Insuring Resources Commentary:
Early retirement produces a serious gap in health insurance coverage for many, many baby boomers as they await later Medicare eligibility. As health insurance premiums have risen fewer employers are providing retiree access to health insurance.
Within the PPACA an interim measure was put in place before the Health Insurance Exchanges get active to aide those retirees of pre-Medicare age access health insurance. This article below describes the federal rules and the funding provided to employers. As I've noted in previous posts, the devil will be in the details as to how this program is implemented.
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Source: Keith Martin- http://ifawebnews.com
5/5/2010
The White House has announced the allocation of $5 billion for a temporary program to make it easier for employers to provide health coverage for early retirees.
The U.S. Department of Health and Human Services issued regulations to establish the Early Retiree Reinsurance Program, a part of the recently signed Patient Protection and Affordable Care Act.
In a statement, HHS Secretary Kathleen Sebelius said rising costs “have made it hard for employers to provide quality, affordable health insurance for workers and retirees.
“As a result, many Americans who retire before they are eligible for Medicare are worried about losing health insurance coverage through their former employers, putting them at risk of losing their life savings due to medical costs, “ she said. “This new program will provide much-needed relief so that employers can provide more retirees with quality, affordable insurance, starting this year.”
According to the White House, the percentage of large firms providing workers with retiree coverage has dropped from 66% in 1988 to 31% in 2008. New reform law includes the $5 billion in financial aid to employers to maintain coverage for early retirees age 55 and older who do not yet qualify for Medicare.
The temporary program, similar to a high-risk pool for uninsured Americans, will end in 2014 when health insurance exchanges should get established. Those exchanges will provide additional coverage options.
Sebelius’ agency said eligible employers can apply for the program beginning at the end of June. Applicants can be from both self-funded and insured plans, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, unions and other employers, according to HSS officials.
Health benefits that qualify for relief include medical, surgical, hospital, prescription drug and other benefits that may be specified by HSS, as well as coverage for mental health services.
The White House said the amount of the reimbursement to the employer plan is up to 80% of claims costs for health benefits between $15,000 and $90,000. Claims incurred between the start of the plan year – often Jan. 1 – and June 1 are credited toward the $15,000 threshold for reimbursement.
However, only medical expenses incurred after June 1, 2010, are eligible for reimbursement under this program, according to officials.
As an example, they noted that if an individual incurs costs of $30,000 between the start of the plan year and June 1, and $40,000 after that date, the amount which may be reimbursed is $40,000 – the costs above the $15,000 threshold that occur after June 1.
Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts
Thursday, May 6, 2010
Friday, February 26, 2010
How to Fix the Cost Issue.... while increasing quality
Insuring Resources Commentary--
Yesterday at the Wisconsin State Capitol a leading expert on cost and quality issues in ehalth care gave a presentation to state lawmakers and others.
Here are some of the details:
Dartmouth Atlas Author Sees ACOs as Solution to Cost, Quality Concerns
Elliott Fisher, MD, Professor of Medicine at Dartmouth Medical School, presented his ideas on how Accountable Care Organizations (ACOs) could be promoted and implemented as a way to improve population health and lower costs. Fisher presented to a group of health care professionals and policymakers on February 25 in the State Capitol at a forum sponsored by the Evidence Based Health Policy Project. Fisher was a principal author of the Dartmouth Atlas that highlighted wide variations in national Medicare spending and utilization. The Atlas showed Wisconsin as having among the nation’s lowest Medicare costs, mainly due to more efficient provision of care.
The ACO model envisions provider organizations that can effectively manage the full continuum of care as real or virtually-integrated local delivery systems. This structure would be joined with targeted spending levels and health care performance measures to help achieve lower costs and better outcomes, with the providers sharing in any savings.
Fisher said while the ACO model is relatively new, it has shown promise in a number of settings. "Aligning financial and professional incentives, together with having better information that engages physicians and consumers, will enhance their ability to improve health and lower costs." He added that those areas of the country that have ACOs in place tend to have shared aims, physician engagement, use of data to drive change, and communities that are energized to make it happen.
