Diagnosis: Insufficient Outrage
By H. GILBERT WELCH
HANOVER, N.H. — RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?
I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.
Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.
A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran acover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.
Of course, Medicare will have none of this — it sets its own prices. And private insurers negotiate discounts. So no one is actually charged these amounts.
Check that. The uninsured are. They are largely young and employed (albeit poorly) and have little education. So the biggest medical bills go to those least able to pay.
At what point does it become a crime?
Administration Delays the Employer Mandate––But What About Small Employers?
The administration suddenly announced tonight that the requirement that all employers with 50 or more workers offer health insurance has been delayed until 2015.If an employer with 50 or more workers did not provide health insurance to their full time workers in 2014, they would have been subject to a fine of $2,000 per worker. The employer would have also been subject to a $3,000 fine for each worker that went to the insurance exchanges if the employer package was not affordable.
Why did the administration delay the large employer mandate?
Because many employers have been in the early stages of planning to cut back the hours of workers in order to avoid having to offer insurance to those customarily considered part time, those who work at least the 30 hours per week the law established for defining a full time worker––and they haven't been bashful in telling their employees why. In addition, there has been growing evidence that some employers were holding back on hiring in order to avoid more of the mandate costs at a time of high unemployment.
While the administration cited employer administration issues with mandate reporting as the reason for the delay, the bottom line is that the Affordable Care Act ("Obamacare") was looking like it was about to be successfully labeled a job killer and the administration wanted to avoid that.
http://healthpolicyandmarket.blogspot.com/2013/07/administration-delays-employer.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29
Letting Employers Off the Hook, for Now
By THE EDITORIAL BOARD
The Obama administration made a reasonable decision this week to give employers another year before they will be required to make available affordable insurance to their workers or pay a fine. Republicans are portraying the decision as evidence that the whole health care reform is headed for a train wreck, but it actually affects only a narrow slice of companies and workers. It should have no bearing on whether the core provisions of the Affordable Care Act — notably the opening of health care exchanges and subsidized coverage for people on modest incomes — take effect on Jan. 1, 2014, as scheduled.
A vast majority of workers will be unaffected by the delay, and some of those whose companies are given a one-year reprieve may well be better off buying subsidized insurance on their own.
The act requires employers with more than 50 full-time workers to offer affordable health insurance starting next year or face fines of $2,000 to $3,000 per employee — the “employer mandate.” Actually, the majority of the millions of companies in the United States have fewer than 50 employees; they are not required to offer health insurance but many are eligible for federal subsidies if they wish to do so. Most companies with more than 50 employees already provide affordable insurance.
Of some 230,000 firms that had 50 or more workers last year, the Kaiser Family Foundation estimates that about 11,500 did not offer health insurance. They employed roughly 1.4 million workers, about 1.6 percent of the more than 89 million workers at those companies.
Those workers will not be left in the lurch. Most will be able to buy policies on the health care exchanges that will open on January 1, 2014. Those on modest incomes (less than $88,000 a year for a family of four) will be eligible for federal subsidies on a sliding income scale. Many workers could conceivably obtain better coverage that way than from a parsimonious employer who might offer a plan but refuse to help employees pay for it.
There is a downside to the delay. It provides Republican critics with ammunition to portray the heath care reforms as a failure and could encourage other companies to demand exemptions from rules they don’t like. But a year’s delay will allow both employers and the Internal Revenue Service to figure out how this mandate will work. It is more important to do this right than to do it quickly.
Delay of employer mandate in health-care law heightens stakes for Obama administration
By Dan Balz, Published: July 3 E-mail the writer
That question has been at the heart of the debate over the law from its outset, coloring the long and contentious discussions that preceded its congressional passage along partisan lines in 2010, and following it every step of the way as the administration has begun to put its pieces into place.
President Obama long has argued that debates over the size and scope of government — of which health care has become the most important example — should not be seen as a question of bigger government vs. smaller government, but rather whether proponents of activist government are able to demonstrate that the federal government can be both smart and effective.
