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POLICY: Wealthy Floridians fear health care costs

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Brian Klepper steers THCB to this cracker of a headline from the state of endless sunshine and rampant voting fraud. Poll: Wealthy Floridians fear health care costs.

Apparently Florida’s wealthiest residents (although the story doesn’t define wealthy) fear that the high cost of health care may drain their financial assets. Nearly one in three wealthy Floridians polled agreed with the statement "health care costs will ultimately consume a major portion of my financial assets."

As Brian notes, if they’re scared, what about the poor people? Perhaps there’s room for a coalition here.

POLICY: Over at TPMCafe, Medicare Part D

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I have joined in a coversation about Part D with some other old farts and a couple of young punks (but very smart young punks — I was strugling to learn how to pick my nose at their age, and they’re health policy whizzes!) at TPMCafe. The section is called Drug Bill Debacle

Also don’t miss this cracker from a surgeon, Me and my HSA in which she shows why it’s great for her, but terrible for America!

POLICY/THCB: Ron speaks

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So while I was making my lunch and walking the dog everyone’s "favorite" THCB commenter Ron Grenier called me and talked, and talked, and talked. What was he talking about?  Your guess is as good as mine, but let’s just say that he talks exactly like he writes! Oh, and apparently he’ll be doing a radio-show soon, Actually he’s make a very good Sean Hannity-type pontificator, although he’s probably a little too non-profane to make it in the rough and tumble world of loony conservative talk-radio.

But for those of you who thought he was an invention of the loony left to make the loony right look bad–nope he’s real!

PHARMA/POLICY: Drug coverage in Medicare Catastrophic (1988) and in the Clinton plan (1994), by MedPac

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This is taken straight from a hard to navigate PDF document created in 2000 by MedPac (and advisory body on Medicare for the Congress). It’s a good primer on what happened, especially to  drug coverage under the by now forgotten Medicare Catastrophic Act. I reprint it here because there’s some confusion over that issue and I don’t want to have to do more writing myself when they’ve explained it so well!

Policymakers previously approached the issue of adding Medicare prescription drug coverage: in 1988, with the Medicare Catastrophic Coverage Act (MCCA) of 1988, and in 1994, with the Health Security Act. Both efforts failed, but for different reasons and under different circumstances.

Medicare Catastrophic Coverage Act of 1988

In 1988, Congress added a catastrophic benefit to Medicare that would have provided comprehensive coverage for outpatient drug expenses greater than $600 in 1991 with a 50 percent coinsurance, and those greater than $652 in 1992 with a 40 percent coinsurance. The coinsurance was to be lowered to 20 percent in 1993. The intent was to revise the deductible  annually, providing 16.8 percent of beneficiaries with benefits each year. The new coverage was to be entirely financed by  Medicare beneficiaries through an increase in the Part B premium and a supplementary surcharge. The surcharge was to cost higher-income beneficiaries those with incomes greater than about $40,000as much as $800 in 1989 and $1,050 in 1993 (Congressional Quarterly 1988, Coster 1990). Opposition to the new benefit was fueled by confusion about the specifics of the financing (many lower-income beneficiaries thought they had to pay the full surcharge), as well as other concerns.

First, enrollment in the program was mandatory, but many beneficiaries would never receive any benefits because their drug costs would never exceed the cap. Second, beneficiaries who already had drug coverage, from either Medigap or an employer-sponsored retiree plan, would be required to pay twice for the same benefit; these people also were the ones most likely to pay the maximum premium surcharge (although it is likely that retiree insurance premiums would either decline due to Medicare coverage or be a wrap-around benefit). Third, beneficiaries were required to start paying the supplemental premium in 1989, two years before the full benefit began. The law was ultimately repealed in 1989; few benefits had taken effect by this time.

Continue reading…

HOSPITALS/PHYSICIANS/POLICY: More data on specialty hospitals suggests the obvious

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HSC is out with another study on local markets, and this time it’s looking at specialty hospitals. Not a new tune. HSC finds that purchasers in three local markets where there are plenty of specialty hospitals believe that the hospitals add to overall healthcare costs without improving quality. While purchasers may get lower prices from the new hospitals, they perceive that more procedures are recommended by physicians driving up their number of procedures and therefore overall costs. In addition, traditional community hospitals have been forced to compete by building new facilities, the costs of which get passed onto purchasers in the end, and have been raising their prices for services that specialty hospitals do not offer to compensate for their losses where the specialty hospitals have taken their business.

Yup, it’s all a scam. A war between docs and hospitals with the payers (and the taxpayer) picking up the tab. Of course, as discussed multo–times on THCB, if this was done within the context of some type of fixed budget, then maybe specialty hospitals or teams would be found to be the best way of delivering care. But in a FFS-based cost-unconscious system, they’re just adding to the death of health care affordability by a thousand cuts.