Fisher recommends that policymakers promote the proliferation of the ACO model by legislation (as in enacting Medicare ACOs) or by easing regulatory barriers that complicate the formation of ACOs.
Yesterday at the Wisconsin State Capitol a leading expert on cost and quality issues in ehalth care gave a presentation to state lawmakers and others.
Here are some of the details:
Dartmouth Atlas Author Sees ACOs as Solution to Cost, Quality Concerns
Elliott Fisher, MD, Professor of Medicine at Dartmouth Medical School, presented his ideas on how Accountable Care Organizations (ACOs) could be promoted and implemented as a way to improve population health and lower costs. Fisher presented to a group of health care professionals and policymakers on February 25 in the State Capitol at a forum sponsored by the Evidence Based Health Policy Project. Fisher was a principal author of the Dartmouth Atlas that highlighted wide variations in national Medicare spending and utilization. The Atlas showed Wisconsin as having among the nation’s lowest Medicare costs, mainly due to more efficient provision of care.
The ACO model envisions provider organizations that can effectively manage the full continuum of care as real or virtually-integrated local delivery systems. This structure would be joined with targeted spending levels and health care performance measures to help achieve lower costs and better outcomes, with the providers sharing in any savings.
Fisher said while the ACO model is relatively new, it has shown promise in a number of settings. "Aligning financial and professional incentives, together with having better information that engages physicians and consumers, will enhance their ability to improve health and lower costs." He added that those areas of the country that have ACOs in place tend to have shared aims, physician engagement, use of data to drive change, and communities that are energized to make it happen.
Fisher recommends that policymakers promote the proliferation of the ACO model by legislation (as in enacting Medicare ACOs) or by easing regulatory barriers that complicate the formation of ACOs.
Wednesday, January 6, 2010
Health bills would shift Medicare money to Marshfield, Mayo and other 'high-value' hospitals
Insuring Resources Commentary:
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
Tuesday, December 8, 2009
Senate Dems Compromise- public plan is out
Insuring Resources Commentary
The Senate Dems reached a compromise today (the details of which I predicted three months ago on this blog). I said back then that the final bill would not have a gov't run public plan but instead would use private plans heavily regulated by the Feds much like Medicare Advantage.
In addition the Senate Bill now includes a Medicare buy-in program for persons age 55 and up to buy in to Medicare early. This particularly helps early retirees.
The bill also requires insurance companies to spend at least 90 percent of their premium income providing benefits. By the way, according to the Wisconsin Association of Health Plans (WAHP) their 16 member health plans pay out 91% of premium in benefits. I've long touted those companies (Dean, GHC, Gunderson and others) as models on which to build the foundation of health care reform. Perhaps this is the stick that incents plans to base reimbursement on quality outcomes and efficiency.
From WAHP's website: "In 2007, the Association-member health plans participating in the commercial health insurance market in Wisconsin paid out approximately 91 cents in health care services for every $1 of insurance premium taken in. They spent less than 10 cents on administration, and profits remained among the lowest in health care: less than 2 cents for every $1 in premium."
http://www.wihealthplans.org/inner.iml?mdl=about_us.mdl
So what does Sen. Feingold think about this compromise (copied from below). "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars," Feingold said.
Competition may reduce premiums 1-2% while waste reduction, payment reform and quality incentives could have ten times the impact.
Time for my FIFTH phone call to his office staff.
---------------------------------------------
Dems reach deal to drop gov't-run plan
Dec. 8, 2009
After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.
In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage.
Additionally, the emerging agreement calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
At a hastily called evening news conference in the Capitol, Majority Leader Harry Reid, D-Nev., declined to provide details of what he described as a "broad agreement" between liberals and moderates on an issue that has plagued Democrats' efforts to pass health care legislation from the outset.
With it, he added with a smile, the end is in sight for passage of the legislation that Congress has labored over for months.
The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly. Several officials stressed that so far, Democrats had technically agreed only on submitting proposals to the Congressional Budget Office for their impact on the bill's cost and other analysis.
