mpp -- Hopefully this makes more sense. Sorry about the previous post...I'm just kinda frustrated that I haven't received any interviews. I will certainly apply next year, and that will be fine...it's just hard to stay optimistic when nothing is working!
1. Align Medicare with appropriately managed market forces to facilitate value-based purchasing. In other words, make Medicare accountable to a health care marketplace. Compared to private health insurance, Medicare is ridiculously wasteful and inefficient.
Make Medicare beneficiaries understand what benefits they receive, and provide them with incentives to choose efficient plans. Medicare, in return, will be forced to operate more efficiently. One way to help consumers (Medicare beneficiaries) to compare plans is to define standard benefit plans (CalPERS used this technique when it switched to a managed-competition approach). Defining enrollment (e.g. annual open enrollment) will help prevent adverse selection. Distributing information about comparative plan quality will encourage consumers to analyze their use of health care services and pick the most efficient plan for themselves, thereby encouraging health care providers to provide competitive rates/benefits/plans.
2. Began transitioning Medicare away from FFS, although this could take decades.
87 percent of Medicare beneficiaries use a fee-for-service arrangement. Transitioning to managed care will be difficult for a variety of reasons: elderly beneficiaries who have strong attachments to doctors they've had for decades, the lack of availability of managed care plans in rural areas, managed care is not known for its ability to care for the elderly and chronically ill, etc.
3. Look to the Federal Employees Health Benefits Program as an example.
Unlike Medicare, FEHBP relies primarily on the private market for most functions, including decisions on benefit package design. It uses open enrollment and has a variety of plans – fee for service, preferred-provider options, HMOs – and is able to evolve much more rapidly (or at all!) compared to Medicare. It would be a good model for reform.
4. Some suggest eliminating supplemental insurance and integrating Medigap programs into Medicare.
Medicare's only true cost-control mechanism is cost-sharing with beneficiaries. Private supplementary insurance (Medigap) has eliminated this control by paying deductibles and coinsurance. Beneficiaries with supplemental insurance consume much more care (roughly 28% more), and Medicare pays the difference – about $1000 per beneficiary. Since only 13% of Medicare recipients have neither Medigap or Medicaid, the total costs burden imposed on Medicare as a result is about 20 percent of the total Medicare budget, or about $30 billion. Prohibiting/discouraging supplemental insurance or integrating it into Medicare would result in a tremendous savings.
Hope it helps!