Thursday, March 31, 2011

Health Care Reform Articles - April 2, 2011

2 insurers’ boards will keep taking pay

AG criticizes Tufts, Harvard Pilgrim

By Robert Weisman
Globe Staff / March 31, 2011
Text size  +
The state’s second- and third-largest health insurers said yesterday their board members have decided to keep paying themselves five-figure annual fees despite objections from the state attorney general and an inquiry into directors’ compensation at nonprofit health plans.

Medicare to cover prostate cancer 

April 1, 2011

More Physicians Say No to Endless Workdays

HONESDALE, Pa. — Even as a girl, Dr. Kate Dewar seemed destined to inherit the small-town medical practice of her grandfather and father. At 4, she could explain how to insert a pulmonary catheter. At 12, she could suture a gash. And when she entered medical school, she and her father talked eagerly about practicing together.
But when she finishes residency this summer, Dr. Dewar, 31, will not be going home. Instead, she will take a job as a salaried emergency room doctor at a hospital in Elmira, N.Y., two hours away. An important reason is that she prefers the fast pace and interesting puzzles of emergency medicine, but another reason is that on Feb. 7 she gave birth to twins, and she cannot imagine raising them while working as hard as her father did.

April 1, 2011

Cuts Leave Patients With Medicaid Cards, but No Specialist to See

LAFAYETTE, La. — Eight-year-old Draven Smith was expelled from school last year for disruptive behavior, and he is being expelled again this year. But his mother and his pediatrician cannot find a mental healthspecialist to treat him because he is on Medicaid, and the program, which provides health coverage for the poor, pays doctors so little that many refuse to take its patients.
The problem is common here and across the country, especially as states, scrambling to balance their budgets, look for cuts in Medicaid, which is one of their biggest expenditures. And it presents the Obama administration with a major challenge, since the new federal health care law relies heavily on Medicaid to cover many people who now lack health insurance.

Obama administration proposes rules for healthcare partnerships

The Obama administration is trying to encourage doctors and hospitals to collaborate more closely to improve patient care. Providers would be rewarded for delivering better results for Medicare patients.

By Noam N. Levey, Washington Bureau
8:34 PM PDT, March 31, 2011
Reporting from Washington

The Obama administration proposed new regulations Thursday to encourage doctors and hospitals to collaborate more closely to improve patient care, a major goal of the sweeping healthcare law the president signed last year.

The much-anticipated rules will reward new partnerships, known as Accountable Care Organizations, that deliver better results for Medicare patients.,0,2633120,print.story

Group rallies
against Vermont
health care reform

Wednesday, March 30, 2011

Health Care Reform Articles - March 30, 2011


A couple of today's clippings show an ominous trend toward increasing the number of for-profit health care systems, even in places that have been bastions of not-for-profit medical, such as Massachusetts. 

I have long been an advocate of managed care systems, since I believe they hold the hope for better coordination of health care services and, therefore, improved quality and for "bending the cost curve" downward through improved efficiency.  But if for-profit systems become managed care systems (aka "Accountable Care Organizations), those efficiencies could simply go to their bottom line, not to reducing the cost of care. 

Caveat Emptor!  


Ranks of for-profit hospitals may grow

Caritas owner pursuesdeals in Taunton, Lowell

Cost control the next step for Massachusetts health reform

All eyes will monitor the effort as national reform unfolds, but experts expect payment revisions to vary depending on the state.

By TANYA ALBERT HENRY, amednews correspondent. Posted March 28, 2011.
Already a pioneer of health coverage expansion, Massachusetts is beginning to tackle the critical next phase of its health system reforms: containing costs. There may be debate about the best way to accomplish that, but observers agree it is the necessary next step if universal coverage is to be successful.

The Model of the Future?

The health-care law promoted accountable-care organizations. But it's hard to know what they are.

1,000+ pages of health-care rules?
By: David Nather and J. Lester Feder
March 29, 2011 05:22 PM EDT
Health care lobbyists and advocates are bracing for six pages of the health care reform law to explode into more than 1,000 pages of federal regulations when the Department of Health and Human Services releases its long-delayed accountable care organization rules this week.

“What, you expected less than a thousand pages for legislation that only took a page and half?” a staffer with one of the current proto-ACOs asked.

Health Insurance Exchanges Already Making Waves

MAR 30, 2011
This story was produced in collaboration with wapo
It seems like a simple idea: create new marketplaces, called "exchanges," where consumers can comparison shop for health insurance, sort of like shopping online for a hotel room or airline ticket.

But, like almost everything else connected with the health overhaul law, state-based insurance "exchanges" are embroiled in politics. Some Republican governors are threatening to refuse to set up exchanges unless they get more flexibility over Medicaid, the state-federal health program for the poor. Others say they don't want to implement any part of the federal health care law.

As Medicaid Budgets Squeezed, States Consider Eccentric Ideas On Cutting Costs

MAR 30, 2011
When New York's Medicaid director asked the public for money-saving ideas, the most popular suggestion - as measured by the sheer volume of e-mails raising the idea - left him a bit red-faced.

End payments for routine circumcisions, e-mailers advised.

Though the idea didn't make the final list for New York's cost-curbing plan, it's just one example of how interest groups, such as, which opposes circumcision, businesses and other policy proponents are pushing to capitalize on states' dire Medicaid shortfalls. 

