Tag: "Medicare"

Paul Ryan’s Medicare Reform Falls Short

The Medicare part of Paul Ryan’s budget proposal, Path to Prosperity, is superior to the status quo, or anything proposed by President Obama. Unfortunately, it falls short of the high standard he set himself last year, in Roadmap for America’s Future.

The Roadmap contained a very precise Medicare “payment” (in Mr. Ryan’s words) of $11,000, to be adjusted for future inflation by a factor combining changes in the Consumer Price Index and changes in medical prices, for future Medicare beneficiaries who are now under 55 years of age. Path to Prosperity, however, eliminates the “payment” in favor of the woolier “premium support.” Nor does it even report how it would calculate this premium support, beyond asserting that “wealthier beneficiaries would receive a lower subsidy” (p. 46).

Under the previous Roadmap, you could have taken the “payment” and used it to “to pay for one of the Medicare certified plans, or any other plan, such as those offered by former employers or available from the private market” (p. 51).  In other words, you had the freedom to buy a Medicare Advantage plan, or to pay your employer for a retiree health plan, or buy an individual plan regulated by your state’s Insurance Commissioner.

Not any more: Under the current proposal, we’d be forced to choose a plan from a federal “tightly regulated exchange” (p. 47). We need to put this talk of “exchanges” to bed until we finally get rid of ObamaCare.  People rightly associate an exchange with a limited choice of plans selected by a politically appointed board, offering benefits determined by bureaucrats’ whims.  This is what motivates those who are currently blocking states from implementing ObamaCare’s Health Benefits Exchanges, or preventing Dr. Donald Berwick — an outspoken champion of medical rationing as practiced by Britain’s National Health Services — from taking over the Centers for Medicare & Medicaid Services.

Apr 08, 2011 | 15 comments | by

Federal Kidney Program: Unintended Consequences

When Congress established the entitlement to pay for kidney patients in October 1972 … it … was expected … that fewer than 40 patients per million would need dialysis, and that most of those patients would be healthy — except for their failed kidneys — and under age 54.

Now more than 400 people per million start dialysis each year. More than a third of the patients are 65 or older, and they account for about 42 percent of the costs. People over 75 make up the fastest-growing group of dialysis patients. And most elderly dialysis patients have other serious diseases like diabetes, heart failure, stroke and even advanced dementia. One-third of them have four or more chronic conditions.

Full article on the issues stemming from the federal kidney program.

Apr 07, 2011 | 7 comments | by

Why are There Large Differences in Medicare Spending Across States?

Research by the Dartmouth Atlas team finds large differences in Medicare spending on patients with similar health conditions across the country. States such as Florida, for example, spends much more per beneficiary than Minnesota. Dartmouth researchers tend to attribute these differences to differences in the practice patterns of physicians. Some doctors practice medicine conservatively; other’s do not.

A new study, however, seems to rebut this idea — finding that variations in medical conditions are the main cause of regional variations in health care costs, once one controls for the health status of patients (The Dartmouth Atlas is based on spending averages).

Another finding of the paper is that the elderly move around a lot.  In fact, one in five Medicare beneficiaries receive medical treatment in more than one census division. These beneficiaries could either be snowbirds or the medical care they require is not available near where they live.

(HT to Jason Shafrin)

Apr 06, 2011 | 6 comments | by

You Can’t Take That Away From Me

Is this “the end of progressive government?” asks E.J. Dionne in The Washington Post. Do Republicans intend to break “America’s promise to seniors and to the poor?” asks Jon Cohn in The New Republic. Will the Republicans leave “the old and the poor without health care,” as Ezra Klein suggests? There’s no question in Paul Krugman’s mind. The “savings will come entirely from…denying medical care to those who can’t afford to top up their premiums,” he says. It’s “radical,” “irresponsible,” and “extreme,” adds Dionne.

They’re writing about the Medicare reform in Paul Ryan’s Republican budget plan. That’s the reform he devised with former Clinton-era budget director Alice Rivlin, which mainly reflects a bipartisan proposal made by a Clinton-era Medicare reform commission. Perhaps this is as good a time as any to introduce:

Goodman’s Rule                   Everyone is entitled to become hysterical;
For Civil Discourse:              but only on topics you actually know something about.

before reminding everyone that all these critics were unapologetic supporters of ObamaCare. Now take a look at the graph below. I’ll explain it below the fold.

No, No.
They Can’t Take That Away From Me

Read More » »

Apr 06, 2011 | 18 comments | by

Internal Obama Administration Memo Explains How to Answer Voters’ Worries

But it’s not completed yet. For example:

To the question “Won’t some ACOs become a monopoly and drive up costs while limiting access to care?,” the document answers: “Need CMS to insert answer.”

Other likely questions the memo anticipates: What to say to seniors who worry they will lose their doctor and be forced to join an ACO?

I second that last question.

Apr 05, 2011 | 5 comments | by

Ponzi Schemes

Jack Lew is lucky he isn’t in prison. Were he representing a private pension fund and if he made the sort of statements he made in USA Today the other day, he might well be sharing a cell with Bernie Madoff.

