Pieces of the health care portion of the Obama budget are leaking out.
Based upon published reports, the Obama “down payment on health care reform” will include:
- $634 billion to help pay for health care reform over the next ten years.
- $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.
- Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.
- Cutting Medicare HMO payments by $175 billion over ten years.
- Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.
- Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.
- Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.
The biggest spending reduction is the cut to Medicare HMO payments. This one is hardly a risky political move as everyone has expected it. That said, in no event would they
get the full $175 billion in savings because it is simply impractical
to implement such a major change in the Medicare Advantage program by
the next enrollment season which begins late this fall.
Interestingly, the Obama budget reportedly calls for creating a system where the private Medicare plans will bid market to market
to compete with the traditional Medicare plan rather than continuing
the current system where the government tries to set the rates for them.
Ironically, that was the original Republican idea for using the competitive value of managed care to reduce long-term Medicare costs
and is what should have happened in the first place rather than this
temporary system of overpayments the HMO industry has been fighting to
keep permanent.
With $318
billion in tax increases and another $175 billion in Medicare HMO cuts,
the $634 billion "down payment" only contemplates a total of another
$141 billion in federal health care cuts <>over ten years (which amounts to about 1% of annual federal spending each year).
That is hardly a rounding error on a federal health care budget that
CMS just announced will already total $1.19 trillion in just 2009.
This week, CMS estimated that at present trends annual national health care spending would reach $4.35 trillion or 20% of GDP by 2018.
If
the Obama administration is serious about not “kicking the can further
down the road” then any overhaul of our health care system has to do
more than fritter around the edges with spending reductions.
More,
it needs to be paid for from real savings—not half of the "down
payment" coming from tax increases as they are reportedly proposing.
If
the plan is to raise taxes to pay for a big part of health reform that
just means they better raise enough taxes to pay for the $4 trillion
health care system CMS says we are going to have in 2018.
As
the budget details come out over the next few days the question we all
need to be asking is, Just what is this administration willing to do to
make health care affordable over the next ten years?Affordability
will have a lot more to do with the how this administration deals with
the $2.5 trillion we already spend every year not whose taxes we can
raise.
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.
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I see the Obama plan is more realistic in trying to reform health care than your previous article “For the Obama Administration Health Care Reform Will Require Tough Cost Containment”. It is not possible to move a large mountain appreciably over a short period of time.
Do you want a for-profit business making decisions about your health care?
For-profit health care insurers can deny doctor recommended treatments based on their bottom line and sometimes people die.
But the CEOs still get their bonus at the end of the year.
The CBO scoring of the Medicare HMO/Advantage proposal doesn’t register savings until 2012, so I’m not sure the post’s pessimism re: the infeasibility of the policy is on target … it’ll take a few years to generate the new bidding process, but the numbers pile up in the outyears.
No help for uninsured/underinsured. Same as usual with still projected 20% GDP healthcare bill. Don’t call me Pres. Obama until you really have something worthwhile.
I say tax the rich for a while until we can really reduce costs long term in a more meaningful way.
This will require systemic changes that include-
- more primary care
- more home care
- more prevention (individual and institutional)
- more public health
- more ethical and compassionate rationing especially at the end of life
- more rigorous efficacy and safety standards
Then maybe we can achieve the holy grail of HEALTH CARE SYSTEM SUSTAINABILITY?
Dr. Rick Lippin
Southampton,Pa
On Tuesday night, February 24, President Obama announced that he was initiating a major healthcare reform and that portions of it are to be completed by the end of this year. As a healthcare consultant, I sincerely question what is going to be reformed when the Obama Administration does not have a cabinet member appointed over Health and Human Resources. In addition to having no leader in place, there are no committees in place and no corresponding Congressional committees in place; therefore, we must fear healthcare reform being conducted in a vacuum! Finally, I am the first person in line to suggest that we must address healthcare reform and its various components, but it is extremely terrifying to think that a few people who do not work and live in our industry are going to try to significantly affect it.
John O. Goodman, President
J O Goodman & Associates, Inc.
jgoodman@jogoodmanassociates.com
http://www.heartandvascularblog.com
Robert writes, ” . . . in no event would they get the full $175 billion in savings [from Medicare Advantage] because it is simply impractical to implement such a major change in the Medicare Advantage program by the next enrollment season which begins late this fall.”
According to the charts at the end of the budget message, the first cuts in MA ($11 billion) won’t come until FY 2012.
See what The Wall Street Journal had to say about the switch to electronic medical records here at http://blogs.wsj.com/american-journey/2009/02/26/how-doctors-will-use-their-stimulus-mone/
If the $634 Billion is any indication of Obama’s health care plan, Obama is planning a radical change in the health care system. The plan has not yet been laid out and already Obama is earmarking more than half a trillion for it and explaining that it will just be the beginning of what will be necessary.
