ObamaCare and Jobs

Joe Paduda

Posted 2/22/12 on Managed Care Matters

Will the health reform bill kill jobs? Devastate small businesses? Push us back into recession?

According to several organizations and and anti-reform politicians, it’s the worst thing to hit the economy since the Depression.

But it turns out those doomsayers are mostly wrong.

Here’s what FactCheck.com says about these claims:

“this is health-care hooey, aimed at exploiting public concern over continuing high unemployment, with little basis in fact.

Continue reading “ObamaCare and Jobs”

Prevention Axed To Pay For Doc Fix

Merrill Goozner

Posted 2/19/12 on Gooz News

Would you sell your home’s storm doors to pay for this winter’s heating bills? That’s what Congress did Friday to pay for part of a 10-month “doc fix.”

Friday’s payroll tax cut extension bill included $18 billion to maintain Medicare physician salaries at current levels for the rest of this year. Unlike the payroll tax extension, Congress insisted on paying for the doc-fix with offsetting budget cuts.

They raised nearly a third of the money by cutting $5 billion from prevention programs initiated under the Affordable Care Act. The rest came from reduced payments to hospitals, nursing homes, and clinical labs, and reduced Medicaid payments to Louisiana.

Continue reading “Prevention Axed To Pay For Doc Fix”

HR Benefit Ideal – Time For Change

Tom Emerick

Posted 2/14 on Cracking Health Costs

The Human Resources notional view of health care benefits needs to change and do so quickly.

At one time the view of health benefits was one of satisfying/motivating employees, closely coupled with a notion that health benefits were a great way to attract and retain top talent.  Truthfully, that was never really the correct notion of health care reimbursement models.

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There is No Free Lunch and There is No Free Contraception

Robert Laszewski

Posted 2/10/12 on Health Policy and Marketplace Review

The otherworldy Obama Administration solution to the contraception firestorm might work politically but it makes no sense in the real world. The President, hoping to quell a growing political firestorm, today announced a new policy that no longer requires religiously affiliated organizations to provide employees with contraception coverage in health-insurance plans. Under the new policy, insurance companies will be required to offer free contraception for their employees and dependents. The administration’s idea is to shift the onus for the coverage from the employer to the insurer. Catholic leaders, and lots of other people, had objected to the requirement, which exempted churches but not hospitals, charities and universities with religious affiliations. So, let’s just play a game here. The religious organization just pretends that it has nothing to do with it but the insurance company pays for it anyway. Hey, the insurance companies are rich. Continue reading “There is No Free Lunch and There is No Free Contraception”

Mini-Meds For Maxi Greed

Dan Munro

Posted 2/10/12 on Forbes 

Within a certain part of Italy that mints its own coins and has a standing army outfitted in designer togs from Michelangelo, when one makes a mistake, the correct and only exclamation is Mea Culpa.  Well actually it’s more like Mea Culpa, Mea Culpa, Mea Maxima Culpa – but even Italians are known to abbreviate their Latin for the sake of expediency.  That’s my mantra this week after last weeks post on Medical Gluttony.  In that article we highlighted a new book by Dr. Otis Webb Brawley – How We Do Harm – in which he characterized portions of our healthcare delivery system as gluttonous.   In all fairness, doctors and providers are most definitely not alone in their greed.  I never said they were – but I tend to err on the Italian side of life when it comes to my public Mea Culpas.

This week it’s time to turn our attention to another form of healthcare malfeasance – a form of Payer Gluttony.  By the time we’re done with our mini series on gluttony, we’ll likely get to include Pharma Gluttony, Political Gluttony and possibly some other gluttony’s as yet to be uncovered.  It’s no wonder our system is $3 trillion per year and represents 18% of GDP.  In their landmark study from 2008 – The Price of Excess – PWC estimated that roughly half of our healthcare spending is completely wasted.  The real question remains – is it truly wasted – or is this just the biggest trough America has ever built?

