Major expansions in Medicare such as those proposed by Medicare for All advocates are unlikely in the future, but more modest proposals such as Medicare buy-in at an earlier age are a real possibility, according to physicians and health care policy experts who spoke Tuesday.
(Left to right) Patel, Starc, McClellan
Medicare for All, an umbrella term for a collection of ideas involving a more far-reaching public health insurance, has been proposed as a solution to the disparities that plague the U.S. health care system.
"I don't see that as being realistic," said Kavita Patel, MD, senior policy advisor at Stanford University and former official in the Obama administration. "Not only because we're dealing with a more divided Congress but also a more divided public too."
A more likely scenario involves continued growth in Medicare, Medicaid and Medicare Advantage, also known as Medicare Part C, said Mark McClellan, MD, PhD, professor at Duke University and former administrator of the Centers for Medicare and Medicaid Services.
"Not Medicare for all, but if we don't do anything else we're going to see Medicare for more," said Dr. McClellan. "That's just demographics, with more people aging and more income inequality that means fewer people being able to afford their insurance."
Declining Reimbursements, Implications for Radiology
Drs. McClellan and Patel appeared as part of a conversation on Medicare and U.S. health care policy moderated by Amanda Starc, PhD, associate professor at Northwestern University's Kellogg School of Management in Chicago. In a wide-ranging discussion, the two physicians talked about everything from AI to radiologist shortages. Declining reimbursement, though, was at the forefront of the discussion.
"We're coming up on a time when we'll probably see a bigger change in physician reimbursement, maybe over the next several years," Dr. McClellan said. "Now is a time when Congress is starting to think about what it could do differently."
"Medicare is so big, so it's not always influenced by the commercial sector, but it does look for what is working," Dr. Patel said. "It's incredibly important to have radiology as part of these population based models."
Dr. McClellan suggested that people concerned about government-run health care may be unaware that managed care plans make up almost 90% of Medicaid. Policymakers in Washington, he said, are currently focused on how to pay for Medicare, Medicare Advantage and Medicaid in a way that makes them more accountable, not only for keeping total costs down but for improving quality, access and equity.
"That's where the future is headed," said Dr. McClellan. "More government oversight in Medicare and Medicaid, which are the fastest growing parts of our health care system. The question is, can we do it right?"
No matter what shape the policies take, radiologists must work to ensure their voices are heard, Dr. Patel said.
"I haven't seen enough of radiology at the table," Dr. Patel said. "I think RSNA doing this discussion is a great step in that direction, but these conversations should become more commonplace within the profession."
Access the presentation, "Medicare and U.S. Healthcare Policy: A National Conversation," (T6-RCP04) on demand at Meeting.RSNA.org.
