I'm not going to dissect his proposal here because that has already been done by others, but I will make this suggestion to Rep. Ryan: Stop focusing on the money and think about the care.
Improving health, lowering cost, and saving lives is Donald Berwick's mantra. He contends that we won't improve medical care by cutting costs, but we will get there by improving the process of delivering care.
That message seems lost in all of the political posturing that regularly takes place around the federal budget debates.
Among the suggestions bandied about to reduce Medicare costs is to increase the beneficiary share of the Medicare Part B premium, which covers doctor visits and other outpatient services. Some think it might be a good idea to add copayments for home health services or for the first 20 days of a stay in a skilled nursing facility.
I'm sure the people who support these ideas can throw around some impressive numbers about how much this or that change will save taxpayers. But are these "savings" a Bandaid or a cure? How does increasing the cost of seeing a doctor help make someone healthier? And what is accomplished by adding copays to home healthcare or stays at an SNF?