Future of Medicare at stake in Presidential election, opinion piece states

"At stake in the presidential election is whether we will all need to consult lobbyists to have our medical issues heard by a remote, bureaucratic Medicare program," Scott Gottlieb, a former CMS official and an American Enterprise Institute fellow, writes in a Wall Street Journal opinion piece.

According to Gottlieb, CMS, lawmakers and presumptive Democratic presidential candidate Sen. Barack Obama (Ill.) "are all moving to expand government influence over the medical choices we make," and the House as early as Tuesday might approve legislation that would reduce funds for Medicare Advantage. "Democrats hate Medicare Advantage and have been trying to cut it for quite some time because they don't like health care markets," Gottlieb writes, adding, "Why cut? For all the talk about finding health care savings with painless 'reforms' like better information technology or disease management, the only way to really control costs under our current health care model is to control access to drugs, devices and services."

He writes, "The crucial question is where the controls should be -- with patients working through private plans or with government agencies," adding, "While private health insurance is imperfect, there's a misguided faith in Medicare's superiority." Gottlieb writes, "Many in Congress assume that private insurers are driven by greed" and that "only a government-run health program can ensure adequate access to services," but MA plans "offer prevention and wellness benefits, care coordination and alternatives to hospitals at the end of life that traditional Medicare does not provide."

Presidential Candidate Proposals

Obama "has been honest about his intentions" to "cut from Medicare Advantage to pay to expand 'fee-for-service' Medicare programs," but his "endgame is to leave the government-administered Medicare program in a position to set decisions for the entire health care system," according to Gottlieb.

He adds that the "fundamental question we are being asked in November" is whether "we stick with a 'defined benefit,' where everyone is promised the same government services," or "move toward a 'defined contribution' system" -- a system supported by presumptive Republican nominee Sen. John McCain (Ariz.) -- "where seniors can buy private health insurance." Gottlieb concludes, "Patients covered under Medicare Advantage have their own discomforts, but at least they can always change plans and appeal decisions," without having to "consult a lobbyist" (Gottlieb, Wall Street Journal, 6/24).