Simpler, better
By George Dyck, M.D.
The Wichita Eagle, Letters, May 20, 2014
As we still hear about confusion surrounding the Affordable Care Act, I think about how different it is in Canada. I go there to work in the summer and see how much simpler things can be for the person who needs medical care. Residents of Canada can go to the Manitoba Health website and see the following:
“Medicare has become culturally and politically important to Canadians as a reflection of, and as a defining influence on, our national identity. Shared principles of equity, fairness and compassion are embodied in the health care system, and the services it provides are now regarded as a basic right.
“In order to receive medical attention, Canadians need only go to the physician or clinic of their choice and present the health insurance card issued to all eligible residents of a province or territory. There are no charges, deductibles or dollar limits for insured medical services (physician, hospital and surgical-dental), and there are no forms for patients to fill out.”
What is it that prevents Americans from embracing this kind of system? We hear voices saying we do not want to give up our freedoms. But what kind of freedom is this for those who cannot figure out how to get their medical care?
I do not hear people in Manitoba complaining about lost freedom. They shake their heads in disbelief about how complicated it is south of the border. And statistics show they have better health and greater longevity, as well as better overall satisfaction with their health care.
Dr. George Dyck resides in North Newton, Kan.
http://www.pnhp.org/print/news/2014/june/simpler-better
The Wichita Eagle, Letters, May 20, 2014
As we still hear about confusion surrounding the Affordable Care Act, I think about how different it is in Canada. I go there to work in the summer and see how much simpler things can be for the person who needs medical care. Residents of Canada can go to the Manitoba Health website and see the following:
“Medicare has become culturally and politically important to Canadians as a reflection of, and as a defining influence on, our national identity. Shared principles of equity, fairness and compassion are embodied in the health care system, and the services it provides are now regarded as a basic right.
“In order to receive medical attention, Canadians need only go to the physician or clinic of their choice and present the health insurance card issued to all eligible residents of a province or territory. There are no charges, deductibles or dollar limits for insured medical services (physician, hospital and surgical-dental), and there are no forms for patients to fill out.”
What is it that prevents Americans from embracing this kind of system? We hear voices saying we do not want to give up our freedoms. But what kind of freedom is this for those who cannot figure out how to get their medical care?
I do not hear people in Manitoba complaining about lost freedom. They shake their heads in disbelief about how complicated it is south of the border. And statistics show they have better health and greater longevity, as well as better overall satisfaction with their health care.
Dr. George Dyck resides in North Newton, Kan.
http://www.pnhp.org/print/news/2014/june/simpler-better
Colon Cancer Screening Saves Lives
Widespread screening for colorectal cancer has helped prevent an estimated half-million cases of the disease since the mid- 1970s, a new study suggests.
At a time when screening for many kinds of cancer is being questioned, the findings underscore the importance of screening for colorectal cancer in saving lives, said the senior author of the study, Dr. James Yu, an assistant professor of therapeutic radiology at Yale School of Medicine.
Colonoscopies, beginning at age 50, are considered the gold standard in colon cancer screening, although other techniques, like fecal occult blood testing, can detect some cancers.
Using data from the National Cancer Institute from 1976 to 2009, Dr. Yu and his colleagues at Yale found that the incidence of late-stage cancer among people over 50 fell from 118 cases per 100,000 people to 74 cases. And for early stage cancers, the rate dropped from 77 cases per 100,000 people to 67. During that period, colorectal screening rates nearly doubled among people 50 and older.
The study, published in Cancer, found that there was a particularly significant decline in cancers of the left colon, the cancers most easily detected by screening.
“Colorectal screening is an important public health intervention that has prevented half a million people from the trauma of cancer,” said Dr. Yu. “I think that’s a big deal.”
Selected letters on the VA scandal
The following four letters to the editor represent a sampling of opinion by single-payer advocates across the U.S. on the recently exposed wait-time problems in the Veterans Health Administration. For more on the current VA situation, see PNHP's Articles of Interest and Dr. Don McCanne's Quote of the Day.