One of the reasons that health care seems to be so expensive (among many others) is the cost of research and development in order to procure new treatments and drugs.
At the moment the health care industry has a significant incentive to pour money into research and development because of the possibility of making money. What will happen when this incentive is marginalized when the government has taken over the health care system? Will our advancements slow down or even cease?
http://www.weeklypoint.com/2009/02/26/obama-budget-plans-634-billion-down-payment-for-health-care-reform/
Dan,
This is an old canard, hopefully succesfully discredited at least among THCB readers. Promotional budgets are larger than R&D budgets … and don’t forget that R&D includes studies for new uses of established drugs, and development of the so called “me too” drugs (i.e. pharma comp. x wants a statin, or triptan, or whatever succesful class, “too”).
If the Obama admin. just offers a well run public plan (an improved medicare), it will, as B. Sagdiyev put it, “crush” all private competitors in open competition, except for some very well off who will insist on gold plated health care and choose commercial insurance since they are able and willing to pay the price.
Dan D – The stimulus included $10B for the NIH and upped the annual budget from $29B to $39B. That’s huge and the floor essentially for future NIH funding is now set at least $40B annually.
Robert wrote: “Affordability will have a lot more to do with the how this administration deals with the $2.5 trillion we already spend every year not whose taxes we can raise.”
I fully agree with you. But I don’t see how a significant change in the total spend is coming this year, or next. That will be the second wave of health care reform under Obama, probably in the second term.
Why isn’t anyone really looking at why our healthcare costs are so high?
Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-diminishing insurance denials.
HEALTH INSURANCE COMPANY PROFITS IN 2007:
1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
3. Aetna Inc. — $ 1.831 BILLION
4. CIGNA Corp — $ 1.115 BILLION
5. Humana Inc. — $ 834 million
6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
7. Health Net — $ 194 million
The huge insurance company profits—BILLIONS EACH YEAR—could provide quality healthcare for millions of people, and to pay physicians adequately for their work.
We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.
The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/
Congressman John Conyers has introduced HR 676, THE UNITED STATES NATIONAL HEALTH INSURANCE ACT, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services. Only a single-payer approach will end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor, and has resulted in 50 million Americans without healthcare.
HERE’S WHAT YOU CAN DO TO HELP:
E-mail, call or write to your Senators and Representatives and ask them to support HR 676 – SINGLE-PAYER healthcare reform. You’ll find easy contact information here: http://www.usa.gov/Contact/Elected.shtml
Don’t mistake health insurance for health care. Health insurance companies do not drive the cost of health care. I’m not particularly thrilled with their profits and executive salaries, but focusing on them will not get you very far in terms of cost containment. Contrary to what the media and single payer proponents are telling you, insurers don’t make people sick. People make people sick.
“As the budget details come out over the next few days the question we all need to be asking is, Just what is this administration willing to do to make health care affordable over the next ten years?”
Good question Bob. I can tell you what they’re not going to do: attack the real cost drivers.
$19 billion to be spent on HIT and only $1 billion spent on battling chronic illness and encouraging healthy behavior. What a joke!
“Contrary to what the media and single payer proponents are telling you, insurers don’t make people sick.”
No, they just yank their coverage when people are sick.
Deron, eliminating for-profit insurance and promoting healthy life styles are not mutually exclusive. We all agree that the solution must actually be an aggregate of multiple changes. Eliminating profiteering from health care is just one piece of the puzzle, but a critical one.
Let’s assume that we spend the HIT money wisely (big assumption) and we are able to improve efficiency, reduce duplication of tests, increase generic usage and reduce costs overall. What do you think is going to happen? Are patients going to pay less for coverage? Are physicians going to see higher reimbursements? I don’t think so. The result will be that the profits of private payers will increase by leaps and bounds. Is that what we are trying to achieve?
Yes, I know that Medicare/aid will see some savings as well, but is that enough bang for the buck? Can we do better?
This is my experience with Massachusetts health care reform;
Health insurance plans are not affordable and have high dedutables.
Because of the individual mandate I was forced to sign masshealth application which states the state can recover my assetts when I die.Sign this document or be fined.
Discriminated by income and age.I will be charged double from a younger person.As with income;middle income pays double from low income brackets.
The fact is if anyone makes any extra money it will increase your payment.
This only encourages welfare.
If a person does not sign up they will be fined through DOR.
The Massachusetts lawmakers turn a blind eye to any and all complaints,so does the Governor’s office.
How can anyone in Massachusetts think this law is ok?
My hope is someone will put a stop to this madness.
> How can anyone in Massachusetts think this law is ok?
