A Vision for Medicare Sustainability

Medicare Rights Center continues to push for common-sense changes in policy, thinking, and practice to ensure that Medicare meets its full potential for current and future beneficiaries.

Medicare Still Matters

In a recent Health Affairs column, Dr. Marilyn Moon, a distinguished Medicare expert, former Public Trustee of the Medicare and Social Security Trust Funds, and member of the Medicare Rights Center’s Board of Directors, highlights some of the challenges the program and policymakers face.

Medicare Financing is Complex

Dr. Moon discusses some of the problematic myths and misconceptions that can underlie calls to “save” Medicare and explains why comprehensive, beneficiary-centered reforms are necessary.

Opportunities to improve Medicare financing are often narrowly focused on Part A’s Hospital Insurance trust fund.

Medicare Rights agrees. Medicare’s current financing structure is complex. In our experience, opportunities to improve it are often narrowly focused on Part A’s Hospital Insurance trust fund. But this approach ignores other cost growth factors, such as shifts in physician and outpatient coverage, that have made Part B a bigger driver of spending than Part A.

Funding Needs Change Over Time

As Dr. Moon notes, Congress did not expect to set and forget Medicare financing: “Instead, the earliest Medicare analysts argued that new funding sources would be needed over time.” The history of the payroll tax shows that adjusting the numbers to meet the demand used to be a regular feature of congressional action.

Reining In Spending on Medicare Advantage

Dr. Moon also flags the need to address Medicare Advantage (MA) overpayment. Congress and others have touted the potential for these private plans to save Medicare dollars, but the opposite has proven true. In a report to Congress, the independent Medicare Payment Advisory Commission put it simply: “[P]rivate plans have never yielded aggregate savings for the Medicare program. Throughout the history of Medicare managed care, the program has paid more—sometimes much more—than it would have paid for beneficiaries to have remained in fee-for-service (FFS) [Original] Medicare.”

Structural and cost barriers may effectively lock beneficiaries into plans or pathways that do not best meet their needs.

Driven by overpayment and marketing advantages, MA plans have multiplied, making it harder for people to evaluate and choose between their coverage options. Lack of information about supplemental benefits plans may offer compounds this problem. At the same time, structural and cost barriers make it difficult for people to undo their choices or switch from MA to Original Medicare, effectively locking them into a plan or pathway that does not best meet their needs.

Smarter Investments, Not Cuts

Dr. Moon points as well to the paradox of driving up Medicare spending through program cuts, including reductions to Medicaid. Eroding systems and services that help Medicare beneficiaries stay healthy and independent will undermine those goals in ways that lead to worse outcomes and higher costs.

Medicare Rights supports smart investments to help people build health and economic security. This includes restoring what was cut by the reconciliation bill as well as filling longstanding gaps in Medicare coverage for services such as dental, hearing, and vision care.

A Vision for Medicare Sustainability

At Medicare Rights, we agree wholeheartedly with Dr. Moon’s analysis. A dynamic Medicare financing system that centers beneficiary needs is necessary to ensure the program remains strong and effective. Medicare matters for the millions of people who rely on it, for the taxpayers who help fund it, and for the health system as a whole.