The $2.7 Trillion Medical Bill
Colonoscopies Explain Why U.S. Leads the World in Health Expenditures
By ELISABETH ROSENTHAL | Published: June 1, 2013
MERRICK, N.Y. — Deirdre Yapalater’s recentcolonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.
That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.
“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”
The shocking truth about Obamacare’s rate shock
By Ezra Klein,
Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109.
When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies.
So here’s the question: Does that television really cost $109?
Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen.
But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year.
Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges.
The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all.
Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease.
We Are Not Having A Serious Discussion, Obamacare Edition
I fairly often receive mail pleading with me to take a more even tone, to have a respectful discussion with people on the other side rather than calling them fools and knaves. And you know, I do when I can. But the truth is that on most of the big issues confronting us, there just isn’t anyone to have a serious discussion with. Ezra Kleinoffers a nice illustration of this point today, in his takedown of Avik Roy on Obamacare in California.
The thing you want to bear in mind is that Roy is widely considered a good example of a reformist conservative, not to mention a health policy wonk. So what does this reform-minded wonk have to say about Obamacare?
Klein tries really hard to keep his temper even; too hard, I think, because I wonder how many readers will stay with him all the way through. But to cut to the chase, Roy claims that Obamacare will cause soaring insurance rates, using a comparison that is completely fraudulent — and I say fraudulent, not wrong, because he is indeed enough of a policy wonk here to know that he is pulling a fast one.
So here’s the comparison Roy uses: he points out that the insurance premiums that will apparently be charged on the California exchange will be higher than the lowest rates being offered by some insurers in California right now.
As Klein says, this isn’t just comparing apples and oranges; it’s comparing apples with oranges you can’t even buy.
Right now, California has a basically unregulated individual market, in which insurers are free to reject whoever they choose, and charge whatever rates they choose. This means that a few young, healthy people with no record of prior medical problems can get cheap plans; these are, of course, precisely the people who need insurance least, and these plans are cheap not just because they’re only available to the very healthy but because they don’t provide much insurance. If you’re not healthy or wealthy enough to get by with this kind of insurance, too bad.
So looking at these rates tells you nothing at all about the success of a program that offers insurance to everyone, regardless of medical history, and sets fairly high minimum standards for the quality of that insurance.
What’s more, this isn’t some obscure issue. When people try to explain the logic of ObamaRomneyCare — certainly when I try to explain it — they often start from precisely this point, pointing out that unregulated insurance markets give the healthy and wealthy a pretty good deal but leave everyone else out in the cold, then work from that point toward the “three-legged stool” of community rating, mandates,and subsidies that supports reform. So Roy has to know that he’s making an essentially fraudulent argument — and does it anyway.
Medicaid standoff has serious consequences for needy
Some with existing health conditions must forgo visits to their doctor in favor of paying for housing.
By JOE LAWLOR Staff Writer
SPRINGVALE - Several prescription bottles sat on the small, square kitchen table in Patty and Roger Kidder's cluttered house in Springvale.
Hands quivering, Patty pointed to and explained each medication -- three were anti-depressants, one was for anxiety and two control high cholesterol.
Since being kicked off MaineCare last year, they don't know how they can keep affording their pills, the mortgage and other day-to-day bills.
The prescriptions cost $90 per month, up from about $21 per month when they were on MaineCare.
On the rare occasion they do go to the doctor, they can't afford it.
Pressure Grows to Create Drugs for ‘Superbugs’
By BARRY MEIER
Government officials, drug companies and medical experts, faced with outbreaks of antibiotic-resistant “superbugs,” are pushing to speed up the approval of new antibiotics, a move that is raising safety concerns among some critics.
The need for new antibiotics is so urgent, supporters of an overhaul say, that lengthy studies involving hundreds or thousands of patients should be waived in favor of directly testing such drugs in very sick patients. Influential lawmakers have said they are prepared to support legislation that allows for faster testing.