At its core, the legislation would expand health care to millions who lack it, ban insurance companies from denying coverage on the basis of pre-existing medical conditions and rein in the rise of health care spending nationally.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Taken together, the day's developments underscored the complexity that confronts the administration and Reid as they seek the 60 votes needed to overcome Republican opposition and pass a bill by Christmas. Despite their reluctance, some senators had talked openly and in detail earlier in the day about the progress of the negotiations.
The provision in the legislation to be dropped under the emerging agreement provides for a government-run insurance option to be available to consumers, with individual states permitted to drop out. Liberals have long sought such as arrangement, as a means of forcing competition on insurance companies.
One participant in the talks, Sen. Tom Harkin, D-Iowa, referring to a deal among the negotiators, told reporters he didn't like it, but added, "I'm going to support it to the hilt" in hopes of securing passage of the health care bill.
Another senator involved, Sen. Russ Feingold, D-Wis., issued a statement saying, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars." But he did not rule out voting for the measure.
The White House quickly applauded the developments. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," said a spokesman, Reid Cherlin.
In his comments to reporters, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."
It wasn't clear what he meant by a "public option," the Medicare expansion or a fallback in case private insurance companies declined to participate in the nationwide plan envisioned to be overseen by the Office of Personnel Management. One possibility was for the agency to set up a government-run plan, either national in scope or on a state-by-state basis.
Under the tentative agreement, liberals lost their bid to expand Medicaid, the federal-state program that provides health care for the poor, elderly and disabled. But they prevailed on the Medicare expansion, and the negotiators appeared ready to maintain a separate health care program for children until 2013, two years longer than the bill currently calls for, according to officials familiar with the details.
Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.
The Senate Dems reached a compromise today (the details of which I predicted three months ago on this blog). I said back then that the final bill would not have a gov't run public plan but instead would use private plans heavily regulated by the Feds much like Medicare Advantage.
In addition the Senate Bill now includes a Medicare buy-in program for persons age 55 and up to buy in to Medicare early. This particularly helps early retirees.
The bill also requires insurance companies to spend at least 90 percent of their premium income providing benefits. By the way, according to the Wisconsin Association of Health Plans (WAHP) their 16 member health plans pay out 91% of premium in benefits. I've long touted those companies (Dean, GHC, Gunderson and others) as models on which to build the foundation of health care reform. Perhaps this is the stick that incents plans to base reimbursement on quality outcomes and efficiency.
From WAHP's website: "In 2007, the Association-member health plans participating in the commercial health insurance market in Wisconsin paid out approximately 91 cents in health care services for every $1 of insurance premium taken in. They spent less than 10 cents on administration, and profits remained among the lowest in health care: less than 2 cents for every $1 in premium."
http://www.wihealthplans.org/inner.iml?mdl=about_us.mdl
So what does Sen. Feingold think about this compromise (copied from below). "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars," Feingold said.
Competition may reduce premiums 1-2% while waste reduction, payment reform and quality incentives could have ten times the impact.
Time for my FIFTH phone call to his office staff.
---------------------------------------------
Dems reach deal to drop gov't-run plan
Dec. 8, 2009
After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.
In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage.
Additionally, the emerging agreement calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
At a hastily called evening news conference in the Capitol, Majority Leader Harry Reid, D-Nev., declined to provide details of what he described as a "broad agreement" between liberals and moderates on an issue that has plagued Democrats' efforts to pass health care legislation from the outset.
With it, he added with a smile, the end is in sight for passage of the legislation that Congress has labored over for months.
The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly. Several officials stressed that so far, Democrats had technically agreed only on submitting proposals to the Congressional Budget Office for their impact on the bill's cost and other analysis.
At its core, the legislation would expand health care to millions who lack it, ban insurance companies from denying coverage on the basis of pre-existing medical conditions and rein in the rise of health care spending nationally.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Taken together, the day's developments underscored the complexity that confronts the administration and Reid as they seek the 60 votes needed to overcome Republican opposition and pass a bill by Christmas. Despite their reluctance, some senators had talked openly and in detail earlier in the day about the progress of the negotiations.
