It's no secret that Medicare has problems to be fixed. However, the issue regarding oxygen support for patients on Medicar who need that type of treatment to basically stay alive is confusing Medicare recipients. The gist of the proposal by President Obama and his team working on Medicare and Healthcare reform is that first of all, patients will continue receiving their oxygen. 
This is an important point, since the way it sounds as lawmakers are hashing ths out is that patients coule lose their oxygen care. This should not happen. It is an issue to be hashed out with oxygen providers and not patients. What is actually proposed is that from the time that individuals on Medicare begin oxygen, suppliers and providers will provide it at their regular prices for the first three yeas that it is being provided. (more...)
Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients. (more...)
It's no secret that Medicare has some problems and flaws, and it's no secret that some pundits and lawmakers would like to just toss it in the trash and start over - or not. The unfortunate part about eliminating Medicare is the millions of seniors it would affect - seniors who depend upon Medicare to survive - literlly.
Many seniors live on Social Security and bring in well under $1,000 per month to pay all their bills including their rent. They can barely afford to keep the lights on and food on their table, and the only way for them to get medical care is through Medicare. (more...)
It is estimated that the number of internists will decline substantially by 2025, and the Medicare Payment Advisory Commission indicates finding a new primary physician is becoming more difficult for seniors—meaning that Medicare recipients should begin as early as possible for the best doctor and get established and comfortable with that doctor.
According to MedicareSupplementPlans.com: Many Medicare recipients, are having a difficult time finding a new primary care physician. A 2008 survey conducted by the Medicare Payment Advisory Commission (MedPAC) found that by 2025 there will not be enough primary care physicians. In addition, an estimate from the American College of Physicians (ACP) that there won’t be enough internists to go around by 2025. Let's add one more issue: the ACP also indicates that current internists are becoming less willing to accept new Medicare patients. (more...)
This seems to be a week for special stories that need to be told and need to be heard. There are many stories about problems with Medicare, just as there have been many successes with Medicare, as well. The fact that Medicare is in trouble in various ways is not news. We have been hearing this for decades, yet, it has taken until now - where Medicare is in a crisis - for lawmakers to sit down and really pull up their sleeves and put in the work to try to stabilize not only Medicare, but Social Security and the entire healthcare system. (more...)
When you have one pot of money and it is finite, it can be hard to split it up in a way that makes everyone happy. Let's take what the government is going through with the budget right now. It would be great if they had unlimited amounts of money, if the automakers and banks weren't in big trouble and if Medicare/Medicaid and Social Security were at least stable.
But the picture isn't that pretty, and the fact that we are in the middle of a recession doesn't help either. Add to that bad mortgages, foreclosures all over the place and handing over money to the banks without an accounting of where it has gone and the picture gets worse. (more...)
The New York Times, Washington Post, and Wall Street Journal's world-wide newsbox all had lead articles with regard to a new government report that paints a dire picture of the financial situation of the nation's two largest benefit programs. The recession, of course, has not helped with the already stressed Medicare system, especially the fund for hospital care which will run out of money (purportedly, depending upon who you get your information from) in 2017, two years earlier than the government had predicted a year ago.
The Social Security trust fund is in a bit better shape but will still start spending more money than it receives in 2016 and will be depleted by 2037, four years sooner than projected last year. lawmakers are arguing over whether the country can really afford to expand health insurance coverage, the report sparked calls for the administration to start working on a plan to prevent the two entitlement programs from becoming insolvent.
There is a great deal of work going into the Medicare situation as well as trying to create a similar healthcare system for everyone who does not have health insurance or access to health insurance, to strengthen the Medicare system that definitely needs bolstering and create a health care system that millions of people need.
Lawmakers feel that tax dollars from workers, such as payroll tax, deductions for social security and other funds will be able to help finance all of these ideas. In addition there are some Lawmakers pushing hard to stop subsidizing and just flat-out give banks and othe institutions "bailout money" why not give out less or none at all , for that matter, to fund more of the domestic issues especially. Another idea has been to patner the banks with the insurance companies and help them work together to develop a policy that would be fiscally responsible. If the polcy worked out well, it could very possibly help bolster Medicare and the the vast majority - if not all - of the people in the country that are uninsured.
"The New York Times, Washington Post, and Wall Street Journal's world-wide newsbox all had lead articles with regard to a new government report that paints a dire picture of the financial situation of the nation's two largest benefit programs."" The recession, of course, has not helped with the already stressed Medicare system, especially the fund for hospital care which will run out of money (purportedly, depending upon who you get your information from) in 2017, two years earlier than the government had predicted a year ago.
