INCREASED HEALTH CARE
COST SHARING WORKS
AS INTENDED
It burdens patients who need care the most
BY ELISE GOULD
COST SHARING WORKS
AS INTENDED
It burdens patients who need care the most
BY ELISE GOULD
A number of different health care policy proposals that
have emerged in recent years share a common goal: make
households directly pay for a larger share of most health
expenditures by encouraging higher deductibles, higher
copays, or higher co-insurance rates. The rationale of
such proposals is that too-generous insurance policies
(either those provided by employers or public insurance
such as Medicare) distort the prices consumers face, and
that removing this distortion would allow patients to
choose their health care more wisely, hence slowing
health care cost growth. The “success” of increased cost
sharing hinges on the ability of patients to make edu-
cated decisions about their health care purchases much
like they do when buying other goods and services such
as milk, cars, or cell phone plans.
This brief argues that this is a flawed strategy for health
care cost containment. The health care market is unlike
other markets; thus, forcing increased cost sharing on
American households is a deeply inefficient strategy for
trying to contain health care costs. Forcing Americans to
pay a higher share of health costs will not induce them to
shop around and compare prices when they are experien-
cing chest pains or their child is suffering from an asthma
attack. Further, consumers of health care are in no posi-
tion to second-guess their doctor when she tells them an
MRI is better than an X-ray (and hence worth the higher
price) to diagnose a condition. Lastly, unlike other mar-
kets, prices of health care services faced by consumers bear
very little relation to providers’ cost to supply these ser-
vices. Hence, these prices provide little to no informa-
tion for consumers looking to judge the relative efficacy
of various health care interventions.
http://www.epi.org/files/2013/increased-health-care-cost-sharing-works.pdf
http://www.epi.org/files/2013/increased-health-care-cost-sharing-works.pdf
Healing the Overwhelmed Physician
By JERRY AVORN
BOSTON — DURING an 1817 visit to Florence, the French author Marie-Henri Beyle, known by the pen name Stendhal, was seized by palpitations, dizziness and a feeling of being overwhelmed by the abundance of great art surrounding him; an Italian psychiatrist later coined the term Stendhal syndrome to describe this phenomenon.
We physicians are susceptible to a kind of medical Stendhal syndrome as we confront the voluminous evidence about the clinical choices we face every day. It would take dozens of hours each week for a conscientious primary care doctor to read everything he or she needed in order to stay current — a dizzying and impractical prospect.
To remedy the problem, many medical groups issue clinical-practice guidelines: experts in a field sort through the reams of clinical research on a medical condition and pore over drug studies, then publish summaries about what treatments work best so that physicians everywhere can offer the most appropriate, up-to-date care to their patients.
While this sounds straightforward, the process can go astray. Take, for example, the recommendations issued recently by the American Association of Clinical Endocrinologists on caring for patients with diabetes. The A.A.C.E.’s latest guidelines elevate many second- or third-line drugs to more prominent positions in the prescribing hierarchy, rivaling once uncontested go-to medications like metformin, an inexpensive generic. They also emphasize the riskiness of established treatments likeinsulin and glipizide, which now carry yellow warning labels in the A.A.C.E. summary.
Several of the now promoted drugs are expensive newcomers that lack the track records of clinical effectiveness and safety held by the older, potentially displaced treatments. The changes were made, ostensibly, to give physicians more treatment choices for their patients. But there is also concern that they could have been influenced by another factor: the manufacturers of some of these new drugs financially supported the development of the guidelines, and many of the authors are paid consultants to some of those companies.
Expensive Medicine
Rising prices — not waste — are the main force behind rising health care spending.Related Article »
Intensity of use*
Price per service
COMPONENTS
OF CHANGE
CHANGE IN
SPENDING
PER CAPITA
Frequency of use
Spending components
Change in Americans’
health care spending 2010-11
–0.3
–0.6%
–0.4
+1.2%
+1.6%
+2.1%
–4.2
+1.0
+3.7
+3.5
+9.6
+5.9
+4.5%
+6.2%
+7.2%
+4.9%
Professional
procedures
Other outpatient
services
Outpatient
visits
Inpatient
care
Obamacare Exchange Watch: Low Healthcare Costs or California Dreaming?
By Trudy Lieberman
Low projected premiums for Obamacare healthcare Exchanges were the big news in California last week. But the story the media told was a flawed one, characterized by gee-whiz reporting, a willingness to accept official spin, and failure to ask basic questions.
::::::::
Re-posted with the permission of The Columbia Journalism Review where this article originally appeared on June 5, 2013
Low healthcare premiums on the West Coast were trumpeted as a big, good-news Obamacare story. But: "Compared to what?"
The same day the paper also ran a piece from The Associated Press advising readers that premiums in Oregon would be so low that two insurers were scrambling to re-file their rates to compete with lower price tags. An official from the Oregon Insurance Division announced that the rate comparisons were "a taste of what is to come." In other words, cheap insurance is on the way.
