Posts Tagged ‘Medicare’

Impact on doctors: There are three major points to consider here. First, America already has a shortage of doctors, particularly primary-care and family practice physicians. Even doctors are advising their own children to go into another profession. One of the biggest reasons for this has been the outrageous costs of malpractice insurance – in many cases $30,000/yr or more for generalists, $70,000-150,000 (or more) for many specialists – to help guard against lawsuits in an increasingly litigious society. As much as 25% of the money paid for health care is spent on ‘defensive’ medicine and documentation, which also takes up a lot of a doctor’s time. Unfortunately, there is no medical liability reform (aka ‘tort reform’) included in the Obamacare legislation to alleviate this. (By the way, some states have successfully reformed their tort systems, like Texas and Indiana, so there are workable ways to do this.)

The second point is that, under the proposed legislation, doctors will be paid much less. Currently, insurers decide (or negotiate) what percentage of full price they will reimburse a hospital, physician, pharmacist, or other health care professional for a particular drug, procedure, examination, test, or consultation. Such rates are typically about 50-80%. Put another way, the doctor must write off roughly 20-50% of the “list” fee (i.e., what someone without any insurance would pay). When your overhead already runs 60-70% of revenues, that really eats into your income, as well as the viability of your practice. In a 2008 survey conducted by The Physicians’ Foundation, 82% said that if proposed cuts to Medicare reimbursements went through, their practices would no longer be sustainable. But, it gets worse….

For programs like Medicare and Medicaid, the government unilaterally decides how much they will pay – typically 60-80%, but sometimes as low as 20%. In the TPF survey, 36% said Medicare reimbursements were less than their cost of providing care and 65% said Medicaid reimbursed less than their cost. (This is why many doctors are reluctant to take very many patients on government programs. Some simply don’t take them.) Plus, most managed care plans tie their reimbursements to Medicare’s fees, often paying providers just 20-30% more than Medicare does. Under Obamacare, the “public plan” would reimburse only about 5% more than the Medicare rates. The more people get put on this government-controlled insurance, the less doctors will be earning. Thus, one of the major incentives to go into, or remain in, medicine will erode away. (Especially when one considers the high debts one must pay off at the beginning of a medical career and the enormous insurance rates, overhead, etc., throughout one’s career.)

Here is an excerpt from a blog post by a board certified, private practice oncologist, that gives an excellent “insider’s view”.:

It’s quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit….

Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They’ll scarcely need to ration care: there just won’t be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.

Is it any wonder that a cash-only system is being adopted by more and more medical practices? Not having to deal with insurance claims and related paperwork saves time and money. Will this even be an option in an era of government-mandated, government-structured health insurance?

In addition, the President has already been asking Congress to grant the Executive Branch – in the guise of an ‘independent’ advisory board – more power to recommend (dictate?) Medicare reimbursement rate modifications. These rates now vary from region to region, where local legislators often help decide what they will be. The proposed new board would end this practice, handing more control to the federal government.

Thirdly, there is a development that is only just now coming to light. When you think of people who belong to unions, you don’t usually think of doctors and other medical professionals. (Well, maybe nurses.) But, that may change. It seems some congressional friends of Big Labor slipped some “last minute” provisions in the proposed bill that will force hundreds of thousands of physicians, surgeons, and other health care workers to unionize. This will mean millions (billions?) of dollars in new union dues going to union war chests, to be spent on new bureaucracies to influence health care policies and negotiations, more corruption, and financing of the Big Labor political agenda. (Of course, unions will get favored treatment under the legislation, but not necessarily in the better interests of the average union member.) And if you object to Obamacare and/or compulsory unionization, you may find yourself on the wrong end of intimidation and other strongarm tactics of persuasion. (Just ask Kenneth Gladney, who recently spent a couple days in the hospital recuperating from a harsh beating at the hands of union thugs, when they found him handing out anti-Obamacare “Don’t Tread On Me” flags.)

