Healthcare reform

[DukeNukeEm]

Still dont feel like "we" won this.

[Harry Chappas]

Anyone see this? About Medicare fraud. Hundreds of BILLIONS lost.

 

http://abcnews.go.com/Nightline/video/amer...1133&page=1

 

I saw this and the first thing I thought was how do I open a pharmacy. One computer a nice set of records and pow, millions with no questions asked.

[bmags]

depends if you read policy wonks or political bloggers.

[bmags]

Nice article to answer some quesitons on where these savings come from.

From Ezra Klein

http://voices.washingtonpost.com/ezra-klei...ost_c.html#more

 

The five most promising cost controls in the health-care bill

 

It's hard to overstate how important the Congressional Budget Office (CBO) -- which makes the official judgments on how much bills cost and save -- is in Washington. But the rest of the country doesn't know what the CBO is, and it doesn't care. "Washington may live and die by the pronouncements of the Congressional Budget Office," wrote pollsters Doug Schoen and Scott Rasmussen in the Wall Street Journal, "but 81 percent of voters say it's likely [health care reform] will end up costing more than projected."

 

That's left Democrats in a worst-of-both-worlds situation: They've built a bill that Washington's toughest scorekeeper says will cut the deficit by more than a trillion dollars over 20 years. They're getting attacked for the taxes and Medicare reforms that save all that money. But the country doesn't believe the savings are real.

 

One of the problems Democrats have had is that it's very easy to understand the one thing the bill does to spend money -- purchase insurance for people who can't afford it -- and considerably harder to explain the many things it does to save money. Another is that a lot of the savings have to do with changing how medicine is practiced, which people are less familiar with than how insurance is purchased.

 

But the fact that the cost controls are complicated and numerous doesn't mean they're absent, or that they won't work. So here are five of the bill's best ideas, and how they're meant to work:

 

(1) Create a competitive insurance market: This is the bill's first, and most important, step. Right now, the insurance market's version of competition is pretty brutal. Companies compete to avoid the sickest people and sign up the healthiest people. Offering the best coverage for the lowest cost isn't much of a priority, because most consumers don't know whose coverage is best, and the ones who really do know are probably sick customers who spend their days researching this stuff.

 

Outlawing the bad kind of competition while enabling the good kind, which the bill does, is more than just a humanitarian measure. It's a cost control. The insurance "exchanges" imitate the market in which federal employees (including congressmen) purchase their health insurance. In the exchanges, insurance products have to be above a minimum level of comprehensiveness (no more insurance that doesn't cover anything) and their benefits have to be presented in a standard, comprehensible way. The insurers themselves can't discriminate based on preexisting conditions, will have to answer to regulators if they attempt to jack up premiums, and will be rated by their customers -- a rating that everyone else will see when shopping for their insurance.

 

If all goes well, consumers will be able to log onto the exchange's Web site, compare insurance plans and choose their favorite. That means insurers will have to compete for customers in a more transparent market, where shoppers have more information, and where the relationship between price and quality is more obvious. As any free-market conservative will tell you, that should drive prices down and quality up. If it doesn't, insurers will have some annoyed legislators to answer to: The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.

 

(2) The Medicare Commission: The next cost control worth mentioning is an effort by Congress to solve the problem of, well, Congress. Medicare's cost problem is, in many ways, a political problem: Saving money means cutting someone's profits or someone's benefits, and politicians are afraid to do either.

 

Enter the Independent Medicare Advisory Board. Modeled off of the highly respected (but totally toothless) Medicare Payment and Advisory Commission, IMAC is a 15-person board of independent experts chosen by the president, confirmed by the Senate and empowered to cut through congressional gridlock. IMAC will write reforms that bring Medicare into like with certain spending targets. Congress can't modify these proposals, it can't filibuster these proposals, and if it wants to reject them, it needs to find another way to save the same amount of money. Making the process of passing tough reforms easier is the single most important thing you can do to make sure tough reforms actually happen.

 

(3) A tax on "Cadillac plans": The least popular, but most direct, cost control is the tax on expensive, employer-provided coverage, which should really be thought of as a disincentive to buy insurance plans that don't control their costs.

 

Today, the average employer who offers insurance pays more than 70 percent of a worker's premiums, all of it tax-free. This amounts to an annual $250 billion subsidy for private insurance for people with good jobs. But it's not just the size of the subsidy; it's how we use it that matters. Because it's only good for insurance that employers buy for their workers, people have their employers buy their health-care insurance for them. But that means individuals don't know how much their insurance really costs and don't have as much incentive to keep those costs down. Imagine the pressure for cost control if the 70 percent that employers pay were coming out of our own pockets, instead of quietly coming out of our wages.

