Tag: "Medicare"

What?

This is The LewinGroup on Senator Max Baucus’ health care plan:

The Baucus proposal creates a public plan modeled on the Medicare program. Such a plan would be 20 to 30 percent less costly than comparable private insurance, due to lower provider payment levels and administrative costs under Medicare….. We have estimated that up to 70 percent of the 170 million people now with private health insurance would lose that coverage and enroll in the public plan. However, the Baucus plan appears to envision a less aggressive form of the public plan. His proposal states that “Rates paid to health care providers by this option would be determined by balancing the goals of increasing competition and ensuring access to high quality health care.” (emphasis added)

May 04, 2009 | 4 comments | by

Hits & Misses – 2009/4/30

Social Security now joins Medicare in producing red ink.

Two-thirds of the uninsured will pay only $100 a month for insurance.

Apr 30, 2009 | 10 comments | by

Should Public Plans Compete Against Private Plans in Health Care?

Two Wall Street Journal editorials have already tackled this issue — explaining the unfairness of public/private health insurance competition and the likely crowd-out of private insurance, based on a Lewin report. So is there anything else to say? Actually, quite a lot. Bottom line: It’s very hard to do this right; but if the advocates are intellectually honest, they can start with the State Children’s Health Insurance Program (SCHIP) and adopt a proposal Gene Steuerle and I made some years ago.

Here’s the background. Everyone is assuming that President Obama will keep his campaign promise to create a parallel system for health insurance. Those who don’t get insurance through an employer would have the opportunity to buy insurance in an Exchange. Details on how the Exchange would work are murky; and the clearer they become, the worse the whole idea sounds. But that’s not the problem. The deal-killing issue is whether one of the plans in the Exchange will be a government plan.

Two immediate questions jump to mind. What would it mean for a public plan to compete with a private plan? Why would anyone want that to happen? Let’s consider each of these in turn.

We are the Children

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Apr 27, 2009 | 18 comments | by

“Never Event” Occurs at VA Hospital

In the United States, the Centers for Medicare & Medicaid Services has classified any "patient death or serious disability associated with a fall while being cared for in a health care facility" as a never event – something that is "usually" preventable. In general it either reduces payments, or will not pay at all for additional hospitalization needed to treat the consequences of a never event. Logic suggests that this ruling may have some unintended consequences for medical liability cases.

According to Emergency Physicians Monthly, the widow of a patient who fell to his death from the roof of a VA hospital is suing the hospital and its doctors for $4.5 million after a suicidal patient was admitted and placed on an unlocked neurology floor.

The problem is that if the federal government (CMS) has already declared that a patient death associated with a fall while being cared for in a healthcare facility is a "never event," how can a VA hospital possibly argue that it is not liable?

Apr 24, 2009 | 1 comment | by

“Never Events” are Pay-for-Performance in Disguise

On October 1, 2008, Medicare announced its first list of “never events.” A never event is something that Medicare believes should never happen and it refuses to pay hospitals when such events occur.

Some of the items on the original October 2008 never event list make sense – surgery on the wrong patient or the wrong body part is obviously inexcusable. So is leaving a surgical instrument in a patient.

Unfortunately the list has expanded to include relatively unlikely but routine complications with the result that Medicare’s “never events” policy has the potential to skew clinical decision making in a way that does grave harm to patients.

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Apr 24, 2009 | 3 comments | by

Retiree Health Care Costs

According to Fidelity Investments, a 65-year-old couple retiring this year will need $240,000 to cover their post-retirement health care costs:

Retiree Health Costs

Apr 23, 2009 | 2 comments | by

Do Smokers Cost Society Money?

The idea that they do is often used to justify higher taxes on tobacco. On balance, however, society makes a profit off of smokers:

The Centers for Disease Control and Prevention (CDC) [estimates] that smokers cost the country $96 billion a year in direct health care costs, and an additional $97 billion a year in lost productivity….. However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents.

A Dutch study published last year in the Public Library of Science Medicine journal said that health care costs for smokers were about $326,000 from age 20 on, compared to about $417,000 for thin and healthy people.

Apr 21, 2009 | 3 comments | by

Cost-Shifting: Government vs. the Uninsured

An important study by the actuarial firm, Milliman finds that Medicare underpays hospitals by $34.8 billion and physicians by $14.1 billion, while Medicaid underpays hospitals by $16.2 billion and physicians by $23.7 billion. These amounts are made up for by commercial payers, resulting in 18% greater costs for private carriers for hospital services and 12% for physician services.

Milliman does not separate out the uninsured self pay population from those covered by other government programs, but if one-half of the loss is from the uninsured, we are looking at approximately $6 billion, one-fifth of the loss from Medicare and Medicaid!

Yet the issue of uncompensated care for the uninsured is one of the primary drivers of the current push for mandatory coverage and health reform. It has been called a "hidden tax" that we all pay for, and is seen as justification for a massive reordering of the entire health care system. But hardly any attention is paid to underpayment by public programs, a problem that is perhaps five times greater!

And you wonder why public policy so often goes astray.

Apr 21, 2009 | 7 comments | by

Disruptive Innovation

Mea culpa. Many apologies. My bad.

Some time back I took a whack at Clayton Christensen, without having read his book. My mistake. His book, The Innovator's Prescription, co-written with Jerome Grossman and Jason Hwang, is actually much closer to my own way of thinking about health care than anything I have read in quite some time.

I was misled on two counts. First, by a New York Times article that linked Christensen with Uwe Reinhardt and Alain Enthoven. Second, by the publicity for the book itself. The adage is wrong. You often can judge a book by its cover, at least by the blurbs on the cover. In this case, a whole slew of adulations by Tom Daschle and other people who are known for taking a technocratic, noneconomic approach to health care adorn the book jacket. There are no quotes from Regi Herzlinger, Mark Pauly, Mark McClellan — or other people known to have taken Econ 101.

So imagine my surprise when I discovered that Christensen and his colleagues quote Milton Friedman, warn repeatedly against single-payer systems ("access to a waiting list is not access to health care"), argue against more government regulation and make a full-throated case for Health Savings Accounts (HSAs), especially in the treatment of the chronically ill. They also defend specialty hospitals and walk-in clinics, reject such current fads as medical homes and a top-down approach to electronic medical records, advocate high-deductible insurance with HSAs for the uninsured and explain why evidenced-based medicine and pay-for-performance (at least as currently envisioned) won't work.

Indeed, one wonders if the authors of the blurbs made the same mistake I made — spouting off without actually reading the book.

httpv://www.youtube.com/watch?v=_mOA8pZ_I4M

My favorite piece of music
Sung by the twentieth century's greatest soprano

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Apr 17, 2009 | 24 comments | by

Doctors Opting Out

Opting out of Medicare and Medicaid, that is:

More and more of my fellow doctors are turning away Medicare patients….. One of the top mammographers in New York City…… no longer accepts Medicare and charges patients more than $300 cash for each procedure……

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance.

Apr 17, 2009 | 6 comments | by
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