CT Scan May Be Too Good at Finding Lung Problems, Study Finds
By NICHOLAS BAKALAR
CT imaging is a very good way to find pulmonary embolisms — sudden blockages of an artery in the lung, which can be fatal if not treated quickly. But a new analysis finds that the procedure might be too good, revealing tiny embolisms that are harmless and leading to treatments that are unnecessary, expensive and potentially dangerous.
Until the introduction of CT angiography in 1998, the primary test for pulmonary embolism was ventilation/perfusion scanning, in which inhaled or injected radioisotopes are used to create an image of air and blood flow in the lungs. The small amount of radiation involved little risk for most people.
But when CT angiography was introduced, doctors enthusiastically adopted it. It is now widely used instead of ventilation/perfusion and often employed to find the causes of various other lung disorders.
Its versatility is only one reason for its popularity. Missing a pulmonary embolism can be a fatal mistake that doctors obviously want to avoid. A CT scan can reassure them and protect against claims of malpractice. Medical device manufacturers enthusiastically advertise and sell the scanners to hospitals and sponsor public “awareness campaigns” to encourage patients to ask for scans.
Hospitals like the devices because having the most advanced scanner helps confirm a reputation for technical sophistication. CT scanning devices are expensive, and when a hospital buys one, officials want to use the machine as often as possible to justify the investment.
“There’s a lot pressure to order the most advanced tests, no matter how small the problem,” said the lead author of the new analysis, Dr. Renda Soylemez Wiener, an assistant professor of medicine at Boston University. “We want to raise awareness that this kind of diagnosis of clinically insignificant embolisms can occur.”
Dr. Daniel Cornfeld, an associate professor of radiology at Yale who was not involved in the new report, agreed. “We sometimes find small pulmonary embolisms in a very distant vessel,” he said. “Oftentimes, I’ll tell them on the phone that it’s probably not significant. This sort of discussion probably happens very frequently, but I don’t make it part of the report. But maybe that makes me part of the problem.”
Keeping Cancer a Secret
By MIKKAEL A. SEKERES, M.D.
My patient came to see me every six months or so with his wife of 40 years, making the five-hour drive from West Virginia, where he managed a few businesses. He had myelodysplastic syndrome, a type of bone marrow cancer that in his case was indolent, requiring only regular shots with a hormone, but no chemotherapy – yet.
While his blood counts were not normal, they were what I used to jokingly call “good enough for government work,” until another patient of mine, who was a postal worker, reminded me that not everyone found that comment funny.
This was a routine checkup, and I always looked forward to seeing him and his wife. When I walked into the exam room, they were sitting quietly next to each other, with books open, members of the cadre of patients and family members I referred to as my “intellectuals.” They both beamed when I entered, like old friends.
“It’s good to see you,” I said, and I meant it.
“It’s good to be seen!” he joked.
We reviewed his blood counts, which were stable, and he had not required any blood or platelet transfusions since I had last seen him.
“I think we achieved our goal of wasting your time again,” I teased him. “Any plans for July Fourth?”
“We’re having the kids and grandkids over for a few days,” he answered.
“How are they dealing with your diagnosis?” I asked.
He shifted in his seat and looked over toward his wife. “We haven’t told them about it yet,” she said.
I was surprised. My patient had been dealing with this serious medical condition for a couple of years, and he was usually so pragmatic in how he managed all aspects of his life. Not telling his children was more than just an oversight. I asked him why.
“Our son has been away, doing a couple of tours of duty in Afghanistan,” he said. “We were going to tell our daughter, but. …” He paused, trying to find the right words. “It wouldn’t be fair, for her to know, to have this burden, and not him. We were planning on telling them when we’re together over the holiday.”
He seemed uncomfortable talking about it, as if their family members didn’t keep a lot of secrets from one another. His illness was a biggie, because his condition could deteriorate at any time. I worried about his support network.
