The Medicare Miracle
by Paul Krugman
So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate.
The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue.
But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
This is a really big deal, in at least three ways.
First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these days, projections of federal debt as a percentage of G.D.P. show it creeping up rather than soaring. We’ll probably have to raise more revenue eventually, but the long-term fiscal gap now looks much more manageable than the deficit scolds would have you believe.
When something medically goes wrong
By Liz Kowalczyk
| GLOBE STAFF SEPTEMBER 01, 2014
Each year in Massachusetts hospitals, hundreds of patients are injured because of serious medical errors and other safety problems. Some die as a result of these mishaps.
Earlier this month, the state Department of Public Health published its latest tally of serious reportable events: 753 in 2013. That’s a 70 percent jump over the prior year, when acute-care hospitals reported 444 incidents. While health officials attribute the rise to more complete reporting by hospitals — rather than to deteriorating conditions — it’s clear that safety problems are prevalent.
Patients who are harmed and their families are entitled to information about the incident under state regulations. Some hospitals are going further by improving communication with all patients who experience something unexpected in the hospital, and by compensating those who are seriously injured before a lawsuit is filed.
Here is what to expect, and what to ask for, if you experience a medical error in a Massachusetts hospital.
What is a “serious reportable event?”
Report: Health Law Ups Taxes On Insurers With Big Pay Packages
August 27th, 2014, 6:47 AM
While average compensation for top health insurance executives hit $5.4 million each last year, a little-noticed provision in the federal health law sharply reduced insurers’ ability to shield much of that pay from corporate taxes, says a report out today.
As a result, insurers owed at least $72 million more to the U.S. Treasury last year, said the Institute for Policy Studies, a liberal think tank in Washington D.C.
Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans, finding they earned a combined $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as a business expense, estimates the report. Before the health law, 96 percent would have been deductible.
UnitedHealth Group, which paid CEO and President Stephen Hemsley about $28 million in pay and stock options in 2013, had the biggest tax bill among the 10 companies, the report found. Hemsley’s compensation accounted for nearly $6 million of the firm’s estimated $19 million in taxes that the report says it owed on pay packages for five executives under the health law.
“They’re paying more in taxes just to protect these pay packages,” said Sarah Anderson, global economy project director at the institute.
The insurers’ lobby opposed the provision, saying deductibility rules should be consistent across all industries.
“Requiring plans to pay higher taxes does nothing to make coverage more affordable or accessible,” said Brendan Buck, spokesman for the trade group, America’s Health Insurance Plans, which had not seen the report.
Cholesterol Drug Halves Heart Attack and Stroke in Early Test
BARCELONA — An experimental cholesterol-lowering drug fromSanofi and Regeneron Pharmaceuticals cut roughly in half the number of heart attacks and strokes in a clinical trial, researchers reported on Sunday.
The result is not conclusive, because the analysis was done retrospectively, but the study provides the first evidence that targeting a protein known as PCSK9 could reduce cardiovascular risks for millions of patients.
The drug, alirocumab, is from a new class of medicines, which are also being developed by Amgen and Pfizer. They lower LDL, the so-called bad cholesterol, in a new way and are expected to reap multibillion-dollar sales.
The finding is likely to spur enthusiasm about the drugs, which could reach the market next year, although specialists said it remained subject to confirmation in a much larger trial.
Sanofi and Regeneron said in July that nine studies had shown consistent LDL reductions with alirocumab, which is injectable. But details from four of those trials have only now been reported at the European Society of Cardiology’s annual meeting in Barcelona.
The encouraging cardiovascular findings came from an interim safety analysis of one of these studies showing patients on alirocumab were less prone to a combination of cardiovascular events, including cardiac death, heart attack, stroke and chest pain requiring hospitalization.
Both groups of patients received conventional anti-cholesterol statin pills in addition to alirocumab or a placebo. Among the alirocumab group, 1.4 percent of patients suffered a major cardiovascular event compared with 3.0 percent of those in the placebo group.
The 2,341-patient study, called Odyssey Long Term, is expected to conclude early next year, but researchers said the early sign of effectiveness was clearly positive.