"The Social Security trust fund is in a little better shape than that, but will still start spending more money than it receives in 2016 and will be depleted by 2037, four years sooner than projected last year.
Lawmakers are arguing over whether the country can really afford to expand health insurance coverage, the report sparked calls for the administration to start working on a plan to prevent the two entitlement programs from becoming insolvent. "
There is a great deal of work going into the Medicare situation as well as trying to create a similar healthcare system for everyone who does not have health insurance or access to health insurance, to strengthen the Medicare system that definitely needs bolstering and create a health care system that millions of people need.
Lawmakers feel that tax dollars from workers, such as payroll tax, deductions for social security and other funds will be able to help finance all of these ideas. In addition there are some Lawmakers pushing hard to stop subsidizing and just flat-out give banks and othe institutions "bailout money" why not give out less or none at all , for that matter, to fund more of the domestic issues especially. Another idea has been to patner the banks with thr insurance companie help them work togethe develop a polcy that would be fiscally responsible. If the polcy worked out well, it could very possibly help bolster Medicare and the the vast majority - if not all - of the people in the country that are uninsured.
There are many other ideas floating around and some are being very seriously lookde at by Lawmakers and the administration, especially when it comes to where revenue from taxes that already exist could be found and used. As the president said in the beginning, this is not going to be easy but we will figure out a way to get through it.
With the healthcare system -including Medicare - being as out of kilter as it is, there have been many suggestions as to how to make it work more efficiently and turn it into a system that can last and help many more people for a long time.
Social Security and Medicare work beautifully for the majority of enrollees and they provide at least some security and medical care to millions of American families who would otherwise go without, especially now in hard economic times.
More and more people are asking President Obama to look into supporting a "single payer'' health plan, assuring universal health care in this country.
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Usually, the single payer is a government agency that provides one-stop health coverage. In contrast, the American system of paying for health care has been called a chaotic maze of health providers, private insurance plans with wide variations in coverage, deductibles, co-pays, and a confusing and frustrating situation for the individuals who need the coverage and are trying to figure it out.
Many lawmakers are saying that an effective way for the U.S. to move toward a single payer plan would be to expand Medicare to everyone. The smart idea in this is that it would not be free. If you are working, some of your taxes could pay for the premium, and there are other ways to offset the expenses.
At present, the White House stated that a single payer system was not acceptable to the Obama administration.at this time
because the goal of the president's health care reform objective was "to cut costs for families that are watching their premiums and their co-payments and their deductibles skyrocket.''
Experts who have compared the various plans say a government-run single payer plan would be less expensive than private insurance. There would be less overhead and no marketing costs and no compulsion to rack up profits.
There are some 47 million people without health insurance -- and thousands more are losing their health benefits with their jobs.
There are a number of proposals being presented in Congress that would provide health insurance coverage for every person in the United States. They would provide all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, as well as dental, mental health, physical therapy, hearing and vision aids and long term care. And though each one is a little different in the details, 6 or 7 of these proposals are for single payer plan.
The current administration is trying to create big changes in Medicare as they try to overhaul and reform the healthcare system. This could mean something quite new for seniors and may be a template for reforming healthcare in this country in general.
The idea is to create less waste in the entire healthcare system and strengthen Medicare, as well as covering the uninsured.
Medicare covers about 45 million Americans who are elderly or disabled, and its policies are followed by many private insurance companies when they set up their internal systems. The new approach and ideas for seniors would helMedicare p medical professionals stress and help patients with follow-up care by their family doctors and nurses so that more chronically ill patients could avoid being hospitalized and re-hospitalized when chronic problems such as high blood pressure get out of control.
There would be changes for doctors and hospitals, too. Primary care doctors who care for patients on a more constant basis would be paid more, while specialists would be watched more closely, especially as they order more tests and procedures. Hospitals could have to pay penalties if they did not provide adequate follow-up care, therefore having the same patients continually being readmitted for the same problem.
Medicaid would also see similar changes, which would affect most of the 50 million low income people that they cover.
“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.
The committee meetings that are slated will iron the details out, and some of the meetings have already started. This effort is aimed at helping even out who pays for these benefits and how. The sickest 10% of the patients account for nearly 2/3 the cost that Medicare spends per year. These are frail individuals who usually have more than one serious chronic condition such as high blood pressure, diabetes and heart disease. The cost is so high because they are seeing several specialists for each issue. If the changes that are being examined can be put into place, they could be seeing one doctor who could control and coordinate the other treatment they receive, eliminating duplicate procedures and eliminating waste.