The provision in the legislation to be dropped under the emerging agreement provides for a government-run insurance option to be available to consumers, with individual states permitted to drop out. Liberals have long sought such as arrangement, as a means of forcing competition on insurance companies.
One participant in the talks, Sen. Tom Harkin, D-Iowa, referring to a deal among the negotiators, told reporters he didn't like it, but added, "I'm going to support it to the hilt" in hopes of securing passage of the health care bill.
Another senator involved, Sen. Russ Feingold, D-Wis., issued a statement saying, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars." But he did not rule out voting for the measure.
The White House quickly applauded the developments. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," said a spokesman, Reid Cherlin.
In his comments to reporters, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."
It wasn't clear what he meant by a "public option," the Medicare expansion or a fallback in case private insurance companies declined to participate in the nationwide plan envisioned to be overseen by the Office of Personnel Management. One possibility was for the agency to set up a government-run plan, either national in scope or on a state-by-state basis.
Under the tentative agreement, liberals lost their bid to expand Medicaid, the federal-state program that provides health care for the poor, elderly and disabled. But they prevailed on the Medicare expansion, and the negotiators appeared ready to maintain a separate health care program for children until 2013, two years longer than the bill currently calls for, according to officials familiar with the details.
Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.
Monday, September 21, 2009
5 Facts on the Uninsured
Source- Kaiser News
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
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1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
------------------ ----------------- ---------------
1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
Thursday, September 17, 2009
Dems and GOP Agree- Baucus bill appears to be DOA
I guess Sen. Baucus has achieved what few others have. He's gotten Democrats and Republicans to agree... this is a horrible healthcare bill... except for widely different reasons.
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Monday, September 14, 2009
Negotiations heating up, Closing in on a deal
The latest compromises and my analysis
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
------
WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
------
WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
63% of Physicians Support Inclusion of Public Plan Option
Source- Robert Wood Johnson Foundation survey
Survey: 63% of Physicians Support Inclusion of Public Option Robert Wood Johnson Foundation Survey Shows Physicians Support Reform Plan that Includes Both Public and Private Options
A Robert Wood Johnson Foundation survey summarized in today’s New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.
Survey: 63% of Physicians Support Inclusion of Public Option Robert Wood Johnson Foundation Survey Shows Physicians Support Reform Plan that Includes Both Public and Private Options
A Robert Wood Johnson Foundation survey summarized in today’s New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.
Saturday, September 12, 2009
LaCrosse health plan is potential model to build from
http://www.jsonline.com/business/59087997.html
This is exactly the type of health care model we should be utilizing to undertake true reform.
Efficient, quality, and integrated care. I apologize for the length of this entry. I think this is very informative, however, so I'd hate to edit it too much.
-----------------------
Here are excerpts:
La Crosse - The United States would spend less money on health care if more health systems were like Gundersen Lutheran.
This community in western Wisconsin has the fourth-lowest health care costs in the country based on Medicare spending.
Only Honolulu and two North Dakota cities, Fargo and Minot, rank lower. At the same time, the quality of care is as good as or better than most parts of the country.
Gundersen Lutheran, a health care system that employs 6,600 people, including 453 physicians, is one reason. The other is its crosstown competitor, Franciscan Skemp Healthcare, part of the famed Mayo Health System.
Both are among the health systems being cited as proof that the United States can slow the rise in health care spending without hurting quality.
"There are models available, and we happen to be one of them," said Jeff Thompson, a physician and chief executive of Gundersen Lutheran.
Medicare spent 30% less on average for each beneficiary in the La Crosse area than the national average in 2006, the most recent year for which data is available, according to the Dartmouth Atlas of Health Care.
It spent 64.5% less than in Miami and 61% less than in McAllen, Texas, the two most costly areas. And it spent 23% less than in the Milwaukee area.
The huge regional variations in Medicare spending - documented by more than 30 years of research at Dartmouth College - occur after adjusting for age, sex and race.
They also exist among areas with similar poverty rates. And they exist within the same geographic areas, varying from one hospital to another.
The variations show that some parts of the country - and some health systems - simply make better use of health care dollars.
