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Why Wait Four Years?

I was struck during President Obama’s health care speech before Congress several months ago that the reforms he advocates would not go into effect for four years, until 2014. This timetable, too, is written into both the House and Senate versions.

Why the delay? It is hard for me to imagine, even given the federal rulemaking process, that it should take four years to establish an insurance exchange from which people can buy coverage. This is the exchange that would eliminate the nasty practices of insurance companies: Denying coverage because of pre-existing conditions; limiting annual or lifetime payments; and rescission of policies. It is hard for me to imagine, too, why it should take four years to fully deliver targeted subsidies to lower income people so they can afford insurance.

As noted by Princeton Professor Paul Starr in an article in the  New York Times earlier this week: “By comparison, when Medicare was enacted in 1965, it went into effect the next year.”

This leaves me with a bad feeling. It looks like the Obama team does not want implementation of the health care bill to take place during their first term. Why? Perhaps they know that the cost of the plan is higher than they are saying. Or maybe they know that the options available to consumers will be less attractive than currently portrayed.

Maybe they are worried that if all this happens on their watch, re-election in 2012 will be in jeopardy.

I have yet to find a knowledgeable observer who does not agree that the cost of universal coverage will be high and that consumer choice will become more limited to the degree that federal policy tries to control costs.

I personally think the cost of universal access is worth it and an important public policy imperative; but the administration puts itself into a box when it downplays the consequences of the legislation. It is forced to postpone the effective date until after the 2012 election, so it will not suffer political backlash from a public that has been misled.

Let’s hope that Congress sees this otherwise and implements these important measures more quickly. (Wouldn’t it be ironic if the Republicans offered a floor amendment accelerating the effective date? How could the majority party oppose that?)

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Ruth OgdenchrisStephanie Jewett, RN, MBATuckertcoyote Recent comment authors
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Ruth Ogden
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Ruth Ogden

If the current administration waits four years to start the reforms they approve, they can all get re elected into office before the shit hits the fan and the people realize what I mess they have created. That is why they don’t want the reforms to start immediately.

chris
Guest

We really shouldn’t have wait 4 year’s for Obama’s health-care plan kick into action, some of us dont even have 4 year’s to live. We need this health-care plan to take immediate action for our live’s, my grandma is 97 year’s old, and without healthcare, she would have been dead by now. So join me in this protest on to make the new health-care plan take immediate acction!

Stephanie Jewett, RN, MBA
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Your site is great! I’m just getting started on a new nursing website blog and I was wondering if we could exchange links. I’m so new to this, I just figured out how to work on my blogroll. My site addresses various topics for colleagues, patients, caregivers and the general public. I’m trying to share, through words, my 30+ years nursing experience. My name is Stephanie Jewett, RN, MBA from Iowa and I’ll leave my site for you to visit. THANKS!
http://www.nursingcomments.com/

Tucker
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Send Congress home for a year or more so they can’t do any more damage to our economy and country! These people and this administration have their heads in the sand. All evidence indicates the government’s involvement in any way will just drive costs up for everyone else (as in our subsidy of Medicare) and load more on taxpayers and business just when our economy can’t bear any more! Don’t enact health care legislation!! If Congress needs to do anything contract with a private company charged with reduction of waste in Medicare, Medicaid and any govt. function surrounding these programs.… Read more »

Nate
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Nate

Margalit as much marble and glass as the politicians can redirect from my paycheck. These hospitals are huge business and your local Democrat is going to take kindly to them losing 30% of their revenue. Large amounts of campaign contributions and many shared seats on non profits etc pass back and forth. Read up on Metro Health and their recent scandal and Cuyahoga County and the corrupt democrats falling one after the other there. Then jump out to Vegas and see what the Democrats did with UMC and the Chicago crook they brought in then run over to CA and… Read more »

Barry Carol
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Barry Carol

Peter – I would like to see Medicare negotiate rates like everyone else rather than dictate them but I would also like to see movement away from the fee for service payment model toward an approach that rewards quality and not volume. The problem, as I see it, boils down to patient expectations broadly defined. Patients expect to receive imaging when they don’t need it, they want their doctor to prescribe a drug they saw advertised when they don’t need it, and they want way too much futile care at the end of life. They oppose eliminating the tax preference… Read more »

Margalit Gur-Arie
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Margalit Gur-Arie

What Peter said, plus, if what was said here is correct and the Clevelands and Mayos prices are really 20% to 30% above other regional providers, it seems that there is room to manage costs down. After all, how much marble and glass is required in order to provide excellent care?