I really don’t know. In Massachusetts “insurance” is supposed to mean “somebody else pays” and this silly law says “no, you pay”. It’s just gotta go — it is SO un-Massachusetts.
t
The “revamp” or “reform” of the healthcare economics in the United States is merely a continuation of policies and activities directed by politicians with a 10 year plan. Let’s face reality, the problem is now and not 10 years from now when a new political gang can father and promoye another “revamp” or “reform”. The reality is that what is now proposed is piecemeal and has been done before. If done again it will only fail and create another political opportunity in 10 years or less.
I do agree with the President’s plan to let private industry administer and manage the insurance plan(s) however I have a lot of disagreement with continuing any federal program, including Medicare, Medicaid and the now passed children’s health program. Aside from the military maintaining its own network and structure I would propose a plan to cover all Americans from cradle to the grave.
I would fund this plan with a health tax on all gross earnings of every individual in the United States and while I am not equipped to justify the figure I have been told by many individuals with knowledge and experience that this could be done with a tax of 1.5%. By individual, I mean every real person and every legal individual or corporation. This a tax on gross earnings with no allowed deductions.
As far as fees to hospitals, physicians and healthcare providers, the private insurers are far better equipped to deal with those rates than federal government. The mere fact that the three major insurers turned a profit on their Medicare Advantage products while the Federal lost money for the same time period is really adquate proof of their ability to effectively manage.
As to other bloggers who are concerned about care denials, I would propose that there are three critical steps that must be taken and this would require federal and state action. A first step is to define the health coverage and I would propose the acceptance of the plan currently in place for the senators and congressmen as the health care coverage to be available to all residents.
The second step is to make it mandatory that the private insurer invoved with accepting the enrollees must offer that plan to all residents of a state or region (an area larger than a single state to provide a reasonable population base) and the premium would be the same for all enrollees of that state or region. The insurer must make that plan available to all residents of that state or region and the premium would be paid through the central agency responsible to the insurer on an enrollee basis.
The third critical step is the elimination of the various risk pools currently in use by Insurers that deal with not health factors such as the size of a business or the zip code of an enrollee. There would be a single risk pool applied. That date would arise from the actual experience for that state or region or even a national risk pool.
This plan would end employer control of the plan and all contributions from employers but would make all industries, including healthcare and healthcare insurers cognizant of healthcare costs. A 1.5% tax on gross earnings would apply to all and its distribution to the insurer would be a federal charge.
The above plan is a national system but is not nationalized healthcare and it would allow what we as Americans have always proven. That is that the entrepreneurial system fostering competition will produce the best results for all. It also will end the abomination of dependence on employment for affordable healthcare.
There are other aspects to what I propose but they are numerous an involved to be mentioned or even ennumerated in the simple blog.
While there are many good thoughts and excellent analysis in this thread, I don’t see a single suggestion that will change the upward trajectory of medical costs. Medical costs are a function of fees and utilization. Push down on one and the other rises. This simple function has been at work for over 30 years leading to higher medical costs and we are still not talking about a viable solution.
It is obvious to me that if one wishes to control medical costs, then one must assure appropriate care. The issue, and only issue, with which we must deal is how to assure appropriate care. I don’t want to quibble about the meaning of appropriate care. I mean care that is necessary and sufficient and provided in a timely manner to solve a patient’s medical problem. One cannot solve the medical cost problem with competition, single vs private payers, universal or limited care, rationing, or any other scheme in current use. If care is not controlled to assure appropriateness, none of these really matter.
I don’t want to waste time dissing the current systems, but ultimately, there is only one solution and it’s only a question of how long it will take policy makers to recognize it. Care must be coordinated. To keep this short, I’ll say only that we cannot depend on either the care providers or the payer(s)to coordinate care. Both of their fundamental interests lie elsewhere. The care coordinators must be independent of both yet trusted by all parties, payers, providers, and patients.
I personally worked in a care coordination system and can attest that it drove medical costs down by 30 to 50 percent. I challenge any other health care model to match that performance. Applied in our current system, the savings could largely fund coverage for the uninsured.
Here’s a cool map of the number of uninsured people state by state:
http://show.mappingworlds.com/usa/?subject=NOHEALTHINSUR
and another by percent:
http://show.mappingworlds.com/usa/?subject=NOHEALTHINSURRATE
Mass. is lowest, but still at over 9%.
“As far as fees to hospitals, physicians and healthcare providers, the private insurers are far better equipped to deal with those rates than federal government.”
And your reasoning for this would be? It hasn’t seemed to work so far in containing costs, so why would it with a 1.5% health tax? Where is all this “competition going to come from? As an MD are you going to negotiate your fees with patient? Are you a primary care doc or a specialist?
