Tag: "Medicare"

Levels Versus Growth Rates

[I]t is well established that some regions spend considerably more than others in the Medicare program without delivering higher-quality care or generating greater patient satisfaction.

Yet low spending is not the same as low spending growth, and even efficient areas can experience considerable spending growth. In fact, many areas that had low spending in 1992 did not have notably lower spending growth between 1992 and 2006 than other areas…  Rochester, Minnesota, and Salt Lake City, for instance, are known for high-quality, integrated providers and have low Medicare spending per beneficiary. Yet between 1992 and 2006, inflation-adjusted Medicare spending per beneficiary rose 4.3% annually in Salt Lake City and 3.8% annually in Rochester, as compared with 3.2% for the country as a whole. In short, areas with exemplary delivery systems do not necessarily have exemplary rates of spending growth.

From a study Joe Newhouse and his colleagues in the New England Journal of Medicine (gated, but with abstract).

Feb 11, 2011 | 4 comments | by

What If We All Were Rich?

Barack Obama has said on numerous occasions that if you make less than $200,000 he wants the government to look after you, but if you make more than that you’re on your own and can fend for yourself.

Okay, I know those weren’t his exact words. But it’s a reasonable approximation.

Now consider this. What if we lived in a world where the average family earned more than $200,000? What if almost every family earned more than $200,000? I’ll tell you in a moment why it’s reasonable to speculate this way and why it’s relevant for current public policy. First, I want to consider the implications of almost everybody being rich.

For one thing, we could forget the funding problems of Social Security and Medicare. People who are rich can take care of themselves. In fact, without too much trouble we could cut the federal budget in half. We could eliminate the federal debt in fairly short order. Then we could cut everyone’s federal taxes in half. We wouldn’t need ObamaCare. There would be no appealing argument for card check. In fact, other than some environmental goals, the entire Obama domestic policy agenda would become unnecessary, superfluous and undesirable. Indeed, from the Obama administration’s point of view, if everyone were rich there would be almost nothing for government to do!

Have I got your attention? Okay, now I’ll tell you why this is not a pipe dream.

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Feb 09, 2011 | 15 comments | by

A Leftwing Idea for Privatizing Medicare

This is Matt Yglesias, writing at his blog:

Here’s an idea. Right now, if you’re over 65 in America and you have a health problem, you’re entitled to have the federal government pay for your treatment. These treatments are often expensive, and are also often a pain-in-the-ass to undergo. What if in addition to being entitled to get the treatment you were also entitled to just pocket the money. Maybe at the margin you’d rather have a vacation in Paris and a shorter life than spend more time in the hospital.

If I had suggested this, Paul Krugman and Johnathan Cohn would have accused me of heartlessly exploiting the poor.

Feb 01, 2011 | 13 comments | by

Into the Lion’s Den

On Tuesday, I will appear at a Brookings Institution conference on Accountable Care Organizations (ACOs). As far as I can tell everyone else on the program believes in “evidence-based medicine,” while I will be the only advocate of “evidence-based public policy.”

My message: the latest comprehensive review of all the studies of report cards and other quality-measuring-and-reporting techniques finds they don’t work and may do more harm than good; the latest comprehensive review of all the studies of electronic medical records finds they do not live up to their promises; and the most recent study of pay-for-performance finds that it doesn’t work either.

What does work? Within the third-party payer system, islands of excellence are distributed randomly and do not appear to have characteristics that can be replicated by others. Outside the system, however, providers compete on price and quality; transparency is the rule, rather than the exception; and low-cost, high-quality medicine is the norm.

Solution: Let patients control the marginal cost of their care, wherever possible.  At a minimum, Medicare should let the private sector find the improvements and pay providers a portion of any savings for the taxpayer.

This conference will be webcast here.

Jan 31, 2011 | 9 comments | by

More Evidence Against EMRs, and Other News

More evidence that EMRs are not improving the quality of care.

Medicare Chief Actuary: Claims that ObamaCare will reduce medical costs are “false, more than true.”

Another disappointing study result: Pay for Performance doesn’t work.

