First published 4/28/11 on Health Care Reform Update
The Congressional Budget Office estimates that the government deficit will exceed one and a half trillion dollars this year, with federal health care annual expenditures expected to hit the trillion dollar mark by 2012. The largest federal health care program is, of course, Medicare, with costs projected to be close to $600 billion in 2012, and growing at around seven percent a year thereafter, although forecast to drop to a mere six percent annual increase if and when the Accountable Care Act is fully implemented.
Continue reading “Controlling the Medicare Budget – Time To Fast Forward to 1999”
C. Eugene Steuerle
First published 4/21/11 on The American Square
President Barack Obama and House Budget Committee Chairman Paul Ryan (R) have laid out different approaches for curbing growth in health care costs. One would empower government-appointed officials to constrain health prices and services by, for instance, strengthening the power of the Independent Payment Advisory Board (IPAB) created in 2010’s health-reform legislation. The other would provide Americans with premium support up to some dollar limit to cover their health insurance purchases. Both count on efficiency improvements as well. The political debates have quickly centered over whether Obama is heading toward ever-more cumbersome government regulation and price-setting and whether Ryan is opening up unregulated markets that would deprive many of needed health care.
It’s not that simple, though. Three questions are actually at issue:
(1) How should budget constraints be applied?
(2) Should automatic budget growth for health care programs (particularly, Medicare) finally be reined in?
(3) Should government health program budgets be limited even if neither side gets its way?
Continue reading “Does Constraining Health Cost Growth Require Choosing between Obama and Ryan?”
First published 4/25/11 on the HCMS Group Blog
Behind closed doors trouble is brewing, and maybe it’s about time.
The situation has all the elements of a daytime drama: an exclusive cartel dictating price; a powerful committee with secret members and closed-door meetings trying to avoid exposure; members threatening mutiny; and media “spin” making it hard for the public to tell good guys from bad guys.
No, I am not referring to the NFL dispute between owners and players. This is medicine.
The soap opera around the RUC (Relative-Value Update Committee) is real and the stakes couldn’t be higher: this little-known group influences the allocation of 2.5 trillion dollars (1) in healthcare spending each year. But a closer look leads me to believe things are about to change.
Continue reading “A Football Team Without a Front Line. That’s Medicine When (If) Primary Care Declares Independence”
First published 4/5/11 on Health Policy and Marketplace Review
Paul Ryan’s overview of his proposed 2012 Budget Resolution contains an honest and compelling description of America’s debt and deficit spending dilemma.
Every American should read it.
As I read through his discussion of the huge hole we’re in and the imperative to fix it, he had me thinking that we finally have a politician willing and ready to deal with the problem. But when I got to the end of the document, I felt like there was a missing chapter—the one with the controversial and politically problematic but necessary bad news solutions.
Continue reading “The Path To Prosperity – Where’s The Health Care Cost Containment?”
Paul M. Fischer and Brian Klepper
If you agree with this letter, please redistribute, particularly to other primary care physicians.
As many of you know, we have developed an effort to shine a bright light on the Relative Value Scale Update Committee, or RUC. A new site, Replace the RUC, provides a wealth of expert background information, and we’re working now to get more visibility on this issue.
A specialist-dominated panel within the AMA, the RUC is little known and under-appreciated, but extremely powerful and opaque. More important, through its longstanding relationship with CMS, it is central to the explosion in health care costs over the past 20 years, why primary care physicians are paid so poorly compared to their specialist colleagues and why few medical students now choose to enter primary care as a career. Meaningfully address the RUC, and you relieve America of more health system waste than all the cost control measures in the health care reform law combined.
Continue reading “An Open Letter To Primary Care Physicians”