By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013
Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.
At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.
As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.
Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.
The entire Op Ed is here.
The study debunking the "rate shock" rumor is here.
Showing posts with label Health care costs. Show all posts
Showing posts with label Health care costs. Show all posts
Friday, March 29, 2013
Thursday, March 21, 2013
Report rebuts claim that ACA is unfair to young adults
A Robert Wood Johnson Foundation/Urban Institute analysis says health system reform's coverage provisions will help mitigate the effect of setting new age rating bands.
By Jennifer Lubell
amednews.com
Originally published March 18, 2013
An Affordable Care Act provision that seeks to limit the amount by which insurance premiums can vary based on enrollees' ages won't result in young adults paying unreasonably high premiums, an analysis has concluded.
By Jennifer Lubell
amednews.com
Originally published March 18, 2013
An Affordable Care Act provision that seeks to limit the amount by which insurance premiums can vary based on enrollees' ages won't result in young adults paying unreasonably high premiums, an analysis has concluded.
The impact of the ACA's new formula for setting age rating bands has attracted recent interest in Washington. Starting in 2014 under the law, insurers will be prohibited from selling nongroup coverage to an adult 64 or older for more than three times the premium they would assign to a 21-year-old for the same coverage. This translates into a maximum 3-to-1 premium ratio based on age, which narrows the gap between what younger and older people pay for insurance now.
(cut)
A Robert Wood Johnson Foundation report prepared by the Urban Institute acknowledges that tighter ratios will lead to increased premiums for younger adults and lower premiums for older adults. However, the study projects that other ACA coverage provisions will mitigate the negative effects that young people may experience from the new age rating bands.
Saturday, March 16, 2013
How Mom’s Death Changed My Thinking About End-of-Life Care
By Charles Ornstein
ProPublica – Co-published with The
Washington Post
Originally published February 28, 2013
Here are some excerpts:
I've long observed, and sometimes
chronicled, the nasty policy battles surrounding end-of-life care. And like
many health journalists, I rolled my eyes when I heard the phrase
"death panels" used to describe a 2009 congressional
proposal that would have allowed Medicare to reimburse physicians who provided
counseling to patients about living wills and advance directives. The frenzy,
whipped up by conservative politicians and talk show hosts, forced the authors
of the Affordable Care Act to strip out that provision before the bill became
law.
Politics aside, I've always thought
that the high cost of end-of-life care is an issue worthy of discussion. About
a quarter of Medicare payments are spent in the last year of life, according to recent
estimates. And the degree of care provided to patients in that last
year — how many doctors they see, the number of intensive-care hospitalizations
— varies dramatically across states and even within states, according to the authoritative Dartmouth
Atlas.
Studies show that this care is often
futile. It doesn't always prolong lives, and it doesn't always reflect what
patients want.
In an article I wrote for the Los
Angeles Times in 2005, I quoted a doctor saying: "There's
always one more treatment, there's always one more, 'Why don't we try that?'
... But we have to realize what the goals of that patient are, which is not to
be in an intensive-care unit attached to tubes with no chance of really recovering."
Friday, March 8, 2013
Why the Ethics of Parsimonious Medicine Is Not the Ethics of Rationing
By Jon C. Tilburt and Christine Cassel
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
The entire article is here.
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
The entire article is here.
Tuesday, March 5, 2013
Bitter Pill: Why Medical Bills Are Killing Us
By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Monday, February 25, 2013
U.S. proposes scrapping some obsolete Medicare regulations
By Reuters
Originally published February 13, 2013
The Obama administration on Monday proposed eliminating certain obsolete Medicare regulations, a move it said would save hospitals and other healthcare providers an estimated $676 million a year, or $3.4 billion over five years.
The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program's elderly and disabled beneficiaries.
"We are committed to cutting the red tape for healthcare facilities, including rural providers," Health and Human Services Secretary Kathleen Sebelius said in a statement.
"By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients," she added.
Industry representatives largely welcomed the changes, saying the proposed rule would help hospitals free up more resources for patient care.
"There are a number of particularly meaningful provisions in the proposed rule," said Chip Kahn of the Federation of American Hospitals.
The American Hospital Association, though, said it was disappointed the administration did not allow "hospitals in multi-hospital systems" to have single integrated medical staff structures.
