Tag: Policy/Politics

The Problem with Medicare Advantage

Jul 10, 2008• 16

By MAGGIE MAHAR

Everyone understands why Congress was so reluctant to cut physicians’ fees. Reimbursements for primary care physicians are very low—so low that 30 percent of Medicare recipients who are looking for a new medical home can’t find one. Cut fees, and fewer doctors will take Medicare patients. The AMA, seniors and the AARP are all up-in-arms. Few politicians like to disappoint this trio.

But why are so many Congressmen willing to cut Medicare Advantage? After all, one out of five seniors is in the program: Won’t they be upset?

The truth is that, as many seniors have discovered, Medicare Advantage fee-for-service (the plan Congress has now voted to phase out by 2011) is not turning out to be an advantage for them.

Here is what David Fillman, an International Vice President of the American Federation of State, County and Municipal Employees (AFSCME), which represents some 1.4 million workers, had to say about MA’s fee-for-service insurance when he testified before Congress in January:

“Insurance companies have targeted our employers for the hard sell, including offers to pass through some of the federal subsidies to state and local governments.”

Senate votes to reign in private Medicare

Jul 9, 2008• 19

By Robert Laszewski

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. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

Ted Kennedy came to the Senate floor and led Senate Democrats to an amazing victory in their first real attempt to rein-in private Medicare spending and rescind the 10.6 percent physician fee cuts.

The veto-proof margin puts President Bush’s threat to veto the Senate bill, which was approved by the House on another veto-proof 354-59 vote just before the holiday, in doubt. Why bother?

I was not surprised to see Senator Kennedy on the floor.

This vote was not about the doc cuts. It was about Medicare and its future. The doc cut was just the leverage Democrats were using to get at the private Medicare program.

Medicare is part of the Democratic legacy, and it is at the core of the Kennedy legacy.

What the candidates’ searches say about them

Jul 4, 2008• 4

By Craig Stoltz

One of the fun parlor games of Election ’08 is to look at Internet data and figure out what they mean.

The answer may be "nothing," of course.

But let’s play along and look at the latest Hitwise data on popular search terms. HitWise, a company that tracks Internet traffic, counted the search words that sent people to John McCain or Barack Obama’s websites. [Here’s a press release about the findings on the candidates’ top Internet search terms.]

"Health care" didn’t make Obama’s top 5 search terms in the first quarter of 2008. In the second quarter, health care took the number 4 slot. [Q1’s top term was "gay marriage," Q2’s "abortion."]

Meantime, "health care" took the tops spots for John McCain in both Q1 and Q2.

So: Does this mean people think they already know Obama’s healthcare plan and don’t need to search about it on the Internet? Or, don’t they have much interest in the issue?

As for McCain, do the searches mean his plan is little-known and people want information on it? Or do those interested in McCain care more about healthcare than Obama’s voters?

Retreat to the parlor and discuss, please.

AMA and AHIP go head to head with TV ads

Jul 2, 2008• 3

By Sarah Arnquist

The American Medical Association this week began a television ad campaign, lambasting Republican Senators who failed to prevent the July 1 automatic 10.6 percent Medicare physician fee cut.

In the one-minute ad, AMA President Nancy Nielsen says, "A group of Senators decided it was more important to protect the health insurers than seniors."

Just as Robert Laszewski predicted here last week, the doctors are coming out in full lobbying force.

But wait. The Association of Health Insurance Plans is also running ads filled with nice looking seniors saying that to protect seniors Congress must protect the Medicare Advantage program.

Who is a senior taking 10 prescription medications for six chronic diseases with a calendar full of doctor’s appointments to believe?

Here are the ads.

We need to make some changes to change health care

Jul 2, 2008• 5

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let’s Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

This question — is the future just like the past, or something different — was raised again for me earlier this week when Brian Rosman — a good guy with whom I almost never agree — posted a blog on the Health Care for All Web site that basically said that more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.

Docs get mad, 2.0 style, at Sermo

Jul 1, 2008• 8

By Matthew Holt

Sermo Of course, it’s not just cornering a Senator at July 4th picnic that changes policy.
These days there are online communities doing it too. And with increased grumpiness among many doctors, and now the almost-here-rather-than-looming-on-the-horizon cuts in Medicare, you can expect a response online. And here it is: Fed up Sermo docs draft manifesto. Yup, those docs hanging out on Sermo are not just discussing clinical cases, they’re on the verge of getting politically active. As you might expect, they’re pissed off with insurers, the government and lawyers. And who could disagree? (I know, I know it’s more complex than that….)

