Category: Healthcare

Medicare Trust Fund Lifetime Extended

Score another one for Obamacare, the exhaustion date for the exhaustion of the Medicare trust fund has been pushed back:

Falling health-care costs are brightening the financial outlook for Medicare, extending the life of the trust fund that supports the program until 2026 — two years later than previously forecast.

The new projections, released Friday by the program’s trustees, credit President Obama’s Affordable Care Act in part for the improvement in the finances of the federal health insurance program for the elderly. The act’s limits on Medicare Advantage, a more expensive form of Medicare run by private insurers, are proving more effective than previously forecast, the report said.

The trustees also cited lower-than-expected spending in “most . . . service categories — especially skilled nursing facilities,” a development that is not well understood. Costs have been slowing throughout the health-care industry, partly because of the recent recession, economists say, but also because of what appear to be more fundamental changes aimed at reducing waste and improving health outcomes.

This is particularly interesting when juxtaposed against the New York Times article on the pricing of colonoscopies:

A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.

………

But she noted that gastroenterologists in Austria do have their financial concerns. They are complaining to the government and insurers that they cannot afford to do the 30-minute procedure, with prep time, maintenance of equipment and anesthesia, for the current approved rate — between $200 and $300, all included. “I think the cheapest colonoscopy in the U.S. is about $950,” Dr. Ferlitsch said. “We’d love to get half of that.”

Dr. Cesare Hassan, an Italian gastroenterologist who is the chairman of the Guidelines Committee of the European Society of Gastrointestinal Endoscopy, noted that studies in Europe had estimated that the procedure cost about $400 to $800 to perform, including biopsies and sedation. “The U.S. is paying way too much for too little — it leads to opportunistic colonoscopies,” done for profit rather than health, he said.

The real problem here is that prices are are not transparent, and they are excessive to boot, being many times for routine procedures compared to the rest of the industrialized world.

The idea of market driven healthcare does not work, because there is no transparency in pricing, and even if there were, much of the time there is no opportunity to engage the market as a rational actor (auto accident, gun show wound, etc.).

It’s why, even with its apparent benefits, Obamacare, does not address the core of the problem, which is that healthcare in the US is tremendously overpriced.

Why Would a Race Baiting Republican Go to the Wall Over Medicaid Expansion?

Yes, Arizona Governor Jan Brewer is following through on her threat to veto all legislation until Medicaid expansion is passed:

Gov. Jan Brewer (R-AZ) has a message for her party: expand Medicaid — or else.

The combative GOP governor is sticking by a threat she made to veto all legislation until lawmakers resolve the 2014 state budget and pass Obamacare’s Medicaid expansion. On Thursday, Brewer proved that wasn’t just talk, vetoing five bills sent to her desk in quick succession.

“I warned that I would not sign additional measures into law until we see resolution of the two most pressing issues facing us: adoption of a fiscal 2014 state budget and plan for Medicaid,” wrote Brewer in her veto message. “It is disappointing I must demonstrate the moratorium was not an idle threat.”

Arizona officials only have five weeks before reaching the constitutional deadline for passing a budget. Last Thursday, six Republican state senators joined a unified Democratic caucus to pass a Medicaid expansion bill — but efforts have been gummed up in the state House since then.

Brewer isn’t letting the issue slide. She has been touring the Grand Canyon State to shore up support for the expansion and put pressure on reticent lawmakers in her own party.

Seriously, I do not know where this is coming from.

This is the politician who continuously repeated false claims about beheaded bodies in the desert, and blamed “Mexicans,” and she is going to the mat for Obamacare?

I really cannot figure out her angle on this. 

From a budget and economic standpoint, it makes sense, it makes the state more attractive to employers, and the Feds cover almost all the costs for the next few years, but budgetary reality is not something that typically drives movement conservatives.

Obamacare Seems to be Working in Oregon

In Oregon, they have up exchanges that allow people to easily compare standard insurance policies, and as a result, premiums are falling:

This is what competition looks like: One health insurer wants to charge $169 a month next year to cover a 40-year-old Portland-area non-smoker. Another wants $422 a month for the same standard plan.

The new health insurance marketplace envisioned by federal health reforms doesn’t formally kick in until fall. But it already is taking shape – and consumers for the first time can compare, premium by premium, identical plans by different insurers.

Soon they’ll be able to compare benefit-by-benefit as well.