"Hospitals are delivering more coordinated, patient-centered care and (the administration) should not let antiquated organizational structures stand in the way," AHA President Rich Umbdenstock said in a statement.
The entire article is here.
Originally published February 13, 2013
The Obama administration on Monday proposed eliminating certain obsolete Medicare regulations, a move it said would save hospitals and other healthcare providers an estimated $676 million a year, or $3.4 billion over five years.
The Department of Health and Human Services described the targeted regulations as unnecessary or excessively burdensome and said their proposed elimination would allow greater efficiency without jeopardizing safety for the Medicare program's elderly and disabled beneficiaries.
"We are committed to cutting the red tape for healthcare facilities, including rural providers," Health and Human Services Secretary Kathleen Sebelius said in a statement.
"By eliminating outdated or overly burdensome requirements, hospitals and health care professionals can focus on treating patients," she added.
Industry representatives largely welcomed the changes, saying the proposed rule would help hospitals free up more resources for patient care.
"There are a number of particularly meaningful provisions in the proposed rule," said Chip Kahn of the Federation of American Hospitals.
The American Hospital Association, though, said it was disappointed the administration did not allow "hospitals in multi-hospital systems" to have single integrated medical staff structures.
"Hospitals are delivering more coordinated, patient-centered care and (the administration) should not let antiquated organizational structures stand in the way," AHA President Rich Umbdenstock said in a statement.
The entire article is here.
Tuesday, February 19, 2013
SGR Repeal Bill Favors Primary Care
MedScape Medical News
Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.
One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.
When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.
Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.
The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.
After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.
Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.
The entire article is here.
Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.
One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.
When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.
Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.
The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.
After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.
Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.
The entire article is here.
Monday, January 28, 2013
In Second Look, Few Savings From Digital Health Records
By REED ABELSON and JULIE CRESWELL
The New York Times
Published: January 10, 2013
The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.
Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.
“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.
RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.
The entire story is here.
Saturday, January 26, 2013
Who Knew? Patients’ Share Of Health Spending Is Shrinking
By Jay Hancock
KHN Staff Writer
Originally published January 13, 2013
Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.
But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.
"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."
True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.
But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.
The entire article is here.
KHN Staff Writer
Originally published January 13, 2013
Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.
But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.
"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."
True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.
But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.
The entire article is here.
Monday, January 21, 2013
U.S. could save $2 trillion on health costs - study
By David Morgan
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Reuters
Originally published January 10, 2012
The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.
Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.
Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.
But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.
"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.
The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.
The entire article is here.
Tuesday, January 15, 2013
Access To Electroconvulsive Therapy In Decline: A Clinical Choice Or An Economic One?
MedicalNewsToday.com
Originally published January 12, 2013
Here are some excerpts:
A new study in Biological Psychiatry suggests that reductions in ECT treatment have an economic basis. From 1993 - 2009, there was a progressive decline in the number of hospitals offering ECT treatment, resulting in an approximately 43% drop in the number of psychiatric inpatients receiving ECT.
Using diagnostic and discharge codes from survey data compiled annually from US hospitals, researchers calculated the annual number of inpatient stays involving ECT and the annual number of hospitals performing the procedure.
Lead author Dr. Brady Case, from Bradley Hospital and Brown University, said, "Our findings document a clear decline in the capacity of US general hospitals - which provide the majority of inpatient mental health care in this country - to deliver an important treatment for some of their most seriously ill patients. Most Americans admitted to general hospitals for severe recurrent major depression are now being treated in facilities which do not conduct ECT."
This is the consequence of an approximately 15 year trend in which psychiatric units appear to be discontinuing use of the procedure. The percentage of hospitals with psychiatric units which conduct ECT dropped from about 55% in 1993 to 35% in 2009, which has led to large reductions in the number of inpatients receiving ECT.
The entire story is here.
Originally published January 12, 2013
Here are some excerpts:
A new study in Biological Psychiatry suggests that reductions in ECT treatment have an economic basis. From 1993 - 2009, there was a progressive decline in the number of hospitals offering ECT treatment, resulting in an approximately 43% drop in the number of psychiatric inpatients receiving ECT.
Using diagnostic and discharge codes from survey data compiled annually from US hospitals, researchers calculated the annual number of inpatient stays involving ECT and the annual number of hospitals performing the procedure.