 

In 2018, the proposed excise tax on so-called "Cadillac plans" slaps a 40 percent tax on every dollar spent on an insurance plan above $27,500 annually. So if your plan costs $27,600, the final $100 bucks would be taxed (technically, the insurer pays the tax, but it'll pass that onto your employer). That's a very expensive plan, but over time, that $27,500 threshold grows by inflation, usually around 3 percent) rather than health-care inflation (closer to 7 percent). So if we don't get health-care inflation down, this will hit many more plans.

 

But the excise tax is part of getting that inflation down. The idea isn't that people will pay this tax. It's that they, or their employers, will evade it by choosing insurance that holds its costs down more aggressively. That gives insurers who hold costs down a competitive advantage against insurers who don't, because those who don't are not only offering pricier insurance, but are also passing along a hefty tax attached to their excess spending.

 

(4) Medicare "bundling" programs: The most obviously illogical part of our current health-care system is that we pay doctors the way we pay car dealers: They get more money for every item they sell. But while we aren't afraid to ignore a car dealer's recommendations, we are afraid to disagree with our doctors. As you'd expect, this pushes costs higher.

 

The health-care bill seeds Medicare with many experiments to change this status quo, the most immediately promising of which are the "bundling" programs. Instead of getting paid for everything they do to help a diabetic, hospitals will get paid once for treating that person's diabetes and all related conditions over a certain period of time. If this leads to lower costs and doesn't harm patients, it will be expanded. That would be the beginning of the end of paying for quantity of treatment, and the beginning of paying for quality of treatment.

 

(5) Changing the politics of reform: Republicans and Democrats both agree that we need more cost control in the health-care system. But politicians don't like to actually cut costs, because those votes reduce benefits and make people angry. So we've played a shameful game: We passively control costs by letting people become and stay uninsured, or by letting their insurance deteriorate and cover less, because those things don't require a vote in Congress.

 

But because the individual mandate in the bill brings everyone into the insurance market and the subsidies for those who can't afford insurance on their own put Washington on the hook for costs, Congress will have to get serious about holding costs down in the system. The alternatives, for lawmakers, are high costs infuriating constituents who're being forced to buy something they can't afford, or yawning deficits forcing them to vote to take subsidies -- and thus health-care coverage -- away from people who currently have it. The days of letting inertia win the day and watching the system fall apart on its own are over.

 

Thus ends the list. There are more cost control ideas in the bill, of course. Everything from modernizing the system's IT infrastructure to amassing and disseminating research on which treatments work and which don't to penalizing hospitals with the highest rates of infection. Five is just a good round number.

 

The bill's basic theory is to try pretty much everything in the hopes that some of it works out. The net effect is to make reform a continuous, rather than occasional, process, with different cost cops patrolling different beats. Insurers will have to work to stay a step ahead of the excise tax because employers won't want to buy plans that trigger it. The industries that provide medical care and technologies will have to hold their costs down because they don't want to become a target for the Medicare Commission. Hospitals will need to make sure they don't spend more than their competitors because they'll lose money under bundling. And if we want to try other things -- a public option, say, or incentives for insurers to abandon fee-for-service -- the exchanges give us an actual structure where we can make changes and test reforms.

 

Also important is that the various elements work together. For instance, the excise tax and the exchanges have an important interaction. Right now, there's a substantial amount of inertia among employers. They've got a contract with a health insurer and they don't want to waste time soliciting new bids and trying to figure out the relatively quality of different providers every year. In the exchanges, however, changing would be trivial: You'd see the prices (with the excise tax built in), and it would be a lot easier to see if cheaper plans were providing a good consumer experience.

 

Same goes for IT improvements and the comparative effectiveness research: As the data is crunched, it could be fed into software that'll help doctors choose the most effective treatment based on the latest evidence -- a far cry from them mainly knowing about new evidence because drug companies have spent money publicizing it. Or take the Medicare Commission, which will use a lot of the comparative effectiveness program's data when making its decisions.

[NorthSideSox72]

what is their (insurance companies) profit margin on premiums? probably between 3%-5%. So ok, cut out let's say 4% of cost. That $1000 doctor visit is now only $960? and that's under the assumption that a non-profit insurance group is going to be as efficient as the for profit companies. So yea, I agree, it would seem like the larger issue of cost didn't get the focus it should have.

I'm not talking about the profit margin, I'm talking about methodologies used by the insurance industry, and how they contribute to the cost problem overall.

 

Point is still the same though, this bill seems too focused on just the insurance companies, and not even focusing on the right problems therein.