Continue reading “Mini-Meds For Maxi Greed”

The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System

Jane Sarasohn-Kahn

Posted 2/7/12 on Health Populi

U.S. health consumers’ purchase and use of over-the-counter medicines (OTCs) generate $102 billion worth of value to the health system every year. Half of this value accrues to employers who sponsor health insurance for their workforce; 25% goes to government payers (e.g., Medicare, Medicaid); and, 25% returns to self-insured and uninsured people.

For every $1 spent on OTCs, $6.50 is saved by the U.S. health system, shown by the chart.

For millions of health consumers, OTCs substitute for a visit to a doctor’s office: most cost-savings generated by OTC use are in saved costs of not visiting a clinician, as discussed inThe Value of OTC Medicine to the United States, published by the Consumer Healthcare Products Association in January 2012.

Continue reading “The Self-Care Economy: OTC Medicines in the U.S. Deliver Value to the Health System”

Medicare Advantage Premiums Drop an Average of 7% and Enrollment Is Up 10%—That Must Make Republicans Just Want to Cry

Robert Laszewski

Posted 2/6/12 on Health Policy and Marketplace Review

Medicare Advantage would appear to be a fantastic success—senior premiums are dropping and enrollment is increasing.

Listening to Health and Human Services Secretary Sebelius last week, you would think private Medicare plans were a Democratic idea and this is their success. Many industry observers, including me, have worried that Medicare Advantage benefits would shrink and premiums would rise because the new health care law reduced federal payments to the plans by $136 billion over the next decade.

Continue reading “Medicare Advantage Premiums Drop an Average of 7% and Enrollment Is Up 10%—That Must Make Republicans Just Want to Cry”

Addressing Chronic Illness Can Help Cure The US Budget Deficit

Chronic illness represents $3 of every $4 of annual health spending in the U.S. That’s about $1.5 trillion.
– Adopting evidence-based interventions for disease preventionLiving Well With Chronic Illness, a report fromThe Institute of Medicine (IOM), issues a “call for public health action” to address chronic illness through:

– Developing new public policies to promote better living with chronic disease
– Building a comprehensive surveillance system that integrates quality of life measures, and
– Enhancing collaboration among health ecosystem stakeholders: health care, health, and community non-healthcare services.

Continue reading “Addressing Chronic Illness Can Help Cure The US Budget Deficit”

Can Medical Management Succeed Within A Fee-For-Service Environment?

Brian Klepper

The column immediately below is an important discussion by Douglas Elmendorf, the Director of the CBO – actually it was prepared by Lyle Nelson of CBO’s Health and Human Services Division, but it has Mr. Elmendorf’s imprimatur – which recently released an issue brief concluding that major cost control approaches had not produced savings in Medicare. This of course elicited a cascade of pro/con medical management commentary.

Most important is this sentence near the bottom.

Demonstrations aimed at reducing spending and increasing quality of care face significant challenges in overcoming the incentives inherent in Medicare’s fee-for-service payment system, which rewards providers for delivering more care but does not pay them for coordinating with other providers, and the nation’s decentralized health care delivery system, which does not facilitate communication or coordination among providers.

Continue reading “Can Medical Management Succeed Within A Fee-For-Service Environment?”

Why Only Non-Health Care Business Can Save America From The Health Care Industry

Brian Klepper

The attached PP deck is a presentation I’ve given several times that has received an overwhelmingly positive, if frightened, reception.

It is, perhaps, the most disturbing public argument of my career (which is going some), because it tries to document the health care industry’s “capture” of health care regulatory processes, particularly those that govern payment. The result, as many people understand, is that the health care industry, in its rapaciousness, is effectively driving the larger US economy off a cliff.

Only one group, the non-health care business community, has the heft, influence and motivation to save us, though health care has done a good job dividing and conquering this sector as well, insinuating itself into many of the most powerful institutions (e.g., the Chambers of Commerce). It remains very unclear that the business community can be galvanized/mobilized from its malaise to turn this problem around.

