By Trudy Liberman

What’s going to happen to Medicare?

That’s not an insignificant question given the political shift in Washington.  Now, with Republicans controlling the presidency and both houses of Congress, some ideas they’ve been pushing for years have a chance of passing. Those ideas would drastically change the way Medicare works for those already on it and those joining in the next few years.

Medicare is wildly popular, but that popularity doesn’t necessarily translate into understanding of a very complex program, what’s happened to it, and what may happen.

Writing about Medicare for nearly 30 years and watching it evolve, I’ve seen how easily Congress has already made big changes with hardly a peep from the press or the public.  The same could happen again. In this column I discuss a few of those possible changes gleaned from my decades of experience covering the program.

Since the election, there’s been talk of “voucherizing” or privatizing Medicare, an idea Republicans have been pushing for 20 years.

Under a fully privatized arrangement Medicare would no longer be social insurance like Social Security but more like Obamacare with everyone eventually buying their coverage from private insurance companies.

Beneficiaries would receive a sum of money, likely to be called “premium support” instead of the more dire-sounding “voucher,” to help buy their coverage. The amount of support and how well it would keep pace with medical inflation would be buried in the details Congress would hash out.

Today, the government provides the benefits for hospital and physician care for most Medicare beneficiaries, but that could change with more privatization. There already is a lot of privatization in Medicare, and it came about step-by-step – usually with both political parties in agreement and lots of buzz words like “consumer choice” to sell changes to the public.

The long steady march toward Medicare Advantage (MA) plans now used by about one-third of all beneficiaries and the prescription drug benefit are privatized insurance programs within Medicare.

Seniors in MA plans give up their traditional, standardized Medicare benefits for doctor and hospital services and buy them from insurers that receive subsidies from the government.

In a totally privatized arrangement, there may be no standardized benefits, and seniors would choose from a menu of insurance company options much the way drug plans are sold today.

How do you think Medicare should change?  Write to Trudy at trudy.lieberman@gmail.com.