Star Tribune (Minneapolis), Letters, May 31, 2014
True, the VA has waiting lists, real and fake. We spend fortunes to send youngsters to war, yet underfund their care when they come home. They suffer for no good reason.
That is unacceptable.
Here’s what else is unacceptable. Even with the Affordable Care Act, 30 million U.S. people will remain uninsured. No one keeps their waiting lists, but each year tens of thousands will die because they lack adequate access to medical care. Nearly half of the states refuse to expand Medicaid, effectively condemning more than 7,000 uninsured each year to preventable deaths. Medical bills remain the leading cause of bankruptcy. We don’t have enough primary care physicians, both inside and outside the VA.
Even the best programs could be better, and doctoring waiting lists must stop, but patient surveys still make the VA the highest-rated health care program in the country. Let’s face it. The VA is a public, single-payer health care program. The day the United States and Minnesota choose an adequately funded, public single-payer system, everyone will have access to timely care, and everyone will be protected from financial disaster in time of illness.
Now that is acceptable.
Dr. Inge De Becker resides in St. Paul.
http://www.startribune.com/opinion/letters/261324261.html
*****
Bennington (Vt.) Banner, Letters, June 4, 2014
We read in the Banner that as many as 40 veterans may have died in Phoenix because they could not get needed care at the VA hospital. This is truly outrageous (surely an overused adjective but probably better than disgraceful). We must do better for our veterans.
Here is another statistic that you may or may not want to know depending on your political mindset. It is estimated that in 2013 there were over 40,000 Americans (not a misprint) who died because they had no health insurance and could not access health care in a timely manner. This is similarly outrageous.
I long for the day when we Americans are smart enough to elect leaders who can translate outrage into action. The action that we need is improved Medicare for all. Everybody in, nobody out.
Dr. G. Richard Dundas resides in Bennington.
http://www.benningtonbanner.com/opinion/ci_25891663/letters-we-need-i
*****
The New York Times, Letters, June 2, 2014
Part of the cause of the long waiting times in the V.A. system is surely a combination of the V.A.’s difficulties in recruiting doctors (especially primary care doctors) and the surge in demand in recent years due to our military interventions in Iraq and Afghanistan. Neither of these causes of the current backlog will be fixed quickly.
If Congress is serious about helping to alleviate the problem and showing our gratitude to and support for our veterans, it will expand Medicare coverage to include all veterans. If that is done, our veterans could choose between the V.A. system and any doctor who participates in Medicare.
Medicare is approaching its 50th anniversary as one of the most durable, successful and popular federal programs ever created. Do our veterans deserve any less?
Dr. Lee, a Korea veteran, was an assistant secretary for health in the Johnson and Clinton administrations. Dr. Caper was a senior health care adviser to Senator Edward M. Kennedy; he resides in Brooklin, Maine.
http://www.nytimes.com/2014/06/03/opinion/addressing-the-problems-at-the…
http://www.pnhp.org/print/news/2014/june/selected-letters-on-the-va-scandal
The VA scandal, and the ones beyond
By Inge De Becker, M.D.Star Tribune (Minneapolis), Letters, May 31, 2014
True, the VA has waiting lists, real and fake. We spend fortunes to send youngsters to war, yet underfund their care when they come home. They suffer for no good reason.
That is unacceptable.
Here’s what else is unacceptable. Even with the Affordable Care Act, 30 million U.S. people will remain uninsured. No one keeps their waiting lists, but each year tens of thousands will die because they lack adequate access to medical care. Nearly half of the states refuse to expand Medicaid, effectively condemning more than 7,000 uninsured each year to preventable deaths. Medical bills remain the leading cause of bankruptcy. We don’t have enough primary care physicians, both inside and outside the VA.