Never one to miss a trick, Sermo has allowed itself to be used as a vehicle for the open letter that’s going to get much more publicity (and yup, as a doc you have to sign up for Sermo to sign the letter, to verify that you are a doc!). Here’s the site called Doctors Unite.

Every other form of political activism has moved online, so don’t be surprised to see more like this. Of course, if the details get specific, it’s tricky to know whether the coalition of pissed off docs will hang together, and also whether Sermo will become type-cast as representing a particular flavor of doctor (see: Medical Association, American) which may somewhere down the road limit its business initiatives. But for now, it’s fun to see online organization get serious in health care.

A classic from a cardiologist

Jun 30, 2008• 5

By Matthew Holt

The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee’s fabulous book Overtreated which has a whole chapter on the topic. But it’s good to get the debate out there.

It appears that essentially there’s no real reason to use these scanners for the vast majority of patients. And in fact they’re use probably leads to more unnecessary angioplasties and stenting (which in itself doesn’t seem to reduce the number of heart attacks). But of course once a practice buys a 64 slice CT it’s an ATM machine sitting in the corner—not much good if you don’t use it, but very profitable if you do. Of course, the more conservative approach gets short shrift and those waiting for evidence to justify all this spending get ignored in the rush by both doctors, hospitals and manufacturers to get at the taxpayer’s coffers.

I was though vastly amused by this quote from an Manhattan cardiologist which will bring joy to the ears of those fuddy-duddies in the pay for performance movement:

Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said. “It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”

Of course he just knows that thousands are dying due to lack of these scans, so why do we need any evidence!

Run for the hills: the doctors are coming

Jun 30, 2008• 5

By Robert Laszewski

What is the one thing no human being should want to be next week?

A Republican Senator at a Fourth of July Picnic.

In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts to pay for nixing it. Also at stake is another 5% physician fee cut set for January 1, 2009.

Doctor fee stalemate exemplifies problems of universal health care

Jun 30, 2008• 13

By Donald Johnson

The thousands of physicians and millions of Medicare beneficiaries who think the government should provide “universal health care” insurance to all Americans are getting a good look at how ugly such a politically-driven scheme would be. Doctors would see their incomes fall, and patients would suffer big time.

Because Congress cannot agree on how to prevent a 10.6 percent cut in Medicare payments, doctors are threatening to drop their Medicare patients. And because the Democrats want to prevent the cut in Medicare payments to doctors by cutting payments to private insurers that cover millions of Medicare beneficiaries, insurers are threatening to drop out of that program and make those Medicare beneficiaries very unhappy.

The Washington Post’s report on the politically-driven stalemate is here. Clearly, the Democrats are intent on winning political points regardless of what happens to patients. And the Republicans are intent on preserving Medicare Advantage, which they created when they controlled Congress.

Under a “universal health insurance system,” which is advocated by the Democrats, political fights like this would happen every year. Doctors and insurers, if they were still in business, would face payment cuts. Patients would face uncertainty about who their doctors and insurers would be. And relationships between doctors, insurers and patients would become more strained than some of them already are.

Should Progressive Reformers Talk About Reining in the Cost of Care?

Jun 27, 2008• 14

By MAGGIE MAHAR

“It seems that John McCain may have stolen some of the fire that Democrats traditionally wield on health issues by making cost control his top priority, rather than universal coverage.” -Rob Cunningham, “Health Affairs” May/June 2008

Last week, the bold proposal for health care reform that Dr. Ezekiel Emanuel outlines in Healthcare, Guaranteed drew high praise from the American Prospect’s Ezra Klein. As Klein described it:

Emanuel’s Guaranteed Health Care Access Plan maps out “a total transformation of the system. It does not build on the inefficiencies of the current structure, preserving them in amber for the next generation.”

Rather than expanding on the dysfunctional system that we have today, Emanuel, who is the director of bioethics at NIH (and brother to politician Rahm Emanuel), is calling for structural reform. This is what makes his proposal both brave and fresh.

But Emanuel’s plan isn’t just exciting; it’s practical. As usual, Klein cuts to the heart of the matter: “The big deal, he explains is cost control. In health care, cost control is everything.”