Monday, November 2, 2009

Healthcare Opinion Leaders' Views on Medicare Reform

According to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, more than eight of 10 leaders in health care and health care policy believe Medicare has been successful at accomplishing two major goals—providing beneficiaries with access to basic medical care and providing stable, predictable coverage over time. Several of the Medicare proposals being discussed in Congress as part of comprehensive reform legislation, including expanding the power of the Secretary of Health and Human Services to put payment pilots on a "fast track" and to work with other parties to implement multipayer payment initiatives, are supported by most opinion leaders. Respondents also voiced strong support for using Medicare’s leverage to negotiate pharmaceutical drug prices and creating an independent Medicare advisory council with authority to make payment and benefit design decisions within parameters established by Congress and the president.




As Congress continues to craft and debate health reform, Medicare finds itself both a target of reform and a means through which policymakers seek to transform the larger health care system. Persistent spending growth, budgetary pressure, and an aging population have taxed the program’s resources and created concerns over its fiscal future. Nevertheless, the program remains popular among beneficiaries and successful at providing access to needed care and financial protection. Analysts have noted that as the country’s largest purchaser of services, Medicare is uniquely positioned to encourage efficiency in health care finance and delivery.

Health reform bills under active consideration in the House of Representatives and Senate include provisions designed to restore fiscal balance to the program and use its strengths to generate larger changes in U.S. health care. Specific proposals include bundling payments to providers to cover care delivered over a specified period, revising fees to increase compensation for primary care, and offering providers financial incentives to serve as patient-centered medical homes. These strategies seek to stimulate more collaboration among providers, increase accountability for patient outcomes, and encourage efficient use of resources.

In the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, leaders in health care and health policy were asked for their views on Medicare reform. A large majority of respondents felt the program has been successful in fulfilling two major goals: providing the elderly and disabled access to basic medical care and stable, predictable coverage over time. Despite that success, leaders favored several broad changes, including expanding the scope of the Secretary of Health and Human Services’ power to put payment pilots on a fast track, working with other parties to implement multipayer payment initiatives, and establishing an independent Medicare advisory council. Respondents also strongly supported several policies that focus more specifically on strengthening or expanding how Medicare fulfills its current role, including using Medicare’s leverage to negotiate pharmaceutical drug prices, filling in the Medicare Part D coverage gap, and eliminating the two-year waiting period for the disabled.

These views are in line with the recommendations of the Commonwealth Fund Commission on a High Performance Health System, which has a mission to promote better access, improved quality, and greater efficiency across the U.S. health care system. The Commission has put forward an integrated set of payment and delivery system changes in Medicare that, taken together with more far-reaching coverage and system reforms, have the potential to extend affordable health insurance to all and slow the growth of health spending by an estimated $3 trillion through 2020. By encouraging the delivery of more effective and efficient care, the Commission’s proposals could yield greater value for health spending, return substantial savings to families, businesses, and the public sector, and place Medicare and the nation on a more sustainable fiscal path.


K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders Views on Medicare Reform, The Commonwealth Fund, November 2009.

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