Even the best programs could be better, and doctoring waiting lists must stop, but patient surveys still make the VA the highest-rated health care program in the country. Let’s face it. The VA is a public, single-payer health care program. The day the United States and Minnesota choose an adequately funded, public single-payer system, everyone will have access to timely care, and everyone will be protected from financial disaster in time of illness.
Now that is acceptable.
Dr. Inge De Becker resides in St. Paul.
http://www.startribune.com/opinion/letters/261324261.html
*****
We need improved Medicare for all
By G. Richard Dundas, M.D.Bennington (Vt.) Banner, Letters, June 4, 2014
We read in the Banner that as many as 40 veterans may have died in Phoenix because they could not get needed care at the VA hospital. This is truly outrageous (surely an overused adjective but probably better than disgraceful). We must do better for our veterans.
Here is another statistic that you may or may not want to know depending on your political mindset. It is estimated that in 2013 there were over 40,000 Americans (not a misprint) who died because they had no health insurance and could not access health care in a timely manner. This is similarly outrageous.
I long for the day when we Americans are smart enough to elect leaders who can translate outrage into action. The action that we need is improved Medicare for all. Everybody in, nobody out.
Dr. G. Richard Dundas resides in Bennington.
http://www.benningtonbanner.com/opinion/ci_25891663/letters-we-need-i
*****
Addressing the problems at the VA
By Philip R. Lee, M.D., and Philip Caper, M.D.The New York Times, Letters, June 2, 2014
Part of the cause of the long waiting times in the V.A. system is surely a combination of the V.A.’s difficulties in recruiting doctors (especially primary care doctors) and the surge in demand in recent years due to our military interventions in Iraq and Afghanistan. Neither of these causes of the current backlog will be fixed quickly.
If Congress is serious about helping to alleviate the problem and showing our gratitude to and support for our veterans, it will expand Medicare coverage to include all veterans. If that is done, our veterans could choose between the V.A. system and any doctor who participates in Medicare.
Medicare is approaching its 50th anniversary as one of the most durable, successful and popular federal programs ever created. Do our veterans deserve any less?
Dr. Lee, a Korea veteran, was an assistant secretary for health in the Johnson and Clinton administrations. Dr. Caper was a senior health care adviser to Senator Edward M. Kennedy; he resides in Brooklin, Maine.
http://www.nytimes.com/2014/06/03/opinion/addressing-the-problems-at-the…
http://www.pnhp.org/print/news/2014/june/selected-letters-on-the-va-scandal
Now application ‘inconsistencies’ vex health law
MaineCare rides broker to get millions more in final months
It’s about to be phased out for poor service, but CTS is due to get millions in supplemental money from the state in May and June.
The company whose contracts to arrange rides for MaineCare recipients weren’t renewed because of its poor performance is set to receive more extra money from the state in its last weeks on the job, records indicate.
Connecticut-based Coordinated Transportation Solutions, whose contracts end this summer, already received about $2.6 million in extra payments in February and April. It likely will continue getting extra payments at least through June, according to state records obtained by the Portland Press Herald through a Freedom of Access Act request.
If those payments for May and June are similar to the earlier payments, the state will give an estimated $2.5 million extra to the company. That means Coordinated Transportation Solutions would collect about $5 million on top of the $28.3 million called for in its six contracts to arrange rides in most of Maine.
“I think this is absolutely terrible,” said Lynne Richmond, 69, of Augusta, who uses the MaineCare rides program and said she had to give up going to the chiropractor after missing so many rides because of CTS. “They haven’t done anything to deserve it.”
Since Aug. 1, when Maine began a new regional broker system, thousands of low-income Mainers have missed rides. Coordinated Transportation Solutions, which covers all but the Bangor and York County regions, was cited by Maine officials for having the worst problems of the three brokers. The company lost out on future work because of its poor performance, according to an evaluation by the state Department of Health and Human Services.
Contract amendments obtained by the Press Herald show changes to the formulas for paying CTS. Although no bottom-line figure is provided, the changes for May and June are similar to the formula changes made for February and April.
