We are talking about how to save Medicare. It’s a conversation that needs to happen in Washington, but politicians seem to be more interested in scoring political points and demonizing their opponents, than in solving this important problem.

In Part I of this series, I talked about a new book just published called Modernizing Medicare: Harnessing the power of consumer choice and market competition, edited by Robert Emmet Moffit and Marie Fishpaw. The book features a dozen top health policy experts who have come together with detailed prescriptions for Medicare’s looming bankruptcy – solutions with decades of demonstrated success.

Grace-Marie Turner, writing for Galen.org and Forbes, reviews the book and its many highly-rated healthcare policy authors. Turner says the key is competition and consumer choice in a sensibly regulated system that provides extra support for the poor and most vulnerable.

In Part I we heard comments from Doug Badger, a key architect of the Medicare Advantage and Part D Prescription Drug Benefit programs introduced in 2003. We also heard from Doug Holtz-Eakin, former CBO Director who warned us not acting is not an option. We also read comments from Brian Miller of the American Enterprise Institute and former Medicare Chief Gail Wilensky.

Today, we will read the comments of other healthcare policy experts as they discuss the alternatives. Those who believe in government rather than market control of this issue gave us the Affordable Care Act of 2010, otherwise known as ObamaCare. This plan opted for sharp cuts in payments to hospitals, physicians, and other providers – cuts that grow over time. “This will eventually endanger the financial stability of providers, “ says American Enterprise Institute’s Joe Antos.

The ACA also promoted alternative payment models. Antos writes, “including accountable care organizations (ACOs), value-based purchasing arrangements, and bundled payments for specific services within traditional Medicare. The results have been disappointing. The largest ACO initiative resulted in higher program spending at first and only began to show savings in the last few years. In 2018, savings averaged $73 per participating beneficiary.”

Chris Pope of the Manhattan Institute details the successes of a defined contribution system of coverage and care. “Competitive private health plans, governed by flexible regulation and free to innovate in payment and care delivery, have proven that they can secure better care at lower costs than the highly centralized, bureaucratically controlled, and outdated Medicare fee-for-service program.”

John Goodman of The Goodman Institute offers a range of options to build on these successes, including empowering chronically ill patients with new and better options, harnessing the power of virtual medicine, improving access to primary and preventive care, and rewarding patients for making cost-saving choices. “It is the exercise of patient choice that fueled Medicare Advantages successes, and the power of patients to make even more decisions could lead to further improvements,” he writes.

The dean of the health policy community, Wharton Prof. Mark Pauly, has been diving into the details of Medicare reform longer than any of the co-authors of this book. He concludes that current and near-beneficiaries will strongly resist cutting benefits or increasing taxes. With his usual wry sense of humor, Pauly concludes that “Premium support can thus be a better way of avoiding the doomsday scenario.”

Heritage’s Ed Haislmaier tackles the essential but in-the-weeds issue of Medicare risk adjustment in a premium support system, offering improved ways to stabilize the market and avoid gaming of the system.

He describes an approach to risk mitigation in a reformed Medicare program that “has the virtue of being simple, universally applicable, flexible, and self-correcting…using mechanisms that allow the market to smoothly and organically evolve over time.”

And Walt Francis, the guru of the Federal Employees Health Benefit Program (FEHBP), writes that the program, which launched in 1960, is now “the largest employer-sponsored health insurance program in America with about 8 million enrollees.” He says policymakers can learn from the FEHBP and use the experience to demonstrate the durability of its premium support model in maximizing choice and containing costs.

Clearly, there are many ideas for solving the Medicare insolvency problem. Now what is needed is the willingness of politicians to put the interests of their constituents first and to have the courage to fight for these needed changes, lest Medicare die for lack of trying. Furthermore, those politicians who demagogue the issue and try to bash their political rivals should be vilified by the press and punished by the electorate. One can only hope!

Medicare is dying. That’s the inconvenient truth that most politicians don’t want to talk about for fear they will be accused of “killing Medicare.”  But the Medicare board of trustees say that Medicare will be insolvent in six years if changes aren’t made soon. In other words, doing nothing will kill Medicare.

I did a series on this subject a couple months ago called Solving Medicare/Medicaid Insolvency – Part I – III. For more on this subject, you can read those posts by typing the name of the post into the search engine to the left of this page on my website.

I bring the subject up again for several reasons. First, it continues to be a political third rail that no one wants to talk about. Even Republican presidential candidate and former President Trump is bashing Governor Ron DeSantis with ads in Florida that accuse DeSantis of wanting to kill Medicare. Trump seems to have stolen a line from the Democratic playbook in his desperate attempt to diffuse the momentum of the governor even before he announces his candidacy. Yet neither Trump nor the Democrats are offering any ideas on how to save Medicare.

Second, Grace-Marie Turner, writing for Galen.org and Forbes, tells us there is a new book just published which directly confronts the issue. It’s called Modernizing Medicare: Harnessing the power of consumer choice and market competition, edited by Robert Emmet Moffit and Marie Fishpaw. The book features a dozen top health policy experts who have come together with detailed prescriptions for Medicare’s looming bankruptcy – solutions with decades of demonstrated success.