A single-payer health care system would work for Oregon

Published: Tuesday, March 29, 2011, 7:00 AM     Updated: Wednesday, March 30, 2011, 7:42 AM
Guest Columnist 
By Samuel Metz 

Am I crazy, a physician embracing legislative efforts to create a single-payer health care system in Oregon? You be the judge.

It would create thousands of jobs. It would provide health care to people whether they work full time, part time or are retired, disabled, sick or unemployed. It would stimulate Oregon business. It would reduce our state deficit. And it would provide comprehensive care to every Oregonian without spending more than we do now.

Where would the money come from? Oregon businesses and families already spend this money. But Oregon wastes $4 billion annually in private insurance administration. That's premium money that never goes toward health care. Half is the insurance company overhead. The rest is what hospitals and providers like me waste collecting payments from insurance companies. Princeton economics professor Uwe Reinhardt, speaking recently before the Senate Finance Committee, said of Duke University's 900-bed hospital: "We have 900 billing clerks at Duke. I'm not sure we have a nurse per bed, but we have a billing clerk per bed. It's obscene."

Study Finds Raising Medicare Age Would Shift Costs

MAR 29, 2011
Raising Medicare's eligibility age by two years would save the federal government $7.6 billion but those costs—and more—would shift to others, according to a report out today.
The analysis by the Kaiser Family Foundation says that increases in total costs for people 65- and 66-year-olds, employers and the state governments in 2014 would outpace the federal savings. (KHN is an editorially independent program of the foundation.)
The report assumed full implementation of the health law and an increase in Medicare eligibility to 67 in 2014.
The shift in costs include added out-of-pocket expenses for people who are 65 and 66 that year, higher retiree costs for employers and increased Medicaid costs for states.
The total out-of-pocket costs for 65- and 66-year-olds would increase by $5.6 billion while employer retiree health care costs would rise $4.5 billion, according to the report.

Aetna pushes back and sues doctors

Posted by Don McCanne MD on Friday, Mar 25, 2011This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived onPNHP's website.

Ultrasound at $59,490 Spurs Aetna Outrage in Suit Naming Doctors

By Peter Waldman
March 23, 2011
Aetna Inc. (AET) is suing six New Jersey doctors over medical bills it calls “unconscionable,” including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.
One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website.

Tuesday, March 29, 2011

Health Care Reform Articles - March 29, 2011

HCAN Analysis Shows Health Insurers Pocketed Huge
Profits in 2010 Despite Weak Economy
Washington, DC—The five largest Wall Street-run health insurance companies parlayed the economic meltdown of
2008 and the nationʼs subsequent fragile recovery into huge profits in 2010, the last year before market reforms in
the Affordable Care Act (ACA) take full effect, according to an analysis by Health Care for America Now (HCAN).
The five insurers made combined profits of $11.7 billion by reducing the share of premiums spent on the
shrinking membership in private health plans.

A little profiteering anybody?

Critics slam cost of FDA-approved drug to prevent preterm births

By Rob Stein, Monday, March 28, 9:07 PM

When a drug to prevent babies from being born too early won federal approval in February, many doctors, pregnant women and others cheered the step as a major advance against a heartbreaking tragedy.
Then they saw the price tag.

Hospital executives occupy top tier of California's public workers

Controller's latest report shows CEOs of hospital districts among the highest-paid public employees. Healthcare-industry experts say those salaries reflect the rigors of the job and pale in comparison to the private sector.

By Sam Allen, Los Angeles Times
March 29, 2011

Three hospital district executives have emerged as among the highest-paid public employees in California, according to a state report, including an official in San Diego County who made more than $1 million in 2009.,0,7929958,print.story

Medical students rally for single-payer system in Vermont

Monday, March 28, 2011

Health Care Reform Articles - March 28, 2011

Mini-Med Plans, ACOs Among Health Law Provisions Triggering Analysis

News outlets are reporting on a range of health law policy issues, ranging from how mini-med plans are continuing to live on as a result of waivers and how states are mulling the design of health insurance exchanges to what might become of the regs for accountable care organizations and what's in the future for the individual mandate.


Under Siege — The Individual Mandate for Health Insurance and Its Alternatives

Jonathan Oberlander, Ph.D.
N Engl J Med 2011; 364:1085-1087March 24, 2011

IBM should support single-payer

Saturday, March 26, 2011

Health Care Reform Articles - March 26, 2011

House OKs health care

By CHRIS GAROFOLO / Reformer Staff

Friday March 25, 2011
MONTPELIER -- The Vermont House of Representatives passed a bill calling for a single-payer system Thursday afternoon, putting the state on a path to become the first in the nation to adopt universal access to health care.
Lawmakers voted 92 to 49 after nearly two days of debate, including discussion on the floor until the early morning hours on Thursday.
Advocates hail the measure as the solution to control costs by reducing administrative overhead. However, critics said it leaves too much financial uncertainty and could hurt the economic growth in Vermont.
The legislation proposes to develop a unified health system where all Vermonters are eligible for benefits under a universal coverage program called Green Mountain Care. Democratic leaders are optimistic the single-payer plan will contain the skyrocketing costs of health care and put the state on a more sustainable fiscal path.

Friday, March 25, 2011

Health Care Reform Articles - March 25, 2011

HCAN Analysis Shows Health Insurers Pocketed Huge
Profits in 2010 Despite Weak Economy