QUALITY/PHARMA: Statins in the water in the UK, but generic ones

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And in more from the UK, statins are now going to be put in the water. Well not quite, but allowed to be given to anyone ever suspected of maybe in the future developing heart disease given to anyone ever suspected of maybe in the future developing heart disease, which in the UK is basically anyone.

Almost six million people in England and Wales — nearly 15 per cent of all adults — are from today eligible for treatment with statins under ground-breaking NHS guidelines. A report by the National Institute for Health and Clinical Excellence (NICE), which advises on best treatments, will recommend that anyone at risk of cardiovascular disease should be prescribed the drug.About 1.8 million adults in England and Wales currently take statins, which are thought to save 7,000 lives a year. Doctors believe that the new ruling will double uptake to 3.4 million people, saving another 10,000 lives a year.

While this might sound like fantastic news for the drug companies, I think that the decision might somehow be connected to the fact that most of the big statins (with the exception of I believe Lipitor and Crestor) have gone off patent in the UK, and one suspects that Pravachol and Zocor will be most popular!

POLICY/QUALITY: Assisted suicide, as rational as can be

In a remarkable front page story, the London Times has an excellent article on why assisted suicide should be legal in any rational country, as it is in Oregon and apparently Switzerland. The story is called Why a retired GP chose to end her life seven years before time and it shows how a determined lucid retired physician from the UK made the right choice for herself, but was forced to travel far from home to do so. Luckily her children supported her through the process, and they present a united front to those who’d interfere in the rights of those who want to make this choice. She wrote more than 100 letters explaining her actions.

On a personal note, my own grandmother made a similar choice and committed suicide when she felt the infirmities of her old age was making her life unbearable. She wrote me a loving letter that I received after her death, but unfortunately society wasn’t ready then to allow her to do it in a more public way, or to let us know it was coming. I wish that I’d had the opportunity with her that the GP’s children had with their mother.

 

POLICY/POLITICS: Ezra Klein skewers the HSA, Joe Paduda skewers the CDHP, with UPDATE

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(This entry bumped up to top because of fun UPDATE)

Apologies for my later start this morning, those of you who follow my knee problems will perhaps be as pleased as I am to know that I spent the weekend snowboarding with apparently no ill effects on it! But it mean that there’s only limited fodder for THCB written over the weekend.

The good news is that while I’ve been slacking, over at Tapped, Ezra Klein skewers the HSA, reminding us that it’s a destruction of the risk pool. I suspect that educating Bush about health care is like the story of David Stockman trying to explain the budget to Reagan, and realizing that he never had a clue about the difference between real and nominal dollars. One of Ezra’s commenters also points out the obvious–that the HSA will do nothing to reform the underlying problems of the system’s cost explosion, and so is by definition a temporary fix.

Last year, when I bought health insurance for my law firm (me, my family, my paralegal and my secretary) I could get coverage with a five hundred dollar annual deductible for $1,900 a month. I looked through all the options and saw that a plan with a $5,000 annual deductible was $1,200 a month. If there was one with a $10,000 deductible it would maybe cost maybe $900 a month (guessing). With health-care inflation running at 8-10% a year that policy with a $10,000 deductible would soon be prohibitively expensive.

Meanwhile over on his Managed Care Matters blog, Joe Paduda skewers the CDHP, with a big assist from Alain Enthoven. Remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.

CODA: In the transcript of the debate between Enthoven and Reggie Herzlinger on the KaiserNetwork site, Reggie’s comments have all been excised. I wonder whether there’s censorship of some kind here, or whether she was so embarrassed at what she said that she asked for them to be pulled…anyone who knows the truth please get in touch!

UPDATE: Reggie apparently did ask the Kaiser people not to publish her remarks. So was she chicken embarrassed, or was it a bad hair day, or was she selling her schtick to someone else for an exclusive?

TECH/PHYSICIANS: Medtronic helps out whistleblowers, by The Industry Veteran

The Industry Veteran is back on his preferred way to make a buck in health care

Another whistle-blower makes good, this time on the device side of health care manufacturing.  It appears that Medtronic pays spinal surgeons upwards of a half million dollars a year in bogus consulting arrangements (e.g., for eight days of work during the year) if these payees agree to use the benefactor’s products.  What brightens the career prospects for whistleblowers in this suit is the fact that the plaintiff is not a scientist, a physician, a sales rep, an MSL or any of the usual types within either the clinical or the business operations.  The woman here worked as a travel agent for Medtronic, in which capacity she arranged accommodations for the bribed surgeons.  Her duties made her privy to the occasions where the amorality of business managers intersect with the usual conditions of gross immorality and psychopathic narcissism among physicians.  The news here is encouraging.  The day might dawn where the greed-is-good, corporate, fiduciary officers and the my-son-the-genius-doctors will have to fear their own admin assistants, office managers, temps, and maintenance workers.  Well, probably not, but at least the possibility brings a smile.

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