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Medicare performs better than private plans

Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage

By Karen Davis, Kristof Stremikis, Michelle M. Doty and Mark A. Zezza
Health Affairs, July 18, 2012

The 2010 survey results indicate that compared to people who are privately insured, Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home—a primary care provider who knows their medical history well, is accessible, and helps coordinate their care. Studies show that patients with medical homes are less likely to report medical errors or gaps in the coordination of their care and are more likely to be up-to-date with their preventive care.

Given these findings, it is not surprising that Medicare beneficiaries are far less likely than privately insured adults to give their health insurance plan a fair or poor rating, while being far more likely to report excellent quality of care.

Among Medicare beneficiaries, those with Medicare Advantage are more likely than adults with traditional Medicare to give their insurance a fair or poor rating. Although Medicare Advantage enrollees are less likely to spend 10 percent or more of their income on premiums and out-of-pocket expenses, they are more likely to report cost-related access problems than adults with traditional Medicare. This may in part reflect beneficiaries’ experience with private health maintenance organization plans that offer lower premiums in return for limited access to a smaller network of providers.

The evidence reported here from surveys now spanning a decade shows that Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.

http://content.healthaffairs.org/content/early/2012/07/16/hlthaff.2011.1357.abstract

Summary by The Commonwealth Fund:
http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2012/Jul/1613_Davis_Medicare_vs_employer_ins_HA_07_18_2012_ITL.pdf

Comment:

By Don McCanne, MD

One of the goals of the Affordable Care Act was to protect private, employer-sponsored health plans - a sector that was considered to be functioning well. In so doing, a less expensive Medicare for all model was rejected. So how do the private plans compare to Medicare?

According to this report, "Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home - a primary care provider who knows their medical history well, is accessible, and helps coordinate their care," and are "far more likely to report excellent quality of care."

Medicare is not perfect and does need improvement, but it performs far better than the best of the private plans - the employer-sponsored health plans. Individual and small group plans have an even worse performance.

Above all, "Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection."

Right now, efforts are being made to convert Medicare into a market of private plans. Why should we pay more for less health care choice, greater risk exposure, and poorer quality? Any sane individual who is paying attention should realize that we should be doing the opposite - improve Medicare and then provide it for everyone.