On Thursday, a comparison of proposed 2014 health premiums became public online, causing two insurers to request do-overs to lower their rates even before the state determines whether they’re justified.

The unusual development was sparked by a comparison that used to be impossible because plan benefits varied so widely. But under the federal reforms that take effect Jan. 1, health insurance is mandated and every insurer must offer certain standard plans.

Good, but somehow, I do not think that it’s going to last.

Expect to see an orgy of mergers and acquisitions, and inventive ways to collude to follow.

H/t John Aravosis.

Confusopolies are Obamacare’s Achilles Heel

At the heart of healthcare reform, it is the insurance exchanges, and your average consumer lacks the sophistication necessary to see how the insurance companies will f%$# them until it is too late:

One of the big reasons I’m so pessimistic about the new health insurance exchanges created under the Affordable Care Act is the principle behind them. The idea is that everyone will be well- informed dedicated shoppers who will know how to select the best plan to fit their needs, which will reduce cost for everyone. Aflac’s 2013 WorkForces Report shows how deeply misguided this assumption is in reality.

Two numbers from the report really stick out. The survey found 54 percent of workers would prefer not to be more in control over their health insurance expenses and options because they will not have the time or knowledge to effectively manage it. This is completely understandable. Selecting the best insurance plan requires not only significant knowledge about every component of insurance, but also the ability to accurately predict the likelihood of future medical needs.

One thing that you can be sure of is that the insurance companies will do their level best to confuse customers so that they will make a decision that will increase their profits.

As John Maynard Keynes noted, “Capitalism is the theory that the worst people, acting from their worst motives, will somehow produce the most good.”

The health insurance industry is one of the best examples of this, and the health insurance reform plan requires us to rely on their good will.

Pleasant dreams.

Obamacare Hiccup ……… Is this the Shape of Things to Come

The healthcare market for small business medical insurance mandated under the PPACA will be delayed:

Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation.

The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan.

The choice option, already available to many big businesses, was supposed to become available to small employers in January. But administration officials said they would delay it until 2015 in the 33 states where the federal government will be running insurance markets known as exchanges. And they will delay the requirement for other states as well.

The promise of affordable health insurance for small businesses was portrayed as a major advantage of the new health care law, mentioned often by White House officials and Democratic leaders in Congress as they fought opponents of the legislation.

Supporters of the law said they were disappointed by the turn of events.

………

D. Michael Roach, who owns a women’s clothing store in Portland, Ore., said the delay was “a real mistake.”

“It will limit the attractiveness of exchanges to small business,” he said. “We would like to see different insurance carriers available to each of our 12 employees, who range in age from 21 to 62. You would have more competition, more downward pressure on rates, and employees would be more likely to get exactly what they wanted.”

John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group, said that the delay of “employee choice” was “a major letdown for small business owners and their employees.”

Gee, the delay shafts small businesses, and favors the big players in the FIRE (Finance, Insurance, and Real Estate) sector.

Gee, that’s a surprise ……… Not.

The Obama administration doesn’t work hard for anything that does not have a payoff for the banksters and their ilk.

What PZ Myers Said

He suggests that the buying spree of hospitals by the Catholic church is a stealth assault on reproductive rights and needs to be stopped:

Imagine if you lived in a town where the only hospital was owned by the Jehovah’s Witnesses, and you were in a car accident — you’ve got a ruptured spleen, you’re bleeding internally, and your life is at risk. The surgeon is going to go in and stitch up and cauterize everything, but you’re warned that they don’t keep any kind of blood supply in the hospital, and they refuse to do blood transfusions — they have an in-house professional ethicist (who is a Jehovah’s Witness, of course) who rejects the morality of exchanging sacred blood, and the administrators have signed an agreement with the church to never, under any circumstances, carry out blood transfusions.

If you need a blood transfusion, they say, don’t worry, the ambulance will take you to a different hospital…50 miles away. You, unfortunately, are in shock, you’ve got a gusher pouring blood into your body cavity, and this is not an option. You get to die.

………

So why are Catholics allowed to buy up and impose Catholic dogma on hospitals? Is it because their ignorant dogma does the greatest harm to women (especially those slutty ones who have sex) and bizarre rules about reproduction don’t directly harm men?

But Catholics are buying up hospitals all over the country. They’ve got declining attendance, they’re closing churches, they’re having trouble recruiting priests, but they’ve still got buckets of money, and they’re using that money to impose control in another way — by taking over your health care.

