Tag: Health Care Reform

Will Victory on Health Care Reform Mean Defeat for the Democrats?

Sep 27, 2009• 50

Being a futurist is not really about making predictions, but people ask for them anyway.

So here is one: The way things are trending right now, Obama and the Democrats will succeed in getting a reform bill – and it will cost them the Congress in 2010 and possibly the presidency in 2012. Why? Because it will be ineffective at bringing most voters any tangible benefits soon, and ineffective especially at bringing down the cost of health care.

Obama (along with everyone else) repeatedly talks about “affordable” health care. What the bill is most likely to bring is health insurance reform. This is very important, and will bring tangible benefits especially for those who must go without insurance now because they have “pre-existing conditions.” But there is nothing in the bills that are most likely to pass that will really bring down the costs of health care any time soon. Yet the bills demand that the health plans cover many more people, and the providers treat them, while putting in place no mechanisms that would forcefully and quickly control costs – so costs are likely to go up even faster than before.

Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?

Sep 27, 2009• 1

By JEFF GOLDSMITH

As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform. No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.

No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress: the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected. These parties have very little in common other than the Capital D after their names.

“Reform” Means Higher Costs, Not Lower

Sep 21, 2009• 4

By JOE FLOWER

A reader asks: “If the current bill passes are my health insurance costs likely to go up, down, or remain about the same?”

If the form that I believe most likely to pass actually passes (insurance reforms, individual mandate, weak or no public option or co-ops), I believe that they will continue to go up. There simply is nothing in the bill that would make things more affordable. In health care markets, for a convoluted nest of reasons, more competition causes prices to go up, not down.

Health Care Outlook Not Improving

Sep 21, 2009• 58

By ROBERT LASZEWSKI

Sen. Max Baucus (D-Mon) released his much-anticipated healthcare proposal Wednesday morning.

The next big test for a health care bill in 2009 (notice that I did not call it health care reform) will come in Senate Finance.

The
final vote in that committee will tell us a lot about whether the
Democrats have any chance for 60 votes in the full Senate. So far, it
does not look good.I have the greatest respect for Senators
Baucus and Grassley and their good faith efforts to find a bipartisan
health care solution. But I also think their efforts were fatally
flawed from the beginning.I think the problem is that Baucus
and Grassley were trying to bridge the wide chasm between liberal and
conservative ideas. Finding the fine balance necessary has created an
unwieldy compromise—no one is happy. Most striking, the compromise
reached between cost and premium subsidies has yielded an $880 billion
bill that requires middle class people to buy health insurance they will in no way will be able to afford. On top of that, the policies have big deductibles and out-of-pocket costs.

Obama’s Medicare Half-Truth

Sep 20, 2009• 11

By AUSTIN FRAKT

Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful about the implications of cuts to Medicare. Obama repeated that his health reform plan includes payment cuts for private Medicare Advantage (MA) health plans:

The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.

Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others have pointed out the proposed cuts will in fact reduce benefits to some degree, contrary to the President’s assertion. But seniors, in general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.

Health care reform: econo-think, democracy and sustainability

Sep 20, 2009• 1

By LAWRENCE W. ARRINGTON

Bill Moyers Journal recently interviewed Wendell
Potter, who spent much of his career in corporate communications for health
insurance giants CIGNA and Humana. Every American concerned about affordable
and quality health care and the American political system should watch it.

Potter went public to tell the truth about how the health
insurance industry advances both its bottom line and its massive political
advocacy against meaningful health care reform.

Moyers asked Potter, “Why is the industry so powerful on both
sides of the aisle?” Potter’s
reply: “Well, money and relationships, ideology.”

The distinctive ideology Potter mentions deserves more national
dialogue and deeper understanding.

Alvin
Toffler in his groundbreaking work Future Shock labeled the strict adherence to free market principles
Potter references “econo-think.”

A core belief is that investor profit drives
the material and moral “worth” of products and services, and is the metric of
social progress.

