When Hospitals Buy Doctors’ Offices, and Patient Fees Soar
Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.
Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill.
Patients around the country are getting that unpleasant surprise, as more and more doctors’ offices are being bought by hospitals. Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.
This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.
In the dry language of the annual budget, the White House asks Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” In normal English, that means reducing financial incentives that are causing many doctors to sell their practices to hospitals just to take advantage of extra revenue.
The heart doctors are a great example. In 2009, the federal government cut back on what it paid to cardiologists in private practice who offered certain tests to their patients. Medicare determined that the tests, which made up about 30 percent of a typical cardiologist’s revenue, cost more than was justified, and there was evidence that some doctors were overusing them. Suddenly, Medicare paid about a third less than it had before.
But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.
Physician calls for single-payer health care system in NH
By GARRY RAYNO
Pushed by Granite State Physicians for a National Health Program, House Bill 686 would provide health care to all the state’s residents who fill out an application form while doing away with private carriers.
But opponents said the bill would double the state’s budget, raise taxes and cripple key industries in the state.
But the bill’s prime sponsor said it is an opportunity for the state to control costs and provide health care for all its citizens.
Under the bill, every New Hampshire citizen would be eligible for health care after filling out an application. There would be no co-pays nor deductibles.
Canada Court Strikes Down Ban on Aiding Patient Suicide
By IAN AUSTEN
FEBRUARY 6, 2015
OTTAWA — The Supreme Court of Canada on Friday struck down laws banning physician-assisted suicide for patients with “grievous and irremediable” medical conditions.
The unanimous decision, which reverses the position taken by the court 22 years ago, came more quickly than expected and might become an issue in federal elections to be held this year.
“The prohibition on physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice,” the court wrote, adding that an absolute ban was not needed to ensure that vulnerable people are not coerced “to commit suicide at a time of weakness.”
The decision, which follows hearings last fall, comes at a time when Canadians are widely debating assisted dying. In June, Quebec passed legislation that would allow the practice starting at the end of this year. Until the Supreme Court ruling on Friday, that legislation seemed likely to be overturned under federal criminal law.
Then, in August, the Canadian Medical Association altered its long-established opposition to doctors’ assisting in suicides. Its new policy allows physicians, within the bounds of laws, “to follow their conscience when deciding whether to provide medical aid in dying.” But some churches and some groups that advocate on behalf of disabled people urged the court not to revoke the law.
The decision, which follows hearings last fall, comes at a time when Canadians are widely debating assisted dying. In June, Quebec passed legislation that would allow the practice starting at the end of this year. Until the Supreme Court ruling on Friday, that legislation seemed likely to be overturned under federal criminal law.
Then, in August, the Canadian Medical Association altered its long-established opposition to doctors’ assisting in suicides. Its new policy allows physicians, within the bounds of laws, “to follow their conscience when deciding whether to provide medical aid in dying.” But some churches and some groups that advocate on behalf of disabled people urged the court not to revoke the law.
Republicans cut and pasted their ‘new’ Obamacare alternative
Congressional Republicans took a novel approach to announcing their Obamacare alternative this week: out with the old and… well, back in with the old.
On Thursday, the Senate Finance Committee put out a news release announcing “Burr, Hatch, Upton Unveil Obamacare Replacement Plan.”The three men, Senate Finance Committee Chairman Orrin Hatch (Utah), House Energy and Commerce Committee Chairman Fred Upton (Mich.) and Sen. Richard Burr (N.C.), are well-regarded legislators, and the press went along with this “news.”
“GOP unveils new Obamacare alternative,”proclaimed The Hill newspaper.
“Take a look at the first real Republican ‘Obamacare’ alternative,” suggested The Examiner.
Robert Pear of The New York Times reported that the plan was “drafted with encouragement from Republican leaders,” “devised” by Hatch, Burr and Upton, and included a “potentially explosive proposal.” Pear reported that “Republicans said the need for such an alternative had become more urgent.”
But Caroline Behringer, the eagle-eyed press secretary for Democrats on the House Ways & Means committee, was suspicious that this “urgent” and “explosive” new proposal had just been “devised.” So she did some sleuthing and discovered that the Republicans had lifted the thing — right down to quotes in the news release — from the rollout of the same proposal a year earlier.
This “new” plan in fact had something old, something borrowed and something blue: a two-page explainer borrowing virtually the same 700 words from the 2014 version and even set in the same robin’s-egg blue font. The only thing that appeared to be new was the name of Upton, substituted for that of Sen. Tom Coburn (Okla.), who “unveiled” the plan with Hatch and Burr in 2014 but has since retired.
The nine bullet points were identical, as was the description of the Patient Choice, Affordability, Responsibility and Empowerment (CARE) Act as “a legislative plan that repeals Obamacare and replaces it with common-sense, patient-focused reforms that reduce health care costs and increase access to affordable, high-quality care.” The first 359 words of the news release were the same as those in the previous year’s model, with the exception of Upton’s quote. Burr’s quote (“The American people have found out what is in Obamacare --- broken promises…”) remained the same.