Lead author Dr. Brady Case, from Bradley Hospital and Brown University, said, "Our findings document a clear decline in the capacity of US general hospitals - which provide the majority of inpatient mental health care in this country - to deliver an important treatment for some of their most seriously ill patients. Most Americans admitted to general hospitals for severe recurrent major depression are now being treated in facilities which do not conduct ECT."
This is the consequence of an approximately 15 year trend in which psychiatric units appear to be discontinuing use of the procedure. The percentage of hospitals with psychiatric units which conduct ECT dropped from about 55% in 1993 to 35% in 2009, which has led to large reductions in the number of inpatients receiving ECT.
The entire story is here.
Wednesday, December 26, 2012
'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'
By Russ Mitchell
Kaiser Health News
Originally published December 18, 2012
Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse.
The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. "If I'd had to wait until 67 for Medicare," Lewis said, "I'd be dead."
A proposal to raise the Medicare eligibility age from 65 to 67 to ratchet down spending is one of the more explosive ideas in the fiscal talks between House Speaker John Boehner and the White House. The negotiations are aimed at a deficit deal to avert automatic tax increases and spending cuts slated to take effect Jan. 1. Liberal Democrats say they loathe the Medicare proposal, but the White House has not taken a public position on it.
President Barack Obama was open to a similar proposal last year during his failed effort to reach a "grand bargain" with Republicans. And many expect it to pop up again in next year’s discussions about curbing entitlement costs if it is not included in this year’s deal.
The entire article is here.
Wednesday, December 19, 2012
New Taxes to Take Effect to Fund Health Care Law
By ROBERT PEAR
The New York Times
Originally Published: December 8, 2012
For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.
The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.
Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.
To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.
The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.
The entire article is here.
Thursday, December 13, 2012
Justice Dept. recovers record $5 billion under False Claims Act
By Peter Finn
The Washington Post
Originally published: December 4, 2012
The Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care and mortgage industries.
The department pursued settlements and judgments under the False Claims Act, which Acting Associate Attorney General Tony West described Tuesday as “quite simply, the most powerful tool we have to deter and redress fraud.”
“Vigorous enforcement of the act allows us to protect not only taxpayer dollars but also the integrity of important government programs on which so many Americans rely,” West said.
The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.
“Many of these cases would not be possible without the whistleblowers . . . who have come forward to report fraud, often at great personal risk,” said Stuart Delery, the principal deputy assistant attorney general for the civil division.
The entire story is here.
The Washington Post
Originally published: December 4, 2012
The Justice Department’s civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health-care and mortgage industries.
The department pursued settlements and judgments under the False Claims Act, which Acting Associate Attorney General Tony West described Tuesday as “quite simply, the most powerful tool we have to deter and redress fraud.”
“Vigorous enforcement of the act allows us to protect not only taxpayer dollars but also the integrity of important government programs on which so many Americans rely,” West said.
The amount of money recovered in 2012 is up from $3.2 billion last year, and two-thirds of it was secured through the act’s whistleblower provisions.
“Many of these cases would not be possible without the whistleblowers . . . who have come forward to report fraud, often at great personal risk,” said Stuart Delery, the principal deputy assistant attorney general for the civil division.
The entire story is here.
Saturday, December 1, 2012
Medicare Is Faulted on Shift to Electronic Records
By REED ABELSON
The New York Times
Originally Published: November 29, 2012
The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.
The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.
But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.
The entire article is here.
Sunday, November 25, 2012
Move Over Economists: We Need a Council of Psychological Advisers
Much of governing involves predicting behavior or getting people to change it. Lawyers and economists need some help with both.
By Barry Schwartz
The Atlantic
Originally published
Though President Obama won reelection decisively, he won't have much time to celebrate. Many of the nation's problems -- stimulating employment, reducing the deficit, controlling health-care costs, and improving the quality of education -- are very serious, and some of them must be addressed with great urgency. And none of these problems can be addressed simply by waving a magic government wand. To a significant degree, they all involve understanding what motivates current practices -- of business-people, financiers, doctors, patients, teachers, students -- and what levers we may be able to use to change those practices.
Historically, when the need has arisen to change behavior, political leaders have turned to economists. That's one reason why presidents have a Council of Economic Advisers. When economists speak, presidents listen. And when economists have the president's ear, all their whispers are predicated on a set of assumptions about human behavior. Whether it's increasing GDP, reducing unemployment, sustaining Social Security, making sure people are financially prepared for retirement, or stabilizing the financial sector, economists commonly hold certain beliefs. They will for example argue that people are motivated by self-interest and are rational calculators of their interests, and that the most effective way to get people to change the way they behave is by creating the right material incentives.