If and when lawmakers are able to straighten the health care fragmentation out, it is very possible that everyone could get good care and save money at the same time.
The current administration inherited a lot of problems, not the least of which is the healthcare issue – both Medicare/Medicaid and private health care plans. Trying to balance all these out is difficult at best and, though people are looking at the “first 100 days”, 3 months is not actually a lot of time to deal with these issues on top of the other national and international issues this country faces, not to mention that even Superman and all his super-hero friends could not come up with a plan to solve all these problems in 3 months – period.
However, Obama and lawmakers are trying to iron things out. Healthcare is extremely critical because of the number of families without it and the number of seniors who depend upon it.
There have been many ideas explored to try to solve the problems inherent in the system at this point, but no solutions yet. One of the ideas on the table is something called entitlement reform, which means that Social Security and Medicare/Medicaid would be rationed (no examples given yet) and supposedly save the system, the government and the taxpayers trillions of dollars, partially by eliminating or rationing services – including education and prevention programs to keep people from getting worse and having to use the system in the first place.
Proponents of this entitlement reform in the form of rationing, feel that this would then balance the budget because of the trillions of dollars saved. They blame President Obama for not offering this type of reform, but instead trying to initiate universal health options so that everyone in this country would be able to have at least some sort of health care – even if it was very basic.
They seem to forget that Obama did not create the problem; he inherited it and is simply trying to fix it somehow with the help of Congress. Lawmakers are working on adjustments to try to make all of this work, however this will take time. As promised, the president and lawmakers hit the ground running minutes after inauguration. Is it possible that the pundits who say that the only answer to the healthcare issues is rationing can just give the actual lawmakers enough time to work on this mess – that has taken decades, especially the last 8 years – to get to this point? It’s like gaining 50 pounds in 5 years and expecting to lose it in 3 weeks. It is impossible for that to happen. It took time to get to that point. It will take some time to get fixed.
A quote from Charles Krauthammer of the Washington Post, a proponent of rationing sums it up this way:
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“It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective —- and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.
Rationing is not as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.
Social Security was the third rail of American politics. Not anymore. Health care rationing has ascended —- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow. It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.”
Charles Krauthammer may be right in the end, however, exploring other avenues that could possible help more people in a broader way and bring in premiums to offset costs might not be a horrible answer, either.
We will all have to see what happens as things get hammered out, and when they do, if Charles is right, I’ll be eating my spinach right along with everybody else.
The cost to Medicare for managing chronic kidney disease (CKD) is high; however, IPRO is urging health care providers in New York to work together to both improve patient care and reduce costly complications from the disease.
Medicare costs for CKD and end-stage renal disease (ESRD) exceed $70 billion annually according to United States Renal Data System (USRDS) data. IPRO is one of only eleven organizations from across the country that has been chosen by the Centers for Medicare & Medicaid Services (CMS) to work on a new pilot project that has the potential to both help patients and save taxpayers a substantial amount of money.
"We are partnering with primary care physicians, nephrologists and vascular surgeons to improve care for patients at risk of, and with CKD by preventing or slowing the progression of the disease," explained Clare Bradley, MD, MPH, Chief Medical Officer at IPRO. According to the USRDS, the savings to Medicare for each patient who does not progress to dialysis is estimated to be $288,000.
Bradley said improving the health and well-being of CKD patients could have a substantial economic impact considering Medicare beneficiaries with CKD account for 16.5 percent of Medicare costs in the year the disease is diagnosed, and 11.1 percent in the next year.
"We are confident that better care for these patients can lead to considerable cost savings, improved outcomes and better quality of life because it can mean less reliance on drugs, dialysis, and hospitalization," said Bradley. The IPRO project encourages prevention and early detection of CKD and proper medication recommendations to slow the progression of the disease.
IPRO also supports the nationwide Fistula First effort which addresses the need for patients who suffer from ESRD to have safer, higher-quality access to hemodialysis through a fistula. Bradley explained that a fistula is a "connection" surgically created by joining a vein and an artery in the forearm allowing blood from the artery to flow into the vein for safe and easy access for dialysis.
"Fistulas make a real, proven difference in the health of the patient. By providing a method of dialysis that is safer, longer lasting, and less likely to cause infection, fistulas are seen as the gold standard for vascular access," said Bradley.
Fistulas reduce serious infections and complications leading to hospitalizations and mortality often associated with other forms of vascular access for kidney patients. Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions, contributing to about $1.5 billion in Medicare costs annually. In addition, fistulas cost less to maintain than other forms of access and are associated with less re-work and complications requiring hospitalization.