JBCollins
Assuming average spending if you eliminated ALL carrier profit you mention you could insure 3 million people. Where your propoganda falls apart is your proposal for government single payor. If you would look at those profits you quoted in billions as a percentage of revenue they generally come in around 6%. Every government plan operating has around a 10% loss rate due to fraud. So far from saving 6% of spending and insuring 2 million people or less you are actually proposing s system that would spend 16 billion more then the current system and cost millions of people their insurance. Oops, think they call that unintended consiquences of good intentions, you still just killed people though.
“engaging in rampant price gouging that discourages patients from going to the doctor, and has resulted in 50 million Americans without healthcare.”
So everyone can have a good laugh please explain how insurance companies gouge on provider billing. And if you can cite one valid study showing 50 million americans are without healthcare I’ll never post here again….
Margalit Gur-Arie why are you ok with for profit hospitals and providers but against for profit insurance? I can’t think of any logical explaination for that. Your OK with the person providing care taking advantage of peoples illness, thus having no choice but to buy care, to make a profit but are mortally opposed to a company selling a voluntary financial instrument from profiting. What’s your train of thought on why one is acceptable but the other is not?
“The result will be that the profits of private payers will increase by leaps and bounds. Is that what we are trying to achieve? ”
Have you ever taken 5 minutes to research carrier profit before you make wild claims like this? Can you name any time in history where carriers have averaged 10% profits? In a free market carrier profits will NEVER increase like you fear. If carrier profits ever approached anything close to what you are saying numerous other entrants into the market would drive them back down. There is no historical basis for your claim but decades of proof it wouldn’t happen. The only way carrier profits could increase like you fear is if Congress artificically limited the market to a few national super carriers…oops thats right that has been a stated goal of liberals for 40 years. I guess we better watch out then.
A few comments need to be addressed. Hospital fees are very expensive but by using the Medicare DRG schedule combined with the actual reported costs (which all must do in each state)it is possible not only to rduce costs but to concentrate services to facilities with the best performance and greatest experience. I know this because I did just that when I put together the CABG contract that was an all inclusive fee for all professionals and all hospital services for $25,000. That fee was less than Medicare reimbursement.
Competition among the insurance providers should turn on the services that they provide and not the performance of healthcare professionals over whom they have no control. It should rest with prompt payment and clear coverage guidelines. When one insurer pays claims within 30 days and another takes 90 days or denies coverage then the enrollee suffers. This should not exist but it does and it has not improved with legislative acts but has improved in New York with an aggressive Attorney General going after the companies. Again my experience as a healthcare insurance exective tells me this.
Finally, it does not matter whether I am a specialist or primary care, but to clarify I am a retired general surgeon with over 20 years of experience in group administration in the So. California market and an executive with a major insurer on the East coast that was acquired by United Health.
What I am saying to anyone who will listen is that the complex plans proposed by the politicians (and Obama) addressing healthcare involving multiple goverment managed programs with money taken from Peter to pay Paul will fail. They always have and they always will. Reform and revamp will not work. Create a new and defined program with all having a stakeholder position and you will see success.
Richard C. Ferreira MD, JD
I completely agree with the program that you have outlined. We need strong individuals to carry out such a program that are more concerned about restoring healthcare to the people than profiting from the money healthcare can bring to the table. This represents one of the truly viable options to moderating costs as this attacks the problem of out-of-control insurers. I think that this should be the first step in healthcare reform. It should not cost billions to implement such changes and could be done with existing dollars. Yes there are other issues that it does not address that drive up costs such as unnecessary regulation, rapidly escalating drug costs, social issues associated with medical care, malpractice concerns, etc., but I would address your issue first and then after a period of time move forward and address other issues.
I would rather see a 1.5% national sales tax instead of an income tax as everyone would have access to the healthcare system, but not everyone pays income tax. (illegal immigrants and other types of income that fly under the income tax radar)
If you combine lifestyle changes and a defined benefit (rationing), you will go a long way in reducing costs.
P.S. America can’t stomach the last two paragraphs, but it is nice to talk about change. As long as there is a tobacco industry in this country and no willingness to end this, then there will be no willingness to improve other aspects of healthcare. I’d be the first to give my EMR money to the tobacco farmers in exchange for eliminating the production and use of tobacco.
Howdy Nate, I am as opposed to for-profit hospitals as I am to for-profit health insurance. The unfortunate reality is that even non-profit hospitals sometimes exhibit the same predatory behavior as the private ones. I don’t know what the solution should be, but I am pretty sure that the incentives for any organization providing healthcare should be aligned with the wellness of its constituency, not with maximizing cash flow. I know that it is a fairly naive approach to somehow expect that a multi-billion dollar industry will be operating on the basis of ideals and public good and do so efficiently.
The obvious solution is to have the government, which is supposed to represent us all, run healthcare services. I can see you grin, or laugh, and I know that the government track record in running anything is less than stellar.
