On November 9, MedPac, the non-partisan commission that advises Congress on Medicare Policy, held a meeting (PDF, pp.313+) during which it examined several measures (PDF) of the quality and effectiveness of Medicare Advantage (MA) plans, those run by private insurance companies and paid by the Medicare Program to provide all medical services to Medicare beneficiaries. As most readers of this diary know, these plans were created by the Medicare Modernization Act of 2003 (MMA). A high point of the Republican Congress' privatization agenda, the MA program was touted as a triumph for "the free market" that would create competition with the public program and among private plans. This competition would, in turn, reduce costs of the Medicare program and improve its quality.
We already know that MA plans cost, on average, 12% more than traditional fee-for-service Medicare (PDF). So there has been no cost reduction; there has been, in contrast, a cost increase.
Now, there is evidence that MA plans do nothing to improve quality. The National Committee for Quality Assurance, a non profit institution, has developed measures of process (Are recommended procedures done?) and intermediate outcomes (Outcome measures not including death, but such measures as control of blood sugar in diabetics or control of blood pressure). These measures have become the standard for evaluating the quality of managed care systems. Because of different demographic compositions the number of measures applied differs for MA plans, commercial plans and Medicaid
For MA plans, the results were not good. On average, Medicaid plans improved on 34 of 43 measures; commercial plans improved on 30 of 44 measures, but MA plans improved on only 7 of 38 measures. Moreover, some kinds of MA plans were exempted from reporting any quality measures by the MMA, so MA quality may be worse than these averages suggest. Other kinds are exempted from some reporting.
MedPac also looked at a specific and important measure, the provision of eye exams to detect incipient blindness in diabetics. It saw that 24% of MA plans provided such exams for fewer than 50% of their diabetic members, and about half gave them to more than 60%. Only 10% provided the exams to 80% or more.
The extremely negative implications of these data were not lost on the MedPac Commissioners. Its Chairman stated
. . . a number of things depress me about the results. But one of them is that I fear that we're going backwards. . . .
These results are just a reflection of our -- we're not evolving. We're devolving, and moving away from better care for Medicare beneficiaries, more efficient care.
The MedPac Commissioners generally agreed with this evaluation. The question is will Congress be able to overcome the combined power of the insurance and drug industries combined with the extended brainwashing of the public about the "superiority" of "the free market". Will it be able to eject private insurance from the Medicare program or, at the very least, to pay private insurance plans no more than the costs incurred by beneficiaries of traditional fee-for-service Medicare?