(cut)
There is also growing evidence, some of it provided by psychologists Carol Dweck and Angela Duckworth, that the focus on beefing up the cognitive components of education that has dominated reform for the last 30 years may be misplaced. More important may be efforts to cultivate motivation and character (Paul Tough's remarkable new book, How Children Succeed, provides a vivid summary of this work). The importance of character and motivation suggests that the drill-and-test model of education that has become so common may actually be not just ineffective, but counterproductive.
The entire story is here.
By Barry Schwartz
The Atlantic
Originally published
Though President Obama won reelection decisively, he won't have much time to celebrate. Many of the nation's problems -- stimulating employment, reducing the deficit, controlling health-care costs, and improving the quality of education -- are very serious, and some of them must be addressed with great urgency. And none of these problems can be addressed simply by waving a magic government wand. To a significant degree, they all involve understanding what motivates current practices -- of business-people, financiers, doctors, patients, teachers, students -- and what levers we may be able to use to change those practices.
Historically, when the need has arisen to change behavior, political leaders have turned to economists. That's one reason why presidents have a Council of Economic Advisers. When economists speak, presidents listen. And when economists have the president's ear, all their whispers are predicated on a set of assumptions about human behavior. Whether it's increasing GDP, reducing unemployment, sustaining Social Security, making sure people are financially prepared for retirement, or stabilizing the financial sector, economists commonly hold certain beliefs. They will for example argue that people are motivated by self-interest and are rational calculators of their interests, and that the most effective way to get people to change the way they behave is by creating the right material incentives.
(cut)
There is also growing evidence, some of it provided by psychologists Carol Dweck and Angela Duckworth, that the focus on beefing up the cognitive components of education that has dominated reform for the last 30 years may be misplaced. More important may be efforts to cultivate motivation and character (Paul Tough's remarkable new book, How Children Succeed, provides a vivid summary of this work). The importance of character and motivation suggests that the drill-and-test model of education that has become so common may actually be not just ineffective, but counterproductive.
The entire story is here.
Saturday, November 10, 2012
Caregiving as moral experience
By Arthur Kleinman
The Lancet
Volume 380, Issue 9853, Pages 1550 - 1551
3 November 2012
Everyone who has been in love or built a family knows that there are things, essential things, that money can't buy. Patients with serious illness and their network of caregivers know this too, because those things that really matter to us are threatened and must be defended. And many clinicians, reflecting on what is at stake in health care not only for patients but for themselves, know the same thing: the market has an important role in health-care financing and health systems reform, but it should not reach into those quintessentials of caregiving that speak to what is most deeply human in medicine and in living. This is the moral limit of an economic paradigm. Or at least it should be.
But we live in a truly confused age. The market model seems to have infiltrated so thoroughly into human lives and medicine that in certain circles—policy making and analysis, hospital and clinic administration, and even clinical work—economic rationality with its imperative of containing costs and maximising efficiency has come to mute the moral, emotional, religious, and aesthetic expressions of patients and caregivers. Most take it for granted and accept its implications. Models from economic psychology, behavioural economics, and business studies, based on the narrowest calculations of what a “rational” person would choose as most cost-effective, are now routinely applied to clinical decision making and the organisation of care.
(cut)
The great failure of contemporary medicine to promote caregiving as an existential practice and moral vision that resists reduction to the market model or the clarion call of efficiency has diminished professionals, patients, and family caregivers alike. It has enabled a noisy and ubiquitous market to all but silence different motives, ideals, hopes, and behaviours that must be expressed, because they are as much who we are as economic rationality.
The entire piece is here.
doi:10.1016/S0140-6736(12)61870-4
The Lancet
Volume 380, Issue 9853, Pages 1550 - 1551
3 November 2012
Everyone who has been in love or built a family knows that there are things, essential things, that money can't buy. Patients with serious illness and their network of caregivers know this too, because those things that really matter to us are threatened and must be defended. And many clinicians, reflecting on what is at stake in health care not only for patients but for themselves, know the same thing: the market has an important role in health-care financing and health systems reform, but it should not reach into those quintessentials of caregiving that speak to what is most deeply human in medicine and in living. This is the moral limit of an economic paradigm. Or at least it should be.