The argument goes like this:

  • The data are clear that the US’ health care economy is absorbing most gains in the larger economy, and driving the US economy toward collapse. For example, nearly all increases in total compensation have been directed at increasing health costs, which in turn flows into the health industry.

Are Consumers Ready To Transform Health Care? If Not Now, When?

Wendy Lynch

Posted 1/26/12 on the Altarum Institute’s Health Policy Forum

There is a massive untapped resource in health care: consumers. Like a sleeping giant, unaware of its size and power, consumers have yet to realize what effect they could have on the system simply by asking questions or making choices. It’s not certain when, or if, consumers will awaken.

Consider this finding from our recent online survey of consumer opinions (1). The survey asked a national sample of about 3,000 employed individuals about where they get health information and how they use it. Only half of all respondents ever remember a doctor offering them multiple treatment options from which they could choose. Let’s remember the evidence: individuals who participate in medical decisions have better outcomes, better recovery, lower costs and higher satisfaction than those who don’t (2). Against this backdrop combined with national agencies promoting shared decision making with their “Questions are the Answer” campaign (3), and the new Physician Ethics Manual (4) insisting that the patient should be the primary decision maker about options, this answer is disturbing. But not surprising.

Continue reading “Are Consumers Ready To Transform Health Care? If Not Now, When?”

Medicare Spending Time Bomb

Tom Emerick

Posted 1/23/12 on Cracking Health Costs

A huge amount of attention is focused on the national debt, and it should be.  The real train wreck in the pipeline is Medicare and Medicaid spending.

According to CBO projections, “Total spending on health care would rise from 16 percent of gross domestic product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082.”  Click here for full report.  One problem with CBO estimates is they are notoriously optimistic, with actual costs coming in sometimes as much as eight times higher than CBO projections.

Sometime between 2025 and 2050, America’s going to…. Oh well, I’ll let you complete the sentence.

To quote Alan S. Blinder from a WSJ editorial on this topic, “So no, America, we don’t have a generalized overspending problem for the long run. We have a humongous health-care problem.”

Our children and grandchildren will resent our generation, perhaps bitterly, if we let this stand. In time historians will puzzle over why we knew this was coming but failed to act.

The Awkward World of Private Insurance in the UK

Bob Wachter

Posted 1/16/12 on The Health Care Blog

I remember reading an article that observed that systems of universal insurance – which need to put their energy into providing a “decent minimum” for the masses – must also offer a “safety valve for the wealthy disaffected.” Canada bans private insurance for basic hospital and medical care services. So, when affluent Canadians want “the best,” some of them pop across the border to Cleveland or Ann Arbor.

But from the time of its founding in 1948, the British National Health Service has allowed – and, depending on which party is in power, promoted – a private insurance market. Private insurance in a single payer, government run healthcare system is a funny animal: one part incest, one part conflict of interest, and three parts strange bedfellows. And it’s infinitely fascinating. Here’s how it works:

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Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?

Robert Laszewski

Posted 1/18/12 on Health Policy and Marketplace Review

Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.

If the states don’t do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.
Continue reading “Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?”

Big Government Brings Big Profits To Texas Health Plans

Michael Millenson

Posted 12/11/11 on Forbes

Governor Rick Perry of Texas speaking at the R...While Texas Governor Rick Perry rails against the evils of  federal involvement in health care on the GOP presidential campaign trail, businesses back home are busy raking in record profits from government dollars.

“By largely exiting the employer market and focusing on Medicare and Medicaid, Texas HMOs have enjoyed strong and growing profits in the last six years,” concluded the newly issued Texas Health Market Review 2011, an analysis of financial filings by state plans. It added, “HMOs here now are focused on the niche businesses of Medicare and Medicaid, both of which were strongly profitable in 2010. Overall, Texas HMOs reported net income of $404.1 million in 2010, or 3.3% of underwriting revenues of $12.41 billion.”

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