State officials have repeatedly declined to answer detailed questions about the extra payments. CTS complained last fall that the state had underestimated the workload when it detailed the work that contractors could bid on.
Company officials couldn’t be reached for comment Wednesday.
John Martins, spokesman for the DHHS, wrote in an email response to questions that the company’s volunteer network and the state’s need to make a smooth transition to new contractors were reasons for the extra payments.
“Coordinated Transportation Solutions’ payments were adjusted to support and sustain the volunteer network over the six regions they serve in order to ensure the delivery of the maximum number of rides to MaineCare clients while the department prepared to select a broker for these six regions and to transition services,” Martins wrote.
Maine insurers selling Affordable Care Act plans seek rate increases in 2015
Posted June 03, 2014, at 6:27 p.m.
The two insurers selling plans to Maine consumers under the Affordable Care Act want to raise rates in 2015, but well below the double-digit average hikes cropping up in some other states.
The proposed rates offer a tentative first look at how much insurers seek to charge during the second year of Healthcare.gov, a cornerstone of the Affordable Care Act. The rates remain subject to change and regulatory approval.
If they become final, some Maine consumers could pay slightly more, with increases ranging from an average of 0.1 to 3.1 percent. Others could see their rates drop.
The proposed rates would affect the relatively small population of Maine consumers who buy their health coverage in the “individual market,” rather than get insurance through work or government programs such as Medicaid and Medicare. Many gained coverage over the last six months through Healthcare.gov, the federal government’s gateway for health insurance marketplaces in Maine and 35 other states.
During the first year of enrollment under Healthcare.gov, more than 44,000 Mainers signed up for private health insurance, according to federal data. Health advocates expect even more of Maine’s population to sign up for plans taking effect in 2015, with the next open enrollment period kicking off on Nov. 15.
If approved, the new rate increases may not translate into noticeably higher bills for many policyholders, particularly the 90 percent of Maine enrollees who qualified for financial subsidies that could help absorb an increase. Those who didn’t qualify for subsidies may feel the pinch more.
In Maine, two insurers sold plans through Healthcare.gov. Both plan to continue selling policies in 2015. They’ll be joined by a third, the nonprofit Harvard Pilgrim Health Care, which has sold individual policies in Maine previously but will market plans through Healthcare.gov for the first time next year.
Yet another insurer, Aetna, will bring more competition to Maine in 2015. The company has offered plans to Maine businesses, and now plans to sell individual policies.
“We have built a new product offering that we think is going to be a very highly competitive offering in Maine,” said Susan Millerick, a spokeswoman for the company.
The new insurance product, which will also be available to small and large businesses, is expected to hit the market in January 2015, pending regulatory approval, she said.
The two insurers selling plans to Maine consumers under the Affordable Care Act want to raise rates in 2015, but well below the double-digit average hikes cropping up in some other states.
The proposed rates offer a tentative first look at how much insurers seek to charge during the second year of Healthcare.gov, a cornerstone of the Affordable Care Act. The rates remain subject to change and regulatory approval.
If they become final, some Maine consumers could pay slightly more, with increases ranging from an average of 0.1 to 3.1 percent. Others could see their rates drop.
The proposed rates would affect the relatively small population of Maine consumers who buy their health coverage in the “individual market,” rather than get insurance through work or government programs such as Medicaid and Medicare. Many gained coverage over the last six months through Healthcare.gov, the federal government’s gateway for health insurance marketplaces in Maine and 35 other states.
During the first year of enrollment under Healthcare.gov, more than 44,000 Mainers signed up for private health insurance, according to federal data. Health advocates expect even more of Maine’s population to sign up for plans taking effect in 2015, with the next open enrollment period kicking off on Nov. 15.
If approved, the new rate increases may not translate into noticeably higher bills for many policyholders, particularly the 90 percent of Maine enrollees who qualified for financial subsidies that could help absorb an increase. Those who didn’t qualify for subsidies may feel the pinch more.
