Tag: Merrill Goozner

Comparing Hospitals on Safety, Quality and Cost

Apr 26, 2011• 4

By MERRILL GOOZNER

The Sunlight Foundation today gave us a fascinating first peak at the hospital safety data from the Centers for Medicare and Medicaid Services, which was finally convinced to release the information after years of stonewalling by the American Hospital Association. For the first time, the public can compare less-than-stellar performance at competing local hospitals on key indicators like catheter or urinary tract infections or bed sores.

As their story points out, the data only cover about 60 percent of hospitals since many states, like Maryland, failed to cooperate with the voluntary CMS program. They also caution that any comparison of the raw numbers must take into account the numerous confounding variables that can make one hospital look more slipshod in its practices than another. Some hospitals take in many more older and poorer patients, who are more likely to have multiple chronic conditions that make them prone to complications during their hospital stays.

Yet as Arthur Levin of the Center for Medical Consumers, a New York-based advocacy group, pointed out, “”I think it’s fair (to release the data) as long as everybody agrees on what the limitations are, and what the caveats are. There are those who say this data isn’t ready for prime time and public review. If we waited for perfection, we wouldn’t have anything out there.”Continue reading…

IPAB — The New Punching Bag

Apr 21, 2011• 4

By MERRILL GOOZNER

Remember death panels? Politicians have found a new way to use health care reform as a punching bag.

The Independent Payments Advisory Board (IPAB) will be a 15-member expert panel appointed by the president and approved by the Senate that is charged with coming up with ways of cutting Medicare spending when payments grow significantly faster than the rest of the economy.

Last week, President Obama, in his speech outlining his long-term plan for cutting the deficit, upped the ante for IPAB by ratcheting up the level of cuts the board could impose if the senior citizen health care program grew too fast. Congress, under the law, would have to substitute comparable cuts of its own, or the IPAB’s plan would go into effect.

It didn’t take long for the fireworks to start. The New York Times reported this morning that politicians from both sides of the aisle are lining up not only to deep-six the president’s latest IPAB proposal, but to get rid of it entirely. Republicans like Paul Ryan of Wisconsin cried rationing. Democrats like Pete Stark of California said such decisions are better left in the hands of Congress.Continue reading…

The 100% Estate Tax

Apr 18, 2011• 24

By MERRILL GOOZNER

There is a dangerous but beguiling econometric logic behind the idea that turning Medicare over to the insurance industry will lower health care costs. It’s an idea that could catch on if the general public became convinced that there is nothing we can do acting together as a society to lower the cost of care. Only the market can do it, the Republicans claim. Force seniors (or the poor or anyone, for that matter) to have more skin in the game, and they’ll use their clout as consumers to separate the wheat from chaff in modern medicine. Expensive, wasteful tests, procedures, and drugs will wither for lack of customers.

Democrats, in attacking the Republican plan that passed the House yesterday, relentlessly hammered away at the cost to future seniors of having “more skin in the game.” Two-thirds of the cost of care within a decade of Medicare privatization in 2023 will fall on them. But the 2030s must seem very far away to people in their 40s and 50s. Isn’t it likely that they won’t think about that far-off time, but instead grab on to the promise of future lower costs, which, let’s be frank, the Affordable Care Act (health care reform) may not be able to achieve.

So here’s the real argument young and middle-aged people need to hear, and the real reason why the “more skin in the game” argument can never work for seniors or other vulnerable populations, including them when they reach that age. Seniors and the poor account for over half of health care spending. Within those groups, 5 percent of the population accounts for 50 percent of health care costs; and 20 percent of the population accounts for about 80 percent. These costs come for the most part at times when economic incentives have no influence at all on medical decision-making: in medical crises; in treating chronic conditions; and, for most Medicare patients, in the last six months of life.

That’s why a voucher program for Medicare, which will shift an increasing share of those inevitable costs onto the elderly themselves, can fairly be categorized as a 100 percent estate tax or death tax. People under 55 need to know that if the plan crafted by Rep. Paul Ryan were passed, most of them will never have a cent to leave to their children. It will all go to the health care industry to support the American way of dying.