With 42 percent of Americans unaware Obamacare is law, states have informing to do
A patient waits in the hallway for a room to open up in the emergency room at Ben Taub General Hospital in Houston, Texas, in this July 27, 2009 file photo. Most Republicans oppose Obama's Patient Protection and Affordable Care Act as a costly, ineffective and unnecessary expansion of government. But some Republican governors, like Arizona's Jan Brewer and Michigan's Rick Snyder, have broken ranks to embrace the law's Medicaid expansion as a practical way to help the poor while infusing their state budgets with billions of dollars in federal funding to pay for it.
In addition to the governor and legislative Republicans blocking Medicaid expansion, Maine has another health care problem: People don’t know much about the Affordable Care Act, which aims to extend health care coverage to everyone. It will be important for potential new enrollees to know details, such as which insurers will be available when they choose a required health insurance plan.
According to a Kaiser Family Foundation poll released in April, 42 percent of Americans are unaware the ACA is the law. About half of Americans say they don’t have enough information to understand how the ACA will impact their family; that sentiment increases among the uninsured and low-income adults.
National Health Plans, Designed To Spur Competition, May Be Unavailable In Some States Next Year - Kaiser Health News
National health insurance plans aimed at giving consumers more choice might be unavailable in some states next year, leaving residents with fewer options and potentially higher premiums.Such “multi-state” plans were included in the federal health law to boost competition among insurers, particularly in states with few carriers. They were also seen as a consolation to supporters of the failed effort to require a government-run “public option.”
Debate continues about whether the plans would fulfill those aims, but the bigger question now is which states will have them in October, when new online marketplaces begin selling insurance to individuals and offering federal tax credits to help cover the cost of premiums to those who qualify.
The law requires at least two national plans in every state within four years, overseen by the federal Office of Personnel Management (OPM), which will negotiate rates and contracts. The law says at least one of the multi-state insurers must be a nonprofit, and at least one must not offer abortion services.
http://www.kaiserhealthnews.org/Stories/2013/July/05/multistate-national-health-insurance-plans-exchange-marketplace.aspx
FAQ: What Workers And Employers Need To Know About The Postponed Employer Mandate
Surprising both friends and foes of the health law, the Obama administration on Tuesday announced the delay of a key provision: the requirement that all but the smallest employers offer medical coverage or pay a fine.Companies with at least 50 workers now have until 2015 to provide coverage if they don’t offer it already, giving them and Washington an extra year to work through the complex details of the legislation. The administration will deliver more guidance next week.
Meanwhile other parts of the law remain on track for implementation next year, according to officials. Here’s what the change means — and doesn’t mean — for workers and employers.
Q. The government has delayed the requirement for large employers to offer health plans. Am I still obligated to obtain coverage next year?
White House greases squeaky wheels on Obamacare
| |||||
| The delay of Obamacare’s employer coverage rules is giving the critics plenty of new ammunition — but that doesn’t mean the sudden movement is out of character for the administration at all. It’s just the latest example of a pattern with the implementation of Obamacare: The Obama administration almost always listens to the squeaky wheel. First more than 1,200 employers and health plans got waivers from early coverage rules. Next, many states that couldn’t decide whether to build a health insurance exchange or let the feds do it for them were given repeated extensions. And then, when Republican governors were holding out on expanding Medicaid, they were finally told there’s no deadline at all. (Also on POLITICO: The politics of the Obamacare delay) So when the Obama administration announced Tuesday that it would delay the Affordable Care Act’s insurance mandate for employers for a year, it was just one more piece of evidence that the administration is perfectly willing to bend the rules for some powerful interests — a a welcome invitation for other players to raise their hands in the coming months as the law heads into overdrive. Already, other groups are grumbling at the decision. It’s not going over so well with hospitals, for example, who are worried that the delay means they won’t have as many newly insured patients as they’d expected. On Wednesday, Rich Umbdenstock, president and CEO of the American Hospital Association, said the delay is “troubling for those individuals who will not gain coverage through their employer. … We are concerned that the delay further erodes the coverage that was envisioned as part of the ACA.” (Also on POLITICO: GOP gloats over Obamacare delay) http://dyn.politico.com/printstory.cfm?uuid=4BE5462C-BB13-420A-BE3D-710BC8C59C3C
|
No comments:
Post a Comment