So,… Obamacare is supposed to cover millions more people, but it does nothing to encourage people to go into medicine. Instead, it will cut costs by underpaying hospitals and physicians for their services. Plus, it will force health care professionals to unionize, thereby inserting more bureaucracy, corruption, control, and unnecessary expenditures into the mix. (Can we afford to have our doctors pressured or ordered to go on strike?) Hmmm. If, at the very least, you don’t see long waits and decreased quality of care in our future, you’re just not paying attention.

< to be continued… >

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Impact on private insurers: The first impact is the just-discussed fact that those who offer private insurance plans will be subject to additional federal regulations. Some of these might be good (e.g., disallowing exclusion due to a “pre-existing condition” or cutting off coverage when you get too sick) and some will border on the ridiculous (see above re maternity benefits for childless, single men). Regardless, insurance companies will be doing a lot of adjustments and reassessments of their costs and risks. Some will decide to get out of health care completely.

What about competition? Proponents of the proposed health care overhaul contend that it will provide a “public health insurance option that would compete with private insurers within the Health Insurance Exchange – giving consumers more choices, keeping insurance companies honest and increasing competition.” The first question is whether or not private insurers need more competition. There are currently 1300+ such companies in the U.S., but it is state regulatory legislation (allowed by Congress under the interstate commerce clause, somehow) that prevents them from all competing in every state. At least one state has purportedly allowed only 6 private insurers to cater to its residents. There are examples where one or two big insurers dominate 80% or so of a state’s market. So, there is definitely a problem here, but adding another, government-run bureaucracy into the mix is not the answer. The better solution is to change the law(s) to allow every insurance company to compete in every state. If this does not happen, and the overhaul is enacted, then the “public option” immediately has the unfair, competitive advantage of being the only insurer available in every state.

Furthermore, it is very likely that a majority of businesses will drop health insurance from their employee benefits, because the new, federally-imposed fine for doing so (8% of payroll) will be less than the cost of purchasing coverage that complies with the new standards and minimums. One estimate by the non-partisan Lewin Group is that up to 119 million employees will end up in the “public plan”. State and federal workers will likely be the first to get kicked into the “public plan” – except for our leaders in Congress, the White House, or SCOTUS, of course –, along with union members, because health care is such a huge expense for governments and unions. (This is because the employees in question have been given such great benefits for decades, and there are so many of them, both active and retired.)

This means that, in order to retain or win back those employees (and pensioners) as customers, the private insurers will have to compete against a “public option” that has the full weight and purchasing power of the federal government behind it and, if we are realistic, will be subsidized with taxpayer money. It will be able to set its own reimbursement rates, as Medicare and Medicaid currently do. As I recall, government entities do not pay taxes, either. Finally, there is some question as to whether people will be able to file suit against the “public plan”/government. In a private insurance system, if you do not like the way a matter is handled or you are a victim of wrongful denial of insurance, you can either switch insurance companies or sue. In a government-run, single-payer system, neither option is available. And that is exactly what this will eventually lead to, even if it starts out as a “co-op”.

Bottom line here is that, in their less guarded moments, the Democratic leadership have admitted they are pushing for a single-payer system (see “Trojan Horse” article here), because they want to drive private insurers out of business and have the American people totally dependent on the federal government for their health care. (Socialism, here we come.) Of course, some private plans may indeed be able to survive under these conditions by offering better coverage and better access to providers, but not for long, if the Left has its way. Either way you look at it, this will result in a lot of ruined businesses and unemployed insurance professionals.

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These seem like pretty valid concerns to me. Let’s look at a few more issues brought up by Obamacare’s critics:

Less coverage: In addition to the above-mentioned home care and wellness services provided by Medicare Advantage, it covers several other things not covered by basic Medicare – e.g., improved prescription drug plans, screening for vision and hearing, dental care. Many seniors opt for Medicare Advantage because it is cheaper than getting private supplemental coverage. This goes for the disabled, as well as those of low income and rural residents, too. Without MA, many will no longer be able to afford such coverage and will have to do without, thereby putting their health at risk.

