New York, N.Y., November 2, 2009—A vast majority of leaders in health care and health policy believe Medicare has been successful in providing access to care and stable coverage to the elderly and disabled individuals; however only a small percentage think the program has realized its potential to achieve other important goals, like using its leverage as the country's largest purchaser of services to control costs and promote a high performance health system. In the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders survey, the experts surveyed favor sweeping changes to Medicare—reforms that would help control program costs and support broader health system reform.
Because of Medicare's unique position as the nation's largest insurance program, it can be an important testing ground for cost and quality innovations. To encourage such development, nearly all respondents favor expanding the power of the Secretary of Health and Human Services to put payment pilot programs on a "fast track" (95%) and to work with private payers and providers to establish multipayer initiatives (94%). Similarly, there was strong support for creation of an independent Medicare advisory council (favored by 75%) with broad authority to collaborate in multi-payer initiatives (89%), develop, test, and implement payment reforms rapidly and flexibly (88%), and alter beneficiary incentives based on effectiveness of services, drugs, and devices (86%).
The survey asked respondents their opinions about specific policy options to improve coverage. Respondents strongly supported using Medicare's leverage to negotiate pharmaceutical drug prices (81%) and filling in the so-called Medicare "doughnut hole"—the Medicare Part D coverage gap, through which beneficiaries are responsible for all of their covered drug costs—through some combination of increased copayments, government funding, and drug price discounts (79%). There was also strong support (83%) for eliminating the two-year waiting period currently required of 1.8 million disabled beneficiaries before they become eligible for benefits. Delaying coverage for them can have dire consequences—both financial and physical.
"While these responses confirm that Medicare has been a tremendous success in fulfilling its basic mission," said Karen Davis, president of The Commonwealth Fund, "they also indicate that it is important for Medicare to take the lead in developing innovative approaches to improving health system performance."
Other findings from the survey include:
The survey is the 20th in a series from The Commonwealth Fund, and the 12th conducted in partnership with the publication Modern Healthcare. Commentaries on the survey results by former Medicare administrators Bruce Vladeck, Ph.D., a senior adviser at Nexera, a subsidiary of the Greater New York Hospital Association, and Gail Wilensky, Ph.D., a senior fellow at Project HOPE, appear in the November 2 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings.
The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between September 9, 2009 and October 13, 2009 among 1,467 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 215 respondents from various industries, for a response rate of 16.0 percent. The complete methodology is available on The Commonwealth Fund Web site.