A week later, the healthcare-rates-are-lower story moved down the coast to California, where the insurance premiums have become big, big news in a big, big state, one that will soon have an estimated 5.3 million people in its insurance exchange. The story moved quickly. Last week the advocacy group Health Care for America Now listed 33 news outlets, mostly marquee brands, that had picked up the exchange's "important announcement." California is a bellwether, headlines from around the country suggested, as news outlets from CNNMoney to The Hill signaled that rates in the state's insurance exchange would be cheaper than expected. "California Insurance Exchange Rates: Not Too High, Not Too Low," read the headline on the piece from Kaiser Health News, which quoted the executive director of California's exchange, Peter Lee: "We've hit a home run for consumers. We held insurers' feet to the fire." Kaiser's story reported the premiums were what Lee characterized as "just right"--Goldilocks pricing, surprising analysts and consumer advocates. "The fear had been that shoppers in the individual insurance market would face severe "sticker shock' when the sweeping changes in the health law take effect beginning in January 2014," Kaiser reported. No shock had materialized.
But the story the media told was a flawed one, characterized by gee-whiz reporting, a willingness to accept official spin, and failure to ask basic questions. "I don't see rates going down anywhere I look," says Robert Laszewski, an industry consultant whose blog was required reading for reporters covering the health reform debate four years ago. "Rates are consistent with what the Society of Actuaries forecasted. The fight emerging is over how to compare rates."
http://www.opednews.com/populum/printer_friendly.php?content=a&id=167107
House Medicaid expansion compromise vote falls short of threshold to overcome LePage veto
Posted June 12, 2013, at 12:42 p.m.
AUGUSTA, Maine — The Maine House on Wednesday agreed to a compromise measure that would allow the state to expand Medicaid under the federal Affordable Care Act but cut off the expansion after three years.
The measure managed to attract more support than the Medicaid expansion bill attracted in its last go-around in the House, when five Republicans supported the expansion. But the 97-51 tally means Democrats still fell short of the two-thirds threshold they would need to override a near certain veto from Republican Gov. Paul LePage.
The House voted mostly along party lines to agree to the compromise measure crafted by Assistant Senate Republican Leader Roger Katz of Augusta that passed the Senate last week.
The measure would sign Maine up for the expansion under the federal health care law but have Maine withdraw after the three years during which the federal government pays 100 percent of expansion costs unless the Legislature at that time decides otherwise.
The deal would also require the Legislature hire a nonpartisan research group to study the effect of Maine’s Medicaid expansion after the three-year period expires. And Katz proposed allowing the state’s Medicaid program, known as MaineCare, to charge patients the maximum co-payments allowed under federal law as a way to dissuade Medicaid recipients from using the emergency room for care.
Because Maine would spend less in state funds on Medicaid during the first three years of the expansion, and the state Department of Health and Human Services is working on a number of initiatives to reduce Medicaid costs, Katz’s proposal would set aside the savings in a special account that could be used to cover additional Medicaid costs once the federal government’s share of expansion costs drops below 100 percent in 2017.
Rep. Jeff McCabe of Skowhegan, the assistant Democratic leader in the House, said the Senate version is something to celebrate. He called it the result of lawmakers working together.
The bill “has been amended because people in this room on both sides of the aisle have expressed concern, asked questions and shown courage,” he said. “It’s amended so we can get out at any point in time if the federal government does not stay to their word and pay what they say they will pay.”
Rep. Mark Dion, D-Portland, said providing health care for low-income people would result in savings in the criminal justice system because many arrive at Maine prisons with health problems, particularly with mental health. Dion, a former Cumberland County sheriff, cited the support other law enforcement officials have voiced for expanding Medicaid.
Maine Medical Center moves closer to $40M expansion
Posted June 11, 2013, at 2:29 p.m.
PORTLAND, Maine — A proposed $40 million project to add five new operating rooms at Maine Medical Center has won approval from the hospital’s parent organization and was given its first audience with the Portland Planning Board Tuesday.
The MaineHealth board of trustees voted on June 6 to support the expansion and renovation plan, joining the hospital’s board and paving the way for construction at MMC’s Bramhall Street campus. The proposed project still needs approval from the city and the Maine Department of Health and Human Services.
The expansion project would add five new operating suites and accompanying preparation and recovery areas on the rooftop of the hospital’s existing Bean building. It also would update the area where surgical equipment is prepared and sterilized for delivery to operating rooms and allow the hospital to develop an operating room dedicated to advanced heart surgeries.
Construction is due to begin this fall and wrap up by October 2014.
“The fact is that the added space will better enable Maine Medical Center to perform today’s complex procedures in a modern setting,” Jeffrey Sanders, the hospital’s executive vice president and chief operating officer, said in a press release announcing the board approval. “The enhanced services we’ll be able to offer also give area residents a local option for even more best-in-class care and treatment.”
The plan would allow the hospital to alleviate pressure in its existing operating rooms, which today are performing surgeries at rates above industry norms, MMC said in the release.
MMC performs approximately 28,000 surgeries each year in its 34 operating rooms.