IPRO is part of the nationwide Quality Improvement Organization (QIO) Program. QIOs work with health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all people - particularly those from underserved populations - get the right care every time.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
A lot of people think that Medicare and Medicaid are the same thing. They are however, not the same, not even close. Yet both in our minds and in the news media, Medicare and Medicaid are always lumped together.
On July 30, 1965, President Lyndon Johnson signed both Medicare and Medicaid into law as part of Title XIX, The Social Security Act. Both are related to healthcare. Both have substantial Federal involvement. There are some individuals who are eligible for both. That is where similarities end.
Medicare
Before 1965, only those who were in the workforce could get employer-subsidized health insurance. Thus, the retired (and the non-working) were effectively prevented from acquiring medical insurance coverage. The Medicare Program was planned, like social security, as a pay-in-advance-of-need system where the worker paid a certain amount each month into a government-run fund. At age 65, when the worker retired, this pot of money called Medicare would provide all his or her medical coverage funding. Initially, the Medicare Fund was maintained and accounted separately but quickly the Federal government lumped it into the General Fund.
Twenty-five years later (1990), the GAO measured how much Medicare was actually costing versus what was projected. Medicare then cost more than 800% over projections! This was a medical insurance plan whic intended to pay for itself but instead had become a Federal entitlement that was never intended.
Medicaid
Medicaid was always intended as an entitlement - a social welfare and protection plan funded jointly by State and Federal government funding. Initially, the Program covered low-income and non-working people, children and indigent people.
Medicaid as specific qualifications. To qualify, you must make less than a minimum income level, plus you must meet one of the categorical requirements such as age, pregnancy, disability, blindness, HIV, legal citizenship, etc. In contrast to Medicare, Medicaid recipients pay nothing into any fund. It always was and is an entitlement.
Beware when we tout single payer health insurance funded by the government as a means to provide universal health care that will reduce costs. The upward spiral of healthcare costs will reach the stratosphere - the truly unsupportable - for two reasons. 1) As entitlements expand, costs go UP certainly not down. 2) The government is a notoriously inefficient provider of, well, anything. When Government takes over an activity, the bureaucracy and its associated costs expand exponentially. Just think of the postal service or HIPAA. If you need additional proof of how costly government-run programs are, just remember the initial estimate for cost of Medicare and compare to the reality.
As time has progressed, there has been more attention given to Medicare and Medicaid. The current lawmakers are making some cutbacks wile at the same time trying to make both of these work. We will see what happens in the near future as some of the legislation that is being worked on is rolled out. In the meantime, at least there is an attempt to bring both programs forward into te 21st century.
Medicare is looking for a way to create more seamless transitions from the hospital to home, skilled nursing care, or home health care. These transitions include helping te patients stay well enough that they don't have to return to the hospital.
For years, it has been said that most people who are readmitted into the hospital do not have to be - more often than not - they should be able to go home (or to a skilled nursing care facility), and with the proper care, they should be able to stay home and progress. The Centers of Medicare & Medicaid Services has collected a great deal of data that indicates that many hospital readmissions of Medicare patients are preventable and the agency announced a program in 14 communities aimed at eliminating these “unnecessary” hospital readmissions.
The Care Transitions Project has been created by CMS to improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs, according to CMS.
There are several important components to keeping a individual from returning to the hospital. Two of the most important components are having excellent home care to help the patient stay healthy. Bcing up and coupling this type of care with regular follw-up visits with the doctor will ensure that the patient's health will improve.
The total cost of unplanned hospital readmissions exceeds $17 billion annually, and varies widely across states. One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to a Commonwealth Fund-supported study in the New England Journal of Medicine.
By promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, this community-wide approach seeks, not only to reduce hospital readmissions but to yield sustainable and replicable strategies that achieve high-value health care for Medicare beneficiaries
“Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable,” said CMS Acting Administrator Charlene Frizzera.
“This situation can be changed by approaching health care quality from a community-wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”
CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re-admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at http://www.hospitalcompare.hhs.gov.
“The Care Transitions Project is a new approach for CMS,” added Barry M. Straube, M.D., chief medical officer for CMS and its Office of Clinical Standards & Quality director.
“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings. Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of re-admissions.”
