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Medicare Issues Spark Animated Exchange

How would you strengthen Medicare?

A group of 16 Michigan health-care opinion leaders attempted to address that complicated question during an interactive forum at AARP Michigan.

The session was part of AARP's You've Earned a Say national conversation, an attempt to bring the debate about Medicare out from behind closed doors in Washington and into the light of day in communities across the country.

Participants watched a 90-minute live broadcast on Medicare solution options featuring Stuart Butler of the Heritage Foundation and Henry Aaron of the Brookings Institution.

That served as the launching pad for a lively exchange among the group, which included representatives from health care agencies, advocates for seniors and the disabled, economists, public policy experts, a newspaper editorial writer and others.

Some expressed frustration that it's difficult to measure the costs and potential cost savings of various plans.

"If we fail to look at the cost of care... without benefit-cost analysis somewhere, none of this is going to work," said Richard Douglass, professor of health administration and policy at Eastern Michigan University.

Others said it is politically tough to limit health care options without being accused of rationing.

"The problem we have is everybody gets everything and anything less than that is seen as not fair," said Geraldine Smolka, senior strategic policy adviser from the AARP Public Policy Institute.

Additional questions that arose during the session:

  • "If you don't let the (health care) plan control who the providers are, how do you control costs?"
  • "Why can't we return to the Hippocrates model: Do no harm and establish a close relationship between the doctor and patient rather than always poking people with gadgets."
  • "How can we know how the Affordable Care Act will work? Maybe we need to look back at the first three years of Massachusetts' (universal state health care plan) as an indicator of what we can expect."

Much of the give and take between Aaron and Butler focused on premium support plans, an option that has spurred rekindled interest since U.S. Rep. Paul Ryan, an author of such a plan, was chosen to be the Republican vice presidenialt candidate.

The discussion group had questions about premium supports.

"How do you index the vouchers in a way that doesn't hurt the people who need care but also contains cost growth?"

Douglass warned that Michigan is in for an avalanche of new Medicaid patients should that program be expanded as encouraged by the Affordable Care Act.

"We have changes that should reduce long-term costs but have enormous short-term outlays, like expansion of Medicaid," he said. "You'll have 50,000 new people in the health care system" and most of them will have serious health problems, Douglass added.

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