In Maine, two insurers sold plans through Healthcare.gov. Both plan to continue selling policies in 2015. They’ll be joined by a third, the nonprofit Harvard Pilgrim Health Care, which has sold individual policies in Maine previously but will market plans through Healthcare.gov for the first time next year.
Yet another insurer, Aetna, will bring more competition to Maine in 2015. The company has offered plans to Maine businesses, and now plans to sell individual policies.
“We have built a new product offering that we think is going to be a very highly competitive offering in Maine,” said Susan Millerick, a spokeswoman for the company.
The new insurance product, which will also be available to small and large businesses, is expected to hit the market in January 2015, pending regulatory approval, she said.
New proposed prices
Maine Community Health Options, a startup insurer based in Lewiston that captured 80 percent of all Healthcare.gov enrollment in Maine, has proposed an average 0.1 percent increase next year, an uptick that would affect an estimated 38,300 people, according to a preliminary analysis provided by the Maine Bureau of Insurance.
The actual rate changes vary by plan, from a 1.1 percent hike to a 3.3 percent decrease.
Kevin Lewis, CEO of MCHO, said the proposed rate changes were a “testament to a number of factors,” including the insurer’s solid market position in 2014 and its commitment to keeping costs low and “returning value back to our members.”
The nonprofit, member-run insurer plans to expand into New Hampshire.
Anthem Blue Cross and Blue Shield, the other player that sold plans to Maine consumers through Healthcare.gov, has proposed an average 3.1 percent increase in 2015. Some policyholders could get hit with as high as a 10.3 percent increase, while others would experience an 8.7 percent decrease, according to the analysis. The number of affected policyholders was not available.
Individual member’s rates may vary from the overall average, based on the plan chosen and other factors, such as age and tobacco use, Anthem said in a statement.
“These new rates help ensure that our affiliated plans can pay doctors, hospitals and other health care professionals to provide the care our customers need and deserve,” said Rory Sheehan, an Anthem spokesman. “Once our rates and products are approved, we’ll be working with members and consumers during the next open enrollment period to help them navigate through their options, including subsidies for qualified individuals and tax credits for small employers.”
Anthem and MCHO sell policies both through Healthcare.gov and outside of the federal marketplace, through insurance brokers and directly to consumers. Their proposed rate changes, which would take effect Jan. 1, 2015, reflect plans sold on and off the marketplace.
Aetna plans to sell individual policies off the marketplace, but may join Healthcare.gov in 2016, said Maine Insurance Superintendent Eric Cioppa, addressing the state’s health exchange advisory committee Tuesday.
Mega Life, a health insurer that served as Anthem’s main competitor before MCHO’s establishment, will withdraw from Maine’s individual market, Cioppa said.
Maine Community Health Options, a startup insurer based in Lewiston that captured 80 percent of all Healthcare.gov enrollment in Maine, has proposed an average 0.1 percent increase next year, an uptick that would affect an estimated 38,300 people, according to a preliminary analysis provided by the Maine Bureau of Insurance.
The actual rate changes vary by plan, from a 1.1 percent hike to a 3.3 percent decrease.
Kevin Lewis, CEO of MCHO, said the proposed rate changes were a “testament to a number of factors,” including the insurer’s solid market position in 2014 and its commitment to keeping costs low and “returning value back to our members.”
The nonprofit, member-run insurer plans to expand into New Hampshire.
Anthem Blue Cross and Blue Shield, the other player that sold plans to Maine consumers through Healthcare.gov, has proposed an average 3.1 percent increase in 2015. Some policyholders could get hit with as high as a 10.3 percent increase, while others would experience an 8.7 percent decrease, according to the analysis. The number of affected policyholders was not available.
Individual member’s rates may vary from the overall average, based on the plan chosen and other factors, such as age and tobacco use, Anthem said in a statement.
