Impeding changes to our Health Care system

[TheMercenary]

I have no idea where it is going but there are some interesting points in this article from the NYT today.

March 3, 2008
News Analysis
About Those Health Care Plans by the Democrats ...
By ROBERT PEAR
WASHINGTON — While Senators Hillary Rodham Clinton and Barack Obama fight over who has the better health plan for the uninsured, they say little about a more immediate challenge that will confront the next administration, whether Democratic or Republican: how to tame the soaring costs of Medicare and Medicaid.

The two programs, for older Americans and low-income people, cost $627 billion last year and accounted for 23 percent of all federal spending. With no change in existing law, the Congressional Budget Office says, that cost will double in 10 years and the programs will account for more than 30 percent of the budget.

Economists and health policy experts say the federal health programs are unsustainable in their current form, because they are growing much faster than the economy or the revenues used to finance them. The Medicare program is especially endangered; its hospital insurance trust fund is expected to run out of money in 11 years.

But the need for cutbacks is not a popular theme for political candidates wooing voters who want more care at a lower cost.

The Democrats do not say, in any detail, how they would slow the growth of Medicare and Medicaid or what they think about the main policy options: rationing care, raising taxes, cutting payments to providers or requiring beneficiaries to pay more.

Nor do they say how they would overcome the health care industry lobby, which has blocked proposals for even modest reductions in Medicare payment rates.

Instead, scores of lawyers and lobbyists are continually urging Congress to expand Medicare coverage of specific drugs, medical devices, tests and procedures.

The leading edge of the baby boom generation becomes eligible for Medicare in three years. The number of beneficiaries, now 44 million, is expected to reach 49 million in the first term of the next president and then climb to 55 million by 2017.

Those numbers, while daunting, are less significant than other factors.

Peter R. Orszag, director of the Congressional Budget Office, said, “The bulk of the projected increase in spending on Medicare and Medicaid is due not to demographic changes, such as increases in the number of beneficiaries, but to increases in costs per beneficiary.”

And what is driving those costs?

“Most of the long-term rise in health care spending is associated with the use of new medical technologies,” the budget office said in a recent report. It suggested that more selective use could save substantial amounts — a prospect that alarms manufacturers of some medical devices.

“Medical technology has saved and improved countless lives by reducing disability and death rates from cancer, heart disease and other conditions,” said Stephen J. Ubl, president of the Advanced Medical Technology Association, a trade group.

Spending on Medicare and Medicaid tends to increase in tandem with health spending generally.

“Federal health spending trends should not be viewed in isolation from the health care system as a whole,” said David M. Walker, the comptroller general of the United States.

When Medicare and Medicaid squeeze payments to doctors and hospitals, health care providers often try to increase charges to other patients, Mr. Walker said. To rein in the costs of Medicare and Medicaid, he said, it will be necessary to slow the growth of health costs generally.

For several years, an independent federal panel, the Medicare Payment Advisory Commission, has recommended that Congress reduce payments to private health plans. Those payments are about 12 percent higher, on average, than the cost of caring for similar patients in the traditional fee-for-service Medicare program.

Insurance companies, working with satisfied customers and lawmakers who want to preserve access to such plans, have successfully resisted the proposal.

To help pay for their coverage plans, Mrs. Clinton and Mr. Obama both say they would roll back the “Bush tax cuts” for the wealthiest Americans. But major provisions of the tax cuts, adopted in 2001 and 2003, are already scheduled to expire at the end of 2010. Democratic lawmakers, moreover, have committed the savings from the elapsed tax cuts several times to other pet programs, like eliminating the alternative minimum tax.

Some experts say the only real way to tame health care costs is by limiting access to expensive treatments or by requiring affluent Americans to pay for more of their health care.

Medicare has generally not taken costs into account in deciding which services to cover. If officials even suggest that Medicare should deny payment for an expensive treatment that could produce a small improvement in a person’s condition, they are accused of rationing care.

Researchers at Dartmouth Medical School have found large variations in the amount of hospital care and other services that people with the same condition receive in different parts of the country. In some regions, where doctors favor more intensive treatments, Medicare spends much more without getting better results for patients.

This research “suggests that about 20 percent of Medicare spending could be eliminated with no adverse effects on health,” said Prof. David M. Cutler of Harvard, an adviser to the Obama campaign. Identifying that 20 percent would be “very difficult,” he acknowledged.

President Bush says high-income people should pay higher premiums for the Medicare drug benefit, and at least some liberals are willing to discuss the idea.

“We can go further in setting Medicare premiums at higher levels for affluent beneficiaries without unraveling the universal nature of the program,” said Robert Greenstein, executive director of the Center on Budget and Policy Priorities. But, he insists, “we should also eliminate billions of dollars in overpayments to private Medicare plans.”

The Democratic candidates do believe they can wring savings out of an inefficient health care system that spent an average of $7,400 a person last year, far more than any other country.

Mr. Obama says his plan can achieve “tremendous savings” by making the health care system more efficient. Mrs. Clinton says her plan will save more than $50 billion a year with “efficiency reforms.”

To this end, Democrats and some Republicans are coalescing behind proposals intended to improve care while lowering costs. These proposals call for greater use of health information technology, including electronic medical records, programs to manage the care of people with multiple chronic diseases and research to compare the effectiveness of different treatments.

Senator John McCain of Arizona, the presumptive Republican nominee, describes Medicare as a “fiscal train wreck.” He voted against adding a prescription drug benefit to Medicare in 2003 because, he said, it added huge costs to a program going broke.

Mr. McCain says he, too, wants to cover more people. But he has not explicitly embraced the goal of universal coverage, saying he worries more about costs.

