Impeding changes to our Health Care system

[SamIam]

Well, the article quoted above describes the $440 billion Medicare program. $47 billion of that makes it less than 10%. I am curious as to the percentage of waste in private health care programs.

[TheMercenary]

Originally Posted by SamIam

Well, the article quoted above describes the $440 billion Medicare program. $47 billion of that makes it less than 10%. I am curious as to the percentage of waste in private health care programs.

Waste in the private healthcare programs is also known as profit. You will never see those numbers.

[SamIam]

Well, I can see a doctor or a hospital profitting from unnecessary procedures or operations, but I don't see how the insurance company that pays for them would call that a good deal.

[classicman]

Senate health care legislation expected this week is likely to include a new long-term care insurance program to help the elderly and the disabled avoid going into nursing homes, Democratic officials say.

Senate Majority Leader Harry Reid, D-Nev., is expected to incorporate the voluntary program in legislation to be unveiled as early as Wednesday, said the officials, who spoke on condition of anonymity because a final decision has not been made.

Known as the Community Living Assistance Services and Supports Act, or CLASS Act, the program was a top priority for the late Sen. Edward M. Kennedy, D-Mass. It would begin to close a gap in the social safety net that's received little attention in the health care debate.

Fiscal conservatives and government economists have questioned whether the program would be financially sustainable over the long run, and insurance companies are lobbying to strip it from the health care bill.

Nonetheless, the House included the program in its health care legislation, with the approval of the Obama administration. In the Senate, the Health Committee bill had included it, but the Finance Committee omitted it. The approach Reid is considering in a combined bill would address the objections of fiscal conservatives by stipulating that premiums from the program could not be counted in offsetting the cost of the broader health care bill. Reid's office had no comment on Tuesday.

The cost of nursing homes averages $70,000 a year, and a home care attendant runs about $29 an hour. Medicare only covers temporary nursing home stays. Middle-class households have to exhaust their savings before an elder can qualify for nursing home coverage through Medicaid.

Under the proposed program, people would pay a modest monthly premium during their working years. If they become disabled, they would get a cash benefit of at least $50 a day that could be used to pay a home care attendant, buy supplies and equipment, make home improvements such as adding bathroom railings, or defray the costs of nursing home care.

The Congressional Budget Office estimated that the program would be fiscally solvent over a 75-year-period with the income from premiums, and no taxpayer financing. That assumes an initial monthly premium averaging $123, and a $75 daily benefit. People would sign up for the program at work through a payroll deduction. They would have to pay premiums for five years before they could qualify for benefits. Both the premiums and benefits would be adjusted annually.

Link

lol - fiscally solvent after 75 years.

I think is more the type of program needed than the proposals that the congress just passed, but I'm biased.

[SamIam]

Originally Posted by classicman

I think is more the type of program needed than the proposals that the congress just passed, but I'm biased.

What? Are you for this or against this? A program that avoids throwing people on the expense of Medicaid seems like a good one to me.

[TheMercenary]

Keep reading. You are going to be butt fucked in the end.

[Clodfobble]

Not that end, the other end...

[classicman]

Originally Posted by classicman

Link

lol - fiscally solvent after 75 years.

I think is more the type of program needed than the proposals that the congress just passed, but I'm biased.

Originally Posted by SamIam

What? Are you for this or against this? A program that avoids throwing people on the expense of Medicaid seems like a good one to me.

I am for this TYPE of program. The claims of fiscal solvency after 75 years must be a joke though. Nice of them to project something so far out after they are all dead and buried.

Originally Posted by classicman

I am for this TYPE of program. The claims of fiscal solvency after 75 years must be a joke though. Nice of them to project something so far out after they are all dead and buried.

Provisions regarding a long-term care insurance program and assisted living programs are included in the House bill.

I would agree with you that these programs are essential for serving those who currently are grossly under served in meeting their health care needs.

It is also true that these provisions are probably among the more expensive provisions.