Jan 27, 2011 | 4 comments | by

What Should Medicare Do with Patients Who Have No Possibility of Improvement?

Plaintiffs say almost 78 percent of the 46 million or so Medicare beneficiaries have at least one chronic condition, such as multiple sclerosis or Alzheimer’s. Denying them care if they don’t meet the so-called “Improvement Standard,” the advocates argue, can prevent them from performing routine daily activities or even cause their condition to deteriorate – leading to higher costs down the road….  The agency’s claims are processed by private subcontractors, many of whom require improvements in patient conditions and deny coverage to thousands of people every year as a result…

The suit seeks to require Medicare to cover certain types of rehabilitative care even when it likely won’t lead to an “improvement” in patients’ condition.

Full post on the class action lawsuit at The Hill’s Healthwatch Blog.

Jan 20, 2011 | 4 comments | by

Incentives Matter: Poor Lose Out on Medicare Part D

Since 2006 numerous insurers have stopped serving the low-income segment of the Medicare Part D program, forcing millions of beneficiaries to change prescription drug plans. Using data from participating plans, we found that Medicare payments do not sufficiently reimburse insurers for the relatively high medication use among this population, creating perverse incentives for plans to avoid this part of the Part D market. Plans can accomplish this by increasing their premiums for all beneficiaries to an amount above regional benchmarks.

Read the Health Affairs article on eliminating perverse incentives in Medicare.

Jan 12, 2011 | 4 comments | by

If ObamaCare is Unconstitutional, Why Aren’t Medicare and Medicaid?

Now that a federal judge in Virginia has ruled that an individual health insurance mandate is unconstitutional, here is a natural follow-up question: How can Medicare and Medicaid be constitutional?

Legally, the difference is that the latter two programs are government operations, whereas the individual mandate would have compelled people to buy a private product.  Helvering v. Davis (1937) was the famous (or infamous) case wherein the U.S. Supreme Court found that the Social Security Act was constitutional. As Robert A. Levy and William Mellor explain in their excellent book, The Dirty Dozen: How Twelve Supreme Court Cases Radically Expanded Government and Eroded Freedom, the Administration cleverly argued that the Social Security payroll tax and Social Security checks completely independent operations. The first lies within Congress’ taxing power, and the second lies within its power to spend for the “general welfare.” Because Medicare was an amendment to the Social Security Act, it is also constitutional, according to this reasoning.

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Dec 15, 2010 | 13 comments | by

Reselling Medicaid Drugs

The Government Accountability Office analysis of Medicaid prescriptions obtained in five high-volume states estimates that about 65,000 Medicaid beneficiaries had seen in excess of five doctors in 2006 and 2007 to get multiple prescriptions for narcotics such as oxycodone and hydrocodone.  The cost to the Medicaid program was estimated at about $63 million dollars, excluding the cost of physicians visits. Several dozen people were arrested in Buffalo, New York as part of a criminal scheme to divert Medicaid drugs to drug dealers on the street.

Dec 14, 2010 | 9 comments | by

What Can the Opponents Do About ObamaCare?

We’re not partisan at the National Center for Policy Analysis. We like good laws and dislike bad ones — regardless of which party enacts them. I believe we have been as hard on the Bush administration’s expansion of Medicare as we have been on the Obama administration’s new health law. That said, the hot topic of the moment is: What, if anything, can the congressional opponents do about the new health law? Here is my take.

Everyone expects the new Republican-controlled House of Representatives will vote to repeal ObamaCare. This move will probably be blocked in the Democrat-controlled Senate, however; and failing that, the president will use his veto pen to save the Democrats’ crown-jewel policy achievement.

Then what? As I explained at National Review Online recently, if President Obama is willing to open up the health care issue and get a sensible reform, everyone should cooperate. But if that doesn’t happen, I expect guerrilla warfare. Now it seems that Orrin Hatch agrees with me.

Every move you make                   Every single day
Every vow you break                     Every word you say
Every smile you fake                     Every game you play

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Dec 13, 2010 | 10 comments | by
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