GOP Alternatives to ObamaCare

Joe Paduda

Posted 5/2/12 on Managed Care Matters

When it comes to health reform, perhaps the only thing Congressional Republicans agree on is they hate ObamaCare.

There’s no agreement on a basic framework much less consensus on an actual bill. Moreover, there are parts of ObamaCare that enjoy solid support amongst many Republicans, complicating the GOP’s efforts to develop an alternative without conceding political ground.

Their dilemma is certainly understandable; as anyone who followed the tortuous path of the PPACA (aka Obamacare), there was precious little consensus among the Democrats who passed the bill. While most had serious issues with various bits and pieces, they held their noses and voted “aye” when pressed.

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Is Your Hair On Fire Yet?

Joe Paduda

Posted 4/5/12 on Managed Care Matters

The single biggest crisis facing workers comp is NOT the market cycle, employment, rate adequacy, or regulatory changes.

It is opioids. As Gary Franklin MD, Washington state fund’s Medical Director says, this is a “hair on fire” issue.

I’m not talking about the $1.4 billion employers spend on these drugs, nor am I referring to the other medical costs incurred by claimants on opioids or the dollars wasted on diverted drugs or the hundreds of claimants dead from opioids prescribed for their injury; not even the disastrous personal impact on claimants and their families.

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The Legal Strategy To Defend Health Reform

Joe Paduda

Posted 3/15/11 on Managed Care Matter

There’s a seemingly intractable conflict facing the Obama Administration – how can they argue – simultaneously – that the mandate is crucial to the Affordable Care Act, while also arguing that the rest of the Act should and can survive if the Supreme Court rules the mandate is unconstitutional?

That’s the Hobson’s choice facing lawyers arguing for the Administration, and while the two positions seem irreconcilable, they may not be.

Merrill Goozner is convinced the two positions can comprise a reasonable and legally logical argument. He cites a recent article in the NEJM, to wit:

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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 says about these claims:

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

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Medicare’s “Rationers” – the IPAB

Joe Paduda

Posted 12/19/11 on Managed Care Matters

Among the howls of indignation coming from anti-health reform legislators and more strident Presidential aspirants one can often hear the outrage about “faceless government bureaucrats” rationing medical care to our elderly.

(we’ll leave aside that many of the howlers are the same ones screaming about out of control Federal entitlement spending…for now).

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How Health Reform Will Affect You

Joe Paduda

Posted 12/16/11 on Managed Care Matters

There’s been one consistent finding among all the polls and surveys seeking opinions on health reform: most respondents don’t know much about it and there are many misperceptions and misconceptions about reform.

The good folk at Kaiser Family Foundation have put together an interactive tool to help remedy that situation. The YouToon application shows how reform will impact employers – large, small, and mid-sized; individuals and families, the well-off, middle class, and poor.

It’s easy to understand and a quick read too.

There’s a more “you-specific” tool here that is focused on individuals and families, not employers.

And the Washington Post has an interactive site where you can plug in details on income, family size, source of insurance, and marriage status and get specific info on how reform affects you – specifically – and what, if any, tax impact it has.

Health Care and the Super Committee – The Cost of Failure

Joe Paduda

Posted 11/18/11 on Managed Care Matters

The chances that the Congressional Super-Committee will achieve its stated goal of cutting $1.5 trillion from federal expenditures over the next decade are fading fast.

What happens when the six Republicans and six Democrats can’t agree on cuts?

Big – really big – increases in costs for health plans and workers comp payers. I’ll get to that in a minute, but first let’s walk thru what happens if the Supers can’t agree.

Theoretically automatic, almost-across-the-board cuts in military, entitlement program, and ongoing operational budgets go into effect 1/1/2013.

Don’t bet on it.

The threat of across-the-board cuts was supposed to motivate/force the Supers to hammer out their differences and get to a solution. All reports indicate that isn’t going to happen, as the Republicans refuse to contemplate any form of tax increases and Democrats, who believe they’ve given enough on the entitlement side, refuse to go further unless the GOP budges on taxes.

The looming threat of across the board cuts has become a good deal less likely to happen as politicians on both sides acknowledge that the threat is just that – a threat – and not much more. As with any bill passed by Congress, the threat can be overturned when/if Congress passes another bill overturning the original law.