What about the President’s promise that, if you like your doctor and your insurance, you can keep them? Frankly, he has no business saying such a thing. For one, your employer can decide to change or drop your insurance right now. Or, your doctor can decide not to accept whatever plan you are on. Second, while there are no mandates in the current bill forcing such changes, it is the outworking of the proposals and their consequences that will, in effect, limit what kind of policies you can get and the doctors you can see.

On second thought, I need to amend that “second” statement. There will be no forced changes right away. Most employer-funded plans would need to be modified to meet new, H.H.S.-determined “minimum benefit standards”, but they would have a 5-year grace period to do so. This could mean dropping benefits in some areas, so that they can include other, newly-mandated coverage. Some may lay off workers so they can afford health insurance for the rest. They would be able to choose a level of coverage and give employees the ability to shop for a new plan at the marketplace called the Health Insurance Exchange. Or, they might just decide to stop providing health insurance altogether. (More on this to follow.)

Privately-obtained insurance policies, however, will supposedly not be required to comply with the federal minimums. Or, will they? Given what I have read about the “essential benefit package” to be designed by the new Health Benefits Advisory Committee, I am not so sure any private insurance policies will escape federal dictates. Of course, everyone will be mandated to get some sort of health insurance coverage, or they will be subject to a fine – starting at $750/yr for an individual and ranging from $1500/yr to $3800/yr for a family. And, by the way, there will be a new tax on those who obtain private insurance. Yippee!

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“Death Panel”: A few weeks ago, former Governor Sarah Palin caused a stir when she referred to provision for “death panels” in the proposed health care legislation, which would put the lives of the elderly and disabled at the mercy of some government committee (or some such thing). Hyperbole aside, it is certainly worth investigating. From what I can gather, Section 1233 of H.R. 3200 simply allows doctors to now be reimbursed via Medicare for “end-of-life counseling”, which is often given already and encouraged in federal law. Such counseling is voluntary for the insured. There are no mandates, just a limitation that only one such counseling session is reimbursable every five years or “yearly if the medical condition of the patient makes significant changes or they develop a chronic illness… or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.”

Doesn’t sound too sinister, right? But, the real concern is about something a bit more subtle. I mean, we are not just talking about suggesting that someone have a living will. Consider that the President has said “Our government will undertake very difficult decisions about how to reduce the costs of those chronically ill and those near the end of their lives since they potentially are 80% of the total health care (costs).” So, rather than recommending the latest-n-greatest – but expensive – drug or treatment or procedure to give Grandma a few more months or years of life, her doctor will be paid to advise her about hospices, palliative care, and ways to end her life so that she is no longer a burden on her family and on society.

But, you say, these counseling sessions are voluntary, remember. Well, as Charles Lane points out in the Washington Post, “To me, ‘purely voluntary’ means ‘not unless the patient requests one.’ Section 1233, however, lets doctors initiate the chat and gives them an incentive – money – to do so. Indeed, that’s an incentive to insist. Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit ‘formulation’ of a plug-pulling order right then and there…. Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party – the government – recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.”

It is this type of subtle persuasion towards giving up on life and foregoing life-sustaining treatment, especially when the individual is already depressed or in pain or otherwise vulnerable, that causes worry and fear and incites people young and old to oppose such legislation.

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Rationing of care: If the experiences of those in similar systems in Canada and Europe are any guide, this means looooong waits and many treatments and procedures not approved or otherwise unavailable. It seems every week, now, that one hears reports of someone in the UK who, for example, had to wait a year for some critical procedure or treatment after being given a prognosis of 6 months to live. (As Betsy McCaughey pointed out in her analysis for the NCPA, “A study by the Royal College of Radiologists [in the UK] showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff.”) One also hears periodically of yet another Canadian who came over to the States for surgery because either it was not available in Canada or they could not schedule it for several months. The well-to-do from all over the world fly to the United States to get the best care money can buy.