 

[Y2HH]

I'm not talking about the profit margin, I'm talking about methodologies used by the insurance industry, and how they contribute to the cost problem overall.

 

Point is still the same though, this bill seems too focused on just the insurance companies, and not even focusing on the right problems therein.

 

That's what I've been saying all along.

 

I will edit by saying it does do SOME good things in the insurance arena that I felt were necessary, but it then does some very negative things without fixing the underlying issues at all -- cost. The costs remain the same, but now taxpayers help foot the bill...only now we have 30,000,000 more people involved.

 

Funny that all the health care and drug stocks are up. The financial sector seems to think, if anything, this HELPED them more than it hurt them.

 

Edit again, I see some insurance companies are down now, but not much.

Edited March 22, 2010 by Y2HH

[DukeNukeEm]

Funny that all the health care and drug stocks are up. The financial sector seems to think, if anything, this HELPED them more than it hurt them.

That is not a bad thing.

[Pants Rowland]

So what does this legislation do to solve this problem?

 

 

depends if you read policy wonks or political bloggers.

 

I think a lot of points from bmags post address your question.

[southsider2k5]

Confusing Facebook Comment of the day:

You thought healthcare was expensive before, wait till it's free!

 

You really don't understand this statement?

[Pants Rowland]

That's what I've been saying all along.

 

I will edit by saying it does do SOME good things in the insurance arena that I felt were necessary, but it then does some very negative things without fixing the underlying issues at all -- cost. The costs remain the same, but now taxpayers help foot the bill...only now we have 30,000,000 more people involved.

 

Funny that all the health care and drug stocks are up. The financial sector seems to think, if anything, this HELPED them more than it hurt them.

 

Edit again, I see some insurance companies are down now, but not much.

 

Only time will allow this to play out, but I think you are going to see a lot of those costs are going to shift from one area to another and the additional 30 million will actually prove beneficial to keeping per capita costs down. In other words, there are a large number of low risk insured in the 30 million that their premiums will more than offset the cost of the higher risk patients. Further, by getting some people in the middle ground to be less apprehensive about seeking help for their ailments, you help eliminate more burdensome costs down the line.

 

For example, say you are uninsured and injure your knee and decide to wait to see if it gets better because you are worried about the cost to get it checked out. In the short run, the doctor may prescribe a heavy dosage of ibuprofen with some light stretching exercises to strengthen the area. Overall, a pretty low cost solution that many of us have dealt with in the past. However, because you do not get any advice you rest it instead and overall you just weaken the area more. Rather than stabilizing, the knee ends up bothering you for a long time and continues to get worse, slowly, but surely. Your gait changes slightly and exacerbates the problem. Before long you end up with arthritis and can't walk. Then you are forced to quit your job because of health limitations. Before long you are on government support because you did not pay for some simple advice and were too ignorant to know better. Then we are all paying a lot more for that person's health coverage than we ever realized was possible.

 

I know I am drawing a very doomsday scenario, but stuff this this does happen. That is why I wish that everyone (ie illegals) was included in the bill. It is the power of numbers that help keep the costs down individually. That is how all the poor individual taxpayers were able to pool their money and bail out the banking system when it was on the verge of collapse.

[Pants Rowland]

Sorry for the double post, but I just saw this from a FB friend. I thought it brought up some good points:

 

Those that say this bill costs too much fail to see that it is just an expensive item. It is also too early to determine the cost savings from people getting access before illness turns critical. We pay about 70% of total healthcare dollars in the last year of life. If we can get people under a doctor's care earlier these numbers should improve.

 

Cost will always be an issue when considering national domestic policy. Legislation often makes implicit costs explicit. In other words, these costs already exist in the system. These costs are borne by employees not changing jobs because of insurance issues. The costs are borne by people living in pain with chronic untreated illness. The costs are borne by local municipalities who fund emergency rooms. The costs are borne by millions of families who suffer in silence.

 

Just as and aside, the Healthcare Legislation will cost less than the wars in Afghanistan and Iraq. Substantially less when you consider the long term cost of dealing with the veterans' medical issues.

[bmags]

I'm sure bringing up Sweden will cause some eyes to roll.

 

But yes, in Sweden, their doctors make a lot less money. I don't think anyone could fight the doctors and win. People like doctors.

 

But, you saw a shift in sweden to the way they practice medicine. With them not getting paid by how much treatment they can give to a patient, a lot more focus on preventative medicine occurred. What does that mean? A lot of US medicine relies on suppression of viruses/bacteria. Suppression once it becomes a problem. This does, in fact, solve peoples short term problems. In Sweden, there is a lot more medical practice than here to boost peoples immune systems and health so that they don't become sick. This is important, and I hope we can begin to move towards this. I don't think the bill addresses the problem at all with this, but if it causes an attitude shift, than that can achieve a lot.

