Obamacare vs. Medicare

Meshing the two plans could lead to better care and savings for taxpayers

By Joe Klein Monday, Dec. 17, 2012
    • Illustration by Oliver Munday for TIME

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    That subsidy is a good part of the reason Medicare Advantage currently costs about 115% as much as fee-for-service Medicare. But groups like the Mayo Clinic, Seattle's Group Health Cooperative and Pennsylvania's Geisinger have proved that their accountable-care models can save significant cash when it comes to treating the elderly. The nation's hospitals are discovering that the information culled from electronic record keeping can lead to best-practice procedures that save money and provide more-effective care.

    And that opens some interesting possibilities. Obamacare "is the law of the land," says Tennessee Senator Bob Corker, who is one of the few Republicans who'll admit that. Corker has proposed a creative Medicare Advantage reform that the Congressional Budget Office says would save $290 billion over 10 years. "In the future, I don't see why someone who is happy with the insurance he or she receives through Obamacare can't just continue on with the same plan as part of Medicare," Corker told me, "and that might make it easier to raise the age of eligibility." Corker has proposed a gradual rise from age 65 to 67 for Medicare.

    Actually, you can get really creative here. You can raise the age of Medicare eligibility according to income--and according to whether an individual chooses Medicare Advantage or fee-for-service. You can also lower the age of Medicare eligibility, especially for the less well off, if they choose Medicare Advantage. As Wyden suggested, there's the possibility for a grand compromise here: if Democrats accept a move away from fee-for-service medicine toward Medicare Advantage, Republicans should embrace the possibility that Obamacare could pave the way toward lower health care entitlement spending overall. That won't be easy. But it's not unthinkable, either.

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