Medicaid

Who do we blame for soaring health insurance premiums?

You can blame AARP, health insurers, doctors and hospitals and the politicians that they paid with campaign contributions to distort the health insurance and health care markets.

And you can blame uninformed, unorganized and powerless voters for letting the Henry Waxmans of Congress and every president since JFK for making it all go wrong.

Health care is big money and big government.

Big government spends big money.

Big money in the hands of Big Government corrupts. 

Big government corrupts politicians, campaign contributors, drug companies, hospital administrators, physicians and regulators who have anything to do with distorting our health insurance and health care markets.

That's why America's huge government is and looks so corrupt. We're a third world country now.

Democrats and Republicans are deeply divided within each party as well as between parties on how to avert putting the country over the "fiscal cliff," which really is a slope, not a cliff. As a Small Government Republican Medicare beneficiary who's benefited from the free gift of Part D, cheap Medicare premiums, tax credits on home mortgages and coverage of primary care services that I should be paying for out of pocket, here's the deal I would like to see:

1. Make Medicare and Medicaid catastrophic programs only. Drop all the wellness and primary care nonsense that enriches providers and often hurts patients with false positives and harmful procedures.

2. Take all Congressionally imposed mandated benefits out of M/M.

3. Take all payments for teaching and medical research out of M/M. Fund them in separate bills and programs.

4. Breakup regional and metro hospital systems, medical groups and national health insurers.

5. Free seniors to buy non Medicare health insurance plans that cover primary care, wellness care and alternative care services without any Medicare subsidies for those premiums.

6. Raise premiums on all parts of Medicare. They're ridiculously low. 

7. Raise co-pays for all primary/preventive care and lower co/pays on catastrophically expensive cases.

8. Make Medicare Advantage enrollees pay the full premiums for the expanded coverage. 

9. Use money saved by eliminating coverage of provider-enriching preventive and wellness services to cover long-term care expenses that become catastrophically expensive as a percentage of the beneficiary's wealth, including the value of a a home or other investments. If someone is worth, say, $5 million, and long-term care costs, say, $80,000 to $100,000 a year, let that person pay for that care. If the person is worth $500,000 or less, Medicare could pay. That's the Moocher Nation way, of course.

10. Eliminate the death tax. Keep taxes on capital gains and dividends at 15%. No tax increases on the rich unless everyone gets income tax increases. Shrink the number of people who don't pay income taxes, get food stamps and are fraudulently filing disability claims.

11. Keep SS/Medicare enrollments at current ages. Change CPI calculations to reflect real inflation, which is a lot higher than the CPI shows today.

Congress and the Obama administration are fighting over how to fix entitlements, especially Medicare and Medicaid. Even Democrats disagree among themselves, according to today's Wall Street Journal. Some Democrats want no cuts, others want cosmetic cuts. Republicans want real reforms, but good luck with that.

Here are some ideas for fixing Medicare and Medicaid that I've made over the years and are even more relevant today: 

1. Take free physician office visits out of ObamCare. They waste physicians' time and create tremendous wait times for sick Medicare/Medicaid beneficiaries, which increases costs.

2. Require patients with minor symptoms to see nurse practitioners and other allied providers before wasting the time of the shrinking number of primary care physicians.

3. Eliminate coverage of the most wasteful primary care and allied providers.

Over the last 35 years, there have been a lot of attempts to slow the growth in Medicare expenditures, which have continued to soar unabated because of poor policy making by both parties. 

Although the Budget Control Act of 2011 (S. 365) says the Joint Budget Committee that will try to agree on the next round of budget cuts won't be allowed to change Medicare's benefits, I think it should.

Here are some ideas for changing Medicare that would give consumers and providers strong financial incentives to increase access to care and higher quality care at lower costs per patient and per enrollee:

The Budget Control Act signed by President Obama today creates a Joint Committee of a dozen members of Congress. It's job is to cut the budget by Thanksgiving.

Everyone expects that the committee, which will be comprised of six members of the Senate and six members of the House with six from each party, will target Medicare, Medicaid and other health services for savings.

This is a slightly revised piece I'm posting on comments sections and on Facebook:

What I want GOP candidates to promise:

On Thursday, Mitt Romney, a yet-to-be-announced presidential candidate, will try to get the RomneyCare Massachusetts health insurance disaster off his back. 

Romney experimented with health insurance markets in Massachusetts, and his stab at increasing access to health services while containing costs has failed big time. Health insurance is more expensive and health care is harder to get in Massachusetts under Romney care. And 100,000 still are uninsured.

A Florida Federal District Judge who today ruled ObamaCare (PL 111-148) is unconstitutional because it mandates that all Americans must buy government-approved health insurance also ruled that the law's provisions that force states to spend more on Medicaid is constitutional according to case law. The only thing that will save the states on the Medicaid issue is the judge's ruling that the unconstitutionality of the mandates makes the whole law unconstitutional. Links:  Decision on Florida v. DHHS. Scholars, politicians discuss the ruling here.

Mike Fallon, M.D., Wednesday gave the one best talks on health care economics and policy that I've heard since 1976 when I started covering health care deform. He certainly showed that he knows more about health economics and policy than any Republican who's in the U.S. House of Representatives today. More with links after the jump:

Since Medicaid was created in 1965, politicians have been trying to "fix" Medicaid, the Federal and States program that pays for health care for mostly women and children in poverty. 

The 13 state attorney generals who are suing to overturn ObamaCare’s coercive Medicaid expansion that would cost states billions may be affirmed by the U.S. Supreme Court, according to University of Chicago law professor, Richard A. Epstein. Impact graph:

In Massachusetts v. EPA—the notorious 2007 decision allowing the EPA to treat carbon dioxide as a pollutant—the Supreme Court recognized that the state had standing to sue to protect its own coastline from the supposed ravages of excess CO2. The Supreme Court should likewise also recognize a state’s standing to sue when the federal government seeks to command its resources to serve federal objectives. In New York v. United States (1992), the Court prevented the U.S. from forcing states to take title to nuclear waste. It can surely prevent the federal government from mandating massive expenditures of scarce state resources.

Under the Constitution the states are not wards of the federal government. Clever federal tax and spending statutes must not be allowed to reduce states to a servile status that allows the federal government to force massive wealth shifts among them.

Why Governor Bill Ritter and Colorado’s Democrat Senators Bill Bennet and Mark Udall support the huge Medicaid spending increases required under ObamaCare (HR 3590) continues to mystify. Those increases would make it even more difficult to balance Colorado’s budget, but the state’s Democrats don’t care. Like Obama and Reid, they want to win at any price to taxpayers and patients.

Maybe they think that 

Senators Harry Reid (D-NV) and Chuck Schumer (D-NY) are showing Americans how they would mismanage a public option health insurance plan that would compete with private insurers.

They are trying

Rep. Mike Coffman (R-CO, CD-6) met in Conifer with more than 30 constituents. His summary of the most pressing issues before Congress and questions and answers that followed are below. Click on the headline.

Here’s how politicians manage government single-payer health insurance programs.

Click on head to see story.