The doctors and hospitals in places such as La Crosse, Eugene, Ore., and Grand Junction, Colo., do a better job of eliminating duplicative and unnecessary care, preventing illness or detecting it earlier, avoiding unneeded or preventable hospitalizations, increasing productivity and reducing administrative costs.
They also challenge the contention that slowing the rise in health care spending will mean denying patients needed care. And they refute the widely held belief that more care is better care, and that expensive care is even better.
The evidence is indisputable that high-cost communities do not have better health outcomes, said Tom Oliver, a professor at the University of Wisconsin School of Medicine and Public Health.
"We are spending billions of dollars that is wasted in our health care system," Oliver said.
Quality care
No simple explanation exists why Gundersen Lutheran or the Mayo Health System can provide quality care at a fraction of the cost of their counterparts in Miami or McAllen. But both are integrated health care systems that employ doctors, and research suggests that integrated systems and large physician practices closely aligned with a hospital often produce better care at a lower cost.
Gundersen Lutheran and other integrated systems also often operate their own health insurance plans. That, too, could contribute to their lower costs by giving them an additional incentive to provide efficient care.
The Gundersen Lutheran health plan accounts for about 28% of the revenue at its hospital and its clinics. But when a patient is insured by the plan, the cost of his or her care isn't passed on to an insurance company. Gundersen Lutheran instead incurs the costs.
Being integrated gives Gundersen Lutheran a huge advantage in coordinating care, getting information on best practices to physicians and creating a culture of shared values, said Thompson, its chief executive.
Doctors run the health system, and they are expected to become involved in its operations and to work to control costs, he said.
The health system's orthopedic surgeons, for example, reduced costs by $900,000 a year just by getting together and agreeing to use medical devices from one supplier.
Standardizing care also is easier in an integrated system. The doctors at Gundersen Lutheran have developed specific guidelines and order sets for specific diseases and procedures.
When Gundersen Lutheran installed an information technology system in its hospital, it had more than 300 order sets, said Brian Mulrennan, an internist. It was told by Epic Systems Corp., the Madison-area company that designed the system, that some hospitals had none.
This means that doctors who specialize in diseases of the ear, nose and throat, for example, have developed standard orders for the post-operative care for children who have had tubes placed in their ears for chronic infections.
The standard orders lessen the variation in cost and outcomes.
At the same time, nurses no longer have to follow slightly different orders from each physician, thereby reducing the chance of error.
All this is harder to do when doctors work for dozens of small practices. First, the doctors have to be willing to take the time to develop and agree on the guidelines or standard orders.
And the hospital may be wary of antagonizing doctors who bring it patients and revenue.
There's a saying in health care that a hospital's first customer is the doctor. That's less of a problem in an integrated system that employs them.
Practice guidelines and standard order sets also can help control discretionary care, such as office visits, referrals to specialists and the use of imaging tests. It is one reason for the huge variation in health care costs.
Culture also plays a part. The doctors at Gundersen Lutheran repeatedly refer to the value placed on cooperation and on a focus on the patient. And the health system works to recruit doctors who understand those values.
Gunderson doctors are well paid and make excellent livings. They just aren't the highest paid.
When recruiting, if a doctor notes that he or she could make more money in a Chicago suburb, Thompson will say, "Then you should go."
The low costs incurred by Medicare in La Crosse also stem partly from a communitywide initiative, begun in the 1980s, to encourage people to have advance directives - legal documents that state patients' decisions about end-of-life care should they become incapacitated.
"It's now so part of the process of care that, when we don't know a patient's wishes, it's upsetting to people," said Bud Hammes, a clinical ethicist and director of medical humanities at the Gundersen Lutheran Medical Foundation.
The program, which has drawn international attention, enables doctors to know when patients don't want heroic measures taken to prolong their lives.
In the last six months of life, Medicare spends 29%, or about $8,000, less on patients treated at Gundersen Lutheran than the national average. And it spends roughly $10,000 less than at Aurora St. Luke's Medical Center and Froedtert Hospital, the two hospitals in the Milwaukee area with the highest costs.
