At least two Republicans are on record condemning the Medicare reforms in Rep. Paul Ryan’s (R-WI) proposal and now former Wisconsin Governor and Health and Human Services Secretary Tommy Thompson is also weighing in against the GOP’s plan to voucherize the program. In an op-ed for the Huffington Post, Thompson writes that while encouraging seniors to have “more skin in the game” should be part of the dialogue, policy makers need to focus on changing the incentives in the system to encourage providers to deliver care more efficiently rather than simply cutting the program:
The good news is that we don’t have to wait to begin to realign physician incentives. The Affordable Care Act gives great discretion to the CMS Administrator to experiment with alternative payment systems. CMS has created an “innovation center” and is looking for ideas. I believe the administration should use its discretion to begin to experiment with capitated payment, where one fee is paid for a patient episode of care, regardless of how many procedures are performed. [...] House Budget Chairman Paul Ryan (R-WI) is leading an important conversation about how to develop a system that would encourage consumers to put some skin in the game. [...]
Simply cutting Medicare isn’t the answer by any means. Instead, let’s focus on the most effective fiscal path forward with the least amount of impact on millions of seniors, their families and our broader economy. In other words, reform Medicare, don’t cut it.
Ryan has taken a lot of heat for failing to find health care savings from within the health care system and instead slashing the federal contribution to the program and shifting the extra costs onto seniors. The Congressional Research Service (CRS) reports that it’s unclear if Ryan budget would protect the parts of the law that Thompson is trumpeting, those “that would test various patient care models including accountable care organizations,” but Republicans have previously voted to repeal those provisions.
This isn’t the first time Thompson — who Sen. John McCain (R-AZ) has dubbed “the smartest guy on health care” — has broken with traditional GOP orthodoxy. In November 2010, Thompson said Republicans shouldn’t repeal the entire Affordable Care Act. “When it’s all said and done, you’re not going to be able to repeal health care because President Obama is not going to sign it,” he said. “[T]he overall health care is going to have take a wait-and-see attitude before all the rules are done and drafted.”