Medicare Advantage Redux

Writing at the Health Affairs Blog the other day, Marsha Gold claimed that, “Existing research provides no evidence that either traditional Medicare or Medicare Advantage perform consistently better than the other.” If so, that’s bad news for Obama Care. Medicare Advantage plans and they way they are accessed come closer to what the Administration wants out of health reform than anything on the horizon. Medicare Advantage HMOs are more like the Accountable Health Care HMOs the Administration has been touting than conventional Medicare, and as I wrote before:

  • They provide subsidized coverage to low- and moderate-income people who could otherwise not afford it.
  • They control costs better than conventional insurance by eliminating unnecessary care.
  • They provide higher quality care.
  • They have no pre-existing condition limitations and some plans actually specialize in attracting and caring for patients with multiple illnesses.
  • They provide an annual choice of plans.
  • They even compete against a public plan.

See also here. These results come from industry funded research. But as Jeff Lemieux points out in a response to Gold, these and other studies are going through the peer review process, and in any event Gold should be familiar with them.

I’m not a fan of HMOs but fair is fair.

Comments (11)

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  1. Nancy says:

    Thanks for “the rest of the story.”

  2. Greg says:

    I have never understood why the Administration doesn’t like Medicare Advantage HMOs. How are they any different from the ACO-type HMOs it is promoting?

  3. Vicki says:

    “Fair is fair”? That’s why we need your blog, John.

  4. Devon Herrick says:

    I wonder if the Administration and the Democratic Leaderships’ dislike for Medicare Advantage HMOs is because they fundamentally do not believe private companies have a place in delivery of care. Would critics be as concerned if the subsidy for a non-profit Medicare Advantage plan was 13% higher than FFS — most of which was passed on to poor enrollees in the form of greater benefits? I suspect many of the people that worry about private MA plans would not have a problem if the sponsors were non-profit organizations.

  5. Larry C. says:

    Greg asks a good question. And Devon’s answer is not persuasive. The ACOs are also going to be private and probably mainly for-profit.

    The liberal mind often makes no sense.

  6. Linda Gorman says:

    The major difference is that Medicare Advantage plans are run by people ObamaCare reformers do not like. Medicare ACOs will be run by people ObamaCare reformers do like.

    Any questions?

    Existing research doesn’t provide any answers because the populations choosing to join Medicare Advantage self-select, figuring out how much anything costs in Medicare is a non-starter due to bizarre government price setting, and the metrics available for judging outcomes are not ready for prime time.

  7. Ken says:

    Linda, I think your first point is wrong. Who do you think is going to set up and run ACOs other than United Health, WellPoint, Blue Cross, etc?

  8. Paul H. says:

    Good to have this information. I suspected that Marsha Gold’s piece wasn’t the whole story.

  9. Neil H. says:

    As I understand it, Medicare Advantage plans are comprehensive plans — similar to what non-elderly people typically have. Medicare, by contrast, is a skimpy plan — requiring people to obtain Medigap and Part D drug coverage, basically paying three premiums to three separate plans. Integrated insurance has got to be better.

  10. Linda Gorman says:

    Ken, you may be right. But Medicare Advantage plans have expanded considerably. There are PPO plans and HMO plans. ObamaCare seems to be oriented towards producing gatekeeper HMOs. The Blues and Kaiser have long been in favor of government control, P4P, and evidence-based medicine/comparative effectiveness as benchmarks. As I understand it, ACOs resemble HMOs more than PPOs.

  11. locums says:

    Nice Information Shared