Do you mean Papa Obama Care?
I'm talking about hospital value-based purchasing, physician quality reporting, risk-adjusted physician feedback, value-based payment modifiers for physician reimbursements, payment adjustments for hospital-acquired conditions, launching and supporting innovative payment and delivery models, the shared savings program, bundling of payments, payment adjustments for preventable hospital readmissions, evidence-based transitions into the community from hospitals, extending Special Needs Plans, creating the IPAB, technical assistance for providers struggling with quality improvement, medication management for chronic disease, supporting the patient-centered medical home, coverage and payment coordination for expensive dual eligibles, incentives and technical assistance for electronic health record implementation, and dozens of more targeted reforms.
The key feature of these reforms is they're aimed at altering and improving the way Medicare operates,
not ending Medicare as a public health insurance package for the elderly. A proposal to
reform Medicare will look something like the pieces above--improvements in programmatic elements (particularly in how the program pays for medical services), or in benefit design, or in cost-sharing, etc. A proposal to
destroy Medicare won't have any of that because under it Medicare will no longer be an insurer with a benefit package, or cost-sharing requirements, or programmatic elements around paying for medical services or being concerned with high-quality service delivery. We have a very recent example of just such a proposal to destroy Medicare.