The Health and Human Services Department last month announced an agreement under which it will pay $40 million to a major drug maker, GlaxoSmithKline, to help it develop medications to combat antibiotic resistance and biological agents that terrorists might use. Under the plan, the federal government could give the drug company as much as $200 million over the next five years.
“We are facing a huge crisis worldwide not having an antibiotics pipeline,” said Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the Food and Drug Administration. “It is bad now, and the infectious disease docs are frantic. But what is worse is the thought of where we will be five to 10 years from now.”
Annually, tens of thousands of Americans die from infections, largely acquired in hospitals, that are resistant to antibiotics, experts say.
Doctors, faced with dwindling options and little time to decide, are often left with agonizing choices over how to save a patient’s life. For example, some doctors, in extreme cases, are again using Colistin, an older antibiotic that was largely abandoned years ago because of the damage it can cause the liver.
“A drug like Colistin would not be developed today because it is too toxic,” said Dr. Helen W. Boucher, an infectious disease expert at Tufts University in Boston.
Under a plan proposed by a professional medical group, the Infectious Disease Society of America, new antibiotics approved through quicker testing would carry a special label specifying that their use be limited to very sick patients.
But critics of the plan argue that merely putting a restrictive label on a medicine is not enough, and that limited tests might not be adequate to determine a drug’s safety and effectiveness. They say they worry that the new medications, without the more comprehensive testing, could then be used on healthier patients who do not necessarily need them.
The Geezers Are All Right
By PAUL KRUGMAN
Last month the Congressional Budget Office released its much-anticipated projections for debt and deficits, and there were cries of lamentation from the deficit scolds who have had so much influence on our policy discourse. The problem, you see, was that the budget office numbers looked, well, O.K.: deficits are falling fast, and the ratio of debt to gross domestic product is projected to remain roughly stable over the next decade. Obviously it would be nice, eventually, to actually reduce debt. But if you’ve built your career around proclamations of imminent fiscal doom, this definitely wasn’t the report you wanted to see.
Still, we can always count on the baby boomers to deliver disaster, can’t we? Doesn’t the rising tide of retirees mean that Social Security and Medicare are doomed unless we radically change those programs now now now?
Maybe not.
To be fair, the reports of the Social Security and Medicare trustees released Friday do suggest that America’s retirement system needs some significant work. The ratio of Americans over 65 to those of working age will rise inexorably over the decades ahead, and this will translate into rising spending on Social Security and Medicare as a share of national income.
But the numbers aren’t nearly as overwhelming as you might have imagined, given the usual rhetoric. And if you look under the hood, the data suggest that we can, if we choose, maintain social insurance as we know it with only modest adjustments.
Start with Social Security. The retirement program’s trustees do foresee rising spending as the population ages, with total payments rising from 5.1 percent of G.D.P. now to 6.2 percent in 2035, at which point they stabilize. This means, by the way, that all the talk of Social Security going “bankrupt” is nonsense; even if nothing at all is done, the system will be able to pay most of its scheduled benefits as far as the eye can see.
Still, it does look as if there will eventually be a shortfall, and the usual suspects insist that we must move right now to reduce scheduled benefits. But I’ve never understood the logic of this demand. The risk is that we might, at some point in the future, have to cut benefits; to avoid this risk of future benefit cuts, we are supposed to act pre-emptively by...cutting future benefits. What problem, exactly, are we solving here?
http://www.nytimes.com/2013/06/03/opinion/krugman-the-geezers-are-all-right.html?hp&pagewanted=print
GOP governors’ endorsements of Medicaid expansion deepen rifts within party
By Sandhya Somashekhar,
Republican fissures over the expansion of Medicaid, a critical piece of the 2010 health-care law designed to provide coverage to millions of uninsured Americans, continue to deepen, with battles in Arizona and elsewhere showing just how bitter the divisions have become.
Despite expressing distaste for the new law, some GOP governors have endorsed an expansion of Medicaid, and three — Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — are trying to persuade their Republican-controlled legislatures to go along. The governors are unwilling to turn down Washington’s offer to spend millions, if not billions, in their states to add people to the state-federal program for the poor. But they face staunch opposition from many GOP legislators who oppose the health-care law and worry that their states will be stuck with the cost of adding Medicaid recipients.
