Update on Medicare reform

Several days ago I predicted that the recent Medicare bill would turn out to be largely the prescription drug benefit, with little real institutional reform in the direction of privatization, for better or worse. An article in today's New York Times provides a closely related argument.

Here is a summary:

The most politically charged feature of the Medicare legislation passed by Congress — its attempt to make the federal Medicare program compete with private managed-care plans — is also the least likely to come to fruition on the seven-year schedule set in the bill, according to health policy experts...Similar plans, the experts say, have failed to find support among patients, doctors and hospitals, or even some insurers. Even people who favor the idea say the potential for trouble this time is formidable...Many people enrolled in Medicare fear that they will end up with less generous benefits in a privately run program...Nor do hospitals and doctors like the idea of health insurers pushing down fees to make a profit for themselves, and health plans have balked at previous projects that threatened to squeeze their profit margins...In addition, many privately run Medicare plans, known as Medicare H.M.O.'s, withdrew from many areas of the country when government payments lagged, forcing millions of patients to scramble to obtain new coverage.

The bill passed by the House and Senate in the last few days calls for six-year demonstration projects in four to six cities, where private health plans would compete with the traditional Medicare program to enroll subscribers by offering a variety of new services with the goal of possibly reducing costs...But four previous attempts at experimenting with competition among Medicare H.M.O.'s were aborted before they began — blocked in Congress after members heard objections from health care providers and elderly voters.

Arguably this kind of "mixed privatization," with strong public elements, and few real incentives for cost control, was not a good idea in the first place. But in any case it is unlikely to ever see the true light of day.