Reforming Medicare: Options, Tradeoffs, and Opportunities

Index

Access and coverage: age of eligibility and, 46; coordination of, 116; decisions and determination of, 36, 167n28, 167n29; ensuring access, 31–33; expansion of covered services, 10, 12; general description of, 29, 51, 116; high-deductible plans and, 109–10; limits and reductions of, 36, 47, 116; Medicare Modernization Act and, 10; problems with, 170n49; public views of, 47. See also Reforms Administration and management, 64–65. See also Reforms Agency for Healthcare Research and Quality (U.S.), 56, 100 AMA. See American Medical Association Ambulatory payment classification (APC) groups, 138–39, 188n2, 188n3 American Medical Association (AMA), 4, 18 APCs. See Ambulatory payment classification groups Australia, 56 Balanced Budget Act of 1997 (BBA), 6–7, 17, 26 Baucus, Max (D-Mont.), 7 BBA. See Balanced Budget Act of 1997 Benchmarks, 75, 77–78, 85, 89, 95–96, 99 Beneficiaries: age of, 171n56; approval of Medicare, 116; costs borne by, 2, 10, 78; eligibility of, 13–14; forgoing of care, 109–10; Medicare spending per beneficiary, 14; numbers of, 13. See also Reforms Benefits: core benefits, 76; defined benefits, 53, 76, 117; extension of, 12–13; gaps in, 29, 31; limits on, 2; premium support and, 76–77; retiree health benefits, 10; Social Security Disability Insurance and, 12; taxes and, 43–44; uniformity of benefit structure, 51. See also Reforms Bipartisan Commission on the Future of Medicare (1999), 68 Breaux, John (D-La.), 7 195 Index 196 Index Budget issues, 29, 30t, 38–50. See also Balanced Budget Act of 1997; Costs; Payments Bush, George W., 7, 133 Bush (George W.) administration, 49, 93 Business issues. See Private sector Canada, 61 Capitation, 73, 128 Categories of services: ambulatory payment classification (APC) groups, 138–39; Congress and, 14–15; home health services, 17–18; hospice care, 16–17; inpatient hospital care, 15–16, 32; laboratory services and durable medical equipment, 19–20; outpatient hospital services and ambulatory surgery, 16, 31–32, 138–39; physician and other professional services, 18–19; prescription drugs, 20–21; preventive services, 20, 31; skilled nursing facilities, 17. See also Diagnosis-related groups CBO. See Congressional Budget Office Centers for Medicare and Medicaid Services (CMS), 8–9, 36, 59 Clinton, Bill, 6, 74, 75, 94–95, 132 CMS. See Centers for Medicare and Medicaid Service Cohen, Wilbur, 3 Commonwealth Fund, 36 Competition. See Managed competition; Reforms—premium support model Congress: Medicare and, 2, 3, 7, 71; premium support and, 74; role in Medicare, 65, 68, 116. See also Balanced Budget Act; Medicare Catastrophic Coverage Act; Legislation; Medicare Modernization Act; Parts A, B, C, D; Political issues Congressional Budget Office (CBO), 8–9, 47, 89–90 Consumer-directed Medicare. See Reforms— consumer directed model Consumer Report’s Best Buy Drugs, 100 Controversies, 1–2, 4, 7, 8–10 Costs: adequate funding of Medicare, 28; administrative costs, 43, 113; average annual per beneficiary spending, 176n7; Balanced Budget Act and, 6–7, 26; control of, 38–43; cost containment, 2, 9, 15, 40–41; cost of initial plan, 4; cost sharing, 10, 62, 76–77, 105, 116, 183n48; growth in, 5, 9, 15, 38, 39t, 116–17, 170n51; home health care and, 17–18; hospice care and, 17; individual choice and, 94; for inpatient hospital care, 15; Medicare Modernization Act and, 8, 27, 28; prediction of variation in, 79; premium support and, 74; prescription drug plans, 23; purchasing, 42–43; quality and, 33; RBRVS system, 18, 19b; reasonable and necessary care, 35–36; SGR system, 18–19. See also Financing and funding; Payments Coverage. See Access and coverage Deductibles and co-payments: curtailment of drug use and, 109–10; high-deductible plans, 97–98; for home health services, 17; for inpatient hospital care, 15, 32; for physician and outpatient services, 31–32; for prescription drug plans, 20, 21, 61; for preventive services, 32; reference pricing, 61–62; reform of, 32, 49; for skilled nursing facility services, 32; tiered copayments , 61–62. See also Financing and funding Democratic Party: government negotiation of drug prices and, 54; programs opposed by, 4, 7; programs supported by, 1, 3–4, 5, 6, 53; segregation and, 4. See also Congress; Political issues Diagnosis-related groups (DRGs), 15–16, 41, 142, 143–45, 152n18, 152n19, 190n3. See also Categories of services Diagnostic tools, 55, 154n25 Dialysis, 20, 139, 145, 157n52 Diseases and disorders: Alzheimer’s disease, 55; breast cancer, 55; cardiovascular disease, 20, 35, 59; diabetes, 20, 35, 105; disability, [13.59...