His conclusion is 100% spot on:

Don’t let Catholics control your hospitals. Keep the church out of your health care decisions. Make Catholic Ethical and Religious Directives (ERDs) illegal — individuals may follow them at their personal discretion, but no health care facility gets to impose them on their patients, especially when they defy the law.

Your religious freedom does not include the right to impose your views on me.

This is a Good Thing


Map courtesy of the Kaiser Family Foundation

Notwithstanding the statements of the Obama administration that it was essential that the states should run their own health insurance exchanges, it’s good news that the Federal Government will run 26 of 50 of the exchanges:

Friday was a very important day for health policy days. It was the last day for states to tell the federal government whether they wanted any part in running the Affordable Care Act health exchanges come 2014.

The federal government did not get many takers. Some of the most closely watched states, including Florida and New Jersey, decided to leave the entire task to the federal government. All told, the federal government will run 26 of the state health exchanges. It also will partner with seven states, where state and federal officials take joint responsibility for the marketplace. Seventeen states and the District of Columbia will take on the task themselves. Here’s what that looks like in map form, via the Kaiser Family Foundation.

………

The big question moving forward is: Does this split matter? Is it better or worse for the federal government to be running the majority of the state health exchanges?

In the health policy world, there are essentially two schools of thought on this. The first is that states opting out of the exchanges is horrible for the Obama administration. All along, Health and Human Services has urged states to move forward on their own. Now, HHS has the massive task of setting up 26 separate state exchanges.

………

That is the pessimist’s take on the federal government’s very big workload. But there’s also an optimist’s take, one that suggests that federal oversight of most Affordable Care Act marketplaces will ultimately strengthen the health overhaul.

Remember, House Democrats originally wanted one national health exchange, where everyone in all 50 states could purchase coverage. That idea was nixed in the Senate bill, which aimed to give states a larger role in setting up the Affordable Care Act.

In a way, all these states turning over their exchanges to the federal government brings Obamacare a little closer to the more liberal House bill, which had the federal government running one big marketplace. It allows the White House to have more control over setting up its signature legislative accomplishment. It also creates some economies of scale, as HHS can develop one template exchange that all 26 states it handles will use.

I’m not sure why the Obama administration was so big on the state run exchanges.

My guess was that they are worried about the inevitable teething problems, and wanted as many opportunities as possible to spread the blame around.

The state based insurance system has resulted in a lot of oligopolies in healthcare, and has allowed the insurance corporations to purchase legislators and regulators, so I see this as an unalloyed good.

It moves us away from the inevitable race to the bottom that will occur in state based systems.

You Tell Them to Go Cheney Themselves


Another Cave

Obama tries to split the baby again, offering a compromise on birth control:

The Obama administration proposed yet another compromise on Friday in an effort to address the concerns of religious organizations that object to its policy requiring health insurance plans to cover contraceptives for women at no charge.

Kathleen Sebelius, the secretary of health and human services, said the proposal would guarantee free coverage of birth control “while respecting religious concerns.”

Churches and religious organizations that object to providing birth control coverage on religious grounds would not have to pay for it.

Under the proposal, female employees could get free birth control coverage through a separate plan that would be provided by a health insurer. The institution objecting to the coverage would not pay for the contraceptives. The costs would instead be paid by the insurance company, with the possibility of recouping the costs through lower health care expenses resulting in part from fewer births.

Obama does not get it.

The Catholic Church, and its Talibaptist allies, are want the right to enforce their religious beliefs on others.

This is all about a naked assertion of power, and the proper response is “F%$# You”, not fence mending.

And Congress Gets Into Antivax Bullsh%$

What a surprise, the conman Darryl Issa supports this, and rather depressingly Dennis Kucinich jumps in with both feet:

I’m not exaggerating. The Committee on Oversight and Government Reform held a hearing trying to look into the cause and prevention of autism. Rep. Dan Burton (R-Ind.) launched into a several-minute diatribe (beginning at 12:58 in the video above) that starts off in an Orwellian statement: He claims he’s not antivax. Then he launches into a five-minute speech that promotes long-debunked and clearly incorrect antivax claims, targeting mercury for the most part. Burton has long been an advocate for quackery; for at least a decade he has used Congressional situations like this to promote antiscience.