“These new rates help ensure that our affiliated plans can pay doctors, hospitals and other health care professionals to provide the care our customers need and deserve,” said Rory Sheehan, an Anthem spokesman. “Once our rates and products are approved, we’ll be working with members and consumers during the next open enrollment period to help them navigate through their options, including subsidies for qualified individuals and tax credits for small employers.”
Anthem and MCHO sell policies both through Healthcare.gov and outside of the federal marketplace, through insurance brokers and directly to consumers. Their proposed rate changes, which would take effect Jan. 1, 2015, reflect plans sold on and off the marketplace.
Aetna plans to sell individual policies off the marketplace, but may join Healthcare.gov in 2016, said Maine Insurance Superintendent Eric Cioppa, addressing the state’s health exchange advisory committee Tuesday.
Mega Life, a health insurer that served as Anthem’s main competitor before MCHO’s establishment, will withdraw from Maine’s individual market, Cioppa said.
The health insurance shell game reminds me of derivatives
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing more than a way to relieve gullible investors of their money. It worked. Really well. Well, until the housing market collapsed and the country plunged into near economic collapse. But hey, these things happen. Remember, it was all legal. It just wasn’t a very good idea. Take home message for investors: Stick to owning pieces of real companies. Whatever else happens, there will always be people who need things like houses, cars, food, and other goods and services.
Now look at what’s happening to medical care: First we had insurance companies bully their way into the doctor-patient relationship, and over the years, boy have they thrown their weight around. Administrative costs have generated such enormous profits, many of them have cast themselves as major philanthropists in their markets. They have to: Technically they’re non-profit organizations. Nice work if you can get it.
Back in the 1990s, they tried something called managed care. The stated aim was to improve patients’ health, but the real object was to shift financial risk back onto the doctors. Before this, if a patient visited the doctor five times in a year. the insurance company would have to pay five times as much as if he only went once. So they came up with something they called capitation: They paid the doctor a certain amount per person per month, and that was it. The only other pay the doctor got was a small co-pay from the patient (they started at $2) whenever she came in. If a patient came in ten times a month, the doctor only got an extra $20. Sweet deal for the insurance companies.
They also instituted things like referrals, turning physicians into gatekeepers. They withheld part of the physician payments (called “withholds,” of all things) which the docs could earn back by not spending (technically by not authorizing spending) too much on labs and other testing, specialists, and hospitalizations. As a practical matter, money withheld was rarely seen.
This didn’t work. Well, it worked great for the insurance companies. Lots of people made boatloads of money. But doctors and patients hated it: so much so that it mostly disappeared. Mostly. There are still two huge capitated programs I’ve been with for twenty years now, and I can’t drop them because the companies’ standard contracts include something called “all products” clauses. I have to take the capitated plans to participate in the others. Also, I still have lots of long-term patients in those plans, and wouldn’t you know it: Referrals remain the bane of my existence.
GOP’s Obamacare fears come true
Liberals wanted a national enrollment system under Obamacare.
They might just get it.
Right now, 36 states rely on HealthCare.gov, the federal exchange, to enroll people in health coverage. At least two more states are opting in next year, with a few others likely to follow. Only two states are trying to get out.
That’s precisely the opposite of the Affordable Care Act’s original intent: 50 exchanges run by 50 states.
(Also on POLITICO: Steve Scalise to push GOP leaders on Obamacare alternative)
The federal option was supposed to be a limited and temporary fallback. But a shift to a bigger, more permanent Washington-controlled system is instead underway — without preparation, funding or even public discussion about what a national exchange covering millions of Americans means for the future of U.S. health care. It’s coming about because intransigent Republicans shunned state exchanges, and ambitious Democrats bungled them.
Republicans had warned all along that President Barack Obama’s health law would lead to greater Washington control. “This was all predictable,” said Rep. Tom Price (R-Ga.), a physician who sees growing federal control of the health system hurting patients. “Our friends on the other side didn’t listen.”