Now we hear rumblings from places including Spain, Colombia, the UK, Canada, etc., that their socialized – or, “nationalized”, if you prefer – health care systems are beginning to crumble and go into bankruptcy. Despite having some of the best doctors in the world, the French health care system is experiencing shortages of, among other things, personnel and beds. A recent report by the High Council for the Future of Health Insurance  — an advisory body set up by Prime Minister Raffarin and composed of medical professionals, as well as representatives from trade unions and the health insurance industry — calls their current system “badly regulated and badly governed”. If they do not pass reforms soon to “cut waste and increase efficiency”, they are projected to incur a health care deficit of 10.9 billion euros this year, potentially rising to 29 billion euros by 2010.

Then there are the statistics. For example, in 2007 Lancet Oncology published the results from the largest ever international (i.e., U.S. & Europe) study of cancer survival rates; another recent study specifically compared Canadian health care with that of the U.S. (Note: The Lancet study looked at the chance of living at least five years after a cancer diagnosis. All Americans were included, not just those with private insurance.) The results for overall cancer survival rates were as follows:

Women: U.S. – 61-63%; Canada – 58%; Europe – 56%

Men: U.S. – 57-66%; Canada – 53%; Europe – 47%

It might be noted that the UK’s much-touted National Health Service (NHS) typically scores worse than the European average.

Based on these studies and other reports, McCaughey concludes, “International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles.” Where would you rather be?

If Obamacare passes, dozens of new agencies will also be created that add more bureaucracy and government control over Americans’ health care. For example, five government appointees on a new

Independent Medicare Advisory Council will be charged with deciding what will be covered under Medicare and how much the reimbursements will be. Standards for all health insurance policies – whether private or “public” plan – will be set by the Health Choices Administration and the National Health Insurance Exchange. Similarly, the new Health Benefits Advisory Committee will decide on what will be included in an “essential benefit package” that every private insurance policy will be mandated to carry. As Newt Gingrich has pointed out in the Los Angeles Times, this means that a single male with no children will have no choice but to pay for maternity benefits and well-baby and well-child care coverage. Sound fair and rational to you?

You know how frustrating it is when your insurance company tells you that that procedure your doctor is recommending is not covered by your policy? Now imagine that an additional federal agency (or three) will be adding their controlling 2 cents, knowing their “marching orders” are to cut costs and save money for other programs (like health insurance for illegal aliens). Grandpa needs a new hip? Sorry, he’s too old – i.e., he doesn’t contribute enough to society to justify the cost. Hobble along, now. What, you want that new procedure that has 3x the success rate of the old one to cure your condition? Nope, too expensive. Take another pain pill and deal with it. That is the kind of thing we have to look forward to, say the critics, if this bill passes in anything like its current form.

With unprecedented power to control health care coverage and a mandate to save money in an overburdened economy with the biggest deficit ever, plus historical examples from other nations who “socialized” their health care, can there really be any doubt that H.S. 3200 (or anything similar) will result in the rationing of care? The next question to ask is “How far will it go?” Did someone mention “death panels”?

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Contrary to what some Democrats and others in the press would have us believe, everyone agrees that the U.S. Healthcare system has some problems, especially in the insurance arena, and is in need of reform. But, implementing any change, just for the sake of change or to say “we did something”, is not necessarily good. Fact is, the more the average American – including many Democrats – find out about this bill, the more they realize what a mess (and a threat) it will be. Three of the biggest concerns voiced by many, including at town hall meetings, are:

Huge costs: The proponents of Obamacare insist it will be “revenue neutral”, or even reduce costs to the Treasury, while covering an additional 47 million people* that currently have no health insurance. Others, including the non-partisan CBO, have shown that this is preposterous. On the contrary, it will add another $1-1.5 trillion on top of the already massive debt that the current administration is racking up. (The CBO recently corrected the administration’s estimate of the deficit from $7 trillion to $9 trillion in the next decade!) Even if everything goes according to plan, the CBO says it would still end up $239 billion in the hole. And it all comes back on the American taxpayer. (You have all heard about some of the proposed tax increases, right?)