Communities in the following regions have been selected to participate in the project:
Providence, R.I.;
Upper Capitol Region, N.Y.;
Western Pennsylvania;
Southwestern New Jersey;
Metro Atlanta East, Ga.;
Miami, Fl;
Tuscaloosa, Ala.;
Evansville, Ind.;
Greater Lansing Area, Mich.;
Omaha, Neb.;
Baton Rouge, La.;
North West Denver, Colo.;
Harlingen, Texas; and
Whatcom County, Wash.
The work of the Care Transitions Project will respond to the unique needs of each of the 14 communities, says CMS.
Each of the CTP communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’s quality program to help health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get the high-quality, high-value health care they deserve.
Each QIO in the project is required to work with partners to implement the following:
a) Hospital and community system-wide interventions;
b) Interventions that target specific diseases or conditions; and
c) Interventions that target specific reasons for admission.
The following QIOs serve as Care Transitions leaders throughout the country:
Quality Partners of Rhode Island;
IPRO Inc. (in New York);
Quality Insights of Pennsylvania;
Healthcare Quality Strategies Inc. (in New Jersey);
Georgia Medical Care Foundation Inc.;
FMQAI (in Florida); AQAF (in Alabama);
Health Care Excel (in Indiana);
MPRO (in Michigan);
CIMRO of Nebraska;
Louisiana Health Care Review;
Colorado Foundation for Medical Care;
TMF Health Quality Institute (in Texas); and
Qualis Health (in Washington).
The Care Transitions Project will continue in all 14 communities through summer 2011. For more information about the Care Transitions Project, visit http://www.cfmc.org/caretransitions/. To learn more about the work that QIOs are doing across the country, visit http://www.cms.hhs.gov/qualityimprovementorgs.
The Obama administation has taken an important first step toward reducing what are basically a set of handouts to private insurers, embedded in the Medicare system. These government subsidies to private industry enrich insurance companies at the expense of taxpayers and beneficiaries. The particular handouts in question come in the form of subsidies to so-called Medicare Advantage plans. As the Wall Street Journal reported on Monday:
The federal government made good on its plan to cut 2010 payments for private Medicare plans, diminishing the subsidies to health insurers sooner than the industry originally expected.
The cuts, announced late Monday by the Centers for Medicare and Medicaid Services (CMS), are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.
There have been numerous acknowledgements that the Bush Admiistration pushed for private insurance companies to become more and more involved and imbeded in the system and it is beyond time that everyone has had enough.
Here is th description of the genesis of Medicare Advantage plans in more detail in a post back in January on a blog called Unsilent Generation:
Medicare Advantage (MA) plans–-which offer managed care run through private insurers, paid for by the federal government–-are the point of the stake that conservatives have long been trying to drive into the heart of traditional Medicare (which, for all its shortcomings, is the closest thing to a single-payer program that this country has ever seen). Columnist Saul Friedman recently wrote about the history of of this effort, recalling a 1995 press briefing in which Dick Armey, Newt Gingrich’s collaborator on the “Contract With America,” announced their intent to “wean our old people away from Medicare.” The first step was to introduce private Medicare HMOs–-what later evolved into Medicare Advantage plans, with a big boost from the Republicans’ 2003 Medicare bill.
MA plans have come under increasing fire for their hard-sell tactics to elderly Medicare recipients, shoddy coverage, and rip-offs of the public purse. “Competition” from the private plans was supposed to reduce growth in Medicare spending–but in fact, they cost the government more. A September 2008 report from the Commonwealth Fund calculated that “payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare–-an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004-2008, extra payments to MA plans are estimated to have totaled nearly $33 billion.”
If the Commonwealth Fund’s figures hold true for this year as well, then by my calculations the Medicare Advantage plans are still getting a subsidy of some 8 percent over traditional Medicare, even after a 4 percent cut. (In fact, the baseline payments to private plans will still go up slightly in 2010, but they’ll be offset by adjustments in other areas—so the 4 percent is just an estimate.) Nonetheless, the insurance companies are already whining about (and lobbying against) the cuts, claiming that they will harm the 10 million Medicare beneficiaries who’ve been convinced to switch to private plans. According to Reuters:
Analysts say the new rates will force insurers to cut benefits for elderly and disabled patients enrolled in Medicare Advantage plans or increase premiums in order to maintain profit margins.
That last phrase, of course, is key: It’s the profit margin that matters to these companies, which is why they shouldn’t be in the Medicare business in the first place—especially if they require extra government subsidies just to make enough money to satisfy their greed. The insurers know that in order to maintain their high profits, they’ll now be “forced” to cut the benefits on their private plans, and more and more Medicare patients will just switch back to conventional, government-run Medicare.