No quick cures
National data on the wide variation in costs is available to researchers only for Medicare patients. But studies suggest that how doctors and hospitals provide care for Medicare beneficiaries indicates how they treat patients covered by commercial health plans.
Gundersen Lutheran gives credence to that research. The health system says that its rate increases for commercial plans for the past three years were below the rate of inflation.
That's almost unheard of in health care.
The challenge is how to make the U.S. health care system look more like Gundersen Lutheran and other integrated systems.
That won't be easy to do.
Integrated systems, including large physician practices closely affiliated with hospitals, such as Dean Health System in Madison and the Marshfield Clinic, are common in Wisconsin. But they aren't the norm in the U.S. health care system.
As recently as 2005, roughly half of all office visits were made to practices with one or two physicians, according to the National Ambulatory Medical Care Survey.
Yet the Dartmouth research suggests that high-cost markets are characterized by a much higher percentage of physicians in solo or two-person practices. That kind of fragmentation is characteristic of the U.S. health care system.
It also will be one of the challenges in slowing the growth in health care spending.
This is exactly the type of health care model we should be utilizing to undertake true reform.
Efficient, quality, and integrated care. I apologize for the length of this entry. I think this is very informative, however, so I'd hate to edit it too much.
-----------------------
Here are excerpts:
La Crosse - The United States would spend less money on health care if more health systems were like Gundersen Lutheran.
This community in western Wisconsin has the fourth-lowest health care costs in the country based on Medicare spending.
Only Honolulu and two North Dakota cities, Fargo and Minot, rank lower. At the same time, the quality of care is as good as or better than most parts of the country.
Gundersen Lutheran, a health care system that employs 6,600 people, including 453 physicians, is one reason. The other is its crosstown competitor, Franciscan Skemp Healthcare, part of the famed Mayo Health System.
Both are among the health systems being cited as proof that the United States can slow the rise in health care spending without hurting quality.
"There are models available, and we happen to be one of them," said Jeff Thompson, a physician and chief executive of Gundersen Lutheran.
Medicare spent 30% less on average for each beneficiary in the La Crosse area than the national average in 2006, the most recent year for which data is available, according to the Dartmouth Atlas of Health Care.
It spent 64.5% less than in Miami and 61% less than in McAllen, Texas, the two most costly areas. And it spent 23% less than in the Milwaukee area.
The huge regional variations in Medicare spending - documented by more than 30 years of research at Dartmouth College - occur after adjusting for age, sex and race.
They also exist among areas with similar poverty rates. And they exist within the same geographic areas, varying from one hospital to another.
The variations show that some parts of the country - and some health systems - simply make better use of health care dollars.
The doctors and hospitals in places such as La Crosse, Eugene, Ore., and Grand Junction, Colo., do a better job of eliminating duplicative and unnecessary care, preventing illness or detecting it earlier, avoiding unneeded or preventable hospitalizations, increasing productivity and reducing administrative costs.
They also challenge the contention that slowing the rise in health care spending will mean denying patients needed care. And they refute the widely held belief that more care is better care, and that expensive care is even better.
The evidence is indisputable that high-cost communities do not have better health outcomes, said Tom Oliver, a professor at the University of Wisconsin School of Medicine and Public Health.
"We are spending billions of dollars that is wasted in our health care system," Oliver said.
Quality care
No simple explanation exists why Gundersen Lutheran or the Mayo Health System can provide quality care at a fraction of the cost of their counterparts in Miami or McAllen. But both are integrated health care systems that employ doctors, and research suggests that integrated systems and large physician practices closely aligned with a hospital often produce better care at a lower cost.
Gundersen Lutheran and other integrated systems also often operate their own health insurance plans. That, too, could contribute to their lower costs by giving them an additional incentive to provide efficient care.
The Gundersen Lutheran health plan accounts for about 28% of the revenue at its hospital and its clinics. But when a patient is insured by the plan, the cost of his or her care isn't passed on to an insurance company. Gundersen Lutheran instead incurs the costs.
