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Mathematica’s Marsha Gold Provides a “Perspective”
on Medicare’s Future in the New England Journal of Medicine
Contact: Jennifer de Vallance, (202) 484-4692
WASHINGTON, DC—February 22, 2012—A “Perspective” piece in the current New England Journal of Medicine by Marsha Gold, senior fellow at Mathematica Policy Research and a national expert on Medicare, examines the limits of Medicare Advantage, private health plans, and market competition as proposed solutions to traditional Medicare’s rising costs and growing eligibility rolls.
Gold discusses Medicare’s 30-year experience with voluntary private-plan enrollment—initially through health maintenance organizations and currently through Medicare Advantage managed plans—as an alternative to traditional Medicare coverage. Tapping into her extensive expertise on this topic, she compares Medicare Advantage and traditional Medicare coverage across multiple levels to inform policymakers as they consider solutions to the current Medicare crisis.
Based on the evidence, Gold concludes:
- Neither the private sector (Medicare Advantage) nor government (traditional Medicare) has a magic solution for controlling health care costs.
- Studies comparing Medicare Advantage plans with traditional Medicare in terms of quality of care are limited, but their results do not justify a large differential in payment based on quality.
- Medicare Advantage has increasingly attracted beneficiaries who seek to lower supplemental premiums, limit cost sharing, and consolidate their benefits, but cost sharing in the program can still be substantial.
- The highly skewed distribution of health care spending and the selection patterns of Medicare Advantage enrollees have meant that risk-adjusted payments are essential to an equitable private-plan offering.
- In the absence of strong marketing, enrollment, and other protections, the characteristics of Medicare beneficiaries make them vulnerable to potential abuse by unscrupulous insurers.
- Unlike most proposed voucher or premium-support plans, Medicare Advantage guarantees all Medicare beneficiaries the same benefits and the ability to return to traditional Medicare if they aren’t satisfied.
“In general, Medicare’s experience with private plans strongly suggests that hard decisions cannot be avoided merely by shifting to a different system,” says Gold. “Private plans are not inherently more efficient than those provided by the public sector.”
About Mathematica: Mathematica Policy Research seeks to improve public well-being by conducting studies and assisting clients with program evaluation and policy research, survey design and data collection, research assessment and interpretation and program performance/data management. Its clients include foundations, federal and state governments and private-sector and international organizations. The employee-owned company, with offices in Princeton, NJ; Ann Arbor, MI; Cambridge, MA; Chicago, IL; Oakland, CA; and Washington, DC, has conducted some of the most important studies of health care, nutrition, education, international, disability, family support, employment, and early childhood policies and programs.