Tuesday, October 15, 2019

Privatizing Medicare: Paul Ryan's soul goes marching on

ICYM the prior post on Trump's executive order aiming to advance the privatization of Medicare on multiple fronts, I've had the chance to refine it twice, on BlueWaveNJ and at medicareresources.org (hence the blogging drought here).

The short version (from the medicareresources.org post):
Issued on October 3, Trump’s order instructs the Secretary of Health and Human Services (HHS) to take steps aiming to
  • “Voucherize” Medicare in the manner proposed by Paul Ryan – that is, let private Medicare Advantage plans set prices for traditional Medicare, rather than vice versa as at present.
  • Create a private insurance market outside of Medicare for wealthy seniors that would likely lure doctors away from participation in Medicare.
  • Subject Medicare enrollees to the joys of “balance billing” – getting billed by providers for amount in excess of their normal share of the Medicare bill.

The "ordering" of these changes is best understood as a statement of intent -- goals to be advanced incrementally to the extent possible by administrative rules and guidance, and long-term goals to be pursued when Republicans next gain complete control of the federal government. While the latter seems unlikely to happen soon if ordinary political currents run their course, I think we have to consider seriously the possibility that Trump will move to corrupt or negate the results of the 2020 election -- and that Republicans will go along with that effort. In that case, the statement of intent becomes an action agenda. 

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