Tag: "Medicare"

The Rich Get Richer

Dollar FlagA CNNMoney article lists the 25 richest towns, measured by median family incomes and median home prices.  At the top is New Canaan, Connecticut with a median income of $231,138 and a median home value of $1,465,000!  Even the town that ranks at the bottom of the list (# 25), Garden City, New York, with a median income of $147,804 and a median home price of $840,000, is not doing too shabby. 

Besides abundant earnings and real estate wealth, what else do these towns have in common?   Extraordinary Medicare spending.  That's based on an NCPA study by Senior Fellow Andy Rettenmaier.

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Dec 16, 2008 | 3 comments | by

Hits & Misses – 2008/12/15

Age-adjusted, Canada spends the most on health care.

Mass. Health Plan: It's costing 85% more than originally projected.

Clinical Trials: Investors learn the results; participants rarely do.

Washington State: Nearly 1/3 of doctors have shut the door to new Medicare patients.

httpv://www.youtube.com/watch?v=3drqJ1bUmEA

The Blues

Dec 15, 2008 | 3 comments | by

Which Is Worse: Being Uninsured or Being Enrolled in Medicaid?

This is Greg Scandlen, writing at the State Policy Network blog site here:

MedicaidThis author reviewed all of the 139 studies that comprised [Institute of Medicine's] analysis and found that only seven of them adjusted for income, but 44 identified the results of Medicaid enrollees separately from the uninsured and 26 compared the uninsured only to people with private insurance, omitting the role of Medicaid and Medicare. In 31 of the 44 studies that separated out the Medicaid experience, people on Medicaid did worse than the uninsured on a range of health treatments and outcomes. In a few cases, the uninsured and Medicaid patients both did better than the privately insured, such as mortality in the hospital.

Dec 11, 2008 | 5 comments | by

Memories

At the National Journal Health Blog, Marilyn Serafini asked, "How much does health reform really cost, what elements are worth it, and what are the best and worst options for paying for it?" She invites bloggers to compare the current situation with the passage of Medicare and Medicaid in 1965. [link] Here is part of my response:

Here are five lessons from the Medicare and Medicaid experience:

  1. The cost of Medicare and Medicaid was way beyond what anyone predicted. The reason: failure to realize that when any good or service becomes free, people will consume more of it.
  2. Once started, these programs are extremely hard to curtail. If we ended Medicare today – collecting no more taxes and allowing no more accrual of benefits – we would still owe $33 trillion in benefits already earned! (Results of new NCPA study.)
  3. Looking indefinitely into the future, the Trustees have calculated there is an unfunded liability (promises made over and above expected premiums and dedicated taxes) of $85 trillion – almost six times the size of the entire economy.
  4. According to Amy Finkelstein, although Medicare was financially important to the elderly, it created no discernable health benefits in terms of reduced mortality. [link]
  5. Despite no measurable health benefits, the explosion of spending on these two programs forced up prices for everyone else. In fact, HHS' own internal estimates suggest that every $1 of additional spending buys 57¢ of higher prices.

"Memories Are Made of This"

Dec 10, 2008 | 4 comments | by

Medicaid Payment: Low and Slow

Newly signed Medicaid patients may have a tough time finding a doctor. Only about half of all physicians will accept new Medicaid enrollees, far less than the number of doctors taking on new Medicare patients or the privately insured. The reason? Medicaid reimbursement rates are low and the payment is slow. A study [gated but with abstract] in Health Affairs finds that the average Medicaid pay cycle ranges from a low of 37 days in Kansas to a high of 115 days in Pennsylvania.

Dec 08, 2008 | 2 comments | by

Thinking About Tomorrow

If the federal government stopped the Medicare and Social Security programs today – collecting no more payroll taxes and allowing no more accrual of benefits – it would still owe up to $52 trillion to those who have already earned these benefits, according to a new study by the National Center for Policy Analysis (NCPA).

Of that amount, $33 trillion is owed in Medicare benefits. To put the numbers in perspective, the size of the entire U.S. economy is $14 trillion.

No one thinks we are going to end these programs. Yet these are the right numbers if we account for federal obligations the way private pensions and state and local governments are required to.

 
"Don't Stop Thinking About Tomorrow"

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Dec 05, 2008 | 13 comments | by

Primary Care All Night Long

Another benefit of out-of-pocket medical care:

"In the city that never sleeps, we don't either," read ads plastered on the outer walls….The clinic promises more personalized, attentive late-night care than understaffed hospitals, and the continuity of primary-care physicians rather than a rotating cast of residents….

Uninsured people pay a $125 fee for the first visit and $65 for subsequent visits, with discounts available depending on income….

The clinic takes private health insurance and Medicare for the elderly, but not Medicaid for the poor.

Full story here.

Dec 02, 2008 | 5 comments | by

Daschle

With Tom Daschle slated to become the next HHS Secretary, there has been a mad rush to get a copy of his book, Critical: What We Can Do About the Health Care Crisis, which apparently no one had previously read. Since booksellers can't possibly meet the demand, here is my brief attempt to satisfy your curiosity.

The main ideas: Medicaid expansion, Federal Employee Health Benefits Program (FEHBP) for everyone who wants to enroll, Medicare for the nonelderly as a FEHBP option, a play-or-pay mandate for individuals, income-based, refundable tax credit subsidies (both at work and away from work), a play-or-pay mandate for employers, electronic medical records, a national health board ("to establish a single standard of care for  every other provider and payer"…covering every disease from cancer to diabetes  and even depression), preventive care, dental health, mental health, long-term care, home care, community health centers and combating obesity.

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Nov 26, 2008 | 24 comments | by

Johnson Introduces Medicare “Freedom to Choose” Bill

Congressman Sam Johnson (R-TX) has introduced legislation (HR 7148) that would allow so-called private contracting under Medicare and enable people to decline to enroll in Medicare without forfeiting their Social Security. It would also allow people who are otherwise eligible for Medicare to continue contributing to an HSA. Mr. Johnson, who is a member of the Health Subcommittee of the Ways & Means Committee, said in a press release, "If Warren Buffett wants to pay for his own medical care, I say we should let him."

The private contracting issue means that Medicare beneficiaries could see a private physician and pay directly for the service, without requiring the doctor to opt-out of Medicare altogether, provided there is a written contract between the physician and the patient and they do not attempt to bill Medicare for any part of the service.

At the same time, a lawsuit has been filed on this very issue. (See previous post.)

In an op-ed on this issue, Heritage president Ed Feulner, says "You'd expect those who run entitlement programs to jump at any chance to trim expenses and save money (but) you'd be wrong."

Oct 28, 2008 | 2 comments | by

Managed Competition in Florida Medicaid

Managed competition doesn’t work the way its advocates think it works. Despite glowing descriptions of the Federal Employee Health Benefits Program (FEHBP) by Alain Enthoven and equally effusive praise from some of our friends on the right, the FEHBP is deeply flawed. The versions created for state employees and many college and university employees have these same flaws. Managed competition in Medicaid also shares those flaws – even though it may still be an improvement over traditional Medicaid.

A Kaiser study of the Florida Medicaid program found that:

  • About three in ten enrollees were not aware they needed to choose among competing private health plans.
  • Over half of those who were aware had difficulty making a choice.
  • Four in ten enrollees appear to have been assigned to a plan by the state rather than choosing one on their own.

Had Kaiser investigated the FEHBP or any of the various state and university health systems they would have discovered similar lack-of-information and lack-of-understanding problems. Kaiser researchers seem to think (1) they are studying a consumer choice model and (2) they have found flaws in that model. They are wrong on both accounts.

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Oct 24, 2008 | 3 comments | by
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