Tag: "Medicare"

Medicare for All Would Crowd Out Private Coverage

The Obama health plan envisions an alternative to employer-based health insurance, called a health insurance Exchange. Premiums would be community-rated, people could choose a new plan once a year and the out-of-pocket premium would be limited to be no more than, say, 10% of income.

Some Democrats in Congress insist that one of the options offered in the Exchange be a public plan (e.g., Medicare for nonseniors). A Lewin Group report estimates that 32 million people would lose their private coverage and enroll in the public plan if it paid Medicare-level reimbursements and eligibility were limited to the small firms, self-employed and individuals.  The number of people dropping private coverage and enrolling in the public plan would increase to 119 million people if eligibility were open to everyone.

Apr 16, 2009 | 6 comments | by

The Obama Budget

According to Gene Steuerle, Medicare, Medicaid, Social Security and interest payments are going to crowd out everything else the federal government is doing:

Obama Budget

Source: Tim Roeper and Eugene Steuerle. Based on the President's proposed spending as analyzed by the Congressional Budget Office, "A Preliminary Analysis of the President's Budget and an Update of CBO's Budget and Economic Outlook" March 2009.

Apr 15, 2009 | 2 comments | by

Telling Doctors How to Practice Medicine

Here are two doctors writing about Medicare pay-for-performance guidelines:

Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics…..

One key quality measure in the ICU became the level of blood sugar in critically ill patients….. A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.

But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study….. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.

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Apr 10, 2009 | 2 comments | by

Have More than One Disease? Tough Luck.

Our dysfunctional payment system is incapable of adequately providing for patients with multiple health conditions:

Where all the money goes:

Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions, and 68 percent of Medicare spending goes to people who have five or more chronic diseases.

Who we don't know how to treat:

Yet people with multiple health problems – a condition known as multimorbidity – are largely overlooked both in medical research and in the nation's clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.

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Apr 09, 2009 | 6 comments | by

Opting Out of Medicare

This is from the New York Times:

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before.

Those looking for a primary care doctor had more difficulty. A 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients only 38 percent of primary care doctors did.

Apr 09, 2009 | 4 comments | by

Making Money by Making Mistakes

About one in every five Medicare patients discharged from hospitals need to be readmitted within 30 days, according to a new study.

As previously reported, Geisinger Health System in central Pennsylvania has a warranty on its surgeries, including its heart surgeries so payers don't pay for the same care twice. So how much does Medicare pay for this warranty? Zero. Zip. Nada.

So naturally, other hospitals are not interested in following Geisinger's example.

Apr 07, 2009 | 3 comments | by

Hits & Misses – 2009/4/6

Fewer than 2 percent of U.S. hospitals have abandoned paper medical charts and completely switched to electronic health records.

Only 13 of 75 primary care doctors in Anchorage are willing to accept new Medicare patients.

Can a video game make you fit?

Apr 06, 2009 | 4 comments | by

Medicare

We have previously reported on Medicare’s unfunded liability and ways to reform Medicare. This is from J.D. Foster’s Medicare backgrounder for Heritage:

  • The program has an unfunded liability of $85.6 trillion.
  • The drug benefit alone (Part D) has an unfunded liability of $17.2 trillion – greater than that of Social Security.
  • The average beneficiary receives a benefit of $10,460 a year, but pays premiums of only $1,212.
  • The cash flow deficit in Medicare is being covered by general revenues, thus crowding out other spending programs: currently at $4,053 per beneficiary, the general revenue subsidy will grow to $6,067 by 2020.
Apr 02, 2009 | 12 comments | by

Designing Health Insurance: Politicians vs. the Market

Every health insurance policy purchase represents a compromise between premiums and the amount of financial protection offered. Policies with higher out-of-pocket expenses via higher deductibles or co-pays generally have lower premiums. Pairing low premiums with coverage for even routine health expenses often requires limiting the total amount that the policy will pay to a relatively small amount, say $50,000, rather than the roughly $2 to $5 million that is the current commercial standard for individually purchased policies.

People’s insurance needs depend on their incomes, their assets, their health, and their tolerance for risk. These change throughout a person’s life. Some people need protection against small losses, others can afford larger ones. Some people have very small yearly health costs that they can pay out-of-pocket. They prefer low premiums for plans with large deductibles. Others want certainty. They prefer high premiums for plans that limit their out-of-pocket costs.

Existing evidence suggests that when politicians or their representatives design health insurance, they favor coverage of small expenses even though this increases claims processing overhead and overall costs. To keep premiums low, they often prefer to increase the amount people will have to pay in the event of a catastrophic loss.

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Mar 19, 2009 | 5 comments | by

Surprising Finding on Race

This is from American Health Line:

Black and Hispanic patients often have higher end-of-life care costs than white patients, according to an NIH study [gated, but with abstract].

The study found that Medicare costs for white patients averaged $20,166 in the six-month period. By comparison, the average cost for black patients was about 30% higher, or $26,704, and nearly 60% higher, or $31,702, for Hispanic patients. According to the study authors, minority patients were not charged more than white patients, but they received more invasive, intensive and costly treatments at the end of life.

Mar 18, 2009 | 3 comments | by
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