Republican Matthew A. Doheny said opening up the Medicare program to more private competition could help save it.
U.S. Rep. William L. Owens, his Nov. 6 opponent, said that Mr. Dohenys ideas would essentially end it.
The back and forth on the entitlement that is both popular and costly highlighted a basic philosophical difference between the candidates on the senior health insurance program: Mr. Doheny believes in increasing the role of private insurers, while Mr. Owens does not.
If the current fee for service system works for you, then you should be able to keep it no questions asked, Mr. Doheny wrote on his website Wednesday, after nearly a year of being pestered by Democrats and reporters to flesh out his Medicare position. But Medicare should welcome competition, just like the program that members of Congress use for their benefits.
Mr. Doheny offered scant details on how the plan would differ from the current Medicare Advantage program, which allows seniors to enroll in a private health plan. Medicare Advantage plans have contracts with the Medicare program. Mr. Doheny suggested that his idea was merely an expansion of that, but Mr. Owens said the proposal would privatize the Medicare program, a particularly weighty charge given the attention that Republican Rep. Paul Ryans budget has received.
The 2010 Patient Protection and Affordable Care Act reduced Medicare spending on Medicare Advantage plans. Mr. Owens supported that law. Part of the justification for that reduction in spending was that Medicare Advantage plans were costing more than traditional Medicare, according to several studies.
It does cost more, and thats one of the reasons why some of those dollars were pulled back, because it wasnt getting people better results and better outcomes, Mr. Owens said.
Mr. Dohenys campaign explicitly stated his idea wasnt to turn Medicare into a voucher program. The government would pay private insurers directly, and not issue a voucher or a check to pay premiums for health care, Mr. Doheny said of his campaign idea. (He stated in his essay that it was not a plan, but rather a series of bipartisan ideas.)
But his insistence did not placate Mr. Owens, who said in a news release: Hes saying its not a voucher program. But its a distinction without a difference. The government can give a senior a voucher to buy insurance on the private market, or it can pay the private insurer directly. Either way, its privatization and it ends the Medicare guarantee.
Mr. Doheny also said benefits would not be cut for current Medicare recipients or those approaching eligibility age. He said the eligibility age for Medicare should be gradually raised to 67, and that beneficiaries who have the ability to pay more for Medicare should do so.
Mr. Owens said hes against both ideas. He said Congress should first wait to see whether the health-care law brings down costs by encouraging preventive care and reducing hospital readmissions before taking those steps.
Meanwhile, Mr. Doheny said that while he would vote to repeal the health-care law, hed keep at least two parts of it: closure of the prescription drug doughnut hole that forces seniors to pay more for medicines, and a measure that allows parents to keep their children on their health insurance until they are 26 years old.
Mr. Dohenys idea for more private competition sounded much like a voucher program, according to Henry J. Aaron, a scholar at the Washington-based Brookings Institution.
It really doesnt make any difference whom the check is written to, Mr. Aaron said.
He added that studies have shown Medicare Advantage plans havent helped bring down Medicare costs.
The claim that if we just turn competition on its going to reduce Medicare spending is so far unsupported, he said. Indeed, its contradicted.
But Paul Howard, a scholar at the conservative, New York City-based Manhattan Institute, said a premium support plan modeled after the one federal employees participate in the dreaded voucher, according to some would indeed help bring down costs.
Choice is important, he said.
That sort of model has worked for Medicare prescription drug coverage, he said.
Its not something out of far right field, Mr. Howard said.