In one of the most explosive of the internal Republican battles, Brewer, a firebrand tea party favorite who once wagged her finger at President Obama, has declared a “moratorium” on all other legislation until her Medicaid plan, which would add 300,000 Arizonans to the program, is approved. She has backed up her threat by vetoing five unrelated bills.
In Ohio and Michigan, the governors are pressing for last-minute compromises before their legislatures adjourn this summer. The Florida legislature, which has adjourned, rejected Republican Gov. Rick Scott’s plan to expand Medicaid.
These conflicts over the health-care law illustrate a larger divide within the Republican Party over an array of issues, including immigration and automatic budget cuts.
The Medicaid expansion is one of the two main ways the health-care law would provide coverage to the uninsured. The other is through health insurance exchanges, which will sell policies to individuals whose incomes are too high for Medicaid; many of those people will receive subsidies to buy the health plans.
Medicaid eligibility varies from state to state and depends on income and other factors. The health-care law, in an effort to make eligibility uniform, mandated that anyone earning up to 138 percent of the poverty level, or $15,856 in 2013 dollars, be eligible for the program. But last June, the Supreme Court, while upholding most of the health-care law, ruled that states could refuse to expand their Medicaid programs. That set the stage for bitter debates — ones ruled as much by ideology and politics as by financial realities — that have been occurring in state capitals nationwide.
Both sides cite, spin Medicaid cost study
While Gov. Paul LePage and Democrats in the Legislature continue a seemingly endless war of words over Medicaid expansion, Massachusetts-based researchers recently released a study that examines the effectiveness of such expansions.
So, will expanding Medicaid be a net benefit for Maine? How does the research compare to the rhetoric? LePage last week vetoed a bill that would have expanded Medicaid and reimbursed hospitals for money they were owed by the state.
Harvard health economics professor Katherine Baicker, the lead author of the study released this year about Oregon's Medicaid expansion in the late 2000s, told the Maine Sunday Telegram that its results are not a victory for either side of the debate.
The shocking truth about Obamacare’s rate shock
By Ezra Klein,
Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109.
When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies.
So here’s the question: Does that television really cost $109?
Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen.
But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year.
Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges.
The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all.
Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease.
We Are Not Having A Serious Discussion, Obamacare Edition
I fairly often receive mail pleading with me to take a more even tone, to have a respectful discussion with people on the other side rather than calling them fools and knaves. And you know, I do when I can. But the truth is that on most of the big issues confronting us, there just isn’t anyone to have a serious discussion with. Ezra Kleinoffers a nice illustration of this point today, in his takedown of Avik Roy on Obamacare in California.
The thing you want to bear in mind is that Roy is widely considered a good example of a reformist conservative, not to mention a health policy wonk. So what does this reform-minded wonk have to say about Obamacare?
Klein tries really hard to keep his temper even; too hard, I think, because I wonder how many readers will stay with him all the way through. But to cut to the chase, Roy claims that Obamacare will cause soaring insurance rates, using a comparison that is completely fraudulent — and I say fraudulent, not wrong, because he is indeed enough of a policy wonk here to know that he is pulling a fast one.
So here’s the comparison Roy uses: he points out that the insurance premiums that will apparently be charged on the California exchange will be higher than the lowest rates being offered by some insurers in California right now.
As Klein says, this isn’t just comparing apples and oranges; it’s comparing apples with oranges you can’t even buy.
Right now, California has a basically unregulated individual market, in which insurers are free to reject whoever they choose, and charge whatever rates they choose. This means that a few young, healthy people with no record of prior medical problems can get cheap plans; these are, of course, precisely the people who need insurance least, and these plans are cheap not just because they’re only available to the very healthy but because they don’t provide much insurance. If you’re not healthy or wealthy enough to get by with this kind of insurance, too bad.