Peter
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Peter

Barry, are you arguing for higher Medicare reimbursements so that hospitals can make money, if so Miami/McAllen would love that. How are we to get costs lower if we just continue to feed the beast, hospitals must become more efficient and lower costs, but that would mean a different economic model that rewards efficiency not over-utilization.

Nate
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Nate

insurance company adds 20% the federal government adds 40%. The most efficient method of payment is always to pay your own bills. If you want the Insurance company to do it you pay a little more. If you want your government then you pay a lot more. I am all for reducing the roll of insurance companies, but not so we can be less efficient and have the government do it.

Barry Carol
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Barry Carol

In an article in today’s Wall Street Journal regarding the proposal to allow people 55 to 64 years old to buy into Medicare, Jeffrey Korsmo, Executive Director of Health Policy at the Mayo Clinic, stated that Mayo lost $840 million treating Medicare patients last year. Yet, Mayo is supposed to be an efficient, cost-effective provider due to its use of salaried doctors, electronic records and relatively conservative (lower utilization) practice patterns. I’ve heard executives at other big name medical centers say that they could not continue to provide their current level of service and quality care if they had to… Read more »

Peter
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Peter

“About Miami, do we know what are the most prevalent forms of Medicare fraud there? (just curious)” Margalit, the 60 Minutes program outlined fake medical companies buying stolen Medicare Benificiary numbers then billing Medicare for unprovided services, as opposed to legitimate providers billing for over treatment. Medicare is mandated to pay within 30 days of receiving the bill and has little resources to investigate – which when it does is usually too late as the fraudulent company has closed shop and moved to set up another operation. I don’t know how Medicare goes through the process of checking/approving providers (as… Read more »

Peter
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Peter

“Peter, if company currently offers $500 Ded 80/20 with 1000 OOP our clients will buy a $5000 Ded 100% no OOP plan. THe employee is still liable for the same $1500 they where before. THe company assumes the risk for the 80% between $500 and $5000 not the employee.” I figured someone was paying a higher out-of-pocket for deduced premium of HDHP; great if you have a generous employer that assumes the extra out-of-pocket risk of the higher deductible, oh if we all could get that benefit(subsidy). “Companies save money becuase insurance adds 20% to the cost of a bill,… Read more »

Nate
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Nate

Miami has turned Medicare Fraud into an art. DME suppliers that don’t even exist buy HICNs and bill Medicare for people they never deliver anything to. HIV treatments never given to patients. Treatments that are billed but never done but the memebr actually gets a cut. I think 60 minutes did a real good show on it a month or two ago. They are pulling scams so obvious you have to close your eyes not to see them. They also interviewed people that had been calling Medicare for 7 years saying fake claims where being submitted and Medicare did nothing… Read more »

Margalit Gur-Arie
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Margalit Gur-Arie

About Miami, do we know what are the most prevalent forms of Medicare fraud there? (just curious)
About the employers that self insure for the first 5K, would those employers be very tempted to hire healthier and younger workers and maybe even get rid of the sicker employees once they decide to self insure?
If they fire an employee and he selects COBRA, does the employer still pay for the high deductible, or is it up to the ex-employee now?
Also, how much do they pay for services like you provide, Nate? And do they always use a TPA?

Barry Carol
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Barry Carol

Peter – My comments regarding Medicare costs in Miami were indeed comparing the cost of serving Medicare beneficiaries there vs. Medicare beneficiaries elsewhere. Regional differences in practice patterns have long been documented by researchers at Dartmouth in what is now an annual publication called The Dartmouth Atlas of Healthcare. You can learn more about this at http://www.dartmouthatlas.org. The medical cost situation in Miami is an extreme case and is caused by something of a perfect storm. In addition to the very aggressive (high utilization) practice patterns, providers there receive well above average Medicare reimbursement rates vs. elsewhere including even New… Read more »