That can’t happen soon enough. The government’s next step should be to boot the insurance companies out of the Medicare Part D prescription drug program, which would likewise save the taxpayers a bundle while improving benefits to the old and disabled. I’d love to see this done before I fall into the coverage gap, which usually happens around August. But to accomplish this change, Congress will need to act—and they’ll have to battle Big Pharma as well as the insurance giants. So I’m not holding my breath.
quotes and other information courtesy of Mother Jones
On Sunday, March 29, the Star-Ledger ran "book-end" op-eds on healthcare reform. They quibble about the cost and benefits of Obama's plan. Neither addresses a superior plan that is already before Congress but is being kept "off the table" in most discussions of healthcare reform.
President Obama insists that some consumers like their current health insurance. Most are probably unaware that illness and medical debt are the single biggest cause of personal bankruptcy in the United States, or that three out of four of those households had health insurance when illness or injury first struck. They do not realize that they will not be able to keep their plans if they lose their jobs.
In the United States, most young adults get their health insurance from their employer. If they lose their job, they have to buy health insurance, a huge expense when their income has vanished. What's worse, the high cost of health insurance has been chasing jobs away. Health insurance companies have been making money on employers of all kinds in the United States. Unlike Medicare, which has an overhead of only 3%, the insurance companies skim about 30% off the top, to pay for executive salaries and bonuses, shareholders' profits, and the cost of a wasteful bureaucracy. Many employers can't afford this, especially if they are competing with foreign companies that have efficient national health insurance. So employers from large industries to small businesses to nonprofits like your child's school have to make the nearly impossible choice between cut benefits or cutting staff.
Many citizens feel that the obvious solution is to expand and improve Medicare to cover everything for everyone: 100% of all medically necessary care, including prescription drugs and long-term care. By cutting out the private insurance companies, we could cover everyone at a reasonable cost: 90% of American families would end up paying less than they are paying now.
The United States National Health Care Act or the Expanded and Improved Medicare for All Act (H.R. 676) would be funded by a payroll tax: 4.5 percent from employers and 3.3 percent from employees. There would also be a one third of one percent tax on stock transactions and a small increase in income tax for the top income earners. So most unemployed and retired people won't have to pay a cent.
If Medicare for All is enacted, most Americans will never see another medical bill or pay for another prescription drug. They won't have to sell their home to buy long-term care for a disabled family member. All we need to do is get the House of Representatives to pass H.R. 676, and the Senate to pass the companion bill S. 703, and the President to sign it.
"But it will never pass," people say, "because Congress is in the pockets of the health insurance industry." The truth is that we can get this legislation passed. Pollsters report that most people want a "single-payer" plan like H.R. 676. Strong majorities of doctors and nurses support it. Most employers, from big manufacturers to small businesses to your children's school or your church, would save money on health insurance, while providing better health coverage to their employees. Medicare for All will help make American businesses competitive again. If patients, doctors and nurses, and most employers want this bill to pass, who can stand in its way? And why -unless you are a lobbyist for an insurance company - would you want to?
Nevertheless, getting Medicare for All will be an uphill struggle. The single-payer option is being swept "off the table" by the likes of Max Baucus, Senate Finance Committee Chair and recipient of over $2 million in campaign contributions from the insurance and healthcare industries in the last election. Fortunately, members of the House of Representatives face reelection every two years. If your Representative doesn't support H.R. 676, find someone who will and get that person elected in 2010. Senators serve longer terms, but the principle is the same. Ask Senators Lautenberg and Menendez to cosponsor S.703.
To get involved, connect with groups like Physicians for a National Health Program (www.pnhp.org) or Healthcare-Now! (www.healthcare- now.org). Beware of groups that are really fronts for the insurance companies. Learn the facts of healthcare reform options. Talk to your friends, relatives, coworkers and neighbors. Get organized, and get active. Together, we can do it!
Some quotes and material from Geoff Thomas at oped.com The views expressed in this article are the sole responsibility of the author, Geoff Thomas, and do not necessarily reflect those of this website or its editors.
Drugstore company Walgreen Company, known as Walgreen's Drug Stores, said on Monday it would pull almost half its pharmacies in Washington State from the U.S. Medicaid program to protest against the state's plan to cut reimbursements for drugs.
Cash-strapped Washington State plans to insist on cheaper, generic drugs for low-income Medicaid clients whenever available and equivalent to brand-name drugs, and is also cutting the rate of reimbursements on all drugs to pharmacies which supply them.