Three Formulas

Apr 18, 2011• 51

By MERRILL GOOZNER

During the last election campaign, Tea Party-backed Republicans across the country rode to power on a tidal wave of advertising attacking health care reform as a cut in Medicare. It is. If efficiency programs like the accountable care organizations being formed across the country don’t hold down spending by about $500 billion over the next decade, an Independent Payments Advisory Board would make recommendations for holding growth in Medicare spending to the growth in the domestic economy (GDP) plus one percentage point.

In most years when the economy is humming along, that would be about 4 percent. Over the past decade, health care spending for seniors grew at about 6 to 7 percent — the same as health care spending for the rest of the population. So if the Medicare delivery system reforms don’t work, Congress will either have to adopt the IPAB’s recommendations or institute cuts of its own to ratchet down spending.

This week, President Obama upped the ante to meet his budget deficit reduction targets over the next decade. Medicare spending would be held to GDP plus 0.5 percent, another approximately $300 billion in cuts. About $50 billion would come from eliminating unnecessary errors and hospital re-admissions. The rest was unexplained.Continue reading…

Time to End The Health Care Tax Exclusion?

Apr 12, 2011• 4

By MERRILL GOOZNER

President Obama on Wednesday will unveil his counter offer for bringing the nation’s budget deficit under control. Last week, the Republican plan authored by Rep. Paul Ryan, R-Wisc., chairman of the House Budget Committee, focused public attention on cutting health care subsidies for seniors and low-income people.

Will the president go after the bloated health care sector, too?

Here’s one way he could raise a half trillion dollars in the next four years from health without touching seniors or the poor. The plan would win plaudits from tax purists and deficit hawks. And it would make a major contribution to holding down the growth in health care costs, while testing Ryan’s claim to back putting tax expenditures on the table.

The president should propose eliminating the income tax exclusion for health care benefits.Continue reading…

Medicare, Medicaid Get Squeezed in Ryan Plan

Apr 5, 2011• 38

By MERRILL GOOZNER

Everyone agrees that controlling health care costs is the key to bringing long-term federal budget deficits under control. Government spending on Medicare for seniors and Medicaid for the poor has grown nearly twice as fast as the rest of the economy for decades and is by far the largest component of future projected deficits.

But government funded health care programs aren’t unique in that regard. Employer-based coverage for the working population, which is provided through private insurance companies, has grown just as fast. The problem in a nutshell is the cost of health care, not its funding source.

That’s why it’s important to consider how the two separate sides of our health care system – public plans and private plans – will interact should the Medicare privatization plan that Rep. Paul Ryan, R-Wis., touted on Fox News Sunday become law. The House Budget Committee chairman’s alternative budget would turn Medicare over to private insurers for anyone who retired after 2021. Future retirees would receive a capped payment to buy insurance (he called it “premium support,” not a voucher). Medicaid would be turned into a capped block grant – which translates as a fixed sum awarded to states.

Capping expenditures is central to cost-control in the Ryan plan, which is essentially the same plan that he co-authored with former Congressional Budget Office director Alice Rivlin during the fiscal commission deliberations. The plan limits the annual growth in the amount earmarked for either premium support or block grants to one percentage point more than gross domestic product (call it GDP+1).

That’s about half of the actual health care cost outlays in most years. According to Congressional Budget Office projections released in January, federal spending on Medicare and Medicaid is expected to nearly double to $1.6 trillion by 2021, about a 7 percent annual increase. If the primary goal is holding down taxes and spending, capping that rise at GDP+1 provides the upside. With a wave of the legislative wand, government spending on health care for the old and poor would be reduced to more manageable proportions – between 3.5 and 4.5 percent a year depending on how fast the economy grows. Taxpayers could rejoice.Continue reading…

What’s The Worst Case Scenario In Japan Nuke Crisis?

