Medicare

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.

1. Means testing should be introduced to Medicare. 
2. Premiums should be upped 50% to 100% for the wealthiest beneficiaries, provided that they are allowed to buy non Medicare insurance in place of the lousy Medicare plan. That would take 5 million to 15 million of about 47 million beneficiaries out of Medicare and save billions, if not trillions.
3. The WSJ Health Blog reported on a study that estimated that defensive medicine costs $46 billion a year, or $460 billion over 10 years and growing. Tort reform is imperative.
4. Strip the pork and new public sector jobs built into ObamaCare from the budget and save close to $1 trillion.
5. Revamp Medicaid so that it serves the truly poor, and not every special interest group that votes Democrat. Save billions for the states and federal government.
6. Strip useless preventive care from Medicaid and Medicare and save more billions. Provide only the four preventive care services that actually save lives. Note that I've blogged on a Krauthammer column that reported that preventive services increase health care costs 162%. http://tiny.cc/k4hck
7. Stop using Medicare to subsidize over-staffed inner city and teaching hospitals and save more billions.
8. Reduce Medicare/Medicaid reimbursements for providers' payments to GE and its competitors for equipment maintenance contracts and save more billions.
9. Give consumers on Medicare and Medicaid strong financial incentives to buy reasonably-priced Medicare and Medicaid insurance plans and save more billions.
10. Stop all subsidies to people who want and buy Medicare Advantage plans and to the insurers who offer those plans and save more billions.
11. Spend more on fraud and abuse enforcement for M/M and save more billions.
12. Give workers stronger financial incentives to save for their health care expenditures after they reach 65 and save more billions.
13. Reimburse hospitals for only 50% of the health insurance premiums that they pay for employees. Many hospitals pay 100% of their workers' insurance premiums, which are soaring like everyone else's.

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:

1. How would you like to have Obama cut your income by, say, raising your income taxes, forcing you to buy expensive health insurance mandated by ObamaCare, forcing you to buy expensive food and gasoline as a result of ethanol mandates and forcing you to pay for others’ preventive care even though they can afford to pay for it themselves?

Oh, you are having your disposable income cut. So you know how it feels.

But say you’re a hospital employee—a nurse, a receptionist, a technician, etc. And you’ve been taught guest relations skills so that you’ll help patients and be friendly. Your pay is cut. What happens to your attitude, your attention to details and how much you care about quality?

Cutting the pay of highly-trained, skilled health care workers will destroy much of the quality that we see in today’s health care institutions.

I’ve had to be in and out of hospitals a few times over my pretty long life, and I think that while care always was as good as the workers could make it, today’s care is exceptional. The people who have cared for me and mine have been friendly and attentive with minor exceptions.

2. I’ve covered the hospital industry since 1976 for Modern Healthcare, Health Care Strategic Managment and my blog. I’ve learned that hospital executives care about themselves first. They’re human.

Therefore, they care about their bottom lines second. Profits are important to both tax exempt and taxable companies. They care about physicians third, because the docs control them. Then they worry about their employees and patients in that order.

So hospital associations, which also care about themselves before they worry about their members, are most concerned about protecting their members’ bottom lines. They never suggest changes that cut government’s or private payers’ costs. This is why the AMA, AHA, CHA, etc. are looked at with such scorn and cynicism in Washington where everyone is looking out for number one—himself.

3. Medicare expenditures must be cut by reforming the system, not by cutting payments to doctors and health workers. While it’s impossible to motivate people, it’s very easy to demotivate them by threatening their incomes and their status.

4. Reform Medicare by adopting significant parts of Paul Ryan’s plan and modifying Medicare and Medicaid as much as politically feasible.

Give patients strong financial incentives to be smarter about using Medicare. And give physicians and institutions strong financial incentives to cut costs.

Let everyone make as much money as possible by increasing access and quality of care while cutting Medicare expenditures per enrollee and per patient.

Providers have no control over disease outbreaks nor demographics, which is why controlling the rate of growth in health care expenditures is so difficult.

If the Joint Committee focuses on problem solving instead of politics, it can take $1 trillion to $3T out of Medicare over 10 years.

I assume politics will cut the real savings to about zero.

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.

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:

When you get two Ivy League Easterners debating Colorado issues, you never can be sure which one will talk specifics and which one will talk generalities.

Appointed Obama Democrat Sen. Michael Bennet has voted against seniors, workers, home buyers and Colorado since he began representing his home town of Washington, DC and President Obama about 18 months ago. This National Republican Senatorial Committee ad makes the point: 

Are Colorado’s Sen. Michael Bennet and Conneticut’s Joe Lieberman both winners as a result of the reported decision by Senate Democrat leaders to dump the government-run public option health plan from the health spend and tax bill (HR 3950)?

Bennet has strongly backed the public option that won’t happen. He has endeared himself to 

House Democrats have found they don’t have the votes to pass a health insurance deform bill with a “robust” public option HMO/PPO, and now they’re talking about expanding the number of people who would be eligible for Medicaid benefits.

Unless Sen. Michael Bennet (D-CO) and Rep. Ed Perlmutter (D-CO CD 7) defend Colorado’s budget the way Senate Majority Leader Harry Reid (D-NV) and Sen. Chuck Schumer (D-NY) are defending their states with special favors, Colorado’s taxpayers will pay big time for an expansion of Medicaid benefits by Congress. Colorado and the federal government share the cost of Medicaid, which has been bloating states’ budgets for years.

Martin Vaughan at wsj.com’s impact graphs:

President Obama, Speaker Pelosi and Senate Majority Leader Reid are doing all they can to force working Americans and their families into a Medicare for all HMO/PPO that would sharply cut payments to providers and limit patients’ access to advanced medical technology and quality care. The Wall Street Journal is the only news organization covering this scandal in depth, and it explains in an editorial what the hard left Democrats are plotting. Other media are willingly being sucked in by clever White House distractions designed to hide what’s going on in Congress.

Link

The Public Option Comeback The secret to its budget ‘savings’? Medicare price controls. [Read comments after the editorial.]

Colorado’s two Democrat Senators, Michael Bennet and Mark Udall, today voted for a slight of hand accounting measure that would have taken $247 billion in Medicare physician payments out of the Senate Finance Committee’s health bill (S 1796) and added them to the Federal government’s budget deficit. more

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.

Medicare Advantage enrollees who want to continue to enjoy the added benefits provided by those plans will see their premiums rise 25% in 2010 because Democrats in Congress want to stop subsidizing those plans.

As a Medicare enrollee who buys

In an effort to make sure that wealthy seniors support Medicare, Democrats long ago made sure that Medicare beneficiaries couldn’t keep their Social Security if they dropped Medicare in favor of a private insurance product or self-insuring themselves.

Now, a Wall Street Journal editorial reports and comments on a law suit that seeks to reverse that law, which is basically unAmerican and immoral.

The editorial’s lede graphs: