health Care Reform Articles -September 15, 2012

Health care’s heap of wasteful spending

By Robert J. Samuelson, Published: September 13

How much waste is there in this nation’s health care system? Try $765 billion. That’s the estimate from the Institute of Medicine, covering everything from unneeded tests to excessive administrative costs. The estimate is for 2009, when health spending totaled $2.5 trillion. “Waste” was 31 percent, or almost one dollar in three.
Wow!
Even if waste is only half this, there’s ample room to cut costs without weakening quality of care. By all logic, we should be debating how to achieve these savings, because runaway health spending is the crux of our budget impasse. From 1980 to 2011, health care went from 11 percent to 27 percent of federal spending — and it’s headed higher.
Naturally, we aren’t having this debate.
The campaign’s discussion of health care is purely political. Democrats say Republican proposals to turn Medicare — federal insurance for the elderly — into a voucher program would “end Medicare as we know it.” Well, that’s true; it’s also true that Medicare “as we know it” is busting the budget. Vouchers might control costs. For their part, Republicans denounce the Affordable Care Act (Obamacare) without fully explaining why their alternative is better
http://www.washingtonpost.com/opinions/health-cares-heap-of-waste/2012/09/13/ee62aa62-fdb6-11e1-b153-218509a954e1_print.html

Mass. approves Partners, Neighborhood Health deal

By Robert Weisman

State insurance regulators Friday signed off on Partners HealthCare System Inc.’s acquisition of Neighborhood Health Plan, a transaction that will put the state’s largest hospital and physicians organization into the health insurance business for the first time.

In its decision memo, the Division of Insurance said it was satisfied that Boston-based Partners — which owns Massachusetts General and Brigham and Women’s hospitals — would not use its insurance license to pursue “aggressive growth” in the market.

“We find that the effect of Partners’ acquisition of [Neighborhood Health Plan] will not be substantially to lessen competition in the health care insurance market in the Commonwealth or tend to create a monopoly,” the insurance division said.

The approval came 13 months after Partners and Neighborhood Health disclosed they had signed a letter of intent to merge. In addition to scrutiny by the insurance division’s legal and financial teams, the review process included decisions by the US Department of Justice and the Federal Trade Commission not to intervene on antitrust grounds, and by the office of state Attorney General Martha Coakley’s office not to challenge the deal.

http://www.bostonglobe.com/business/2012/09/14/insurance-regulators-approve-acquisition-neighborhood-health-partners-healthcare/gTpdtrs4eaZ0sf9IUTRChK/story.html?camp=newsletter

Yesterday at 10:42 PM Why are drugs from CanaRx cheaper than those in Maine? By Ann S. Kimakim@mainetoday.com Staff Writer PORTLAND – News this week that a Canadian company had halted sales of mail-order prescription drugs to 1,200 Maine households raised an important question: Why were those drugs so much cheaper than drugs sold in Maine? click image to enlarge Select images available for purchase in the Maine Today Photo Store The main reason: The medications came from countries whose governments negotiated prices with manufacturers. CanaRx supplied Maine households that participated in programs for state workers, Portland employees and workers at Hardwood Products Co. of Guilford until it suspended operations Aug. 17, after Attorney General William Schneider told the company it was violating state law because it was not licensed. The company provides brand-name maintenance medications at discounts of about 50 percent. The medications come from Canada, the United Kingdom, Australia and New Zealand. http://www.pressherald.com/news/why-are-drugs-from-canarx-cheaper-than-those-in-maine__2012-09-15.html?searchterm=ann+kim California Tries to Guide the Way on Health Law By ABBY GOODNOUGH SACRAMENTO — The meeting came to order, the five members of the California Health Benefit Exchange seated onstage with dozens of consumer advocates and others looking on. On the agenda: what to name the online marketplace where millions of residents will be able to shop for medical coverage under President Obama’s health care law. An adviser presented the options, meant to be memorable, appealing and clear. What about CaliHealth? Or Healthifornia? Or Avocado? “I am kind of drawn to Avocado,” declared Kim Belshé, a member of the exchange’s board of directors, which is hustling to make dozens of decisions as the clock tickstoward deadlines set by the law. Delay and outright resistance to the health care overhaul might be the norm in much of the country, but not here. California — home to seven million uninsured people, more than any other state — is at the forefront of preparations for January 2014, when a controversial requirement that most Americans have medical coverage or pay a penalty takes effect. So far, only 13 states and the District of Columbia have told the Obama administration they intend to set up the insurance exchanges that are supposed to provide a marketplace for people to buy health plans. None are being watched as closely as California, whose singular challenges, from the size, diversity and geographic spread of its uninsured population to its vast budget problems, make it stand out. Many feel a successful rollout here could convince other states with high numbers of uninsured residents that the law can be made to work for them. “We are the example,” said Anthony Wright, executive director of Health Access California, an advocacy group. “If it can be done here, it can be done anywhere.” http://www.nytimes.com/2012/09/15/health/policy/california-tries-to-lead-way-on-health-law.html?_r=1&hpw&pagewanted=print Life Went on Around Her, Redefining Care by Bridging a Divide By MARGALIT FOX In 1988, when Anne Fadiman met Lia Lee, then 5, for the first time, she wrote down her impressions in four spare lines that now read like found poetry: barefoot mother gently rocking silent child diaper, sweater, strings around wrist like a baby, but she’s so big mother kisses and strokes her The story of Lia, the severely brain-damaged daughter of Hmong refugees who had resettled in California, became the subject of Ms. Fadiman’s first book, “The Spirit Catches You and You Fall Down,” published in 1997. Its title is the English translation of the condition known as qaug dab peg (pronounced “kow da pay”), the Hmong term for epilepsy, from which Lia had suffered since infancy. In traditional Hmong belief, qaug dab peg, like many illnesses, is spiritual in origin, caused when the soul becomes separated from the body. A traditional cure might entail visits from a shaman, who would attempt to reunite body and soul. A work of narrative nonfiction, Ms. Fadiman’s book is a cautionary tale about the cultural chasm between Lia’s family, with its generations-old animist beliefs, and her rationalist American doctors. “In some sense, I was trying to provide a way of controlling her seizures with Western methods and Western medicines,” said Dr. Neil Ernst, who with his wife, Dr. Peggy Philp, was one of the pediatricians who treated Lia early on. “And in some sense, the Lees were giving up control of their child to a system that they didn’t understand.” That cultural divide — despite the best intentions of both sides, Ms. Fadiman wrote — may have brought about Lia’s condition, a consequence of a catastrophic seizure when she was 4. Over the years, whenever Ms. Fadiman lectured about the book, readers would press a single question on her before any other: “Is Lia still alive?” http://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?pagewanted=2&hpw&pagewanted=print Our View: Lawmakers should have Plan B for MaineCare Getting federal waivers to drop 30,000 people from health insurance looks unlikely. Maine went to court this month to force federal authorities to speed up their decision about whether the state should be given permission to dump thousands of people off health insuranceOn Thursday, the court answered and threw out Maine's complaint, meaning that the cuts scheduled to go into effect on Oct. 1 probably won't happen. The state is now forced to wait until Nov. 1 for its answer. But state officials should have no reason to believe that the U.S. Department of Health and Human Services is likely to be more sympathetic than were the courts. The political high wire act is now coming toward a conclusion, and Republican lawmakers and the LePage administration should come to terms with the fact that they may not have really balanced the budget this spring. "Cuts" were made to Medicaid, known here as MaineCare, that ran counter to federal law and could not be made without a waiver from the federal government. http://www.pressherald.com/opinion/lawmakers-should-have-plan-b-for-mainecare_2012-09-15.html MaineCare director says if state can’t cut Medicaid, it will request more money for budget By Matthew Stone, BDN Staff Posted Sept. 14, 2012, at 5:58 p.m. AUGUSTA, Maine — The state’s Medicaid director said Friday she’s still hopeful federal officials will approve Maine’s request to make about $20 million in cuts to its Medicaid program, and that the state will be able to make those cuts in time to fill a gap in the current state budget. But if those plans fall through, she said, the state Department of Health and Human Services will have to request additional funding from Gov. Paul LePage and the Legislature to plug a Medicaid budget hole. “At this point in time it would be a request for dollars,” Stefanie Nadeau, who directs the state’s Office of MaineCare Services, told the Bangor Daily News. “We don’t necessarily have a plan on how to fill the gap other than a supplemental request. That’s our contingency plan.” Nadeau’s comments came a day after a federal court dismissed a lawsuit filed by Attorney General William Schneider to force a federal agency to expedite approval of Maine’s request to make about $20 million in cuts to its Medicaid program, also known as MaineCare. The state had filed the request with federal officials on Aug. 1 seeking a decision by the start of September so the cuts could take effect Oct. 1. When the federal Centers for Medicare and Medicaid Services indicated it wouldn’t meet the state’s desired Sept. 1 deadline for ruling on the cuts, Schneider petitioned the First Circuit Court of Appeals in Boston to force an expedited decision. That was the case a three-judge panel summarily dismissed on Thursday. On Friday, Schneider said the judges’ decision was not a rejection of “Maine’s substantive legal arguments” that the Medicaid cuts in question are allowed by federal law. “We continue to believe that Maine has a strong legal argument on the substantive merits of this case,” he said in a written statement. The cuts to the state’s Medicaid program — which lawmakers approved as part of two separate budget packages earlier this year — would eliminate coverage for 19- and 20-year-olds, tighten income eligibility requirements for low-income parents and scale back Medicaid access for elderly residents who also qualify for Medicare benefits. The reductions would affect coverage for 36,000 people, according to the Department of Health and Human Services. Whether the reductions are legal has been a topic of debate throughout the year, since the Obama administration’s health care reform law largely bars states from cutting Medicaid services in advance of a planned 2014 expansion of the program. http://bangordailynews.com/2012/09/14/politics/mainecare-director-says-if-state-cant-cut-medicaid-it-will-request-more-money-for-budget/print/ Automatic Budget Cuts Will Reduce Medicare Payments To Doctors, Providers By $11 Billion By MARY AGNES CAREY KHN Staff Writer SEP 14, 2012 Medicare providers would see reductions of about $11 billion beginning in January as part of series of automatic spending cuts set to begin next year unless Congress acts to halt them, according to estimates released Friday by the White House Office of Management and Budget. The numbers came in a report that details how federal agencies would implement roughly $110 billion in mandatory, across-the-board budget cuts agreed to by Congress and President Barack Obama last August as a way to end a bitterly partisan dispute over raising the debt ceiling.  Lawmakers in both chambers, as well as Obama, want to avoid the automatic cuts that would trim federal spending by $2.1 trillion over the next 10 years, called sequestration. Noting that "sequestration would have a devastating impact on important defense and nondefense programs," the administration detailed cuts to more than 1,200 federal government budget accounts. Half the cuts would come from military programs. Social security and Medicaid are exempted. http://www.kaiserhealthnews.org/Stories/2012/September/14/sequestration-and-medicare.aspx