Public opinion polls show broad support for federal action to cover the uninsured. But Robert D. Reischauer, a health policy expert and president of the Urban Institute, said, “It will be difficult for Senator Clinton and Senator Obama to retain popular support for their plans once the details are specified.”

[TheMercenary]

I posted about this a while back and now we are seeing some fallout as plans move forward. One thing discusssed during the run up to the election was how the Obama plan was going to provide care for not only the un-insured but the under insured. And if the government provided plans available to all that was cheaper than what companies provided there would be no incentive for companies to offer care and they would shuffle the people over to the government plan and save millions. Who wins? Big business hands down. Walmart already does this and does not offer health plans for the average worker. Who loses? Patients and health plans that offer insurance better than what you get with the current government plans. Providers will also lose. The government can barely manage medicaid and medicare. The formation or additon of millions of people onto another governent health plan will do little to provide access to care. Medicare and Medicaid patients are limited as to who they can see for care. This may be the straw that breaks the camel's back. Time will tell.

Obama Health Care Plan Squeezes ETFs
Health care companies consider President Barack Obama's budget a potential profit-killer. Investors agreed and dumped their shares last week, dragging down exchange traded funds.

The budget aims to raise taxes and deduction limits for people who earn more than $250,000 a year. The ultimate goal is to raise $634 billion to help fix the health care system. The tax hikes will generate $318 billion of that amount, and the rest will be squeezed from Medicare, the government-sponsored health program for seniors.
The actual cost to create a universal health system is projected to be significantly higher than the budget estimates. To close the gap, the government might cut reimbursements paid to health-care providers, eroding profitability.

The Medicare Advantage plans offered by private insurers could lose as much as $175 billion. The Advantage program is on the chopping block because it pays 14% more to providers than Medicare would for the same services.

The health-care and biotechnology ETFs we track lost 7.4% during the five trading days that ended Feb. 26

Obama promises that workers who like their company plans will be able to keep them. But if the government offers better benefits with lower premiums, private health groups might be forced to compete. If people move en masse to government plans, private insurers would suffer. each lost at least a third of their values.

The nightmare scenario for health insurers, a "Medicare for All" system like the one Representative Dennis Kucinich envisioned in his 2005 bill, could put many of these companies out of business. On the other hand, the U.S. automobile industry and other sectors consider the end of company-sponsored health care the route to international competitiveness.

[TheMercenary]

A national healthcare reform primer
The many issues confronting President Obama as he tries to achieve insurance coverage for all Americans.

http://www.latimes.com/features/prin...,1986914.story

[TheMercenary]

Mass. healthcare reform is failing us
By Susanne L. King, MD, March 2, 2009

MASSACHUSETTS HAS been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.

What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The state's plan flunks on all counts.

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.

In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.

Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.

There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.

A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.

People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we can't afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.

Susanne L. King, M.D., practices in Berkshire County.

[TheMercenary]

An interesting discussion:

An interview with John Goodman on the future of health care

It’s hard to find anyone who likes America's health care system, including John Goodman, president and founder of the National Center for Policy Analysis. But you'll never find Goodman saying that health care is better in places like Europe, where socialist governments provide "free" universal health care for everyone.

Goodman – dubbed "the father of Health Savings Accounts" by The Wall Street Journal – has written nine books, including "Handbook on State Health Care Reform" and "Patient Power: Solving America's Health Care Crisis."


To find out what he thinks America's health care system should look like – and why Europe's government health systems are the last things we should copy – I called Goodman on Wednesday, Feb. 11, at his offices in Dallas:

Q: Many people – mostly people who think health care should be provided free to everybody by the government – point to Europe as a model. Should they?

continues:
http://www.citizen-times.com/apps/pb...D=200990223030

[TheMercenary]

This might actually be a good thing if he can pay for it. Although it might be cheaper to just pay for those who have the facilities to do the work rather than re-invent the wheel. The problem is that most providers are maxed out so I don't see where they are going to get the people to do the work.

Obama pushes centers as one focus of health reform

http://www.reuters.com/article/gover...090302?sp=true

[TheMercenary]

Another interesting opinion piece from a physician ran in the WSJ.

When Doctors Opt Out
We already know what government-run health care looks like.

By MARC SIEGEL
Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn't want to be a patient when that happens.

Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center.

[classicman]

Wait till doctors start accepting "cash only"

[TGRR]

I guess we're just going to have to spend less on bombs.

[lookout123]

Originally Posted by classicman

Wait till doctors start accepting "cash only"

I have one. Smoothest running office ever. The staff is cheerful and friendly and they certainly don't have a shortage of patients.

[TheMercenary]

Originally Posted by classicman

Wait till doctors start accepting "cash only"

Many already do. They take limited private insurance whom they have contracts with and cash, no Tricare, no Medicare, no Medicaid.

[DanaC]

Is the typo in the title a freudian slip Merc?:P

[Juniper]

Originally Posted by DanaC

Is the typo in the title a freudian slip Merc?:P

I thought the same thing, and figured someone would beat me to mentioning it. I thought: how ya gonna stop 'em? This should be interesting!

[TheMercenary]

Originally Posted by DanaC

Is the typo in the title a freudian slip Merc?:P

Naw, just a stupid typo on my part. Maybe it was my unconscious Id taking over my fingers.

[sugarpop]

We need to just get rid of ALL insurance companies and figure out some other way to do this - maybe have a government insurance program where you pay them every month, and they pay out claims - because they are ALL corrupt.

My mother's homeowners insurance is dropping her because she made two claims in the past three years. The two claims totalled $2800. And she has been paying them for many, many years. Like, decades. I just don't understand how they can drop her for having to pay out a little money after she has paid them tens of thousands of dollars over the years.