So the HSA ideology has wormed its way into CMS, and now Medicare is seeking proposals for its Consumer-Directed Health Plan demonstration. Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no-one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.
But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending. Perhaps we’ll get to see if the private plans really can stand on their care management merits—and there’s so much fat in Medicare that they ought to be able to, easily. Although they failed to do so in the late 1990s.
However, it’s just bizarre to increase the costs of a tax payer funded universal risk pool by allowing people who are not paying into it to withdraw cash from it. So the only real explanation is that CMS and its political masters in the White House are eventually intending to put the entire system into a high-deductible plan and not fund the amount below the deductible. Just the same as most employers are doing (as I explained in this Spot-on piece about Intel). That of course makes perfect sense for the government and the taxpayer. Until, that is, the seniors find out! I wouldn’t want to be in charge of Medicare when that happens, remember what those seniors did to Rostenkowski!