The Romney/Ryan campaign and conservative pundits have begun to cite a study by three Harvard economists as evidence that the Medicare voucher plan that the Republicans are now supporting would actually lower health care costs for seniors. One of the authors of that study bluntly tells them to “stop misusing my Medicare study.”
Supporters for the Romney-Ryan approach to Medicare have a new talking point. They say a new study by “three liberal Harvard economists” proves that the plan’s competition will reduce health care costs without harming beneficiaries. But the study doesn’t say that.
And I should know. I’m one of the economists who wrote it.
Both Mitt Romney and Paul Ryan have said they would like to convert Medicare into a “premium support” (nee voucher) system. Their plans are different, and Ryan himself has proposed several versions. But they share a basic architecture. Starting ten years from now, new retirees would not receive a Medicare card, as they would today. Instead, they would receive a voucher and shop for an insurance policy in a specially regulated market…
How would this affect seniors? In particular, how many seniors would end up paying more to stay in traditional Medicare?
That’s the question that Zirui Song, Mikchael Chernew, and I set out to answer in the study, which was published in the Journal of the American Medical Association. To do this, we examined what would have happened if, today, something like the Romney-Ryan plan were in place: In other words, if today’s seniors were getting vouchers, how much would those vouchers be worth?
We found that 24 million seniors, or about two-thirds of the people presently enrolled in the traditional Medicare program, would have to pay more—specifically, an average of $64 per month or $768 per year. Some seniors already enroll in private plans, as part of the “Medicare Advantage” option that has existed, in one form or another, for many years. About 7 million seniors or more than 90 percent of that group would have to pay more.
And he explains in detail where they go wrong in misinterpreting his study:
First, it confuses costs and payments. Medicare Advantage plans bid less than traditional Medicare, but they are paid more. The plans are officially supposed to use these higher payments to sweeten the pot—add additional benefits, reduce cost sharing, and the like—though some likely go for profit as well. This is why the Affordable Care Act reduced the amount that the government pays to managed care plans, over howls of protest from conservatives. Bidding less does no good for the program if the government then overpays relative to what was bid.
Second, they miss a key part of the reason why the Congressional Budget Office estimated that Ryan’s voucher proposal would cost seniors more. Medicare Advantage plans can only cost what they do because the traditional Medicare program is in place to help them. Specifically, Medicare sets very low payment rates to providers, and Medicare Advantage plans bargain up a bit from those rates. Get rid of the traditional Medicare program, or even reduce its enrollment substantially, and the estimated cost of Medicare Advantage premiums skyrockets.
I predict this will not stop them from making the same claims again.