So looking at these rates tells you nothing at all about the success of a program that offers insurance to everyone, regardless of medical history, and sets fairly high minimum standards for the quality of that insurance.
What’s more, this isn’t some obscure issue. When people try to explain the logic of ObamaRomneyCare — certainly when I try to explain it — they often start from precisely this point, pointing out that unregulated insurance markets give the healthy and wealthy a pretty good deal but leave everyone else out in the cold, then work from that point toward the “three-legged stool” of community rating, mandates,and subsidies that supports reform. So Roy has to know that he’s making an essentially fraudulent argument — and does it anyway.
Medicaid standoff has serious consequences for needy
Some with existing health conditions must forgo visits to their doctor in favor of paying for housing.
By JOE LAWLOR Staff Writer
SPRINGVALE - Several prescription bottles sat on the small, square kitchen table in Patty and Roger Kidder's cluttered house in Springvale.
Hands quivering, Patty pointed to and explained each medication -- three were anti-depressants, one was for anxiety and two control high cholesterol.
Since being kicked off MaineCare last year, they don't know how they can keep affording their pills, the mortgage and other day-to-day bills.
The prescriptions cost $90 per month, up from about $21 per month when they were on MaineCare.
On the rare occasion they do go to the doctor, they can't afford it.
Pressure Grows to Create Drugs for ‘Superbugs’
By BARRY MEIER
Government officials, drug companies and medical experts, faced with outbreaks of antibiotic-resistant “superbugs,” are pushing to speed up the approval of new antibiotics, a move that is raising safety concerns among some critics.
The need for new antibiotics is so urgent, supporters of an overhaul say, that lengthy studies involving hundreds or thousands of patients should be waived in favor of directly testing such drugs in very sick patients. Influential lawmakers have said they are prepared to support legislation that allows for faster testing.
The Health and Human Services Department last month announced an agreement under which it will pay $40 million to a major drug maker, GlaxoSmithKline, to help it develop medications to combat antibiotic resistance and biological agents that terrorists might use. Under the plan, the federal government could give the drug company as much as $200 million over the next five years.
“We are facing a huge crisis worldwide not having an antibiotics pipeline,” said Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the Food and Drug Administration. “It is bad now, and the infectious disease docs are frantic. But what is worse is the thought of where we will be five to 10 years from now.”
Annually, tens of thousands of Americans die from infections, largely acquired in hospitals, that are resistant to antibiotics, experts say.
Doctors, faced with dwindling options and little time to decide, are often left with agonizing choices over how to save a patient’s life. For example, some doctors, in extreme cases, are again using Colistin, an older antibiotic that was largely abandoned years ago because of the damage it can cause the liver.
“A drug like Colistin would not be developed today because it is too toxic,” said Dr. Helen W. Boucher, an infectious disease expert at Tufts University in Boston.
Under a plan proposed by a professional medical group, the Infectious Disease Society of America, new antibiotics approved through quicker testing would carry a special label specifying that their use be limited to very sick patients.
But critics of the plan argue that merely putting a restrictive label on a medicine is not enough, and that limited tests might not be adequate to determine a drug’s safety and effectiveness. They say they worry that the new medications, without the more comprehensive testing, could then be used on healthier patients who do not necessarily need them.
The Geezers Are All Right
By PAUL KRUGMAN
Last month the Congressional Budget Office released its much-anticipated projections for debt and deficits, and there were cries of lamentation from the deficit scolds who have had so much influence on our policy discourse. The problem, you see, was that the budget office numbers looked, well, O.K.: deficits are falling fast, and the ratio of debt to gross domestic product is projected to remain roughly stable over the next decade. Obviously it would be nice, eventually, to actually reduce debt. But if you’ve built your career around proclamations of imminent fiscal doom, this definitely wasn’t the report you wanted to see.
Still, we can always count on the baby boomers to deliver disaster, can’t we? Doesn’t the rising tide of retirees mean that Social Security and Medicare are doomed unless we radically change those programs now now now?
Maybe not.