In today’s environment, by definition hospitals want to perform more services and charge more for each one. By definition, payers want to pay for less services and pay less for each one. That’s what they need to do to maximize profits. I don’t see anything here that anybody is driven to do in order to provide patients with appropriate care and/or individual doctors with fair compensation. Everybody is out for the bottom line.
How do we change that Nate? It does not work well at all.
If you think this is bad turning it over to Washington to base care on who gives them the largest campaign contributions will be 1000 times worse. Do we really want our healthcare held hostage every three years to budget politics? We had a good functioning system that was destroyed by the politicians I just don’t understand why anyone thinks they are the solution.
FOr profit physicians are the same as for profit hospitals, for profit insurance companies and non profit hospitals and insurance companies. Executives of non profits make ridiculous salaries. What people need to learn is profit is not a bad thing in a true free market.
Where you have major problems is when politicians restrict the free market allowing excess profit. A basic principal of free markets is competition, that’s why you don’t see insurance companies making more then 6% profit, any more and new competitors would enter the market and take their business. When government limits competition making it hard for other companies or products to compete that allows those favored companies to earn excess profits and over pay staff or stockholders.
When politicians require certificate of need that allows those with the beds or equipement to profit excessivly.
We must get goverment out of healthcare and reintroduce competition ina major way.
For an example take my business. I own TPAs, our service is very defined, we are easily replaced, and there are a ton of us and it’s not hard to start one. Because of that we have next to no margins. Our administrative fees are lower then any insruance company, Medicare, and any other plan in the system. If we don’t do a great job at a competitive price, and have current technology we are gone and no one even notices. Years ago over 60% of those with employer insurance where in self funded plans. Then Ted Kennedy decided we should all be in HMOs, Democrats decided they wanted everyone with a couple super large nationally regulated carriers, States decided they wanted more premium tax dollars, and Congress passed bills every year making self funding less attractive. It’s a far superior product to what the large carriers sell but political it wasn’t popular.
That is how our system was destroyed, not just in this case but almost every major malfunction in our system today can be traced back to political tinkering and “reform”. The last thing in the world we need is Ted Kennedy who created half this mess telling us how to fix it. More Regualtion and reliance on Washington is 100% certain to doom us all to generations of TERRIBLE healthcare far worse then anything we have seen to date.
The college kids have stolen the car and the credit card and are on a binge!! They are spending money that does not yet exist and will never exist if they don’t get out of the way.
Healthcare is a great thing if you need it, but dangerous if you don’t need it. No one can make you sicker quicker than a doctor.
Shield us from John Edwards and doctors will save more money than you can imagine, no matter who the payor is.
A person’s appendectomy does not need to be on a nationwide data base. Spare me the BS about EHR.
If there are no profits then there are no tax revenues. Who do you think is going to generate profits just to have them looted?
If you want to help the healthcare system, you should be kicking off these so called “poor” people that are using the medicare/medicaid system fraudulently. I am surrounded by people on welfare that get medical treatment and prescriptions and come home and suck down as much whiskey and beer as they can, get all slopped up, fight and have to go get stitches….it is rampant fraud on all ends of this thing…I for one am tired of paying taxes to hold up the health care of a bunch of fakers.
In response to some of the comments above I have to say the following.
A 1.5% tax on all GROSS earnings avoids those individuals who for whatever reasons pay no taxes. That is a tax that is imposed before decductions and other tax evasion methodologies are applied. Having that tax applied to consumers in the form of a sales tax would be a cumbersome methodology and it would not be getting contributions from the industries that are currently benefiting from the industry such as the pharmaceutical, oil, energy, tobacco, etc.
Do not blame the illegal aliens and others for the healthcare problem, blame the current system that allows them to gain such access and a bizarre payment methodology that assigns them to a Medicaid support program almost instantaneously. There will always be individuals who through no fault of their own will require healthcare but have no means of paying. In 1964 (the year before Medicare) the elderly were not in a position to pay for healthcare but there were not droves of elderly laying at the hospital and physician office steps being denied care. The same is true for the illegal aliens and others today.
As to fraud, the factor used by major insurers 10 years ago to overcome the fraud and abuse was 13%. I know that this has increased but in many ways it can be quickly and easily addressed. Some (not the majority) of it is true fraud in the legal sense while much of it is a sort of “legitimate” abuse fostered by the payment schemes that deny certain coverage and allow others.
The issue at hand is to generate an economic process applicable to healthcare that will allow coverage for all U. S. residents and a payor system that is competitively driven. The government and politicians do not understand that type of entrepreneurism. Get the government out of healthcare management.
I am a doctor and was wondering how the Obama health care plan will affect my income and work. Am I going to be working more hours, less hours or the same. Am I going to be making more money, less money or the same.
Re your post Sam March 2nd 2009.