Cutting the reimbursement rate of generic and brand-name drugs would severely impact the "economic viability of doing business in Washington," Walgreen said in a statement. However, this is not only being considered in Washington State. There are several other states going through the same financial issues - especially with Medicaid. Washington State is simply the first state that Walgreen's will be pulling many stores out of, severely limiting choices for some seniors who have dealt with Walgreen's for many years when it has come to their medication and other Medicaid needs.
Walgreen, one of the largest U.S. pharmacy chains, is to withdraw 44 of its 111 pharmacies in the state of Washington from the Medicaid program. Medicaid provides health insurance to low income individuals.
Unlike Medicare, the federal health program for seniors, Medicaid is partially funded by states. In order to cut the costs of the program, Washington state announced last week it would cut Medicaid reimbursements for brand-name prescription drugs by 6 percent, effective on Wednesday.
Walgreen said it would withdraw the 44 pharmacies from Medicaid as of May 1, a month after Washington introduces its plan. It said those pharmacies represent more than 60 percent of its total Medicaid business in the state.
There is a chance other pharmacies such as CVS Caremark Corp and Rite Aid Corp will follow suit in pulling out of Washington's Medicaid program
Some information from Reuters.
In the near future, Louisiana could face an even larger shortfall than expected in the money needed to provide health care to the poor, elderly, uninsured and children. Tax collections inflated by the recovery from the 2005 hurricanes are the source of the problem, state Health Secretary Alan Levine said Monday.
Instead of paying 67.6 percent of Medicaid costs in Louisiana, the federal government is expected to only pay 63.1 percent beginning October 2010. Federal funding cuts also are projected for a children’s health-care program. The difference in the percentages amounts to millions of dollars.
“The problem is nobody — and I mean nobody including myself — thought the reduction … would be this large,” Levine said.
Governor Bobby Jindal and his administration is proposing a $26.7 billion budget that trims the state’s health-care costs by more than $400 million in the fiscal year that starts July 1. The reduction would decrease the state Medicaid budget from $6.5 billion to $6.18 billion, affecting hospitals, nursing homes, physicians and others.
The federal “stimulus” package is helping with some health-care expenses. From October 2009 to December 2010, states do not have to bear the cost of changes in the percentage of Medicaid expenses that the federal government pays. The “stimulus” will get the state through part of the 2010-2011 fiscal year, Levine said.
But once the money runs out, the state will have to deal with a shortfall that now is larger than anticipated, he said.
The Federal Funds Information for States estimates Louisiana stands to lose $268 million in health-care dollars in a single federal fiscal year. “This is a massive, massive impact to Louisiana,” Levine said.
The decrease is in the percentage of costs that the federal government picks up for the Medicaid and Children’s Health Insurance programs.
There are other states that are going through very similar plights, however, since Louisiana - and a few surrouding states - is still recovering in many ways, especially financially from Hurricane Katrina, there are difficult issues that have to be ironed out to get the situation together economically so that Medicaid coverage will drop as little as possible and the people that truly need it will be able to have it continuously.
We have written and discssed some o the positives involved in home health care. There are a lot of home health care agencies who make home visits - especially elderly patients and/or those who have a very difficult time getting around. These agencies do a great service and are so valuable to the people they serve. The only negative is that if a patient needs extensive care, tests, or medical care by a physician most of the home health care companies do not have physicians available, which can often result in individuals ending up in the emergency room, which is always an expensive situation. However, if there is a doctor available, much of the care - and many times, all of it - can be taken care of at home, on the spot and without causing extra stress and strain on the patient.
It used to be very common for doctors to make house calls, but expense and other factors all but eliminated. That situation has started to change in the last few years for quite a few reasons. When looking at the changes that have taken place in the past decade or more, portability has made it possible for doctors and other healthcare professionals.
Which would you choose if you were elderly or disabled or both and had to keep going to the doctor? Would you rather have the doctor come to you once every 3 to 6 weeks and keep you healthier and more comfortable and, in addition have the capacity to perform most tests and procedures from the patient's home, fax or send information by computer and receive results without the patient having to go through the difficulty, inconvenience, and sometimes, discofort of having to get to the doctor's office.
In addition, research shows that most of the patients served in their homes stay healthier, live longer, stay out of the hospital and emergency room, and it is all because they are getting regular care. If they didn't have regular care, studies show that they would end up seeing the doctor much less often and end up in the emergency room or hospital mor often. With changes in healthcare and with improvements in Medicare and Medicaid coverage, it is possible for many more people who need care at home to receive it.
