Medicare's governance and structure: a proposal

Medicare and Medicaid need new organizational structures. At the start of a new administration, the Health Care Financing Administration (HCFA) should be replaced by separate agencies to administer Medicare (a Federal Health Programs Administration) and Medicaid plus other state grant programs (a State Health Programs Administration). A new Medicare management agency should have different centers for beneficiary services, provider payments, health plans, prescription drugs, and program development/special populations. The future Department of Health and Human Services (HHS) should have an assistant secretary for prevention and health care quality, and a new Congress should establish a Joint Health Committee.