Being integrated gives Gundersen Lutheran a huge advantage in coordinating care, getting information on best practices to physicians and creating a culture of shared values, said Thompson, its chief executive.
Doctors run the health system, and they are expected to become involved in its operations and to work to control costs, he said.
The health system's orthopedic surgeons, for example, reduced costs by $900,000 a year just by getting together and agreeing to use medical devices from one supplier.
Standardizing care also is easier in an integrated system. The doctors at Gundersen Lutheran have developed specific guidelines and order sets for specific diseases and procedures.
When Gundersen Lutheran installed an information technology system in its hospital, it had more than 300 order sets, said Brian Mulrennan, an internist. It was told by Epic Systems Corp., the Madison-area company that designed the system, that some hospitals had none.
This means that doctors who specialize in diseases of the ear, nose and throat, for example, have developed standard orders for the post-operative care for children who have had tubes placed in their ears for chronic infections.
The standard orders lessen the variation in cost and outcomes.
At the same time, nurses no longer have to follow slightly different orders from each physician, thereby reducing the chance of error.
All this is harder to do when doctors work for dozens of small practices. First, the doctors have to be willing to take the time to develop and agree on the guidelines or standard orders.
And the hospital may be wary of antagonizing doctors who bring it patients and revenue.
There's a saying in health care that a hospital's first customer is the doctor. That's less of a problem in an integrated system that employs them.
Practice guidelines and standard order sets also can help control discretionary care, such as office visits, referrals to specialists and the use of imaging tests. It is one reason for the huge variation in health care costs.
Culture also plays a part. The doctors at Gundersen Lutheran repeatedly refer to the value placed on cooperation and on a focus on the patient. And the health system works to recruit doctors who understand those values.
Gunderson doctors are well paid and make excellent livings. They just aren't the highest paid.
When recruiting, if a doctor notes that he or she could make more money in a Chicago suburb, Thompson will say, "Then you should go."
The low costs incurred by Medicare in La Crosse also stem partly from a communitywide initiative, begun in the 1980s, to encourage people to have advance directives - legal documents that state patients' decisions about end-of-life care should they become incapacitated.
"It's now so part of the process of care that, when we don't know a patient's wishes, it's upsetting to people," said Bud Hammes, a clinical ethicist and director of medical humanities at the Gundersen Lutheran Medical Foundation.
The program, which has drawn international attention, enables doctors to know when patients don't want heroic measures taken to prolong their lives.
In the last six months of life, Medicare spends 29%, or about $8,000, less on patients treated at Gundersen Lutheran than the national average. And it spends roughly $10,000 less than at Aurora St. Luke's Medical Center and Froedtert Hospital, the two hospitals in the Milwaukee area with the highest costs.
No quick cures
National data on the wide variation in costs is available to researchers only for Medicare patients. But studies suggest that how doctors and hospitals provide care for Medicare beneficiaries indicates how they treat patients covered by commercial health plans.
Gundersen Lutheran gives credence to that research. The health system says that its rate increases for commercial plans for the past three years were below the rate of inflation.
That's almost unheard of in health care.
The challenge is how to make the U.S. health care system look more like Gundersen Lutheran and other integrated systems.
That won't be easy to do.
Integrated systems, including large physician practices closely affiliated with hospitals, such as Dean Health System in Madison and the Marshfield Clinic, are common in Wisconsin. But they aren't the norm in the U.S. health care system.
As recently as 2005, roughly half of all office visits were made to practices with one or two physicians, according to the National Ambulatory Medical Care Survey.
Yet the Dartmouth research suggests that high-cost markets are characterized by a much higher percentage of physicians in solo or two-person practices. That kind of fragmentation is characteristic of the U.S. health care system.
It also will be one of the challenges in slowing the growth in health care spending.