That’s probably what the GOP members are banking on. If they are able to maintain control of the House, take over the majority in the Senate, and win the Presidency in next fall’s elections (a distinct possibility), Republicans will be able to do what they wish. I’d expect immediate action to rescind cuts in military spending, extend the Bush tax cuts for top earners, and slash entitlement spending.

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The Massachusetts Health Reform “Disaster”

Joe Paduda

Posted 11/19/11 on Managed Care Matters

To hear the current GOP presidential candidates describe it, former Gov. Mitt Romney’s support for the 2006 Massachusetts health care reform initiative was the worst thing since the Spanish Flu.

We can chalk a lot of the hyperbole up to campaigning, but the critics raise some good points.

First, costs have gone up. That’s not surprising as more people are covered, many of whom didn’t have coverage before and therefore likely had medical issues that, once they were insured, they addressed. Moreover, Mass’ per-capita health care costs have been higher than the national average for a long time – this is a structural issue as much – if not more – than a result of reform.

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On Workers’ Comp Fee Schedules: A Modest Proposal

Joe Paduda

Posted 10/12/11 on Managed Care Matters

Here’s a modest suggestion re an alternative fee schedule methodology that deserves careful consideration by legislators and regulators alike –

Prostate Cancer Screening – Is Science Winning?

Joe Paduda

First posted 10/07/11 on Managed Care Matters

Brian’s Note: Readers interested in this topic will also want to see “Can Cancer Ever Be Ignored” by Shannon Brownlee and Jeanne Lenzer, published yesterday in the New York Times Magazine.

The announcements this week that the United States Preventive Services Task Force has decided healthy men shouldn’t get the P.S.A. blood test is long overdue, but nonetheless very welcome news.

The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don’t.

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Quick Medicare Factoids

Joe Paduda

First posted 9/08/11 on Managed Care Matters

There’s going to be a LOT coming out in the next two months about Medicare, so it may help to know a few things about the program to help put it in context.

– We spent over a half-trillion dollars on Medicare in 2010.

– That’s fifteen percent of total Federal expenditures.

– 48 million people were covered in 2010.

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The Super-Committee: Health Care Experts Need Not Apply

Joe Paduda

First posted 8/11/11 on Managed Care Matters

Note by Brian: On the day this post was originally published, House Minority Leader Pelosi appointed the three Democrats to the Super-Committee: Chris Van Hollen, Xavier Becerra and James Clyburn.

With nine of the twelve spots on the Super-Committee taken, it looks like energy, tax policy, and political connections (now there’s a surprise!) are well-represented. What isn’t is expertise in health care, Medicare, or Medicaid.

With House Democrats scheduled to name their three panelists by Tuesday, it’s possible that someone with real knowledge of health care policy will be included, butregardless of who Nancy Pelosi names, there won’t be someone from the GOP side who’s got deep experience in the issue, someone(s) who could engage in a real discussion of the issues, represent the other side’s views, and act as the ‘in-house expert’ and counsel the other members of their party.

With Medicare and Medicaid likely to account for over a quarter of the Federal budget, the absence of deep health care policy expertise is rather stunning.

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Get Ready for Big Changes in Provider Reimbursement

Joe Paduda

First posted 8/2/11 on Managed Care Matters

Get ready for big changes in provider reimbursement

Now that the debt limit deal is done, the hard stuff starts. While there’s been a lot of focus on the Pentagon budget and lack of revenue increases, the real heavy lifting will come when the super-committee convenes to figure out how to save the next $1.2 trillion. And their focus will be on Medicare, Medicaid, and provider reimbursement.

Because that’s where the ‘super-committee’ is going to have to find a big chunk of the additional savings required by the deal.

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The Debt Limit, Medicare, and Medicaid

Joe Paduda

First published 7/13/11 on Managed Care Matters

While the news this morning is not good, I still don’t think Congress will fail to raise the debt limit; the economic consequences would be catastrophic, and there’s too much political risk for either party to allow it to go that far.

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Why Health Care Reform Is Here To Stay

Joe Paduda

First published 6/10/11 on Managed Care Matters

It’s pretty simple, really.

Once people gain actual real-life experience with a government program, they abandon their fear of the unknown, see its benefits more clearly, and become invested in its future.

We’ve seen that with Medicare, which consistently pleases its beneficiaries. Part D has similar traction, and now we’ve learned that the citizens of Massachusetts are increasingly happy with that state’s health reform.

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