The Ryan Plan Will Make It Hard for Seniors to Find Doctors? So Will Medicare.


Former Obama administration budget director Peter Orszag is worried that under Paul Ryan's Medicare plan, seniors might have a harder time finding a doctor thanks to Medicare's payment rates, which are lower than the rates paid by private insurers. In other words, he is concerned that what might happen under the Ryan plan is what is already expected to happen under Medicare as we know it thanks to ObamaCare.

He doesn't mention this (why bother, really?), but Medicare's chief actuary, Richard Foster, has already sounded the alarm on a number of occasions.

In an actuary's note at the end of the Trustee's report this year, for example, Foster addressed ObamaCare's health provider reimbursement cuts, warning that "there is a strong likelihood that certain of these changes will not be viable in the long range."

The likely outcome? Without some sort of expensive legislative fix, we'd see far fewer doctors and other health providers, and seniors would experience "severe" significant access problems. Here's Foster:

Specifically, the annual price updates for most categories of non-physician health services will be adjusted downward each year by the growth in economy-wide productivity. The best available evidence indicates that most health care providers cannot improve their productivity to this degree—or even approach such a level—as a result of the labor-intensive nature of these services.Without unprecedented changes in health care delivery systems and payment mechanisms, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services. By the end of the long-range projection period, Medicare prices for hospital, skilled nursing facility, home health, hospice, ambulatory surgical center, diagnostic laboratory, and many other services would be less than half of their level under the prior law. Medicare prices would be considerably below the current relative level of Medicaid prices, which have already led to access problems for Medicaid enrollees, and far below the levels paid by private health insurance. Well before that point, Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result.

Orszag's specific concern is that under the Ryan plan, seniors will have the opportunity to switch into private Medicare plans. Those plans will pay more than traditional Medicare, which the Ryan plan would retain as an option. Orszag points to evidence suggesting that doctors are more willing to take Medicare beneficiaries because there are so many of them. So if lots switched to private plans, he argues, that would dilute traditional Medicare's market power and thus make doctors less willing to take those patients.

But Medicare beneficiaries already have pervasive provider access problems. A Health Affairs study published last month found that 17 percent of physicians would not take new Medicare patients last year. A 2009 study of doctors in Alaska found that 11 percent had opted out of Medicare and would only take patients who paid in cash. 

If Medicare's own actuary is to be believed, Medicare's current fiscal path is likely to make those problems worse. And on that path, seniors won't have the option to leave traditional Medicare for a private plan that may ensure better doctor access. Either way, traditional government run Medicare is a sinking ship. Ryan's plan, at least, would offer the possibility of some lifeboats.

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  1. Love the alt-text.

  2. I hear Dr. Obama hands out pain pills like candy on Halloween.

  3. Who knows? If enough doctors opt out of Medicare, perhaps market forces will reduce the price of medical care?

    More likely refusing Medicare will become a felony, or accepting Medicare will be a condition of having a license to practice medicine.

    1. Doctors can’t deny treatment for the preexisting condition of being on Medicare!

    2. Don’t you think that the aura and prestige associated with having MD appended to one’s name have taken a not insignificant plunge in recent decades?

    3. I’m going back to my sci-fi novel/TV series idea of forming a organized crime syndicate that runs a chain of black market hospitals and clinics – like ‘Breaking Bad’ but with hot Doctors and Nurses.

      But instead, I’ll just do it in real life. Hire black listed docs and underpaid nurses and set up shop in RVs and random safe houses. Don’t worry, I’ll pay off the state health code guys and have seperate division handle the drugs.

  4. More paperwork, less* reimbursements?

    Who wouldn’t like that?

    *Hides, waits for Cavanaugh to storm into trap*

  5. Everytime I see that cover, I don’t know whether to laugh or cry. To think they ran that cover without any sense of irony or humor.

  6. When the buffet line is filled with all-you-can-eat patrons the food has to be cheaper. Medicare needs to be whacked.

    OT – Small biz owners support Obama by eight points.…..story.html

    1. One would surmise that most small-business owners would, you know, actually want their businesses to survive.

      1. If you survived the 2008 crash you should probably thank Obama since he extended the NOL provision to five years.

        1. By cutting my own throat – i.e., voting for Obama?

          Fuck that. I’m not suicidal.

          1. Shit, shrike, at least Romney is a capitalist… Obama despises the private sector. “Behind enemy lines”, remember?

            Not that I’m voting for either of these fuckstains… just making a point. One you’ll miss, of course.

            1. Don’t know what you are talking about but it is probably out of context.

              I feel like I am behind enemy lines when I go to Wal-Mart due to their policies and not because they profit.

              1. Must be horrible, all those impoverished obese people with their bad taste and Nascar hats.

  7. Without unprecedented changes in health care delivery systems

    But that’s what ObamaCare did, right?

    What are we worrying about?

  8. I feel like I am behind enemy lines when I go to Wal-Mart due to their policies

    Those bastards!

    Forcing poor little Shreeek into their store at gunpoint.

  9. Any plan that increases demand without increasing supply will fail.

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