Some have said that the bill proposes taking $400-600 billion out of Medicare, Medicaid, and other programs to help pay for the new plan. While the specifics are unclear, no one is denying that many billions of dollars’ worth of health coverage will be cut out in order to save money. In fact, current proposals are to cut from $34-37 billion over the next 10 years from the very successful (and cost-saving) Medicare home care services. Not only will this seriously affect the health and well-being of the 3.2 million people who benefit from these services, but it will put over 6500 home health care workers out of jobs by 2011.

President Obama has also told the AARP that he wants to cut nearly $177 billion in subsidies for private Medicare Advantage programs. This amounts to about 30% of the reductions being proposed. Twenty-five percent of Medicare users take part in these popular programs, which cover additional services not covered by basic Medicare – including “wellness programs”, which are also being pushed by Obamacare. But the President, seeing yet another corner to be cut, says they are a “waste” of federal funds. This leads to our second area of concern….

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*It is claimed by the Left that 46-47 million Americans, or roughly 15% of the population, do not have health insurance. This is a shame and a travesty, they say. Well, as laid out recently by Sen. Orrin Hatch, R-UT, the fact is that 6 million qualify through their employers but choose not to get it. Eleven million qualify for CHIP and Medicaid. Another 9 million earn at least $75K/yr, and therefore can afford to buy their own health insurance, but choose not to. There are about 6 million illegal aliens who do not have health insurance but are still able to use emergency health care (which costs the rest of us money). That leaves about 15 million legal residents who genuinely need to have health insurance and cannot afford it. (Personally, I think these last two numbers are off, since the number of illegal aliens in the U.S. is generally agreed to be 12-20 million.)

Several weeks ago, I decided to write an article – something I’d never done before – on the current legislation being proposed by Congress to address various problems in U.S. health care. I figured the research would help me get a better understanding of the issues, and maybe I could even find someone to pay me to publish it. Well, I never did pursue the publishing thing, but now that I have this newly-minted blog at my disposal, why not share the article with my fellow blogophiles?

I couldn’t cover every issue related to the health care topic, obviously, but the article does discuss some of the larger, more common concerns. It’s a little longer than I originally planned, so I’ve decided to “chunk it up”, probably into 7 or 8 successive posts.

I hope you all find it a worthwhile read….

What’s So Bad (or Great) About Obamacare?
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I mean, really? What is all the fuss about? Are these “protesters” causing all the ruckus at town-hall meetings genuine or just “astroturf” activists organized by Republican Party shills to lie about the currently proposed legislation (specifically, H.R. 3200) and use scaremongering tactics? And, since when is it “un-American” to stage civil protests of government policy or action? The Democrats certainly had no problem with it when they and their radical friends at MoveOn.org and Code Pink were the ones doing the protesting.

Full disclosure: While I’ve never done any work for the Republican Party, I am a member. But, I am also not averse to complaining and pointing out when the GOP politicians and/or leadership do something unwise, unethical, wrongheaded, or otherwise just ‘bad’.

So, are these just spurious, ideologically-motivated attacks? Well, no and yes.

Personally, I’m not so sure how appropriate or effective some of the behavior was that we have seen and heard at these town-hall meetings. To me, more ground could have been covered and (perhaps) progress made if there was a little less ranting and shouting down, however justified.

But, I certainly understand the fear, anger, and frustration expressed by these people. And, as far as I can tell, there is no “astroturfing” going on. (For the uninitiated, this term is used to describe alleged, fake grassroots gatherings and organized protests.) Sure, some conservatively-minded organizations are trying to help educate people on the issues and on the bill and are encouraging people to “get involved” and speak out. But, there are no covert, GOP-funded efforts to attack Obamacare just because they don’t like President Obama or Speaker of the House Pelosi, D-CA, or Senate Majority Leader Reid, D-NV, or anyone else who is pushing for this plan.

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