If you are in a situation that would make it better for you to get treatment at home, checkk with Medicare, Medicaid and any other health coverage you have to see if you can receive care by a physician at home. Then talk to your physician and see if he or she proides that type of care or can recomment a colleague who makes house calls. It may take a little time finding a doctor to make house calls, but there are more and more who are willing to do so.
Once you are able to make the arrangements and get started you will likely feel much more relaxed about seeing the doctor. So, which would you choose? Look at your circumstances and see if you would rather get out of the house, see the doctor, go to the grocery store or go to lunch - which many people do, and it makes them feel better - or if it would be easier for you and more comfortable for the doctor to make a house call to you. Either way, do what you think is the best for your situation and will keep you healthy.
Washington is trying to fix heath care and Medicare. Mark McClellan, a well respected think tank guru, said recently "It's a lot harder to come up with ways to implement reforms than it is to come up with ideas for reform," he said.
McClellan, 45, is an Austin native from a strongly political family. Brother Scott was President George W. Bush's press secretary. Their mother, former Texas Comptroller Carole Keeton Strayhorn, ran for governor in 2006.
Mark McClellan was a major policy figure in health care during the Bush administration. While most of his former colleagues are now in the political wilderness, McClellan is using his post at Washington's Brookings Institution to keep moving in the circle of implementers who want to "bend the curve" of rising health care costs.
Along with several other health care experts, McClellan is trying to persuade President Barack Obama's reform team and Congress to pay hospitals and doctors more if they can show they're improving treatment for Medicare patients while lowering costs.
McClellan argues that sharing savings could keep Medicare viable without bankrupting the federal government. "Right now, we are getting what we pay for – high-volume, high-intensity health care," he said. "Often, there's no support for preventive care."
White House Budget Director Peter Orszag says McClellan's approach is extremely closely aligned with the Obama administration's views on the need to change payment incentives.
"We have the same basic philosophy," Orszag said. "There are huge variations in health care costs across different regions of the country that can't be explained other than because of the intensity of care. ... We need to change the incentives so we get better care, not more care."
Medicare accounts for 20 percent of health care spending, pays providers on a fee-for-service model. Each visit, each test, each procedure a doctor performs pays a certain amount. The system creates an incentive to see lots of patients, lots of times.
For many years, reformers have argued in favor of payment systems based on performance rather than volume. Pay-for-performance advocates argue their approach gets patients the most effective type of care rather than an uncoordinated cascade of diagnostic tests, prescriptions and treatments.
Dr. Elliott Fisher of Dartmouth's Institute for Health Policy and Clinical Practice developed a pay-for-performance approach called Accountable Care Organizations that McClellan is now backing in Washington.
Fisher came to his model after sifting data that shows Medicare pays twice or even three times as much per patient in different parts of the country. The average enrollee in Medicare in Dallas, for example, consumes $10,103 a year in medical treatments, while Medicare enrollees in Salem, Ore., get by on half as much.
Fisher argues the regional cost disparities can be bent toward lower costs if physicians group together around hospital networks where each Medicare patient's care is coordinated and each treatment is evaluated for quality and effectiveness.
If the network can demonstrate its care regimen reduces average spending by 2 percent or more a year, the doctors and hospital would get bonuses amounting to 80 percent of the savings. If the network fails to meet either its quality or savings targets, its compensation would be penalized. "We need some big changes to address quality and regional disparities," McClellan said.
Len Nichols, a health care economist who worked on the Clinton administration's failed reform effort, said the reform emphasis now was less about ideas like pay-for-performance than ways to implement them. "None of these are new ideas," he said. "What we have is a sense of economic urgency driven both by the fiscal realities of our Medicare program and, obviously, the economic situation we're in right now. "We really shouldn't dither any longer about doing serious reconstructive surgery on our health system...We should start this afternoon. The longer we wait, the greater the costs."
This need to implement change is where Nichols and others see McClellan playing a role in the current debate. John Goodman, president of the Dallas-based, conservative National Center for Policy Analysis, said McClellan is "the single-most respected person in health care policy. He's both a medical doctor [Harvard Medical School] and a Ph.D. in economics [Massachusetts Institute of Technology]," Goodman said. "Most people in this debate are neither."
The health care debate is just getting started, and how much success McClellan will have is uncertain. For now, though, he's a busy man, shuttling between the White House, Congress and federal health care agencies. His phone directory includes the heads of major health centers across the nation, including Parkland and Baylor.
"We're gathering momentum," McClellan said. "I'm optimistic."
Some material reprinted from the Dallas Tribune
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