Rep. Poliquin Brushes Off Criticism for Health Care Vote
By Alanna Durkin, The Associated Press
PORTLAND, Maine - U.S. Rep. Bruce Poliquin is brushing off criticism he's getting from some conservatives for not voting to repeal President Barack Obama's health care law.
Poliquin was one of three Republicans in the House to vote this week against repealing the law. The freshman congressman says he opposes it but believes a replacement plan needs to be in place first.
After the vote, the National Board of the libertarian-leaning Republican Liberty Caucus voted Thursday to rescind its endorsement of the congressman. The chair of the caucus said the group was "stunned and disappointed'' and no longer stands by him.
Poliquin said Friday that he's not in Washington "to grandstand,'' but to fix problems. He said the House has already voted to repeal the law several times without success.
About that Bruce Poliquin Obamacare vote
by Matthew Gagnon
Let’s start with a pretty simple premise: the system that existed prior to the Affordable Care Act (Obamacare) was not — repeat not — a free market system.
This is an important concept to grasp, because there is an increasingly prevalent notion among conservatives that “we need to repeal Obamacare so the free market can do its job again.” Boy is it wrong.
More on that in a moment.
For six years now, Bruce Poliquin has been a loud and frequent critic of the ACA, which makes his vote on Tuesday against repealing it curious to many.
As he ran for office this past fall, he made clear that he opposes the president’s health care initiative. On his campaign website, Poliquin went into great detail about his priorities on health care.
In it, he said as far back as last winter, “In Congress, I’ll fight […] to end the expensive, intrusive, and unfair government take-over of our health care. I’ll work tirelessly for a free market solution to help our 2nd District families buy affordable health insurance[.]”
What’s the politics of Poliquin’s vote against repealing Obamacare?
by Amy Fried
I was surprised and pleased that newly elected Republican Congressman Bruce Poliquin was one of three Republicans to vote against repealing the Affordable Care Act.
Pleased, because while the ACA is imperfect, it is doing real good by lowering the number of people without health coverage while holding down premiums and costing less than initially predicted. Surprised, because Poliquin had talked about repealing and replacing it.
During the election, Poliquin’s campaign webpage on health care started with these words in bold:
End Obamacare and Replace with Free Market Solution to Improve Health Care
Poliquin’s website then went on list the standard set of Republican points like selling insurance across state lines and broadening health savings accounts and repealing the medical equipment tax.
Those clearly wouldn’t cover as many people as the ACA. In addition, the ACA’s insurance marketplaces with subsidies were conceived by conservatives and adopted by then-Gov. Romney as a free market solution.
In explaining his vote, Poliquin issued a statement saying he opposed Obamacare but did not want to leave tens of thousands of Mainers in the lurch, without health coverage. He would vote to repeal the law once there was an alternative that would allow continuity of coverage.
What’s the politics of this decision?
Universal Healthcare Advocates Renew Push Toward Medicare-For-All
U.S. Rep. John Conyers says: 'I believe that a single-payer, universal healthcare system is the only way we can truly reshape our broken system'
Single-payer advocates are celebrating the reintroduction of the so-called 'Medicare-for-All' bill that would replace the nation's byzantine healthcare system, dominated by private health insurance companies, with a single, streamlined public agency that would pay all medical claims for the entire population, much like Medicare does for seniors today.
Lead sponsor Rep. John Conyers Jr. (D-Mich) put forth the "Expanded and Improved Medicare for All Act" (H.R. 676) on Tuesday evening, along with 44 other House members. The legislation would create a publicly financed, privately delivered health care system that expands the already existing Medicare program to all U.S. residents and all residents living in U.S. territories. The bill has been defeated in three previous House sessions.
Proponents say the approach would vastly simplify how the nation pays for care, improve patient health, restore free choice of physician, eliminate co-pays and deductibles, and yield substantial savings for individuals, families, and the national economy.
At his website, Conyers says: "I believe that a single-payer, universal healthcare system is the only way we can truly reshape our broken healthcare system."
Dr. Robert Zarr, president of Physicians for a National Health Program, a non-profit research and educational group of 19,000 doctors nationwide that supports Conyers's bill, echoed that claim.
"The global evidence is very clear: single-payer financing systems are the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care," Zarr said. "Medicare is a good model to build on, and what better way to observe Medicare's 50th anniversary year than to improve and extend the program and its benefits to people of all ages?"
The Medicare-for-All bill would be an improvement on the Affordable Care Act, Zarr continued:
[T]he enactment of Rep. Conyers' bill would take us much further down the road to a humane, just and sustainable health care system than the 2010 health law, which, despite its modest benefits, will not be able to control costs and will still leave 31 million people uninsured in 2024, according to the Congressional Budget Office. Millions more will be inadequately insured, with skimpy coverage.As a doctor who sees the children of hard-pressed parents every day, I can tell you that the need for fundamental health care reform has never been greater. It's time to stop putting the interests of private insurance companies and Big Pharma over patient needs. It’s time to adopt a single-payer, improved-Medicare-for-all program in the United States.
Last month, Common Dreams reported that just over 50 percent of Americans—and more than 80 percent of Democrats—say they still support the idea of single-payer healthcare, according to a poll by the Progressive Change Institute.
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