* Republican Medicare reforms would face daunting challenge
* Analysts see reality of legislation years in the future
By David Morgan
WASHINGTON, Sept 10 Republican presidential
candidate Mitt Romney wants to turn Medicare into a voucher
system and President Barack Obama hopes that fact alone will
help him win votes among senior citizens and baby boomers.
But health policy experts, including two analysts who first
floated the idea of Medicare vouchers 17 years ago, say no such
plan is likely to become legislation - let alone law - until
after the next presidential election in 2016.
That is because the mere notion of fundamentally revamping
the $590 billion-a-year healthcare program, which serves 50
million elderly and disabled Americans, raises a multitude of
policy issues that no politician or policymaker has addressed
Medicare voucher plans call for converting the popular
safety-net program from one that offers healthcare benefits to a
system that provides a fixed amount of money that beneficiaries
can use to purchase coverage from a menu of private insurance
"Could we enact legislation in the next year or so and
implement it two or three years from now? My simple answer to
that question is 'no,'" said Robert Reischauer, a former
director of the nonpartisan Congressional Budget Office, which
reviews legislation with budgetary implications.
That may come as news to voters, particularly in
battleground states like Florida, Ohio and Iowa, where the
Medicare reform plan adopted by Republicans, including Romney
and running mate Paul Ryan, is a main target for Democrats who
say it would "end Medicare as we know it."
Reischauer and Henry Aaron of the Brookings Institution
proposed a voucher or "premium support" mechanism for Medicare
in a 1995 article in the journal Health Affairs widely seen as
the first suggestion of such a reform.
On Monday, they spoke at a Washington conference hosted by
America's Health Insurance Plans, an industry trade group. The
two men agreed that the Republican plan and others like it that
have been floated by independent groups in recent years were not
"ready for prime time."
"I don't think any of the premium support plans on the table
now has gone an inch beyond the specifications that we laid out
back then. And I will tell you, we did not design legislation,"
No experts in either the public or private sectors of the
$2.8 trillion U.S. healthcare system have said in detail how a
voucher system might work. The task require better insurance
risk-adjustment mechanisms than are available now, as well as a
deeper understanding of geographic variations in medical costs.
'A ZILLION ISSUES'
"There are a zillion specific issues. And there's plenty of
research, a lot of it unsatisfactory. There's a lot of practical
experience, most of it unsatisfactory," said Joseph Antos of the
conservative American Enterprise Institute, who appeared with
Reischauer and Aaron.
"You can't do this in the next three years," he added.
"Maybe in the next five."
Ryan, who chairs the House of Representatives Budget
Committee, has proposed a version of a voucher plan that
includes traditional Medicare as an option for future retirees
and caps annual per- capita Medicare spending at 0.5 percent
above the rate of U.S. economic growth.
Romney has proposed a similar plan, which appears on his
campaign website. Republicans largely adopted the Ryan plan as
part of the party platform at their national convention last
month in Tampa, Florida.
Critics say Ryan's main objective is to limit Medicare's
ability to widen the federal deficit by shifting costs to
seniors and the disabled. He says the plan would strengthen
Medicare for generations to come.
Reischauer and Aaron warned it was not clear the strategy
would contain costs, saying political pressure could mount on
Congress to do away with spending caps, while private insurers
could have difficulty fielding plans that cost less than
They said the best route could be to combine a voucher
mechanism with reforms being implemented under Obama's Patient
Protection and Affordable Care Act, be tter known to voters as
"Obamacare," which Republicans have vowed to repeal if they win
control of the White House and U.S. Senate in the Nov. 6
The law, which comes fully into effect in 2014, is supposed
to move Medicare away from its current fee-for-service format
that offers healthcare providers incentives to drive costs up.
It also calls for state insurance exchanges that would
offer consumers federally subsidized private coverage.
Reischauer said the exchanges would provide vital lessons
for any future voucher system for Medicare.