If you could make one change to Medicare, what would it be? Ask three former directors of the program and you’ll get plenty of ideas.
Bruce Vladeck, who was head of what was then known as the Health Care Financing Administration, or HCFA, for former President Bill Clinton, wants more market-based competition and less pricing set by Congress.
“I would like to move all of Medicare drug purchasing, whether through Part D or Part B, all of [durable medical equipment] and related services – almost everything other than hospitals, docs and managed care plans — to a real market-based purchasing model,” he said. Give the administrator of the Centers for Medicare & Medicaid Services the authority to negotiate prices “starting with the federal supply schedule for the 20 or 25 percent of Medicare outlays that are creating windfalls for various producers that we don’t talk about so much because it’s only 20 or 25 percent of outlays,” he said.
Gail Wilensky, who ran HCFA for President George H.W. Bush, would urge lawmakers to adopt a competitively bid premium support model that includes the current traditional fee-for-service plan and the payments beneficiaries receive would vary by income and health risk.
Mark McClellan, who ran CMS for George W. Bush, wants to see Medicare make more progress on reducing the growth of costs. The program, which serves 50 million elderly and disabled Americans, “is nowhere near done with those kinds of steps, nowhere near the private sector” on cost control. “Reducing overall spending growth while still insuring access to care and improvements in innovation” are key, he said.