To be fair, the reports of the Social Security and Medicare trustees released Friday do suggest that America’s retirement system needs some significant work. The ratio of Americans over 65 to those of working age will rise inexorably over the decades ahead, and this will translate into rising spending on Social Security and Medicare as a share of national income.
But the numbers aren’t nearly as overwhelming as you might have imagined, given the usual rhetoric. And if you look under the hood, the data suggest that we can, if we choose, maintain social insurance as we know it with only modest adjustments.
Start with Social Security. The retirement program’s trustees do foresee rising spending as the population ages, with total payments rising from 5.1 percent of G.D.P. now to 6.2 percent in 2035, at which point they stabilize. This means, by the way, that all the talk of Social Security going “bankrupt” is nonsense; even if nothing at all is done, the system will be able to pay most of its scheduled benefits as far as the eye can see.
Still, it does look as if there will eventually be a shortfall, and the usual suspects insist that we must move right now to reduce scheduled benefits. But I’ve never understood the logic of this demand. The risk is that we might, at some point in the future, have to cut benefits; to avoid this risk of future benefit cuts, we are supposed to act pre-emptively by...cutting future benefits. What problem, exactly, are we solving here?
http://www.nytimes.com/2013/06/03/opinion/krugman-the-geezers-are-all-right.html?hp&pagewanted=print
GOP governors’ endorsements of Medicaid expansion deepen rifts within party
By Sandhya Somashekhar,
Republican fissures over the expansion of Medicaid, a critical piece of the 2010 health-care law designed to provide coverage to millions of uninsured Americans, continue to deepen, with battles in Arizona and elsewhere showing just how bitter the divisions have become.
Despite expressing distaste for the new law, some GOP governors have endorsed an expansion of Medicaid, and three — Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — are trying to persuade their Republican-controlled legislatures to go along. The governors are unwilling to turn down Washington’s offer to spend millions, if not billions, in their states to add people to the state-federal program for the poor. But they face staunch opposition from many GOP legislators who oppose the health-care law and worry that their states will be stuck with the cost of adding Medicaid recipients.
In one of the most explosive of the internal Republican battles, Brewer, a firebrand tea party favorite who once wagged her finger at President Obama, has declared a “moratorium” on all other legislation until her Medicaid plan, which would add 300,000 Arizonans to the program, is approved. She has backed up her threat by vetoing five unrelated bills.
In Ohio and Michigan, the governors are pressing for last-minute compromises before their legislatures adjourn this summer. The Florida legislature, which has adjourned, rejected Republican Gov. Rick Scott’s plan to expand Medicaid.
These conflicts over the health-care law illustrate a larger divide within the Republican Party over an array of issues, including immigration and automatic budget cuts.
The Medicaid expansion is one of the two main ways the health-care law would provide coverage to the uninsured. The other is through health insurance exchanges, which will sell policies to individuals whose incomes are too high for Medicaid; many of those people will receive subsidies to buy the health plans.
Medicaid eligibility varies from state to state and depends on income and other factors. The health-care law, in an effort to make eligibility uniform, mandated that anyone earning up to 138 percent of the poverty level, or $15,856 in 2013 dollars, be eligible for the program. But last June, the Supreme Court, while upholding most of the health-care law, ruled that states could refuse to expand their Medicaid programs. That set the stage for bitter debates — ones ruled as much by ideology and politics as by financial realities — that have been occurring in state capitals nationwide.
Both sides cite, spin Medicaid cost study
While Gov. Paul LePage and Democrats in the Legislature continue a seemingly endless war of words over Medicaid expansion, Massachusetts-based researchers recently released a study that examines the effectiveness of such expansions.
So, will expanding Medicaid be a net benefit for Maine? How does the research compare to the rhetoric? LePage last week vetoed a bill that would have expanded Medicaid and reimbursed hospitals for money they were owed by the state.
Harvard health economics professor Katherine Baicker, the lead author of the study released this year about Oregon's Medicaid expansion in the late 2000s, told the Maine Sunday Telegram that its results are not a victory for either side of the debate.
No comments:
Post a Comment