Thursday, September 10, 2009
Analysis of Obama's Speech
President Obama on Wednesday clearly laid out his vision for health care reform. Although the speech was long he actually succinctly stated his goals and laid out his vision in language that should make it difficult for opponents to mis-represent and lie about.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Tuesday, September 8, 2009
Health Compromise Floated Before Obama Speech
Below are excerpts from a NY times article on Sen. Baucus' health care reform compromise. I've edited the article to highlight what Baucus' plan would do, what it wouldn't and what it will cost.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
Tuesday, August 25, 2009
Medicare in the Cross-hairs
From today's Wall street Journal
The Republican Natl Committee just released its Health Care Bill of Rights for Seniors. It includes protecting Medicare from cuts and rationing of services. The WSJ says the statement highlights an irony in the health debate, as illustrated during some of the emotional town-hall meetings this month: Many Americans say they fear a government takeover of health care, even as they resist any cuts to Medicare, the federal government's largest health program.
WSJ: "The new RNC position doesn't offer any significant cost-cutting ideas and instead focuses on preserving Medicare and health benefits for military families." Katie Wright, an RN!spokeswoman, said Republicans still believed in controlling Medicare costs but think "money shouldn't be taken from Medicare to fund a new entitlement."
Republicans and Democrats have feuded over Medicare since its inception in 1965, and it is usually Democrats who adopt the stance of protecting the program against cost-cutters. Ronald Reagan proposed cutting $1 billion in Medicare spending while president in 1981, when the program cost just $40 billion a year.
-------------
This underlies the basic misunderstanding the public has of american healthcare. The government currently operates 30% of the "healthcare market" through Medicare and Medicaid. When seniors say they fear the government will end up controlling their healthcare its more than ironic since its worked pretty well for 44 years.
Some on the right do however understand what's needed. Fox News recently suggested ThedaCare of Appleton as a national model. This is exactly what we should do to make health care reform affordable. See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
The Republican Natl Committee just released its Health Care Bill of Rights for Seniors. It includes protecting Medicare from cuts and rationing of services. The WSJ says the statement highlights an irony in the health debate, as illustrated during some of the emotional town-hall meetings this month: Many Americans say they fear a government takeover of health care, even as they resist any cuts to Medicare, the federal government's largest health program.
WSJ: "The new RNC position doesn't offer any significant cost-cutting ideas and instead focuses on preserving Medicare and health benefits for military families." Katie Wright, an RN!spokeswoman, said Republicans still believed in controlling Medicare costs but think "money shouldn't be taken from Medicare to fund a new entitlement."
Republicans and Democrats have feuded over Medicare since its inception in 1965, and it is usually Democrats who adopt the stance of protecting the program against cost-cutters. Ronald Reagan proposed cutting $1 billion in Medicare spending while president in 1981, when the program cost just $40 billion a year.
-------------
This underlies the basic misunderstanding the public has of american healthcare. The government currently operates 30% of the "healthcare market" through Medicare and Medicaid. When seniors say they fear the government will end up controlling their healthcare its more than ironic since its worked pretty well for 44 years.
Some on the right do however understand what's needed. Fox News recently suggested ThedaCare of Appleton as a national model. This is exactly what we should do to make health care reform affordable. See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Tuesday, August 11, 2009
No ‘death panel’ in health care bill
A provision in proposed health care reform bill would finance end-of-life care counseling — if patient wants it.
Former Republican vice presidential candidate Sarah Palin is once again showing she is not ready for prime-time when she says the current proposed health care overhaul bill would set up a "death panel." Palin inferred that federal bureaucrats would play God, ruling on whether ailing seniors are worthy enough to society to deserve life-sustaining medical care. Palin and other critics are dead wrong.
Perhaps this is obvious, but nothing in the legislation would carry out such a bleak vision. The provision that has caused this misguided and manufactured uproar, which opponents are all too glad to use to distract everyone from the real issues, would actually authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes.
Former Republican vice presidential candidate Sarah Palin is once again showing she is not ready for prime-time when she says the current proposed health care overhaul bill would set up a "death panel." Palin inferred that federal bureaucrats would play God, ruling on whether ailing seniors are worthy enough to society to deserve life-sustaining medical care. Palin and other critics are dead wrong.
Perhaps this is obvious, but nothing in the legislation would carry out such a bleak vision. The provision that has caused this misguided and manufactured uproar, which opponents are all too glad to use to distract everyone from the real issues, would actually authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes.
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