A Case for Retiring America’s Worst Four-Word Phrase

As summer heats up, so will the mid-year congressional campaigns.  When they do, we can unfortunately expect to hear more of the dreary rhetoric that arises every time Medicare comes up for discussion.  Candidate X will support changes to strengthen Medicare and improve its financial sustainability.  Candidate Y will respond by charging that Candidate X wants to do away with Medicare “as we know it.”

Even though the “as we know it” accusation was dubbed the Lie of the Year in 2011 by the PolitiFact fact-checking service, politicians continue to use it freely to score points against adversaries who propose any sort of change to the status quo.

A column in today’s New York Times – no bastion of conservatism by any measure – makes a strong case that it’s time to retire this four-word phrase for good.

Health economist Austin Frakt writes that enrollment in Medicare Advantage plans, operated by private health insurers, is increasing significantly, even after the federal cuts to Medicare Advantage plans that were part of the Affordable Care Act.  Today, approximately three of every ten Medicare beneficiaries are enrolled in one of these private plans and current trend lines tell us that proportion will continue to increase.

Frakt speculates that a reason for this growth is the comfort baby boomer beneficiaries have with private plans, having been enrolled in them throughout their working years.  He writes, “…baby boomers, who are just entering Medicare-eligibility age, are more accustomed to the types of insurance Medicare Advantage offers, such as H.M.O.s, than their predecessors were. Newly retired Americans have probably been enrolled in similar, employer-based plans for years if not decades — perhaps by the very same companies that offer Medicare Advantage plans — making it a relatively easy choice to enroll in such a plan for Medicare coverage.”

At the Healthcare Leadership Council, we have commissioned focus groups of middle-aged and older Americans to discuss their perspectives on Medicare.  Our findings closely mirror Frakt’s column.  We have found that Americans in their 40s and 50s are not at all averse to choosing between private plans for their Medicare coverage, and even seniors are adapting well to consumer choice after having experienced it for a decade now in the Medicare Part D prescription drug program.

We also found that, when assessing various options to address Medicare’s financial challenges, middle-aged and older Americans would rather use private sector competition as a tool to contain costs than see deeper cuts to physician and hospital reimbursements.

So when political candidates talk about fighting for Medicare “as we know it,” this phrase rings increasingly hollow.  Millions of beneficiaries are already rejecting the idea of an inflexible Medicare status quo and are gravitating to privately-run plans.  Perhaps it’s time for politicians to follow where the people are already leading.