Mar 22, 2011• 4

By MERRILL GOOZNER

This from John Beddington, the United Kingdom’s chief science advisor at its Tokyo embassy:

Let me now talk about what would be a reasonable worst case scenario. If the Japanese fail to keep the reactors cool and fail to keep the pressure in the containment vessels at an appropriate level, you can get this, you know, the dramatic word “meltdown”. But what does that actually mean? What a meltdown involves is the basic reactor core melts, and as it melts, nuclear material will fall through to the floor of the container. There it will react with concrete and other materials … that is likely… remember this is the reasonable worst case, we don’t think anything worse is going to happen. In this reasonable worst case you get an explosion. You get some radioactive material going up to about 500 metres up into the air. Now, that’s really serious, but it’s serious again for the local area. It’s not serious for elsewhere even if you get a combination of that explosion it would only have nuclear material going in to the air up to about 500 metres. If you then couple that with the worst possible weather situation i.e. prevailing weather taking radioactive material in the direction of Greater Tokyo and you had maybe rainfall which would bring the radioactive material down do we have a problem? The answer is unequivocally no. Absolutely no issue. The problems are within 30 km of the reactor. And to give you a flavour for that, when Chernobyl had a massive fire at the graphite core, material was going up not just 500 metres but to 30,000 feet. It was lasting not for the odd hour or so but lasted months, and that was putting nuclear radioactive material up into the upper atmosphere for a very long period of time. But even in the case of Chernobyl, the exclusion zone that they had was about 30 kilometres. And in that exclusion zone, outside that, there is no evidence whatsoever to indicate people had problems from the radiation. The problems with Chernobyl were people were continuing to drink the water, continuing to eat vegetables and so on and that was where the problems came from. That’s not going to be the case here. So what I would really re-emphasise is that this is very problematic for the area and the immediate vicinity and one has to have concerns for the people working there. Beyond that 20 or 30 kilometres, it’s really not an issue for health.

Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect and The Washington Post. His most recent book, “The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs ” (University of California Press, 2004) has won acclaim from critics for its treatment of the issues facing the health care system and the pharmaceutical industry in particular. You can read more pieces by Merrill at GoozNews, where this post first appeared.

The Message Is The Medium

Jun 28, 2009• 5

By MERRILL GOOZNER

Emory University psychologist and political consultant Drew Westen in the weekend Washington Post offers a troubling view of the public’s role in health care reform. While reform’s reality involves complicated technical issues like insurance exchanges, public plan governance, physician and hospital payments and who will pay higher taxes, the public’s understanding of these issues is virtually non-existent, Westen assumes.

FDA Regulation of Tobacco Called ‘Death Sentence’

Jun 15, 2009• 1

By MERRILL GOOZNER

Legislation
headed for President Obama's desk that would give the Food and Drug
Administration regulatory authority over tobacco was called a "death
sentence" for agency morale by longtime FDA observer Jim Dickinson,
editor of FDA Webview (subscription required).

The impact of this bill internally will be like a death
sentence, steadily killing the agency's old public health spirit and
replacing it with a strange hybrid. This new ethos will have to blend
public health and safety with toleration for and husbandry of
death-dealing products that have no plausible relationship to the
diverse family of other products regulated by FDA.

Health costs increase despite recession

Feb 24, 2009• 3

By Merrill Goozner

The latest one- and ten-year outlook for health care spending from
the Center for Medicare and Medicaid Services projects health care
spending growing 50 percent faster than growth in the overall economy.
By 2018, health care will account for fully one in every five dollars
of gross domestic product, according to the projection. The biggest
jump in health's share of economic activity will come in the next two
years as the sector continues to grow while the rest of the economy
shrinks.

And that's the good news.

There were several unrealistic assumptions built into the
projections. First, the CMS economists assumed Medicare's physician
payments will be cut by 20 percent at the end of next year when the
current payment fix expires. As anyone who follows that issue closely
knows, that never happens. Congress always steps in and restores the
cuts.