Wednesday, August 29, 2012

Health Care Reform Articles - August 31, 2012

Sharp Cuts in Dental Coverage for Adults on Medicaid

BOSTON — Banned from tightening Medicaid eligibility in recent years, many states have instead slashed optional benefits for millions of poor adults in the program. Teeth have suffered disproportionately.
 Republican- and Democratic-controlled states alike have reduced or largely eliminated dental coverage for adults on Medicaid, the shared state and federal health insurance program for poor people. The situation is not likely to improve under President Obama’s health care overhaul: it requires dental coverage for children only.
Illinois became the latest state to drastically cut dental benefits last month, when Gov. Pat Quinn, a Democrat, cut $1.6 billion out of its $15 billion Medicaid budget, reducing adult dental coverage to emergency tooth extractions. The state, whose Medicaid program was considered among the most generous, also cut vision benefits, eliminated chiropractic and podiatry coverage and started requiring co-payments for drugs.
In about half the states, Medicaid now covers dental care only for pain relief and emergencies, according to a recent report by the Kaiser Commission on Medicaid and the Uninsured, a national health research group. Other states cover preventive exams and cleanings but not restorative services, like fillings and root canals.
The federal health care law generally prohibits states from tightening eligibility for Medicaid before 2014, when a vast expansion of the program to cover people with incomes up to 133 percent of the federal poverty line is supposed to take effect. But states are still allowed to cut optional benefits, like vision, dental and drug coverage. Whether to seek broader cuts is part of a contentious debate between Mr. Obama and Mitt Romney over the future of Medicaid and Medicare, the government health care program for older Americans.

Blame the Poor

TAMPA, Fla. - Talking about dismantling health care for the poor might seem to clash with balloons and funny hats, but this is a Republican convention, so it fits right in with the celebratory mood.
Many in the parade of governors scheduled to speak tonight have long complained about how much they are forced to spend to keep poor people healthy, and the Republican platform has an answer for them: They can stop worrying.
Medicaid is a "black hole," the platform says, and is too big and too flawed to be run out of Washington. By turning it into a block grant program and letting the states do what they want with it (i.e., as little as possible), those annoying federal regulations can be deleted.

"Excessive mandates on coverage should be eliminated," said a draft of the platform, a signal to statehouses that anything goes.
Both Mitt Romney and Paul Ryan favor a block-grant system, but the draft platform goes even further in explaining how spending can be squeezed from the program. It's done largely by blaming the patient. Because 80 percent of health care spending is because of "lifestyle," the platform says - specifically smoking, obesity, and substance abuse - it's time to put more emphasis on "personal responsibility."
There's no explanation for how the states will deal with those annoying, expensive lifestyle decisions of poor people to be fat or addicted, but the notion is rich coming from the party that regularly denounces "nanny state" suggestions from public health officials to cut back on fat and salt.
No explanation is really necessary; the line simply holds up a mirror to simmering conservative resentment at subsidizing the problems of the poor. (Of course, by allowing employers a tax deduction for regular health insurance, taxpayers also subsidize the health decisions of everyone else, but that never seems to come up.)

Medicare arguments key for both parties

Monday, August 27, 2012

Health Care Reform Articles - August 28, 2012

Massachusetts leads on health care while Maine regresses

By Philip Caper, M.D.
Bangor Daily News, Aug. 23, 2012

Massachusetts, the first state that attempted to offer health care to all its residents and provided the template for national health reform, recently took the inevitable and much more difficult next step.

It passed a law intended to restrain future growth in total statewide health care costs. Once government has adopted a policy of achieving universal health care, it must then take steps to maintain affordability.

Why ObamaCare is Not Enough: Turning off the Demand for Health Care


n the run up to the presidential election, the political debate is heating up around health care.  Recently the Supreme Court upheld the Affordable Care Act and the individual mandate, but the single biggest question is hauntingly absent from the campaign discourse.
How do we stop and turn back the tsunami of chronic disease, in particular, diabesity – the continuum of obesity, pre-diabetes, and diabetes that is the major driver of 21st century suffering and costs?
Diabesity is the hidden cause of most heart disease, hypertension, high cholesterol, stroke, dementia, many cancers (breast, colon, prostate, pancreas, liver, and kidney) and even depression. Yet is it almost never treated directly because there is no good drug for it.
In short, health care reform addressed the supply side of health care, making it more accessible and improving processes and systems to reduce inefficiencies and medical errors.

For $83, a sling and no simple answers

Patient’s complaint shows intricacies of medical purchasing

Friday, August 24, 2012

Health Care Reform Articles - August 26, 2012

Unhealthy Competition
Paul Ryans Plans to Reduce Health Care Costs by Using Competition Wont Work
by Peter Orzag

Controlling Health Care Costs in Massachusetts With a Global Spending Target FREE ONLINE FIRST

Robert Steinbrook, MD
JAMA. Published online August 22, 2012. doi:10.1001/2012.jama.11322

A Glitch in Health Care Reform

Confusing language in the health care reform law has raised the possibility that millions of Americans living on modest incomes may be unable to afford their employers’ family policies and yet fail to qualify for government subsidies to buy their own insurance. This is a bizarre development that undercuts the basic goal of health care reform — to expand the number of insured people and make their coverage affordable.
The people left in the lurch would be those who had lower incomes but were not poor enough to qualify for Medicaid. They would either have to pay more than they could afford for an employer’s family plan or go without health insurance. The problem arises because the reform law quite properly tries to keep people from dropping affordable employment-based coverage and turning to taxpayer-subsidized coverage on new insurance exchanges, starting in 2014. Only those with coverage deemed “unaffordable” by the health care act would be allowed to receive subsidies.
As Robert Pear reported in The Times recently, the law considers a worker’s share of the insurance premium unaffordable when it exceeds 9.5 percent of the worker’s household income. But that calculation is based on individual coverage for the worker alone, not family coverage, which is much more expensive. That is how the wording of the law has been interpreted by the Internal Revenue Service and the Congressional Joint Committee on Taxation.

Choosing the “Best” Plan in a Health Insurance Exchange: Actuarial Value Tells Only Part of the Story
Ryan LoRe, Jon R. GabeL, RoLand Mcdevitt, and MichaeL SLoveR
ABSTRACT: In the health insurance exchanges that will come online in 2014, consumers will be able to compare health plans with respect to actuarial value, or the percentage of health care costs that a plan would pay for a standard population. This analysis illustrates the out-of-pocket costs that might result from plans with various plan designs and actuarial values. We find that average out-of-pocket expense declines as actuarial values rise, but two plans with similar actuarial values can produce very different outcomes for a given person. The overall affordability of a plan also will be influenced by age rating, income- related premium subsidies, and out-of-pocket subsidies. Actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.

Cuba squeezed by health care costs

1:00 AM 

Cuba's health sector has had millions of dollars in budget cuts and tens of thousands of layoffs.

The Associated Press
HAVANA - Cuba's system of free medical care, long considered a birthright by its citizens and trumpeted as one of the communist government's great successes, is not immune to cutbacks under Raul Castro's drive for efficiency.

Pen Bay Medical Center working to cut down high readmission rates after Medicare penalty

Posted Aug. 25, 2012, at 11:27 a.m.
ROCKPORT, Maine — The new head of Pen Bay Healthcare said steps have been taken to address the high rate of patients who are readmitted to Pen Bay Medical Center after being treated there.
Pen Bay is one of 10 hospitals in Maine being penalized by Medicare for the high rate of readmissions. The Rockport hospital’s penalty is the highest in the state in terms of percentage of payments being withheld by the federally funded health care program.
The monetary penalty for Pen Bay will be $77,590 in 2012-2013, less than one-tenth of 1 percent of revenues received by the hospital.
Medicare is imposing penalties of up to 1 percent starting Oct. 1 for hospitals with greater than acceptable rates for patients who are admitted to the hospital within 30 days of being discharged. The penalty increases to a maximum of 2 percent in October 2013 and up to 3 percent in October 2014.
Wade Johnson, the president and chief executive officer of Pen Bay Healthcare, said Thursday that reducing the readmission rate is one of the priorities. Johnson was hired in February to oversee the health care system that includes Pen Bay Medical Center in Rockport, Quarry Hill retirement village in Camden, the Knox Center for Long Term Care in Rockland, Kno-Wal-Lin Home Health Care, and the majority of physician offices in the area.
“There’s no question that Pen Bay sticks out,” Johnson said of the readmission rates.

Health Care Reform Articles - August 24, 2012

Massachusetts leads on health care while Maine regresses

Posted Aug. 23, 2012, at 4:43 p.m.
Massachusetts, the first state that attempted to offer health care to all its residents and provided the template for national health reform, recently took the inevitable and much more difficult next step.
It passed a law intended to restrain future growth in total statewide health care costs. Once government has adopted a policy of achieving universal health care, it must then take steps to maintain affordability.
For the past 50 years, our national health care policy has been one of relentlessly expanding our system’s capacity. In the mid-1950s, the Internal Revenue Service made employer-provided health benefits tax exempt. In 1965, building on the legacies of Presidents Roosevelt, Truman and Kennedy, President Johnson prodded the Congress into enacting Medicare and Medicaid, thereby infusing billions of public dollars into our health care system for direct care of the poor and elderly.
During the following decades, under both Democratic and Republican administrations, Congress further expanded our health care system, creating community health and mental health centers, the national health service corps and expanding health benefits for federal workers, the military and their dependents, as well as veterans and Native Americans.
Congress also provided support to increase the numbers of doctors, nurses and other health care professionals and to construct hospitals and other health care facilities. Federal support for basic biomedical research was massively expanded through the National Institutes of Health.
That support subsequently spurred unprecedented innovation through the conversion of publicly funded scientific knowledge into commercially viable products and the capability to use them. With the help of sophisticated marketing techniques, these products and services are now being relentlessly promoted in an effort to increase demand.
So our public policy regarding health care has been to spend trillions of dollars to expand our capacity to provide services, personnel, facilities and innovation. These efforts have been hugely successful. Per-capita health care spending (in constant dollars) has increased by about six times since 1966, when Medicare was implemented, and we’re now at about twice the spending level of other wealthy countries.
But despite our high spending, we have the highest percentage of population without adequate access to health care, the poorest health outcomes and the least popular health care system of any advanced country.

Elizabeth Warren on health care and religion

In my column today, I noted that I had interviewed Elizabeth Warren, the Democratic candidate for the U.S. Senate in Massachusetts. In the course of the interview, Warren offered what I thought were particularly interesting thoughts about the Affordable Care Act, and also about the role of her religious faith in her public engagement. I share a partial transcript of the interview here.

Medicare takes over as main issue in congressional races

Both Democrats and Republicans see their path to the congressional majority through Paul Ryan's vision for Medicare.

WASHINGTON — The addition of Rep. Paul D. Ryan to theGOP presidential ticket has upended the congressional campaigns as the battle for the House and Senate swiftly focused on one main issue: Medicare.
As the architect of the GOP's Medicare overhaul hit the campaign trail alongside presumed presidential nominee Mitt Romney, the complicated policy issue was catapulted into the national spotlight.
Suddenly, Americans began hearing Ryan's vision to change the healthcare safety net for the next generation of seniors at a volume that had not been reached before — despite multiple House and Senate votes on the budget proposal.

Wednesday, August 22, 2012

Health Care Reform Articles - August 23, 2012

Turning Medicare into vouchers won't work


Before Medicare began in 1965, many American senior citizens — and their children — struggled to pay for their doctor bills. Ever since, Medicare's been an American success story.
Why, then, do so many Beltway pundits and members of Congress — including Mitt Romney's new running mate, Rep. Paul Ryan, R-Wis. — go after it?
Some of its critics claim that slashing Medicare is the only way to control the deficit. Like most attacks on Medicare, this one is based on ideology, not evidence. Medicare's critics often claim that rising federal health care spending is America's biggest fiscal challenge. In fact, the federal deficit is bloated today primarily due to the Bush administration's irresponsible tax cuts, economic mismanagement, costly wars and increased defense spending.
Of course large numbers of retiring boomers mean Medicare will need more revenue. But Medicare costs won't need to spiral out of control. The new Affordable Care Act includes steps to limit per-person health care price hikes. It's already saving Medicare money. Yet Romney and Ryan promise they would work to repeal it.
What's their alternative? The Ryan Budget Plan calls for extremely deep cuts to Medicare, while promising more and longer-lasting tax cuts for a few very wealthy Americans. Most House Republicans have already voted for that. It would end Medicare as we know it, and instead force seniors to buy private insurance with vouchers that would cover less of their healthcare costs each year.
These vouchers would reduce seniors' choices, not their costs. Why? Republican voucher plans assume that if government ends Medicare, private insurance companies will start to deliver cheaper, more efficient plans. But what's their evidence?