[Pants Rowland]

I'm sure bringing up Sweden will cause some eyes to roll.

 

But yes, in Sweden, their doctors make a lot less money. I don't think anyone could fight the doctors and win. People like doctors.

 

But, you saw a shift in sweden to the way they practice medicine. With them not getting paid by how much treatment they can give to a patient, a lot more focus on preventative medicine occurred. What does that mean? A lot of US medicine relies on suppression of viruses/bacteria. Suppression once it becomes a problem. This does, in fact, solve peoples short term problems. In Sweden, there is a lot more medical practice than here to boost peoples immune systems and health so that they don't become sick. This is important, and I hope we can begin to move towards this. I don't think the bill addresses the problem at all with this, but if it causes an attitude shift, than that can achieve a lot.

 

Not rolling my eyes at all. I think the focus on drugs and cures rather than wellness and prevention are the root of our health problems in this country. I believe that the difficulty in changing the mindset of the healthcare industry will be negligible compared to changing the mindset of the public overall.

[Y2HH]

Not rolling my eyes at all. I think the focus on drugs and cures rather than wellness and prevention are the root of our health problems in this country. I believe that the difficulty in changing the mindset of the healthcare industry will be negligible compared to changing the mindset of the public overall.

 

You can lead a horse to water...

 

Sweden's population is more controllable, being smaller, it's easier to educate them...and its easier to lead a smaller group to water and convince them to drink it.

 

That concept isn't going to work here the US...people don't care about their health until they're not healthy, even those that are way overweight. You can talk to them until you are blue in the face about living a healthier lifestyle...they're simply not interested.

 

I bet a majority of the people on this forum aren't in good shape, with zero excuse as to why. I bet a majority don't eat very healthy diets, either.

Edited March 22, 2010 by Y2HH

[bmags]

You can lead a horse to water...

 

Sweden's population is more controllable, being smaller, it's easier to educate them...and its easier to lead a smaller group to water and convince them to drink it.

 

That concept isn't going to work here the US...people don't care about their health until they're not healthy, even those that are way overweight. You can talk to them until you are blue in the face about living a healthier lifestyle...they're simply not interested.

 

I bet a majority of the people on this forum aren't in good shape, with zero excuse as to why. I bet a majority don't eat very healthy diets, either.

 

True. One of the reasons the scandinavain countries can enact such reforms is they are a largely homogenous culture, and they don't have the problem of people viewing things like this as helping the "other."

 

But, I don't think this is really akin to changing things such as eating habits for Americans. It really goes to how doctors communicate. High cholesterol? lay off the fatty foods, take some (whatever it is). Yeah, his cholesterol will go down with the medicine.

 

But the communication is not there about exactly what a patient can do to improve his health. Diets, for instance, are not universal (and largely not healthy). The south beach diet won't work for everyone, not everyone's body processes foods the same way. But learning what could work for a specific patient would cost time and money - that is - about the same time and money that they use to fix the problem once it happens.

 

The people that do this ? Commence eye-rolling from primary doctors....but naturopaths and the like. The problem and divide about thinking these doctors are kooks, and the problems with the marketing of these doctors themselves is that many start treating patients AFTER the problem occurs. And at that point, traditional american doctor suppression is needed.

 

If applied BEFORE the problem or AFTER, that is when the effect can occur. I don't know. Off Topic.

 

edit: numerous spelling mistakes.

Edited March 22, 2010 by bmags

[Balta1701]

Of course...if we really wanted to make a difference in people's lifestyles, there are other levers we could push. For example, we could stop dumping tens of billions of dollars a year into corn subsidy programs.

[bmags]

Yglesias:

 

The 40 Percent

 

New poll numbers (PDF) from CNN. The topline number for the Affordable Care Act looks bad, 39% favor it with 59% opposed. Another way of looking at it, however, is that 43 percent think it’s too liberal, 39 percent think it’s just right, and 13 percent think it’s not liberal enough. That suggests to me that running on a promise to shift health policy to the right is not much of a winning strategy.

 

Similarly, “Who do you trust more to handle major changes in the country’s health care system – Barack Obama or the Republicans in Congress?” 51 percent trust Obama and 39 percent trust Republicans in Congress. That suggests to me that running on a promise to join Congressional Republicans in an effort to fight Barack Obama’s health care ideas is not much of a winning strategy.

 

But how about Congressional Democrats? “Who do you trust more to handle major changes in the country’s health care system — the Democrats in Congress or the Republicans in Congress?” Well, 45 percent trust the Democrats and 39 percent trust the Republicans.

