60 Seconds with Alice Rivlin, Senior Fellow, Brookings Institution

Alice Rivlin
Alice Rivlin

Medicare just turned 50. Some are asking: Will improving choice and competition in Medicare Advantage keep the program going until 2030?

A: The answer is a very qualified “yes.”

Q: You have previously noted that an attractive scenario could involve two parallel tracks that eventually converge. How might that happen?

A: One track would start with Medicare Advantage and build on its strengths. It would use competitive bidding, improved quality measures and consumer choice on user-friendly exchanges to reduce costs and improve health outcomes in areas where MA plans can compete effectively without subsidies. 

The second track would use payment reforms to lower costs and improve health outcomes in traditional Medicare. It would involve giving beneficiaries incentives to enroll in accountable care organizations that accepted risk and received capitated payments.

Q: But wouldn't that require cooperation between the White House and Congress?

A: None of these policy issues are easy. But if they can be resolved satisfactorily, well-designed competitive bidding could be part of a viable, well-funded Medicare that delivers quality care to the seniors of 2030. Achieving such a result is worth a lot of effort. 

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