The budget President Obama will send to Congress Wednesday is expected to include some $400 billion in reductions to Medicare and other health programs.
And if the word around Washington is correct, it may also include a proposal aimed at winning some bipartisan backing – by changing the way Medicare patients pay for their care.
But there have been previous efforts to streamline Medicare's antiquated system of deductibles and copayments. And none, so far, has been successful.
Tom Miller, a resident fellow at the conservative American Enterprise Institute, says having separate deductibles and co-insurance schemes for Medicare's parts A and B is an anachronism that dates back to the 1960s, when Medicare was created.
"That's been a legacy which has been very hard to change," he says, "because it requires an act of Congress, which requires agreement ... which tends not to be the case."
Currently, Medicare Part A, which covers hospital and skilled nursing home care, and Part B, which covers doctor and outpatient costs, have separate deductible and copayment schemes. This year the Part A hospital deductible is $1,184; the Part B outpatient deductible is $147.
Miller is one of many economists who say it would make much more sense to have a single, merged deductible of around $500. That, however, would likely make many patients pay more. That's because most Medicare patients aren't hospitalized in a given year, but they do almost all go to the doctor.
Under most of the proposals floating around, said Howard Bedlin, vice president for public policy and advocacy of the National Council on Aging, "about 30 million beneficiaries would end up paying more and about 2 million would end up paying less."
In exchange, however, says Miller, beneficiaries would likely get something they don't get now – "stop-loss" protection. That agreement for Medicare to cover all of a patient's medical costs after he or she reaches a specific threshold is something the program currently – and almost inexplicably – lacks.
"That's the world in which you need insurance," Miller says. "But Medicare traditionally doesn't have that type of structure."
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