“To have this result emerge so quickly in this study is very encouraging,” said Dr. Jennifer Robinson, a cardiologist at the University of Iowa, who led the study.
No other drug maker has previously released data suggesting reduced cardiovascular risk from PCSK9 inhibitors.
Dr. Patrick T. O’Gara of the Brigham and Women’s Hospital in Boston and president of the American College of Cardiology said that the finding was “biologically plausible,” but that the retrospective nature of the analysis necessitated caution.
“It’s so much wished-for that we must be careful,” he said.
Baby’s Drug Co-Pay Jumps, and a Health Reporter Is Stumped
Charles Ornstein
It’s not easy being an educated health care consumer.
I was reminded of this when I went to refill a prescription this month for an asthma and allergy medication for my 9-month-old son, Holden.
The first time I filled his prescription for Montelukast granules — the generic version of Singulair from Merck — my insurance co-payment was $15. A month later, the co-payment had risen to $30 (and my insurance was paying $85.94, rather than $118.53).
Why? My insurance coverage hadn’t changed. My son’s prescription hadn’t changed. Our pharmacy was the same. Why was I now asked to pay twice as much out of pocket?
I asked the CVS pharmacist. This happens all the time, she replied. Call the insurance company to find out why.
Consumers are navigating a health care system in which they pay an increasing share of the cost but often have insufficient information to make the right decisions. They assume that pharmacies are charging them the right co-payments, that insurance companies are paying the correct share. But as health plans’ rules for prescription drugs become more complicated, it’s harder to tell.
It used to be that generic drugs had one common co-pay and name-brand drugs another. But that’s not always the case anymore, as with my plan. Some generic drugs are expensive, and consumers sometimes pay a higher share of their cost, more akin to what they would pay for a name brand.
Pam, the first customer service agent with whom I spoke at my insurer,Oxford Health Plans, a division of UnitedHealthcare, told me that it looked as if there was a mistake with the refill, and that I was entitled to a $15 refund. She gave me a tracking number and told me to call back in two to five business days.
Dutifully, I did so, and talked to another agent, named Mike. He told me that there had been a mistake, but that it was with the first prescription. The co-pay should have been $30, not $15, but as a courtesy because of its error, the plan would not seek to recoup the money. The baby’s prescription was on a higher-cost tier because it was for granules of the drug, essentially a powdered version, and not for tablets, which are in the lowest-cost tier.
But a look at Oxford’s website and at its drug list, also known as a formulary, revealed that Montelukast is listed as a Tier 1 drug, with the lowest cost. No distinction is made between tablets and powder.
Insurance plans with multiple cost tiers have become more prevalent in recent years, as prescription drug costs have increased over all. In 2000, nearly half of workers with private insurance had two price categories — typically, one for generics, the other for name-brand drugs, according to a survey by the Henry J. Kaiser Family Foundation and the Health Research & Educational Trust. An additional 22 percent of covered workers paid the same price for all drugs.
By 2013, though, such arrangements had practically disappeared. More than eight in 10 workers had private insurance plans with three or more tiers of drug prices.
But my co-payments may not be the same as yours. Each insurance company — and employer — sets its own list of approved drugs and out-of-pocket costs. Some are fixed amounts and others are percentages of a drug’s cost, sometimes called coinsurance. Medicare prescription drug plans also have their own rules.
Operator? Business, Insurer Take On End-of-Life Issues By Phone
TOPICS: INSURANCE, DELIVERY OF CARE
By ELANA GORDON, WHYY
AUG 27, 2014
This story is part of a partnership that includes WHYY's Newsworks, NPR and Kaiser Health News. It can be republished for free. (details)
Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings.
"My name is Kate. I'm a health care counselor," the gentle voice says from her cubicle in Cherry Hill, N.J..
This is no telemarketing call … it’s about the end of your life.
Kate Schleicher, 27, is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she knows your phone number, your insurance provider and that you are pretty sick.
Schleicher is one of 50 social workers at a company called Vital Decisions. After sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as “nondirected” end-of-life counseling. The company gave a reporter permission to listen to and record the social workers' side of some of these calls.