While I can understand your concern, surely as a doctor your proirity is your patients health and not the amount of money you’ll be earning or the hours being put in.
America remains the only Western Nation without free Healthcare. While some systems like the one in the UK need reform and are not a good example, others like France, Spain and Canada are prime examples of National Healthcare systems working at their best.
An ealry poster mentioned profit and that is exactly what healthcare here in the USA is all about. There is something wrong about a company making profit off the sick and dying citizens of this country. A government run system works for everyone, even the doctors who still earn good money – don’t worry Sam you’ll be well taken care of
TO SAM:
While I agree in part with your statement to the doctor concerned as to how the Obama plan will impact him personally, I do not agree with the remainder of your comments.
Tell me where healthcare is free in the civilized world. I know of no such place. It is paid for by exorbitant taxes in France, England , Germany, Canada and everywhere you look. The only thing you get for nothing is NOTHING.
Medical IT is being pushed by the IT vendors(surprise!), and the policy doctors that want to mine the data to retrospectively deny coverage for everything that they can think of. No night work. No weekends. No adult supervision. No accountability for even the stupidest errors. Dr. Syndey Wolfe, for example, is still at Public Citizen after obvious errors on Bendicin and Breast Implants. Sounds like good work to me. I am certain there will be no shortage of government policy doctors.
IT will rushed to market with huge bugs. It will reduce productivity, and paradoxically increase utilization of a whole host of procedures like colonoscopy which are recommended for screening, but reasonably rarely performed. An IT prompt will increase utilization of a whole host of procedures dramatically.
The cost saving aspects will work out in a similar manner to pre-authorization, gatekeeper, HMO’s, pay for performance,and a number of other methods designed to curb utilization. A new layer of expense, a new army of clerks and programmers and hassle will be added, but people that want to see an orthopedic surgeon for their knee will still find a way through the system.
It will be expensive. Utilization will increased dramatically.
On another matter, it is a testiment to the power of the Trial Bar than even reform minded readers of this blog are afraid to step on their toes. Utilization will never budge without iron clad tort reform. Most of the middle class and all poor will have their babies delivered by nurses and medical students before this happens. By then, it will be too late.
Oh, and in case it hasn’t occured to everyone, malpractice rates are about to skyrocket from insurance company losses caused by this financial crisis.
Maggie, if you are reading, in the Tobacco Bill, there was a proviso which would limit Trial Lawyer pay to a maximum of $20,000.00 per HOUR, which the lawyers defeated. Think about that when you think that your mother’s anesthesiologist will be paid $16 per fifteen minutes in the operating room at three in the morning.
As a society, we are backing into the position that we would rather have a lawyer sue for a less-than-perfect outcome than a doctor to treat us in the first place.
We think that the care will always be there. Believe me when I tell you that critical specialists will disappear very soon if something is not done. Plenty of doctors, but not plenty of general surgeons, orthopedic surgeons or OB’s willing to do emergency (read the medical care that you actually benefit from) care in the very near future.
Tort reform would help reform gain support from doctors. Anyone who thinks that reform will come by vilifing MD’s and going over their heads, to the “people”, may be on the wrong track.
It is huge huge political mistake to make health care for all paid by high earners. Most of these people are not rich, but they are influential. This alone will doom it.
If you want to redistribute wealth, fine. Have at it. But make it a separate proposal. Don’t mix universal coverage with this. It will really confuse the message.
Anyway, by the time this financial crisis there will be no rich left to pay for it.
There is a crisis; if the solution doesn’t include iron clad tort reform it will fail. Oh well.
(As an aside to Maggie, I went to public school, as do my kids. Most of my classmates in college were poor kids from Bronx HS of Science, which at the time was a good school. My point is simply doctors are not wealthy. I am willing to bet that the ones you know making a million are OB’s doing fertility for cash. These people will not be affected by Big Brother’s plan. In my city the people making over a million are are all hospital presidents and malpractice trial lawyers. They are making millions and working banker’s hours.)
Please STOP DROP AND ROLL,
As long as big co. are in control of health care it will not work. People that become DR. are about helping people. As long as the $ is the deciding factor pecple will suffer. Why should health care be decided on if you can afford it. As long as thers is money to be made guess what? Just look at the profit of health ins. oo.. That is where that money it going, STEP UP AND ADMIT THE REAL DEAL.
We can take care of each other. LET’S DO IT NOW.
I have 3 children and have been divorced for 8 years- my x- husband is not paying health insurance as ordered by the St. Louis Courts. I only found this out because – my son went to the doctor and I was billed for the whole amount- they let me know that my x-husband Tom cancelled my son’s health insurance. I hope who ever receives this email does something about this…. Governor Jay Nixon’s office have been working with me in doing the best job that they can. I am behind President Obama – he looks out for our children! Thank you. I hope if there are further steps for me to take please let me know…..I am not receiving child support either- and I am putting three children through college while he is out playing golf and gambling at Ameristar Casino’s in St. Louis, Mo instead of taking care of his kids. I am trying to do my best and I thank God that we have a President who cares about the people. Sincerely, Karen
O.K. O.K.
