Health Reform Update
CBO to Orszag: Medicare reform idea won’t save money.
Tag: "Medicare"
Jul 27, 2009 | 6 comments | by John Goodman
Lessons from Cleveland
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The Visit:
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When President Obama visits the Cleveland Clinic today he will no doubt trumpet the Dartmouth Atlas finding that chronically ill patients in the last two years of life cost Medicare tens of thousands of dollars less at the clinic than similar patients at many other highly ranked academic medical centers. |
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The Question:
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Then the President will ask a question that he has asked before: Why can't other medical centers be just like Cleveland? |
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Where to Find the Answer: |
The answer to that question is not to be found in Cleveland. The answer is to be found back in Washington, D.C. in the Health and Human Services building, only a few blocks away from the Capitol. |
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Jul 23, 2009 | 6 comments | by John Goodman
Almost Any Private Disability Plan Can Trump This
While waiting for Medicare coverage, woman with severe arthritis spends ten hour days at Parkland’s emergency room waiting to see a doctor and get a prescription.
Under current law those with disabilities aren’t eligible for Medicare until two years after they begin receiving Social Security disability insurance checks…… [There are] only two exceptions: a three-month waiting period for people with end-stage renal disease and no wait for people with amyotrophic lateral sclerosis, commonly called Lou Gehrig’s disease.
Forty percent of those in the waiting period go without coverage at some point.
Jul 23, 2009 | 6 comments | by John Goodman
Medicare and Medicaid Spending Has Increased 1/3 More than Private Spending
Both programs' costs per capita have increased by about 1/3 more than private spending over a period of almost four decades (1970 to 2007), according to analysis by my colleague Jeffrey H. Anderson. The primary reason that Anderson's conclusions differ from those of others (such as Professor Jacob Hacker of the University of California, Berkeley) is that others examine only spending by 3rd-party payers (either private or government) and ignore out-of-pocket costs (which are all private).
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Jul 22, 2009 | 6 comments | by John R. Graham
Taking Another Look at McAllen
Atul Gawande published an article in The New Yorker about a month ago, laying out in great detail what he viewed as the inadequacies of the health care system in McAllen, Texas, and compared them to what he views as far superior systems in Grand Junction, Colorado and Rochester, Minnesota (home of the Mayo Clinic). He concluded that we needed to replicate the management systems (not-for-profit, salaried employees, team approaches to service delivery) of the Mayo Clinic in places like McAllen, and indeed, throughout the United States. Voilà! Problem solved.
Now comes the Texas Medical Association with a reality check, including some things Dr. Gawande overlooked about McAllen:
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Jul 14, 2009 | 14 comments | by Greg Scandlen
TANSTAAFL
As each new day brings us another set of numbers from the bean counters on Capitol Hill, there is the inevitable commentary from the sidelines on the cost of health reform. Will the total package cost too much? Can a way be found to make the burden more tolerable? Are there cost cutting ideas no one has thought of yet?
Paul Krugman was absolutely giddy the other day when conferees managed to reduce the cost of the Kennedy bill to $597 billion, down from the previous level of $1 trillion plus. Then, in the same column, he admitted that the total cost is likely to be more than double that amount.
Here's a way to keep score without being privy to the behind-closed-doors deliberations: There Ain't No Such Thing As A Free Lunch (TANSTAAFL). Independent analysts pegged the cost of Obama's health plan last summer at about $1.5 trillion over ten years and predicted it would cut the number of uninsured in half. Nothing has really changed since then except the hard-to-believe spectacle of leading Congressional health reformers — for the first time in their adult lives — actually coming face to face with the economic reality of their ritual campaign rhetoric.
When all is said and done the cost is still going to be about $1.5 trillion. The only real question is: who is going to pay that cost?
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Jul 13, 2009 | 28 comments | by John Goodman
The House Plan Forces 114 Million Americans Out of Their Current Health Coverage
A Lewin Group analysis of the House health reform bill finds that 2 out of 3 Americans will lose their current health coverage:
- 114 million Americans would be forced out of their current private health coverage, including more than 106 million Americans who currently have employer-provided health care.
- There will be substantial cost shifting to private health plans. The “public” plan will significantly underpay health care providers, generally compensating them at rates 20-30% below what private health plans would pay for the same services. As a result, physicians and hospitals would be forced to charge those with private insurance more in order to offset the losses they experience under the Democrats’ government-run plan.
- A December Milliman Group study found current Medicare and Medicaid underpayments drive up the cost of private coverage for the average family of four by $1,788.
- The Lewin Group study estimates that a government-run plan that pays Medicare-based rates would increase the cost shift to $3,628.
- Medicaid enrollment will increase by 16 million.Many of those newly enrolled would previously have had employer-provided health care.
Jul 10, 2009 | 19 comments | by John Goodman
Spending Other People’s Money
There is no evidence that any one of these therapies is any better than any other for Medicare prostate cancer patients.
Jul 09, 2009 | 7 comments | by John Goodman
There are More Healthy Voters than Sick Voters
The one abiding principle of the politics of medicine: Overprovide to the healthy and underprovide to the sick:
- CMS, the agency that runs Medicare, is proposing a set of tweaks that would raise the fees Medicare pays for primary care by 6% to 8%.
- Medicare payments to cardiologists would be cut by 11% overall, with certain procedures (echocardiograms, cardiac catheterizations) facing steeper cuts.
- Radiologists would see a cut of about 20% for doing high-tech scans such as CTs and MRIs.
Jul 07, 2009 | 2 comments | by John Goodman
Robert Reich on Public Option
President Obama and Secretary Kathleen Sebelius, whose biographies indicate zero experience in the private, wealth-producing sector of society, believe that they can launch a new "public" health plan to "compete" against the private sector. They claim that this will keep private insurers "honest." It's an interesting position for a President who also claims that he is not interested in running a car company. Imagine if he proposed a new Government Motors, in order to keep Toyota and Honda honest! What's so unique about health insurance, that it needs government "competition," an idea repellent in other areas of American life?
Robert Reich, Bill Clinton's Labor Secretary, has the answer in today's Wall Street Journal. According to Mr. Reich, a "public option" (actually a swamp of new government bureaucracies, ready from "day one" for perpetual taxpayer bailouts), would "squeeze" the profits of private health providers. It is dead easy for government to "squeeze" profits. But that is not a valid goal of health reform. A valid goal is to squeeze the profits of providers who fail to satisfy patients' needs, and allow those who do to earn increased profits. Patients are capable of doing this, but government is not.
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Jun 26, 2009 | 8 comments | by John R. Graham