Good News for Uninsured Children Should Jumpstart Health Reform

Sep 17, 2009• 3

By JOCELYN GUYER

In 2008, the number of uninsured children in the United States hit the lowest level in two decades. If Congress weren’t in the middle of a fierce debate on health reform, there would be time for everyone to celebrate a remarkable achievement and maybe even pause to reflect on how it was accomplished. To paraphrase David Byrne of the Talking Heads: “We might ask ourselves, how did we get here?” We got here with federal fiscal support, leadership, state ingenuity and a willingness to make a sustained effort to address the issue of uninsured children. The states deserve a lot of credit. It’s been impressive to see how state policymakers from across the political spectrum have rallied to support children’s coverage, despite facing tough economic obstacles in recent years. Even in the midst of terrible fiscal problems, the vast majority of states have maintained children’s coverage in Medicaid and CHIP. This year so far, a whopping twenty-three states found a way to expand or improve children’s coverage, proving what can be accomplished when the federal government is a strong fiscal partner.

The Chairman’s Mark – Good Ideas, Potentially Fatal Flaws

Sep 16, 2009• 4

By Roger Collier

So, at long last, Senator Max Baucus has released his Chairman’s Mark draft health care reform bill for discussion by the full Senate Finance Committee. The 223-page draft bill is generally consistent with the “Framework for a Plan” document that Senator Baucus issued last week. So, no big surprises. But can it make coverage more accessible and affordable? Can it put the brakes on skyrocketing health care costs? Is it likely to help or hurt the economic recovery?

Accessibility and affordability are the main thrusts of the draft. As with the other Senate and House bills, an individual mandate would be imposed and the insurance market would be reformed to assure coverage on a guaranteed issue basis. Also as with the other bills, Medicaid would be expanded to cover anyone below 133 percent of FPL (but with the federal government picking up more of the tab), while subsidies would be available to other lower-income individuals who buy coverage through an insurance exchange. Additionally, benefit standards would be set for the individual and small group markets, with limits on cost-sharing.

Is an IOM v. CBO Smackdown Looming on Health-Reform Costs?

Sep 15, 2009• 8

By TIM MULLANEY

The U.S. can cut health-care spending by $250 billion a year within a decade, a
congressionally chartered panel will say this month in a bid to
show costs can be contained even if all Americans are insured.

A report from the Institute of Medicine, which advises the
federal government on health care, will counter “stingy”
estimates from the Congressional Budget Office, said Arnold
Milstein, planning chairman of the institute’s working group on
health costs. The panel’s annual figure is five times the amount
the budget office says the U.S. will save under a bill in the
House of Representatives, according to the budget office’s July
17 letter to House Ways and Means Committee chairman Charles
Rangel.

The preliminary findings from the institute, part of the
National Academies in Washington, will be issued amid a growing
debate over the health-care overhaul proposals that President
Barack Obama is urging Congress to pass. The report will help
bolster the argument that covering the nation’s 46 million
uninsured won’t bust the budget, advocates of the bill say.

Commentology: Improving Cost-Containment

Sep 15, 2009• 4

Stephen J. Motew writes:

Surgical specialists practice under a slightly more regimented reimbursement model predominantly due to the global period payment for surgical procedures. The total care of the surgical patient for any procedure, including pre-op evaluation, the procedure itself, and all related care post-operatively including most complications is covered under a 90 day global pay period. This system has worked relatively well by containing costs to a specific 'disease' (or procedure) state. In addition, many surgical sub-specialties such as vascular surgery and oncologic surgery for example invest a large amount of time in overall disease-state management that may not even include a procedure. I believe this has allowed many surgeons to understand the concept of cost-containment and efficiency, disease management as well as outcomes-based practices.

A recent experience with a referral patient however, highlights the incredible gaps in cost-containment and disease management that can occur prior to surgical intervention. I have annotated each step in the process to demonstrate points where potential intervention may have occurred. I will leave it to the comments to discuss the reasons and realities of such a case!