Tevi Troy, a health expert who served in the George W. Bush administration and advised Mitt Romney in 2012, says the country needs to stop and discuss the consolidation. “We’re kind of, in a way, stumbling into this situation,” he said of the increasing reliance on the federal portal.
HealthCare.gov is more than a computerized sign-up sheet. It’s a marketplace, where people get health coverage through private insurers, for care from private doctors. It’s not a single, nationalized Canadian- or British-style program. Even within the federal model, each state has its own insurance pool and state officials still regulate health plans.
(Also on POLITICO: Nevada latest state to scrap its Obamacare exchange)
The state-exchange option gave governors and legislatures more leeway to tailor the market to suit local conditions and demands. But the states encountered political and technical obstacles, leading to investigations, recriminations, disputes with contractors and hundreds of millions of wasted dollars.
“While [the administration] spent an inordinate amount of time and energy and money encouraging states to run and own their own exchanges, I think that that has kind of shifted,” said Jon Kingsdale, a prominent consultant who helped build the original Massachusetts exchange under then-Gov. Romney. “How long can you push a boulder uphill?”
HealthCare.gov was originally conceived as a just-in-case alternative that would kick in if a state could not or would not build its own health reform enrollment system. The law didn’t even set aside money to build the federal site, let alone operate it indefinitely. Even when red states shunned a role in running Obamacare and a handful of blue states also turned to Washington, the federal system was still seen as a short-term bridge to a state-based system.
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing more than a way to relieve gullible investors of their money. It worked. Really well. Well, until the housing market collapsed and the country plunged into near economic collapse. But hey, these things happen. Remember, it was all legal. It just wasn’t a very good idea. Take home message for investors: Stick to owning pieces of real companies. Whatever else happens, there will always be people who need things like houses, cars, food, and other goods and services.
Now look at what’s happening to medical care: First we had insurance companies bully their way into the doctor-patient relationship, and over the years, boy have they thrown their weight around. Administrative costs have generated such enormous profits, many of them have cast themselves as major philanthropists in their markets. They have to: Technically they’re non-profit organizations. Nice work if you can get it.
Back in the 1990s, they tried something called managed care. The stated aim was to improve patients’ health, but the real object was to shift financial risk back onto the doctors. Before this, if a patient visited the doctor five times in a year. the insurance company would have to pay five times as much as if he only went once. So they came up with something they called capitation: They paid the doctor a certain amount per person per month, and that was it. The only other pay the doctor got was a small co-pay from the patient (they started at $2) whenever she came in. If a patient came in ten times a month, the doctor only got an extra $20. Sweet deal for the insurance companies.
They also instituted things like referrals, turning physicians into gatekeepers. They withheld part of the physician payments (called “withholds,” of all things) which the docs could earn back by not spending (technically by not authorizing spending) too much on labs and other testing, specialists, and hospitalizations. As a practical matter, money withheld was rarely seen.
This didn’t work. Well, it worked great for the insurance companies. Lots of people made boatloads of money. But doctors and patients hated it: so much so that it mostly disappeared. Mostly. There are still two huge capitated programs I’ve been with for twenty years now, and I can’t drop them because the companies’ standard contracts include something called “all products” clauses. I have to take the capitated plans to participate in the others. Also, I still have lots of long-term patients in those plans, and wouldn’t you know it: Referrals remain the bane of my existence.