First of all we can use statistics and bend them anyway we want to prove our point or theory. I have to say being in the medical and legal profession I think that to really implement a good overall healthcare system we need managed care, Case management and medical management. I have worked as an RN for over 10 years; I have been a case manager, medical manager and now a certified legal nurse consultant. There is no “magic wand” to undo what has already been done so let the past be a lesson but move on to work toward our future. I think that not for profit is an oxymoron! We need people who work in health care, understand the interworking to be the leaders in our “REFORM”. If you are not in the business of healthcare than you do not understand it. If you are not in the legal profession than you don’t understand it. If we can recognize that people are always going to be uninsured or underinsured, then we can focus on utilizing and managing what they do have. Managing the care will allow us to:
1. Give the best quality of care at the best price.
2. Eliminate the MD’s who run test on patients that they don’t need (or their reimbursement for such)
3. Make the practitioners pay if they make a mistake.
4. Have DRG’s but remember that all people are not affected by disease the same and allow for some leniency one a case by case bases. (If demeaned necessary by a concurrent review)
5. Have guidelines for healthcare providers with penalty so that hospitals that do allow GN’s and med students to practice beyond their scope are punished for trying to save a buck by not having appropriate staffing ratios)
Attorney’s are not the enemy, without them malpractice would be worse than it already is!
It’s already a shame that the people are the ones that suffer for the negligence of providers, and most of them don’t have the luxury of retribution due to “tort reform”.
I’m not saying that tort reform is bad I’m saying that anyway you look at it; it’s the people that pay.
Taxing the “rich” is not the answer.
I have worked with great staff and hospitals and I have worked with staff that was so totally inept it would make you vomit.
The people “running” healthcare should be competent healthcare professionals. That focuses not only on managing the care, but on monitoring the competencies of the providers as well.
Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.
HEALTH INSURANCE COMPANY PROFITS IN 2007:
1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
3. Aetna Inc. — $ 1.831 BILLION
4. CIGNA Corp — $ 1.115 BILLION
5. Humana Inc. — $ 834 million
6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
7. Health Net — $ 194 million
The huge insurance company profits—BILLIONS EACH YEAR—could be used to provide quality healthcare for millions of people, and to pay physicians adequately for their work.
We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.
The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/
FOR MORE INFORMATION: http://www.insurancecompanyrules.org/learn_more/the_roster/ and http://www.pnhp.org/
My younger sister was recently diagnosed with Stage 3 breast cancer. Her policy with Anthem BC in California, has a $10,000
deductible and her monthly premiums are $800. This is the policy that she could afford, but no longer can.
With the deductible , premiums and care that her insurance has refused to cover what is her chance at a cure, or further treatment. Does she die because of this country’s lack of healthcare? I myself have had no health insurance for over 10 years due to a pre-existing kidney condition which gives me hard to control hypertension. I take 4 BP medications per day. I need a renal angiogram, and other tests which are way above my ability to afford as I live on a fixed income. I occasionally skip medication as the pills are very expensive. What is my future?
So this is a whole family unable to get health care, with potentially fatal consequences, due to no system available but “cherry picking” private for profit companies. Below has been taken and somewhat modified from another site but it about states it all. Mr. President, Is anyone listening ?
The truth is that there are gaping holes in our health care safety net and that most of these safety-net services are neither effective nor efficient in providing chronic-disease prevention, detection, or treatment. The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year and thousands more to die of other diseases. And for those who are unmoved by this shameful injustice, the data also show that for many hard-working, middle-class families, a diagnosis of cancer sets in motion a series of unfortunate events, including job loss, loss of employer-based insurance, bankruptcy, and all too often, premature death. For too many hard-working “average Americans,” paying for cancer treatment means not paying rent, mortgage (resulting in foreclosure or eviction), or utility bills, or even going hungry.
Surveys have documented widespread dissatisfaction with the way health care access is currently rationed in the United States. Patients are angry, health care providers are frustrated, and businesses leaders are concerned that the rising cost of health care premiums is undermining their ability to compete in the global marketplace.
The United States continues to have the worst record for health care access among all industrialized Western nations. And we are asking the President to propose specific policies intended to mitigate the misery and death caused by lack of health care access.