In Poll, Obama Is Given Trust Over Medicare

The Romney-Ryan proposal to reshape Medicare by giving future beneficiaries fixed amounts of money to buy health coverage is deeply unpopular in Florida, Ohio and Wisconsin, according to new polls that found that more likely voters in each state trust President Obama to handle Medicare.
The Medicare debate was catapulted to the forefront of the presidential campaign this month when Mitt Romney announced that his running mate would be Representative Paul D. Ryan of Wisconsin, who is perhaps best known for proposing a budget plan, supported by Mr. Romney, to overhaul Medicare to rein in its costs.
After more than a week of frenzied campaigning on the issue, Medicare ranks as the third-most crucial issue to likely voters in Florida, Ohio and Wisconsin — behind the economy and health care, according to new Quinnipiac University/New York Times/CBS News polls of the three swing states. The Republican proposal to retool the program a decade from now is widely disliked.
Roughly 6 in 10 likely voters in each state want Medicare to continue providing health insurance to older Americans the way it does today; fewer than a third of those polled said Medicare should be changed in the future to a system in which the government gives the elderly fixed amounts of money to buy health insurance or Medicare insurance, as Mr. Romney has proposed. And Medicare is widely seen as a good value: about three-quarters of the likely voters in each state said the benefits of Medicare are worth the cost to taxpayers.
“On Medicare, I don’t like the Paul Ryan plan,” said Beverly McLaren, 72, an independent from St. Petersburg, Fla., who said in a follow-up interview that Medicare worked well for her and that she planned to vote to re-elect Mr. Obama. “I can’t see how it will help at all, and we’ll have more out-of-pocket expenses, and I’m not really clear how it will work.”

The politics of health care

Posted Aug. 22, 2012, at 6:47 p.m.
To write about health care and politics is to write about the sacred and the profane.
Our word “health” has the same etymological root as our words “whole” and “holy.” It reflects ancient awareness that we are designed and guided by forces — sacred forces — that, although beyond human comprehension, we know to be greater than ourselves and to be good. “Health” has “the Sacred” at its very root.
“Politics,” on the other hand, refers to activities related to governance. Our present political realities foster the greatest disparity of wealth between rich and poor that our country has ever known. One in five Mainers do not seek medical care because they cannot afford it. Many have health insurance but, with high monthly payments and high deductibles, they see doctors only in emergencies. At the same time Maine is hemorrhaging health care dollars to out-of-state insurance profiteers. In 2002, between 38 cents and 50 cents of every dollar spent on health insurance left Maine, never to return. It’s only gotten worse. Working people pay for everybody’s health care. That’s the reality. In a single-payer health insurance system those monies would go into a single “pot” directly paying all healthcare costs: minimal overhead, no insurance company profiteers, direct purchase of medications for the cheapest negotiated price. Our Veterans receive health care through a single-payer system. Minus the prescription-drug nonsense, Medicare, too, is a single-payer system.
In 2001, Maine was the first state to be standing within a hair’s breadth of legislatively passing a single-payer health insurance system. By a vote of 76-54, “single-payer” passed with strong bipartisan support in the House. With the Senate set to vote in favor along party lines (18-16) then-Gov. Angus King vowed to veto the bill. The final senate vote of 15-17 precluded the governor’s veto but in no way changed the fact of his position.

Romney/Ryan would nuke $4.1 billion (and counting) in Medicare prescription drug savings

For patients or for profits?

By Helen Redmond
Socialist Worker, Aug. 22, 2012
Helen Redmond reports on a series of scandals hitting for-profit health care giant HCA--and looks at how the quality of care patients receive has suffered, with sometimes deadly results.
In the last 20 years, as the health care crisis has accelerated and the number of uninsured has soared to over 50 million, publicly funded, not-for-profit hospitals have been transformed into ruthless, investor-owned, profit-generating businesses. Corporations have bought up not only hospitals, but dialysis clinics, outpatient surgical centers, home care agencies and physician practices with the singular goal of making money.
Hospitals are the nexus of profit-making for medical equipment and supply companies, the pharmaceutical industry, medical device makers, doctors who charge exorbitant fees and, increasingly, private investors. The health care sector has grown exponentially and now comprises one-sixth of the national economy.
No single company has been more successful in the hijacking of health care resources to Wall Street than the Hospital Corporation of America (HCA), which is currently facing a series of scandals. The industry giant's insatiable greed for profits has resulted in numerous, ongoing federal and state investigations and hefty fines.
Over the years, nurses and doctors at HCA facilities have consistently blown the whistle on unethical medical practices that have maimed and killed patients.