In the latest hearing, Burton sounds like a crackpot conspiracy theorist, to be honest, saying he knows—better than thousands of scientists who have spent their careers investigating these topics—that thimerosal causes neurological disorders (including autism). He goes on for some time about mercury (as does Rep. Dennis Kucinich (D-Ohio) starting at 21:44 in the video), making it clear he doesn’t have a clue what he’s talking about. For example, very few vaccines still use mercury, and the ones that do use it in tiny amounts and in a form that does not accumulate in the body.

Talking about the danger of mercury in vaccines is like talking about the danger of having hydrogen—an explosive element!—in water. It’s nonsense.

I won’t go further into details, because this shameful travesty of truth and medical health goes on for an hour. On Forbes.com, Steven Salzberg wrote a fantastic article about this Congressional farce. I strongly urge you to read it, since Salzberg brings the hammer down on the Congresscritters who think they know more about science than the scientists who actually devote their lives to this topic.

Let’s be clear, the anti-vaxers do more than hurt themselves, and their hapless children. They harm those for whom vaccines have limited effectiveness, or who are too young, like Dana McCaffrey, because they destroy herd immunity.

The modern version of this was started Andrew Wakefield by a con man who had an interest in a (surprise, non working) “treatment” alternative ginned up a phony controversy to line his own pockets.

The people who support this crap are being either evil or stupid.

Tommy “Toast” Thompson


Bummer of a Birthmark, Hal

You know, when you talk to constituents you get taped.

So if you want to pander to teabaggers your statements saying that you are the best person to get rid of medicare and medicaid will end up online:

Already down almost 10 points in the PollTracker Average, Tommy Thompson has now shown up in a video from a Tea Party meeting in June bragging that who better than him to “do away with the Medicare and Medicaid”.

BTW, I’m watching his debate with Tammy Baldwin right now, and I’m wondering if he if he was always this dense, or if he’s doddering a bit in his old age.

He really sounds out of it.

Here’s a Meme to Run On

This is a rebate check from an insurance company because of Obamacare:


Click for full size.

The short version (more at link) is that insurance companies have to spend 80% of premiums on healthcare, as opposed to paying obscene bonuses to its executives.

Any excess has to be returned to the ratepayers.

I’m no political consultant, but I think that video of people holding up checks that they got back from insurance companies might play well on Youtube.

I’m just sayin’.

Good Point, Yves

Yves Smith discovers an interesting data point on just how badly our healthcare system fails as a market.

The issue has always been two thing, information asymmetry, and the need for immediate services, because when you have a pneumothorax, you are not going to compare prices.

Well her data point is the fact that a study has shown that the happier you are with with your doctor, the more likely you are to die:

There is an important study in the Archives for Internal Medicine last month, which escalates an ongoing row as to whether patient satisfaction is in any way correlated with positive medical outcomes. The answer is yes, and the correlation is negative.

This finding is of critical importance, not just in understanding why American medicine is a hopeless, costly mess, but also as a window into how easy it is for buyers of complex services to be hoodwinked by their servicer provider, whether via the provider being incorrectly confident about his ability to do a good job or having nefarious intent.

Let’s deal with health care case first. The study in question was large scale, of 52,000 patients from 2000 to 2007. This summary comes from the Emergency Physicians blog (hat tip Julie W):

Results of the study showed that patients who had the highest satisfaction ratings spent 9% more on health care and prescription medications than did patients who had the lowest satisfaction ratings. In addition, the most satisfied patients had a 26% greater risk of death compared to least satisfied patients. When patients in poor health were excluded, the risk of death for these highly-satisfied “healthy” patients increased to 44% more than their least-satisfied counterparts.

In commentary accompanying the article, Dr. Brenda Sirovich suggested that discretionary testing is likely the cause of both the increased costs and the increased mortality in highly satisfied patients. Patient perceptions, even if medically inappropriate, drive testing and treatment. Antibiotics are harmful in patients with viral infections, yet a substantial subset of patients are not satisfied without an antibiotic prescription for their colds. Large studies show no link between PSA screening and either overall survival or prostate cancer survival. However, any patient whose life has been “saved” by a PSA screen is often quite satisfied. In both scenarios, there is no perceived negative effect from treatment. Patients will recover from their colds with or without antibiotics. Patients likely would not have died from their prostate cancer even if it was left untreated.

Here’s hoping that Scalia, Thomas, Alito, and Roberts just love their doctor.