New England Journal Of Medicine Provides Health Policy Perspectives On Medicare, ACOs
The New England Journal of Medicine has three health policy perspectives today.
The Public's Views About Medicare And The Budget Deficit
Despite many years of dire warnings about the serious problems for the federal deficit posed by the projected growth in Medicare spending, it has been difficult for political leaders in Washington to find a long-term solution to this problem. ... Whenever either political party has put forth a proposal to improve Medicare's long-term financial situation that includes raising taxes, major changes in the existing Medicare program, or substantial cuts in Medicare spending, the other party has strongly opposed it in the hope of gaining an advantage in the next election. In fact, within the past year, both parties have used the Medicare-cuts issue for campaign purposes. The current debt-ceiling debate has changed the short-term dynamic, but it has not altered the long-term play of these forces (Robert J. Blendon, and John M. Benson, 7/13).
The Economics of Financing Medicare
Medicare expenditures currently account for 15% of federal spending and 3.6% of the total gross domestic product (GDP). ... The public financing of Medicare has particular implications for the economy. Specifically, raising taxes to pay for public insurance exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance. ... Deficit spending on health care also carries an economic cost: taxes are required to pay back any borrowed money (with interest), and rising debt-to-GDP ratios may have calamitous effects on the country's future ability to borrow. ... Although the economy can probably bear some tax increases to help finance Medicare, if recent rates of spending growth continue, taxes would have to increase precipitously (Katherine Baicker and Michael E. Chernew, 7/13).
The ACO Rules - Striking the Balance between Participation and Transformative Potential
In April, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited Notice of Proposed Rulemaking with a proposed policy for the accountable care organization (ACO) program authorized by the Affordable Care Act (ACA). ... The vision underlying the ACO movement - of provider accountability that goes beyond delivering an individual service and of care that is integrated and patient-focused - is one worth pursuing with bold steps. CMS has many good ideas in its ACO proposal. We believe that the final risk-sharing methods should build off this model - retaining the possibility of losses as well as savings - but front-load the benefits more and provide the tools and flexibility that provider groups will need to rationalize the delivery of medical care (Meredith B. Rosenthal, David M. Cutler and Judith Feder, 7/13).