Turner says the key is competition and consumer choice in a sensibly regulated system that provides extra support for the poor and most vulnerable.

Edited by Heritage Foundation’s Bob Moffit and policy consultant Marie Fishpaw, the prestigious authors each conclude that the answer lies in the premium support model upon which Medicare Advantage and the Part D Prescription Drug Benefit are based.

Doug Badger, a key architect of the Medicare Modernization Act that created these two programs in 2003, explains premium support: “The government makes a per capita, income-related contribution to competing health plans on behalf of beneficiaries, and the beneficiaries choose the health plans they determine best meet their personal needs.”

“Medicare beneficiaries and federal taxpayers are benefitting from the efficiencies achieved through the competitive process in Medicare Advantage,” former Medicare Trustee Charles Blahous writes, explaining that “competing health insurers. . . have responded by finding ways to lower their costs while reducing premiums and out-of-pocket expenses facing program beneficiaries.”

Nearly half of Medicare beneficiaries have voluntarily enrolled in private Medicare Advantage plans, and American Enterprise Institute’s Brian Miller and former Medicare chief Gail Wilensky recommend that the program should be the default option for new enrollees to better harness MA’s market efficiencies. Otherwise, Medicare’s outdated fee-for-service segment will continue to be a “blank check” with unlimited draws on taxpayer dollars.

Former Congressional Budget Office (CBO) Director Doug Holtz-Eakin, now president of American Action Forum, says not acting is not an option: “Medicare alone was responsible for 34 percent of all federal debt outstanding at the end of 2019.” Since that’s over three years ago, that percent is likely much higher now. “For policymakers, the primary goal of Medicare reform should be the achievement of better value for this major expenditures of America’s healthcare dollars.”

He goes on to say, “On the basis of evidence to date, there is every reason to expect that a Medicare premium support program can reduce outlays by both beneficiaries and taxpayers. Over the 2022-2032 budget window, for example, Medicare outlays could decline by at least $2.2 trillion, or 11.5 percent. Even more important, however, is that the introduction of consumer choice allows beneficiaries to reveal their values on the crucial issues of medical care and coverage. A values-driven Medicare system will be a better social safety net, regardless of its cost.”

(Note: For more information on this exciting new book, stay tuned for Part II.)

I’m very glad I went to medical school when I did in 1975. I was one of a class of 106 students who only needed to worry about learning anatomy, pathology, pharmacology, biochemistry – those subjects needed to know how to treat disease. It was much easier back then – because we didn’t have to worry about gender pronouns and the color of our patient’s skin.

I first began writing about woke medical education a year ago with a post called The Woke Doctor’s Office and followed up that post with one called Woke Medical Education. Today is intended as an update for those regular readers of this blog, as well as a reference to these previous posts for those who are not.

Dr. Stanley Goldfarb, a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine was the first to call attention to this situation in an Op-ed published in The Wall Street Journal in 2019 called “Take Two Aspirin and Call Me by My Pronouns.” He wrote, “Concerns about social justice have taken over undergraduate education.” He warned about the “focus on climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness.”

Grace-Marie Turner, writing for The Galen Institute, says many students say they are admitted to medical schools only if they give the “right” answers to a litany of woke questions. Students are being indoctrinated to see skin color as the most important thing about a patient.

Dr. Marilyn Singleton wrote in a recent Washington Post op-ed that she “graduated with a medical degree in 1973, a black woman in a class of mostly white men. Since I became a physician, I have seen exactly one instance of racism in health care – and it was from a patient, not a fellow physician. As for my colleagues, I have been consistently impressed with the conscientious, individualized care they have provided to patients of every race and culture. When we all took our oath to ‘first, do no harm,’ we meant it, and we live it.”

This has been my own experience as well, but it is especially powerful to hear these words from a black woman of my peers. But Turner tells us eradicating “white racism” has become a top priority, not just in medical education but in medical practice. California is requiring all physicians who engage in direct patient care to participate in “implicit bias training” to keep their medical licenses. Just another good reason not to live in the state of California.

In a related development, many of the nation’s top medical schools and universities, starting with #1 ranked Harvard, have withdrawn from participation in the U.S. News & World Report’s annual rankings of the “best medical schools.” Most said the criteria do not reflect priorities of their curricula, which includes a strong focus on diversity, equity, and inclusion (DEI). They say rankings focus too much on standardized test scores, reputation and institutional wealth. I guess they don’t care much about smart students; just those who are woke enough.

Some physicians have pushed back by complaining to medical school administrators that students aren’t being properly prepared to care for actual patients. What a novel idea! One administrator’s reply was: “There is too much science in the curriculum and students can just look it up if they need answers.” I hope my doctor doesn’t need “to look it up” when my life is on the line!

Who can turn around this troubling situation for the sake of our medical future?

Turner says it starts with governors and state legislators who have jurisdiction over many state universities and medical schools and with supporting organizations working to educate policymakers and the public about these issues to find the proper balance to assure quality medical education. I hope they fix it before my doctor focuses too much on the color of my skin and not enough on the pattern of my EKG.