But we live in a truly confused age. The market model seems to have infiltrated so thoroughly into human lives and medicine that in certain circles—policy making and analysis, hospital and clinic administration, and even clinical work—economic rationality with its imperative of containing costs and maximising efficiency has come to mute the moral, emotional, religious, and aesthetic expressions of patients and caregivers. Most take it for granted and accept its implications. Models from economic psychology, behavioural economics, and business studies, based on the narrowest calculations of what a “rational” person would choose as most cost-effective, are now routinely applied to clinical decision making and the organisation of care.
(cut)
The great failure of contemporary medicine to promote caregiving as an existential practice and moral vision that resists reduction to the market model or the clarion call of efficiency has diminished professionals, patients, and family caregivers alike. It has enabled a noisy and ubiquitous market to all but silence different motives, ideals, hopes, and behaviours that must be expressed, because they are as much who we are as economic rationality.
The entire piece is here.
doi:10.1016/S0140-6736(12)61870-4
Sunday, October 28, 2012
U.S. Set to Sponsor Health Insurance
By Robert Pear
The New York Times
Originally published October 27, 2012
The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.
These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.
The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.
Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide.
The entire story is here.
The New York Times
Originally published October 27, 2012
The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.
These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.
The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.
Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide.
The entire story is here.
Sunday, October 7, 2012
Abortion Rates Fall When Birth Control Is Free
By Salynn Boyles
WebMD Health News
Originally published on October 4, 2012
Abortions and unplanned pregnancies dropped dramatically in a new study when women and teenaged girls were provided birth control at no cost.
The women and girls were also more likely to choose IUDs or contraceptive implants when cost was not an issue.
Family planning advocates say the study shows the potential of the health reform law (now known by both supporters and opponents as Obamacare) to reduce unplanned pregnancies nationwide.
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About half of all pregnancies in the U.S. are unplanned, and about half of these pregnancies happen when birth control is not used.
The rest happen when contraception is used only some of the time or is used incorrectly.
The new study, published online today in the journal Obstetrics & Gynecology, included close to 9,300 sexually active women and teen girls at risk for having an unplanned pregnancy.
While the women were offered any FDA-approved method of contraception at no cost, the researchers made sure they knew that IUDs and implants were the most effective.
Researcher Jeff Peipert, MD, of Washington University in St. Louis, says around 3 out of 4 study participants opted for the long-acting methods.
“That was a shocker,” he says. “We had hoped to get maybe 15% of the women to choose IUDs or implants, but it was closer to 75%. That made all the difference.”
The entire story is here.
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice opinion can be found here.
Tuesday, October 2, 2012
Is A Competitive Health Care Model All It’s Cracked Up To Be?
By Julie Appleby and Marilyn Werber Serafini
Kaiser Health News, in conjunction with The Atlantic
Originally published on September 20, 2012
Kaiser Health News, in conjunction with The Atlantic
Originally published on September 20, 2012
Republican vice
presidential nominee Paul Ryan says his proposal to overhaul Medicare would use
market competition to tame costs in the government health program relied on by
almost 50 million people.
As models, he often cites
the health program for federal employees – including members of Congress -- and
Medicare’s prescription drug program. "It works with federal employees, it
works with the prescription drug benefit, and more to the point, it saves Medicare,"
Ryan said on "Meet the Press" in April.
Both of those programs get
high marks from beneficiaries for the choices they offer. But their track
record on cost control is more complicated, raising questions about whether the
competitive model is in fact the silver bullet that backers have suggested.
The federal employee
health insurance program is often touted as holding down the increase in
premium prices more successfully than private workplace plans or government-run
programs. But a data analysis done for Kaiser Health News (KHN) and interviews
with experts shows it has not held down costs per enrollee as efficiently as
Medicare during the past decade.
Average spending in the
federal workers’ program grew at 7.1 percent annually per enrollee, higher than
the 5.8 percent growth rate for traditional Medicare – excluding the drug
program -- over the decade ending in 2010, according to data analyzed at KHN’s
request. The analysis, based on 10-year averages, was done by Walton
Francis, a consultant and principal author for 30 years of the Consumers’
Checkbook Guide to Health Plans for Federal Employees.
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