 

The best news for repealers is that only 19 percent say they think the Affordable Care Act will make their family better off. At the same time, an additional 42 percent say it will make other families better off. Just 37 percent say it will make nobody better off.

 

There’s a pattern here. Basically about 40 percent of the public agrees with the conservative take on the bill. The range between the 37 percent who say the Affordable Care Act will make nobody better off and the 42 percent who say the ACA is too liberal is pretty small. And smack in the middle are the 39 percent who trust Republicans in congress more than Democrats in congress or more than Obama. The GOP is destined to make substantial gains in the midterms, but when you talk about repealing the ACA, you’re talking about going to war with 40 percent of the country on your side.

[Balta1701]

Not rolling my eyes at all. I think the focus on drugs and cures rather than wellness and prevention are the root of our health problems in this country. I believe that the difficulty in changing the mindset of the healthcare industry will be negligible compared to changing the mindset of the public overall.

It's not perfect (nothing in this bill is) but there's actually an effort in the bill to change that. One of the medicare changes that kicks in after 2014 is to start changing how medicare pays out. Currently, as you note, most health providers get paid based on numbers; you do more treatments, you earn more. This, of course, encourages doctors to over-prescribe and over-treat, rather than focusing on the outcome, because that's where the profit is. There is a task in the Medicare change part that will, at least at some level, put incentives into Medicare payments for positive overall health care outcomes, rather than number of procedures. No one knows at this point if it'll work and it's somewhat complex, but that's exactly how you want the pay structure to work.

[Texsox]

Washington (CNN) – A Texas Republican acknowledged on Monday that he was the person who yelled "baby killer" during Sunday's House debate on health care reform.

 

Rep. Randy Neugebauer said he shouted out "'it's a baby killer' in reference to the agreement reached by the Democratic leadership" on compromise language that emphasized federal funds would not be used to pay for abortions.

 

That's good enough for me. I hope the story ends quickly.

 

 

[Texsox]

It's not perfect (nothing in this bill is) but there's actually an effort in the bill to change that. One of the medicare changes that kicks in after 2014 is to start changing how medicare pays out. Currently, as you note, most health providers get paid based on numbers; you do more treatments, you earn more. This, of course, encourages doctors to over-prescribe and over-treat, rather than focusing on the outcome, because that's where the profit is. There is a task in the Medicare change part that will, at least at some level, put incentives into Medicare payments for positive overall health care outcomes, rather than number of procedures. No one knows at this point if it'll work and it's somewhat complex, but that's exactly how you want the pay structure to work.

 

 

I like the path this takes. Overall, as more and more concrete examples of the plan being implemented come out, I think we will be pleasantly surprised.

[NorthSideSox72]

Yglesias:

So 40% of people wanted less federal action on health care than they got. Not any kind of majority.

 

But these polls also fail to take into account the undoubtedly significant % of people who wanted something DIFFERENT - not something less, or more.

 

[bmags]

So 40% of people wanted less federal action on health care than they got. Not any kind of majority.

 

But these polls also fail to take into account the undoubtedly significant % of people who wanted something DIFFERENT - not something less, or more.

 

Right, this has been the explanation for a while.

 

People on the left were furious after the PO was taken out in early December. But the poll questions were straight up, do you agree with the bill blah blah etc.

 

And i imagine it was a case of when i worked the phones and had to ask "how many jobs have you had" for a job recruitment company, and they would go in depth about all their jobs and what they did, and i couldn't cut them off to tell them i just needed a number, and after 20 minutes of hearing their life story I would follow up with "So five, then?"

 

They probably got the explanation, it doesn't go far enough, but the numbers than say 40 approve, 49 percent oppose.

 

Also, I would like to reiterate. The dems WILL lose seats in november, this was going to be the case, i mean, pretty much even if unemployment dropped. They gained so many seats in 2006 and 2008, they have so much ground to cover in republican leaning districts. It's very rare to be able to keep those. But, I don't think the house flips anymore, but who knows, 7 mos. is a while.

[BigSqwert]

What does the Health Care Bill mean for me?

 

[BigSqwert]

What does the Health Care Bill mean for me?

 

My results: There will be no change to your insurance coverage. You will not pay any additional taxes.

 

OMG!!! SOCIALISM!! COMMUNISM!!

[Balta1701]

My results: There will be no change to your insurance coverage. You will not pay any additional taxes.

 

OMG!!! SOCIALISM!! COMMUNISM!!

Mine too.

 

Anyway...the sad thing is, that's still over-simplified. Hopefully one of two things should happen. Either you should also see your paycheck increase, or you should see your health coverage improve in quality.