAE supporters argue that being able to bill for the "balance" of unpaid costs would make it more likely that physicians will continue to see Medicare beneficiaries and  "preserve" patient choice. Opponents point out that the threat of drop-outs is a paper tiger and that balance billing will introduce a two-tier system of haves and have-nots, since patients who are unable to 'contract" could be shut out.

Whatever its merits, the likelihood that this will ever get past the Senate and to the President's desk is about as high as the DMCB getting an apology from Google for wiping out some of its recent posts.  This is simply another wrinkle in the politically stunted debate over Medicare as a defined "contribution" versus the status quo of a defined "benefit" and it ain't going anywhere.  What better evidence of that than this peer reviewed medical evidence that the Republicans have no stomach for the topic.

Thanks to Google blogger being down, the DMCB was unable to post this as originally planned on the curiously ironic date of Friday, May 13.  The DMCB apologizes for the inconvenience.