GOP’s Obamacare fears come true
| |
| Liberals wanted a national enrollment system under Obamacare. They might just get it. Right now, 36 states rely on HealthCare.gov, the federal exchange, to enroll people in health coverage. At least two more states are opting in next year, with a few others likely to follow. Only two states are trying to get out. That’s precisely the opposite of the Affordable Care Act’s original intent: 50 exchanges run by 50 states. (Also on POLITICO: Steve Scalise to push GOP leaders on Obamacare alternative) The federal option was supposed to be a limited and temporary fallback. But a shift to a bigger, more permanent Washington-controlled system is instead underway — without preparation, funding or even public discussion about what a national exchange covering millions of Americans means for the future of U.S. health care. It’s coming about because intransigent Republicans shunned state exchanges, and ambitious Democrats bungled them. Republicans had warned all along that President Barack Obama’s health law would lead to greater Washington control. “This was all predictable,” said Rep. Tom Price (R-Ga.), a physician who sees growing federal control of the health system hurting patients. “Our friends on the other side didn’t listen.” Tevi Troy, a health expert who served in the George W. Bush administration and advised Mitt Romney in 2012, says the country needs to stop and discuss the consolidation. “We’re kind of, in a way, stumbling into this situation,” he said of the increasing reliance on the federal portal. HealthCare.gov is more than a computerized sign-up sheet. It’s a marketplace, where people get health coverage through private insurers, for care from private doctors. It’s not a single, nationalized Canadian- or British-style program. Even within the federal model, each state has its own insurance pool and state officials still regulate health plans. (Also on POLITICO: Nevada latest state to scrap its Obamacare exchange) The state-exchange option gave governors and legislatures more leeway to tailor the market to suit local conditions and demands. But the states encountered political and technical obstacles, leading to investigations, recriminations, disputes with contractors and hundreds of millions of wasted dollars. “While [the administration] spent an inordinate amount of time and energy and money encouraging states to run and own their own exchanges, I think that that has kind of shifted,” said Jon Kingsdale, a prominent consultant who helped build the original Massachusetts exchange under then-Gov. Romney. “How long can you push a boulder uphill?” HealthCare.gov was originally conceived as a just-in-case alternative that would kick in if a state could not or would not build its own health reform enrollment system. The law didn’t even set aside money to build the federal site, let alone operate it indefinitely. Even when red states shunned a role in running Obamacare and a handful of blue states also turned to Washington, the federal system was still seen as a short-term bridge to a state-based system. |
Chilling Documentary Looks At The Deadly Consequences Of Denying Medicaid Coverage
Emily was diagnosed with breast cancer just five months after she was laid off from her job as a software developer, right in the middle of the economic downturn in 2009. After her tumor was removed, she couldn’t afford to keep paying for insurance coverage, so she skipped out on chemotherapy and radiation. The cancer came back. Emily is now dead.
Emily’s primary care doctor says her story may have ended differently if she had been able to access coverage under Obamacare’s optional Medicaid expansion. But she lives in Utah, where lawmakers have resisted implementing that policy, despite the fact that it’s a central tenet of the health reform law.
That’s just one of the stories featured in a new documentary, “Entitled to Life,” that’s attempting to put a personal face on the politically contentious issue of Medicaid expansion. Like more than 20 other states across the country, Utah hasn’t yet agreed to accept generous federal funds to extend public insurance to additional low-income residents who don’t currently qualify for Medicaid. “Entitled to Life” makes the case that thehuman cost is too great to continue resisting this Obamacare provision.
Emily was diagnosed with breast cancer just five months after she was laid off from her job as a software developer, right in the middle of the economic downturn in 2009. After her tumor was removed, she couldn’t afford to keep paying for insurance coverage, so she skipped out on chemotherapy and radiation. The cancer came back. Emily is now dead.
Emily’s primary care doctor says her story may have ended differently if she had been able to access coverage under Obamacare’s optional Medicaid expansion. But she lives in Utah, where lawmakers have resisted implementing that policy, despite the fact that it’s a central tenet of the health reform law.
That’s just one of the stories featured in a new documentary, “Entitled to Life,” that’s attempting to put a personal face on the politically contentious issue of Medicaid expansion. Like more than 20 other states across the country, Utah hasn’t yet agreed to accept generous federal funds to extend public insurance to additional low-income residents who don’t currently qualify for Medicaid. “Entitled to Life” makes the case that thehuman cost is too great to continue resisting this Obamacare provision.
|
No comments:
Post a Comment