"When you say that getting better is the most important thing on your mind, what does that look like for you?" Schleicher asks a man in Rhode Island.
"Breathing. Ok," she repeats back, as he describes what a struggle it has become for him. "I also hear concern from you that I don't think that's necessarily going to happen," Schleicher continues. "Has someone told you that, or is that your own feeling?"
The call lasts about 15 minutes. Schleicher asks if it's ok to follow up, in a month or so. The hope of this program, she says, is to build a relationship over the phone, so he might be comfortable discussing his situation and his goals. Then he’ll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It’s paid for by insurers and federal privacy rules permit this for business purposes.
An Often-Avoided Topic
CEO Mitchell Daitz believes critical conversations about end-of-life care just aren't happening enough and the company's goal is to foster them.
"The accepted norm in terms of the role of the individual who's going through this advanced illness experience is to be passive and be along for the ride, not to take charge, not to take control and ask for help," says Daitz, adding that navigating care and an individual's priorities can become increasingly difficult as a disease progresses. "So when you're faced with a set of choices, that none of which represent a really good choice, you become ambivalent."
Spending on health care rises in Mass.
Agency ties increase to outlays by giants Blue Cross, Partners
By Priyanka Dayal McCluskey
| GLOBE STAFF SEPTEMBER 02, 2014
Spending at Massachusetts’ biggest health insurer and health care provider helped drive overall health care spending well above inflation last year, as the state’s efforts to control rising costs met mixed success, according to a report to be released Tuesday.
Spending at Blue Cross Blue Shield of Massachusetts jumped 3.65 percent, and as much as 4 percent for some Partners HealthCare patients last year, compared with an inflation rate of 1.4 percent in the Boston metropolitan area. Overall health care spending grew 2.3 percent, according to the report from the Center for Health Information and Analysis, a state agency.
“The biggest insurer, the biggest provider — that’s where there’s continued cost growth,” said Aron Boros, executive director of the Center for Health Information and Analysis. “You could almost say as goes Partners and Blue Cross Blue Shield, so goes Massachusetts.”
Partners and Blue Cross called the state’s calculations inaccurate.
Sharon Torgerson, a spokeswoman for Blue Cross, said the insurer’s figures show spending grew 2.1 percent, more moderately than the report estimates. “Our highest priority is making quality health care affordable,” she said.
Partners spokesman Rich Copp said costs grew faster than expected in 2013, but that over time Partners will reduce costs by delivering more coordinated care in lower-cost community settings instead of its big academic hospitals, Massachusetts General and Brigham & Women’s. Partners is trying to acquire community hospitals north and south of Boston.
“Slowing the trend of health care cost growth is a long-term effort, and it’s difficult to measure in a simple one-year snapshot,” Copp said.
This is the first time that Massachusetts has calculated the growth of spending throughout the health care system, including the private insurance market; Medicare, the insurance program for the elderly; and Medicaid, government insurance for the poor. The annual estimates are an outgrowth of the state’s landmark health care reforms, which sought first to expand insurance coverage and later to control costs — among the highest in the nation.
A Call for a Low-Carb Diet
People who avoid carbohydrates and eat more fat, even saturated fat,lose more body fat and have fewer cardiovascular risks than people who follow the low-fat diet that health authorities have favored for decades, a major new study shows.
The findings are unlikely to be the final salvo in what has been a long and often contentious debate about what foods are best to eat for weight loss and overall health. The notion that dietary fat is harmful, particularly saturated fat, arose decades ago from comparisons of disease rates among large national populations.
But more recent clinical studies in which individuals and their diets were assessed over time have produced a more complex picture. Some have provided strong evidence that people can sharply reduce their heart disease risk by eating fewer carbohydrates and more dietary fat, with the exception of trans fats. The new findings suggest that this strategy more effectively reduces body fat and also lowers overall weight.
The new study was financed by the National Institutes of Health and published in the Annals of Internal Medicine. It included a racially diverse group of 150 men and women — a rarity in clinical nutrition studies — who were assigned to follow diets for one year that limited either the amount of carbs or fat that they could eat, but not overall calories.
No comments:
Post a Comment