For many years thousands of American Consumers have been injured because of defective prescription drugs and Medical Divises. This is driving Medicare and Medicaid up and the American Public is at risk. In 1962 Congress omitted from the FDCA ACT Product Liability for Prescription drugs and Medical Divises. With Preemption of the law placed a protective shield up for the prescription drug companies and leaves the public at risk. There Is No Law. Show me the Law. Healthcare can never be affordable as long as the drug companies continue to cause injury and kill the public and not made accountable. There is no law. No Federal Law and No state Law. Show me the Law.
If you are really serious about health care reform then you have to break the big myth! By that I mean the one created by the baby boomers. The one that makes us believe that our system is the greatest on earth. We( the baby boomers) worship our doctors because when we were growing up the doctor came to your home, got very little sleep, hardly ever played golf and was lucky if he saw his family more than 4 hours a day. In other words you could trust him to have your health in his hands. NOT YOUR MONEY IN HIS HANDS. Now you have to get permission from the ins. co.before you can have any serious treatment. Come on folks! PAY ATTENTION! Wouldn’t you rather have the gov. in control versus the ONLY FOR PROFIT INS CO? MR. PRESIDENT TEAR DOWN THE MYTH!
The President may want to help the average Joe but the problem I have is this plan does nothing to require more personal responsibility. The Percent of noninstitutionalized adults age 20 years and over who are overweight or obese is 66 percent !! We need to tell folks to change their life by exercising! This is far less cost that a government run high tax health care overhaul. Actually our system needs a tune up but not an overhaul. One of the areas for tune up is health fitness. So get out there and do something so you want be going to the emergency room for a sore belly.
My problem with the whole thing doesn’t stem from the specifics of it. It stems from a broad and sweeping truth.
Any changes of this nature (that actually pass) are geared towards helping the rich, the corporations, or the government. If it didn’t, then it wouldn’t pass because they are the ones pulling the strings.
THE SOLUTION TO THE HEALTH CARE PROBLEM IS KICK ALL ILLEGALS OUT OF THIS COUNTRY. THERE THE ONES BREAKING THIS COUNTRY AND ALL THE WORKING PEOPLES POCKET BOOKS. IM TIRED OF PAYING FOR THESE PEOPLE.
The BS out of his mouth that you can keep your insurance ,,that is if your employer keeps it and nots opts out for the government crap. I say if you need it allow who ever to buy into medicare now. Double it on their salary. Hell why am I paying for it when i can’t use it til 65. what if I die before I can even get access to medicare lots of people die before 65.
If he want to pay for it Tax all those high paying excs more.. or Celebrites making 20 million amovie or sports player make $$$$$ Hell just go broke quit you job and live off the government.
I feel like the only way to really fix the health care system is for America to move to a universal health care program, yes I said it, socialist health care! Being able to see a doctor should be a basic right for every American regardless of their situation. We shouldn’t have to worry about breaking the bank everytime we need a check up. A socialized program would lower costs for the public and would allow for everyone to see a doctor even if they become unemployed. The problem lies in the fact that Americans have become too greedy and the insurance and drug companies don’t want to part with any of their profit. Yes, this would mean that doctors wouldn’t make quite as much, but look at all the other people that don’t have a doctor’s salary and they manage just fine. I don’t understand all the properties to Obama’s plan but it seems like it’s atleast a step in the right direction. Let’s learn from the other countries around the world that have affordable health care programs and follow their example!!
We need to bring back the public option. It is one of the most important components.
Insurance (any kind) is unique because it defies normal economic supply/demand principles. The phenomena of “Adverse Selection” says that the risk spreading mechanism itself is damaged by low-risk people who opt out. In essence, young healthy people say, “I’m young and healthy… I’d rather just NOT participate and keep my money, but thanks anyway.”
Now I pose the question: Should anyone be able to opt out of paying for roadways? (Highly socialized…except in Orlando and a few other places where there is a tole booth every 50 feet. Last time I traversed the city I wanted to shoot myself. Thanks so much, Mickey Mouse).
Should anyone be able to opt out of paying for police, fire departments, or military? (Much like health insurance, all risk spreading mechanisms. All incredibly socialized).
Lastly, do you want to see the country pay 25% of GDP for healthcare? How about 50% (Now at 17% up from around 6% a decade ago and climbing faster than Chuck Yager in a test jet).
Health care insurance is an important risk spreading mechanism. Meanwhile, costs should be very actively managed. People with families should not have to work for large companies (groups) to attain low cost coverage. That effectively dampens job liquidity and hinders broader economic markets. What happens when GM closes down a plant and 800 workers find themselves constrained to working for another big company to find health care comparable to what they had before for their family? (Ever notice how manufacturing plants are often planted in small towns where there aren’t a lot of other big companies?) Job liquidity demands that health care decisions be completely separable from the job. So the current system patently discourages free markets and value flows rather than encourages them.
….Research “Adverse Selection” and understand the underlying economics involved. “High Risk” pools are not going to get the job done.