Tag: "Medicare"

Regional Variation in Medicare Spending May Be Exaggerated

A recent MedPAC report finds that although raw per capita spending is 55% higher for beneficiaries in the area at the 90th percentile than for beneficiaries in the area at the 10th percentile, after adjustment for relevant factors, utilization is only about 30% greater. Approximately, 45% of the regular Medicare population lives in areas that have service use within 5 percent of the national average.

This is from Jason Shafrin at the Healthcare Economist blog.

Feb 05, 2010 | 4 comments | by

Can There Be Scaled-Down Health Reform?

Yes and no.

On the affirmative side, I have ten reforms in mind and every one of them would be especially beneficial to people with chronic (pre-existing) conditions.

But let’s take up the negative side first. Here is Paul Krugman, writing in The New York Times:

Suppose, for example, that Congress took the advice of those who want to ban insurance discrimination on the basis of medical history, and stopped there. What would happen next? The answer, as any health care economist will tell you, is that if Congress didn’t simultaneously require that healthy people buy insurance, there would be a “death spiral”: healthier Americans would choose not to buy insurance, leading to high premiums for those who remain, driving out more people, and so on.

And if Congress tried to avoid the death spiral by requiring that healthy Americans buy insurance, it would have to offer financial aid to lower-income families to make that insurance affordable — aid at least as generous as that in the Senate bill. There just isn’t any way to do reform on a smaller scale.

Alert readers will recall that I made a similar point here and Uwe Reinhardt agreed with me. But I wasn’t arguing for ObamaCare. I was arguing against divorcing health insurance premiums from risk.

In a complex system — especially one that is hugely dysfunctional because of regulation, tradition and bureaucracy — there are basically two ways to go:

  • We can liberate people, giving them new opportunities to solve problems; or we can further constrain them, making problem-solving more difficult than ever before.
  • We can give people new tools to solve problems; or we can take away tools they already have.
  • We can unshackle the price system, allowing competition and choice to solve problems the way problems are solved in other markets; or we can suppress prices even more than they are already suppressed.

The former choices are the path to real problem-solving; the latter are not workable, not desirable and not real reform.

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Feb 03, 2010 | 16 comments | by

Huge Price Jump in Brand-Name Meds, Doctor Payments Lowered, and Amish Exempt from Obama Mandate

Getting ready for health reform: The prices of 416 brand-name medicines have increased by 100%−499%.

Doctors’ payments through the Medicare program are scheduled to be lowered by 21 percent in March. But not in Montana, North Dakota, South Dakota, Utah and Wyoming — where fees will rise.

ObamaCare mandate doesn’t apply if you’re Amish.

Jan 13, 2010 | 4 comments | by

Wrong Doses, Compensation for Organ Donors, and Bending the Curve on Health Care Costs

Tara Parker-Pope (NYT Health Blog):  Why do patients take the wrong dose? Because they don’t know the difference between teaspoons and tablespoons. (A 1992 study of dosing errors.)

Jacob Goldstein (WSJ Health Blog): In this country, it’s legal to compensate donors of eggs, sperm and blood, but it’s illegal to pay organ donors. Compensating donors of bone marrow… is also illegal. But a lawsuit in federal court could change that.

Byron Caplan (Econlog): If Obama really wants to “bend the curve” of health care costs why not try outsourcing Medicare and Medicaid to India?

Jan 12, 2010 | 5 comments | by

Did You Know there are Uninsured Seniors?

The reason: Medicare’s complex rules:

Ms. Gardner’s next chance to sign up for Medicare is in January, and her coverage won’t begin until July. With her current health plan due to expire in March, Ms. Gardner is facing several months without insurance. And as a penalty for missing the deadline, her monthly Medicare premium will permanently be increased by 10%.

Jan 07, 2010 | 9 comments | by

ObamaCare is Off to a Bad Start

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

This is stunning on so many levels: the President’s continuing push for a public plan, the belief that Medicare can be used to bend the cost curve, the claim that Washington knows best about what is efficient care and why, the notion that the federal government can use its purchasing power to make all providers as efficient as Mayo…etc.

Full report on the Mayo Clinic in Arizona.

Jan 04, 2010 | 5 comments | by

A Nasty Surprise for Retirees in the Senate Health Bill

Current law:

Under the 2003 law that created a prescription-drug benefit known as Medicare Part D, companies that continued to provide such benefits on their own qualified for a 28% tax-free subsidy — worth about $600 a year per retiree. Hundreds of major companies took advantage of the provision.

After health reform takes the subsidy away:

One industry group estimated that as many as one-third of the companies providing the benefits could drop them to avoid the hit to earnings… An analysis by the American Benefits Council, an advocacy group for large employers, found the tax change could result in a one-time 35% reduction in earnings for a typical company now receiving the subsidy.

Full report on cuts to retiree benefits.

Dec 31, 2009 | 2 comments | by

Obama Targets End-of-Life Care: Critics Say Lives are at Stake

The charge:

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data.

The defense:

U.C.L.A. and five other big California medical centers recently published their own research results with a striking conclusion: for heart failure patients, the hospitals that spend the most seem to save the most lives.

Full article on end-of-life care in The New York Times.

Dec 30, 2009 | 4 comments | by

Another Doctor Ponders Group Exams Under ObamaCare

If Medicare mandates “Preventive Annual Health Evaluation with no copay,” it means many more primary care doctors will have to choose between accepting very poor payment ($179.29 in Santa Ana California), joining the growing number of “retainer or concierge” practices, providing care in a manner that is consistent with the payment provided (a very, very brief exam, or having a PA, EMT or MA do the exam), opting out of Medicare or choosing a different line of work. A waiter at a local restaurant informed me that he earns over $150,000 annually working 4 days a week.

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Dec 19, 2009 | 16 comments | by

Congress is About to Create a New Ponzi Scheme

Known as the Community Living Assistance Services and Supports Act, or Class Act, this entitlement is in both the House and Senate bills:

The program will hand over its revenues to the feds, who will promptly spend it. In return, the program’s administrators would receive federal IOUs, just as Medicare and Social Security do. But these are nothing more than liabilities that have to be repaid, either by taxes or borrowing. …

[According to the Congressional Budget Office,] “the program would add to budget deficits in the third decade — and in succeeding decades — by amounts on the order of tens of billions of dollars for each 10-year period.” These long-term demands on the Treasury would coincide with shortfalls in Medicare and Social Security projected to be in the hundreds of billions of dollars.

Full op-ed by Scott Harrington in The Wall Street Journal.

Dec 18, 2009 | 5 comments | by
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