So who is Jack Lew? And what did he say?

Lew is the Director of the federal Office of Management and Budget. About Social Security, he wrote: “Taxes are placed in a trust fund dedicated to paying benefits owed to current and future beneficiaries. When more taxes are collected than are needed to pay benefits, funds are converted to Treasury bonds — backed with the full faith and credit of the U.S. government.”  As a result of these investments, the Social Security trust fund will be able “to pay full benefits for the next 26 years.”  Not only is this preposterous, Charles Krauthammer called it a “breathtaking fraud.”

Before dissecting Lew’s transgressions, let’s consider why Bernie Madoff is in the hoosegow. Madoff told investors he was investing their funds in real assets, when in fact he was not. He secretly used their funds for personal consumption and to pay off other investors. Either figuratively or imaginatively, Madoff wrote IOUs to himself, all backed by the full faith and credit of Bernie Madoff. Maybe in the beginning he fully intended to pay off. But that’s beside the point. Inducing people to give you money with this sort of lie is criminal fraud. It’s against the law.

Read More » »

Apr 04, 2011 | 28 comments | by

Churning in ObamaCare

A new article in Health Affairs brings attention to the problem of “churning” in the eligibility requirements for subsidized ObamaCare.

The study by Benjamin Sommers and Sara Rosenbaum looks at how often people will fall in and out of eligibility for, on one hand, Medicaid for people up to 133% of the poverty level, and on the other hand, subsidized coverage for those up to 400% of poverty in the Exchange.

The Washington bureaucracy simply doesn’t understand how dynamic America is. It assumes that people will stay in the box they are put in. But in fact, the job market in this country is extremely fluid, with people changing jobs frequently, or working several jobs at once, or supplementing income with seasonal jobs, or working on a commission basis and getting periodic surges of income.

Read More » »

Mar 30, 2011 | 5 comments | by

AARP to Get $1 Billion from ObamaCare

Several Republicans on the Ways and Means Committee this afternoon issued a report regarding AARP and its business activities. …  Specifically, the report found that while AARP’s Medicare Advantage and Part D plans receive a flat licensing fee from UnitedHealth Group regardless of the enrollment in their plans, AARP receives 4.95% of each Medigap premium dollar paid by senior citizens … Because of these unique contractual arrangements, AARP has NO financial incentive to expand Medicare Advantage but DOES have a financial incentive to expand Medigap enrollment — and Medigap enrollment will expand thanks to the Medicare Advantage cuts in the law.

Based on this information, and estimates of declines in Medicare Advantage enrollment thanks to the cuts in the health care law, the report estimates that AARP will receive between $55 million and $166 million in new revenue in 2014 alone — meaning the ten-year financial windfall received by AARP due to ObamaCare could total over $1 billion.

See Chris Jacobs’ full report here.

Mar 30, 2011 | 7 comments | by

Insurance Coverage Denials: Private versus Public

The people behind the coming denials:

[Centers for Medicare and Medicaid Services] has fewer than twenty physicians on its coverage staff and fewer than forty total clinicians once pharmacists, nurses, and other health care providers are counted. While this isn’t a precise surrogate for sound decision-making, it gives insight into how well the agency informs its decisions. Most of its physicians are generalists. It doesn’t have a single oncologist on its staff, and has just one nephrologist despite the fact that it pays for the vast majority of dialysis performed in the U.S. To give a basis for comparison, private health plans—which exercise far fewer authorities to set prices or coverage rules—have more clinicians by order of magnitude on their staffs. Aetna has more than 140 physicians and about 3,300 nurses, pharmacists and other clinicians. Wellpoint has 4,000 clinicians across its different businesses, including 125 doctors and 3,180 nurses. United Healthcare employs about 600 doctors and 12,000 clinicians across its health care business.

This is from Scott Gottlieb’s chapter on medical innovation. See previous posts here and here.

Mar 29, 2011 | 6 comments | by

Medicare Advantage Redux

Writing at the Health Affairs Blog the other day, Marsha Gold claimed that, “Existing research provides no evidence that either traditional Medicare or Medicare Advantage perform consistently better than the other.” If so, that’s bad news for Obama Care. Medicare Advantage plans and they way they are accessed come closer to what the Administration wants out of health reform than anything on the horizon. Medicare Advantage HMOs are more like the Accountable Health Care HMOs the Administration has been touting than conventional Medicare, and as I wrote before:

  • They provide subsidized coverage to low- and moderate-income people who could otherwise not afford it.
  • They control costs better than conventional insurance by eliminating unnecessary care.
  • They provide higher quality care.
  • They have no pre-existing condition limitations and some plans actually specialize in attracting and caring for patients with multiple illnesses.
  • They provide an annual choice of plans.
  • They even compete against a public plan.

See also here. These results come from industry funded research. But as Jeff Lemieux points out in a response to Gold, these and other studies are going through the peer review process, and in any event Gold should be familiar with them.

I’m not a fan of HMOs but fair is fair.

Mar 24, 2011 | 11 comments | by
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