March 26 will kick off an epic three days of Supreme Court hearings that will not only examine the fate of a sweeping once-in-a-lifetime health reform bill, but tackle far larger constitutional questions about states' rights and the role of government. And nine lawyers, who have never taken care of a patient, had a bill rejected by Medicare, got paid pennies on the dollar by Medicaid or listened to an insurer's on-hold muzak will vote yea or nay on a badly crafted and complicated law that is stubbornly resented by half of all Americans.
Disappointed? So is the Disease Management Care Blog.
But that doesn't mean we Americans won't eventually work something out. Former HCFA Administrator Gail Wilensky seems to agree with that perspective in this recent article. As health reform continues to evolve with or without an intact Affordable Care Act, it is apparent that four broad areas of bipartisan consensus are emerging over how to address Medicare's looming insolvency:
Sorry, Millennials, slowly increase the Medicare eligibility age up from age 65 to age 67 or beyond. While this ultimately transfers the cost of health insurance from the Feds to private insurance, it'll help the deficit.
Soak the Rich by tying the amount of out-of-pocket expenses such as the premium, co-pay and deductibles to income. We're going to do that in other areas of the tax code, so why should Medicare by any different?
Double Down on SGR: Even though the SGR has been a colossal exercise in political fecklessness, that doesn't mean that Medicare's overall budget can't continue to be tied to economic targets like GDP. One factor that's been driving this is the realization that, thanks to a tepid economy, Medicare's per capita growth over the last few years has been paralleling the GDP quite nicely. Why not pass a law and make it so.... forever?
A new form of vilification: "fee-for-service." Like the terms "axis of evil," "WMD" or "Celine Dion," the FFS moniker is quickly turning into a payment methodology uniformly loathed by both sides of the aisle. Expect expansion of other payment methodologies such as bundled payments and modified capitation. This is good news for the population health and disease management vendors, which are typically funded through these types of arrangements.
In other words whatever SCOTUS does and no matter who the President is and who controls Congress, it's very possible that consensus could arise over one or more of the four policy areas described above.
It's far from over.
Image from Wikipedia