Where I might disagree with you is why the bills should exclude other equally necessary provisions to serve the 30+ million uninsured and/or to address the failures in the current system for those covered through employer-based plans.

Most of the provisions below are in both the House and Senate bills, with minor differences..... the form of a public option and the structure of an Insurance Exchange, the revenue sources, mandates on small businesses, and the anti-trust exemptions.

Both bills:

end the practice of insurance companies denying coverage to anyone with pre-existing conditions.

prevent insurance companies from raising rates or dropping coverage for those who suddenly face a serious illness.

cap annual out-of-pocket expenses so that no one faces significant unanticipated expenses or goes bankrupt as a result of a medical crisis.

drop all copays for preventive care.

ends any existing lifetime caps on what insurance companies will currently pay.

provide affordable choices to the uninsured through an Exchange offering multiple plans with different levels of coverage at different costs.

place limits on the administration costs as percent of premiums, thus limiting premium increases.

end the market monopoly in many states, where choices are currently severely restricted, thus opening those markets to increased competition....and increased competition breeds lower costs for consumers.

I still dont know which of these provisions you dont think are essential or, at the very least, an improvement over the current system.

[TheMercenary]

You can't just sell the good parts. The parts with unintended consequences cannot be ignored. Costs are not controlled the bill will not fix the problems in Health Care today.

Originally Posted by TheMercenary

You can't just sell the good parts. The parts with unintended consequences cannot be ignored. Costs are not controlled the bill will not fix the problems in Health Care today.

In terms of the fiscal consequences, the CBO and the CMS both note that their respective findings are highly speculative. The CBO projects $billions in deficit reductions over 10+ years, the CMS projects $billions in additional costs...IMO, most likely it will be somewhere in between (there is a $500 billion guaranteed revenue source with the surcharge on the top .5% of taxpayers but much of the "savings through efficiencies and fraud reduction" are speculative and would only likely occur in the out years rather than immediately)....or you could cherry pick the cost studies that you like.

In terms of "fixing" the problems, the so-called unintended consequences, for the most part, are driven by ideology (your friend McCaughey) and/or corporate interests (insurance lobby, small business lobby, etc).

[TheMercenary]

Tell it to the people who have been laid off in the name of expected changes due to the health care legislation.

Tell it to people who are experiencing skyrocketing deductibles in mandatory employer based plans.

The "highly speculative" findings are exactly the point.

[TheMercenary]

More on the Medicare Commissions which operate now and will receive a significantly new role in the Healthcare Reform Bills now before Congress.

The Rationing Commission
Meet the unelected body that will dictate future medical decisions.Article

As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."


AP
On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."

As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.

The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?

But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.

In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.

Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.

http://online.wsj.com/article/SB1000...025055040.html

[classicman]

Originally Posted by Redux

In terms of the fiscal consequences, the CBO and the CMS both note that their respective findings are highly speculative.

They are also widely disparate. This is one thing that concerns me. Why would the administrations figures be any different?

Where I might disagree with you is why the bills should exclude other equally necessary provisions to serve the 30+ million uninsured and/or to address the failures in the current system for those covered through employer-based plans.

Don't put words in my mouth err (text in my posts?)
You must have me confused with someone else.

Originally Posted by classicman

...

Don't put words in my mouth err (text in my posts?)
You must have me confused with someone else.

Sorry if I misunderstood this recent post:

Originally Posted by classicman

I think is more the type of program needed than the proposals that the congress just passed, but I'm biased.

I willl rephrase the question.

Why do you think long-term care insurance and assisted living programs are "more the type of program needed" than basic coverage for 30+ million uninsured or ending exclusions based on pre-existing conditions for millions or capping out-of-pocket expenses so that other millions dont face bankruptcy every year as a result of a medical crisis or....

I understand that we all have our personal reasons for prioritizing what is needed and what should be covered in any health care reform.

But I believe we need to look beyond our personal experiences to what provides the best opportunity for assisting the greatest number of people in need.