What would a Romney Medicare plan look like and how would it shake down in Connecticut?
We don't know because the candidate isn't giving details, but the Kaiser Family Foundation has put some clues together and come up with a rough picture based on connecting a few dots.
And it isn't pretty.
Connecticut is one of four states in which 90 percent or more of Medicare beneficiaries would pay higher premiums to keep the same coverage they have now.
Across the nation, according to Kaiser, a nonpartisan health research group in Washington, D.C., just under 60 percent of beneficiaries would pay more to keep the same coverage —- including 53 percent of the 35 million current beneficiaries under traditional Medicare.
In Connecticut, 49 percent of Medicare beneficiaries would pay at least $100 a month extra for the same coverage, the report said. Nationally, 27 percent would pay at least that much extra.
The Kaiser study makes clear it's not about a Romney plan, but rather a "premium-support system" like the one proposed by vice presidential nominee Paul Ryan and other Republicans — and generally supported by Romney.
Obama's campaign posted the study, and Ben LaBolt, the campaign spokesman, tweeted it.
Romney's campaign cried foul. "As the authors stress, this is not a study of the Romney-Ryan plan," Romney spokeswoman Andrea Saul said in a story by the Associated Press. "Our plan would always provide future beneficiaries guaranteed coverage options with no increase in out-of-pocket costs from today's Medicare."
Among the many moving parts in this issue is that the private Medicare system will evolve over time — perhaps toward lower costs if, for example, accountable care in the broader health reform leads to lower overall spending and better health outcomes. But that can happen with or without vouchers, and Romney's campaign isn't helping matters by insisting that costs won't rise but refusing to release any details to show how that will happen.
Kaiser's study works as follows:
"This study examines potential changes in the premiums paid by Medicare beneficiaries under a payment approach that caps federal contributions per beneficiary based on the cost of the second lowest-bidding private plan or traditional Medicare, whichever is lower in their area. Under this approach, beneficiaries can choose among competing plans," Kaiser said, but they would have to pay the higher costs themselves if plans were more expensive.
Under the current system, "beneficiaries generally pay the same Medicare premium regardless of where they live," Kaiser noted.
The study takes that set of model and runs it through actual data from 2010 on Medicare beneficiaries' choices, and the actual costs of Medicare services in each county, for both traditional Medicare and private Medicare Advantage plans.
In 2010, the year from which the data were drawn, there was a wide range of private Medicare bids in comparison with traditional Medicare.
No voucher system will happen for anyone who's now 55 or older under the Ryan plan. But if such a plan goes into effect, the Kaiser report suggests that in areas where the federal "premium support" is lower than traditional, government-run Medicare because of lower bids, patients could be forced to switch doctors.
"Some beneficiaries may be willing to pay more for a higher-cost plan to keep their current doctors, but those with modest incomes may not have that option," said Tricia Neuman, a Kaiser vice president who was co-author of the study. (Disclosure here: She's a friend from college.)
One critic of the report, Romney health policy advisor James C. Capretta, wrote in the National Review Online, "According to Kaiser, competition and consumer choice would have only a minimal impact on costs. This defies common sense and experience." He added that it's not realistic to assume a rubust private system will mimic the limited private Medicare we have now, which covers 25 percent of recipients.
It's a fair point, that the supposedly free market could create lower costs than government programs if companies have a chance to compete. But that's a tough argument to make in a market that's necessarily as regulated as health care. Besides, it's possible to have competition and consumer choice — as we have now with private Medicare plans — without a voucher system that caps payments and leaves millions of people worse off.
Read The Haar Report blog at http://www.courant.com/haar.
