Tag: "Medicare"

Medicare Actuaries: Health Care Costs Will Go Up, White House: Health Care Costs Will Go Down, and the I-Never-Took-Economics Quote of the Day

Medicare’s Office of the Actuary:  The nation’s health care tab will go up — not down — by $265 more per person in 2019 as a result of President Barack Obama’s sweeping health system overhaul.

Estimate is optimistic: It presumes a 30 percent reduction in Medicare physician payments takes effect over the next two years.

White House (Nancy-Ann DeParle): Costs will go down, not up, by $1,400 per person.

Understatement of the day:  “When you cover the uninsured and they get the care they need, you have to spend more money.” — Karen Davis

I-never-took-economics quote of the day:  “Insurers are using the consumer protections in health reform as a cover for their own greed.” — Pete Stark

Sep 09, 2010 | 8 comments | by

Seniors Know More than Polltakers

Perhaps you saw the headline: “Most Seniors Misinformed…[About] Key Provisions of the Affordable Care Act.” Yet on closer inspection, it turns out that the seniors — who are about to get taken to the cleaners under ObamaCare — knew a lot more than the polltakers.

It reminds me of last summer’s townhall meetings, when members of Congress claimed their constituents were confused and misled. Turned out, the voters often were much better informed than their representatives.

On the answers to the polling questions, you be the judge.

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Jul 28, 2010 | 14 comments | by

First-Dollar Coverage

Almost 90% of Medicare enrollees have supplemental insurance that pays their 20% co-insurance when they see a physician. Thus, for almost 90% of 46 million Americans, health care is basically “free.”

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Source: Medicare Payment Advisory Commission analysis of MCBS, Cost and Use Files, 2005.

HT to James Capretta via Galen study.

Jul 27, 2010 | 18 comments | by

Quote of the Day

“The payment system doesn’t finance the kind of resources we need to take care of the 20 percent of Medicare patients who use 80 percent of resources.”

— Dr. J. Fred Ralston Jr., president of the 129,000-member American College of Physicians

Jul 02, 2010 | 7 comments | by

The Bipartisan “Doctor Fix”

Last week, Senate Republicans cowered and caved in to yet another short-term Medicare “doc fix” that kicks the can down the road until the end of November. Without the so-called “doc fix,” Medicare reimbursements to physicians would have suffered a catastrophic reduction of 21 percent as of June 1, as I wrote in an earlier post.

Last Friday’s unanimous Senate vote in favor of “fixing” the fee-schedule for another few months was followed Thursday evening by a 417-1 vote (with 14 not voting) in the House of Representatives. (The lone opposing vote was cast by the very liberal Democrat George Miller.)

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Jun 28, 2010 | 6 comments | by

Doctors are Leaving Medicare

The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%. At the state level:

  • In Illinois, 18% of doctors restrict the number of Medicare patients in their practice, according to a medical society survey.
  • In North Carolina, 117 doctors have opted out of Medicare since January, the state’s medical society says.
  • In New York, about 1,100 doctors have left Medicare. Even the medical society president isn’t taking new Medicare patients.

Full article on the increasing number of doctors refusing new Medicare patients.

Jun 25, 2010 | 5 comments | by

The AMA and the Myth of the “Doc Fix”

Of all the huffery puffery in American health policy, what is the most ridiculous? I think a leading candidate is the never-ending lobbying by the American Medical Association and associated medical societies to implement a so-called “doc fix” for Medicare.  This refers to U.S. government’s spending on doctors who participate in the Medicare Part B program, through which American seniors receive outpatient care.

The federal government attempts to calculate the price and value of each medical service delivered to Medicare beneficiaries by using a formula called the Resource-Based Relative Value Scale (RVBS).  Furthermore, it attempts to limit the total growth of Medicare’s spending on physicians by a method called the Sustainable Growth Rate (SGR), which Congress imposed in 1997.

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Jun 11, 2010 | 9 comments | by

The Dartmouth Atlas Controversy

The Dartmouth Atlas shows wide differences in Medicare spending across health care regions that cannot be explained by differences in health care outcomes. It has been touted by the Obama administration as Exhibit A in the case for health reform. However, The New York Times the other day took the Dartmouth researchers to task in a front page article and columnist David Leonhardt piled on. I also weighed in at this blog and the Dartmouth folks defended themselves here.

I think the work of Elliott Fisher and Jonathan Skinner is very important. But behind the very public to and fro about their work is a very important policy issue that all sides allude to and none are confronting directly. To wit: Can we (meaning the government) use statistics on Medicare spending to force the health care system in general, and Medicare providers in particular, to deliver more efficient, higher-quality care?

The weight of the evidence I believe is fairly clear: No, we cannot.

Before getting to details it may be helpful to remind everyone that this health care discussion is very similar — almost word-for-word similar — to the public policy discussion over public education that has been underway for a quarter of a century. See my previous post here.

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Jun 09, 2010 | 25 comments | by

AMA’s Seat at the Table

Scott Becker, an attorney/accountant, writes that last year the American Medical Association (AMA) gave its support to a fledgling health reform process, whose ultimate success was very much in doubt at the time, in return for two basic things: federal tort reform and a permanent fix of Congress’ sustainable growth rate (SGR) threat to reduce Medicare’s physician fees.

Now that health reform has become law, what does the AMA have to show for its early support? No SGR-fix, no tort reform and a number of new payment problems created by the new law. Here are just four examples.

  • a powerful new advisory board that can lower physician fees with little Congressional oversight.
  • an estimated 15 million previously uninsured people who will be covered at very low-paying Medicaid rates.
  • the prospect of intra-professional conflict as Medicare reimbursements for some areas may be raised and, under the zero-sum game of Medicare spending, physician reimbursements will probably fall.
  • the demise of physician-owned hospitals. No new facilities can be built after this year and existing facilities cannot expand upon the date of enactment.
May 24, 2010 | 6 comments | by

The Commission, Part I

As alert readers will know by now, President Obama has appointed a commission on the federal debt, mainly focused on Social Security, Medicare and Medicaid. To signal his seriousness about this venture, the President has gone so far as to put the newly passed health reform bill on the negotiating table — even though the ink on the new law is barely dry.

Just to get everyone’s thinking jump-started, let me propose four bold ideas:

  • A regressive increase in taxes.
  • A regressive cut in benefits.
  • A tax on capital income, destined to remove from the economy the funds needed to create jobs and make workers more productive.
  • No change in the Ponzi-scheme structure of these programs — by which we continue to promise benefits we are not willing to pay for.

If these ideas do not immediately strike you as appealing, you need to know they are not really my ideas. The bullet points above describe the results of the 1983 Greenspan Commission — a bipartisan effort to “save” Social Security. At least inside Washington, D.C., and in the mainstream media, this effort is universally regarded as a stellar example of how politicians should solve problems. Many hope the commission on the federal debt will follow the Greenspan commission example.

More compassionate people, like yours truly, hope they do not succeed.

Behind the Green Door

 

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May 24, 2010 | 13 comments | by
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