The existing operating rooms date to 1984, and at about 400 square feet, aren’t large enough for many modern surgeries, MMC has said. The new 650-square-foot rooms will be known as “interventional rooms” that can house not only surgeries, but other services as needed, such as radiology and cardiac catheterization.
The added space would better suit today’s complex procedures, including a cutting-edge operation offered as an alternative to traditional open heart surgery that requires both a cardiologist and a heart surgeon to be in the room at the same time, along with their staff, the hospital said.
GOP lawmaker’s proposal to add services for disabled to Medicaid expansion would cost $75 million
Posted June 11, 2013, at 8:14 p.m.
AUGUSTA, Maine — A Republican representative’s proposal to provide services to hundreds of people with disabilities on waiting lists would add a $75-million-a-year price tag to a bill that wouldexpand Maine’s Medicaid program under the federal Affordable Care Act.
Rep. Deborah Sanderson of Chelsea said Tuesday she plans to attach two amendments to the Medicaid expansion bill pending in the Legislature. Under those amendments, hundreds of people with developmental disabilities on state waiting lists for services in their homes and communities would receive those services by the start of July.
The move, however, would add a hefty price tag to a bill that currently carries no official price tag and promises the state savings over the next three years, the period during which the federal government promises to cover 100 percent of Medicaid expansion costs. The cost would almost undoubtedly hold up the bill as appropriators in the Legislature search for funds that are likely unavailable.
Democrats said the proposal was an attempt to undermine the Medicaid expansion bill.
“It sounds to me that, if this comes with a huge price tag, it’s a way of them trying to undermine the whole Medicaid expansion and make it not happen,” said Rep. Linda Sanborn, D-Gorham, who’s sponsoring the expansion bill. “I think it’s both somewhat devious and ill-informed. We need to take care of the folks we can expand with, too.”
Republicans opposed to expanding Medicaid in Maine, including Gov. Paul LePage, have frequently pointed to the existing wait lists for services as a reason they can’t support the Medicaid expansion, which would benefit adults without children and parents of dependent children who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household.
“I would like to know when our elderly and disabled will stop getting shoved to the back of the line so that young, able-bodied people can get free health insurance,” Sanderson, the ranking Republican on the Legislature’s Health and Human Services Committee, said in a statement released by the House Republican office. “It’s unconscionable to expand welfare to young adults while Maine’s most vulnerable are left out in the cold.”
Sanderson plans to introduce the two proposals on the House floor when the Medicaid expansion bill returns to that chamber, which could be as soon as Wednesday. Her amendments would require the Department of Health and Human Services provide services to hundreds of elderly people and people with intellectual and physical disabilities and autism — and pay for them.
Single payer is needed cure
By Jack Bernard
Charlotte (N.C.) Observer, June 10, 2013
Charlotte (N.C.) Observer, June 10, 2013
After spending 25 years in the health care field, most of it related to making hospitals more efficient and effective, I have become skeptical of many of Washington’s reform efforts, especially by my party, the GOP.
One of the biggest problems with health care is escalating, uncontrolled expenditures, taking a larger and larger proportion of our GNP. However, what Rep. Paul Ryan and the GOP want to talk about is the federal budget and cost-shifting via Medicare and Medicaid.
Experts in health care economics differ on many things. But one thing they all agree on is that raising the age for Medicare will do virtually nothing to reduce the overall cost of health care in this nation.
Under the Affordable Care Act, everyone must have insurance or be taxed. Medicare has a 3 percent administrative overhead while the private sector has run 28 percent, coming down to 20 percent as required by the ACA. Raising the Medicare age simply shifts the insurer from the government to less efficient private providers. This dumps the extra cost into the lap of the senior, who at 65 is probably unemployed and unemployable. There are no overall cost savings via efficiencies with Ryan’s Medicare “voucher” proposal.
Dr. Gerald Friedman, professor of economics at the University of Massachusetts, was in Charlotte recently for the launching of a physician advocacy group, Health Care Justice. Friedman indicated that U.S. per capita health care cost is $7,920. That compares with $3,323 in Sweden, $2,984 in Finland and only $2,686 in Italy. He points out that people in these countries are healthier than in our country and things are getting worse here. In 2001 among the non-elderly, 14 percent did not see a doctor for needed medical care. The figure rose to 26 percent in less than a decade.
Friedman pointed out that the most basic financial problem with U.S. health care is the for-profit insurance system. Insurance company profits have increased 250 percent in the last decade, Friedman said. The head of Cigna made a whopping $29 million in 2009 while health care premiums and increased deductibles are eating up more and more of workers’ wages.
He further pointed out that the administrative cost of health care insurance is one of the major drivers of escalating health care costs from 1980 to 2005. According to Friedman, the administrative cost of private insurance will be $200 billion in 2013. In the U.S. billing costs run $83,975 per doctor per year versus only $22,205 in Ontario.
This is waste, pure and simple. Although the Affordable Care Act pushed through by the Democrats does not do enough to solve the issue, the current GOP proposals totally ignore it.
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