Today is Friday, May 24, 2013

Preventive Care

How to make a fiscal cliff deal on Medicare, Medicaid and Social Security

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.

Providers are trying to keep health insurance premiums high by protecting expensive mandates

In Colorado, state laws that mandate that health insurers cover services offered by numerous alternative care providers increase the cost of health insurance by some 50%. These mandates generally are backed by the providers who profit from them and by disease-specific advocacy groups that don’t care that they’re making health insurance unaffordable for millions.

The health insurance reforms in the bill before the Senate (HR 3590) would allow 

Ritter pushes costly, ineffective wellness, preventive care policies

Governor Bill Ritter continues to allow his senior health policy advisor to sell costly and ineffective wellness and preventive care services. Under ObamaCare (HR 3962), these services would be free. As a result, patients would clog doctors’ offices demanding preventive services, and many would show up weekly just to talk. That’s what’s happened in Britain, where waits last months and years. The goal of the politicians and bureaucrats, of course, is to use the lonely and mentally ill preventive care seekers to block those who need expensive acute care services from seeing their doctors. Ritter doesn’t get it. And, unfortunately, few Republicans do. Links:

Life expectancy: U.S. health care does very well compared with other countries

A blogger on Reuters writes that the U.S. health care system is really good compared with other countries.

He links to a University of Pennsylvania paper, Low Life Expectancy in the United
States: Is the Health Care System at
Fault?, by Samuel H. Preston and Jessica Y. Ho.

The abstract follows:

 

Preventive care increases health care costs 162%

Columnist Charles Krauthammer, M.D., calls the savings from preventive health services touted by President Obama and other Democrats in their efforts to sell health deform a myth.

Impact graphs:

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

That’s a hypothetical case. What’s the real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons “$30,000, $40,000, $50,000” for a later amputation—a whopper that misrepresents the surgeon’s fee by a factor of at least 30—“that will save us money.” Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost 10 times as much as the savings, increasing the country’s total medical bill by 162 percent. That’s because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

Questions on health insurance reform for Congressional Budget Office

I"ve sent this e-mail to my Senators and Rep. Mike Coffman (R-CO).

Just to get another view of the health options, please ask the CBO for a report that answers these questions:

Estimate the 5, 10 and 15 year costs increases or cost savings for the government if each health insurer were required to community rate all of its insureds by Metropolitan area or state with a minimum enrollment after a set period in business of 50k to 100k per risk pool, assuming that individuals would be required to buy catastrophic policies with no lifetime coverage caps and no or means tested tax incentives?

On Medicare, what would be the savings/costs if benefits covered only financially catastrophic (including chronic) illnesses using community rating, means tested premiums and tax deductions for out-of-pocket expenditures for prescription drugs, medical devices, office visits and wellness care?

On Medicaid, what would happen to state and federal budgets if it were federalized, benefits covered only financially catastrophic illnesses (chronic and long-term) and substantial tax benefits were granted to philanthropists who funded low-cost or free community health clinics for Medicaid enrollees only, not including illegal immigrants?

Assume no government-run health plans for the privately insured. And assume insurers would be required to update their rates and contracts on the Internet daily. Assume insurers could sell policies with no state mandated coverage of preventive, wellness or alternative health care services.

 

What large employers can do to fix health insurance markets

The Wall Street Journal published a PR piece about how CEOs can fix health care. I think the piece is off base and posted the following reply:

How large employers can help fix health care:

 

Posted by Donald E. L. Johnson on 07/28/09 at 07:51 PM
Books • Health insurance • Community Rating • Health Insurance Reform • Preventive Care • Small Groups • Read More

Preventive care, cancer screening are costly and can hurt more people than they help

President Obama, Speaker Pelosi and Democrats who are promising to cut health care costs with preventive care, including cancer screening, are promoting medical services that increase health care costs while doing little to prevent deaths from cancer and other diseases.

That’s the point of Natasha Singer’s NYT article, In Push for Cancer Screening, Limited Benefits.

Impact graphs:

Dr. Ned Calonge, the chairman of the United States Preventive Services Task Force said, “There are five things that can happen as a result of screening tests, and four of them are bad.” His group consists of independent medical experts that Congress has commissioned to make recommendations, based on medical evidence, about what preventive measures actually work.

The one good result of screening, Dr. Calonge said, is identifying a life-threatening form of cancer that actually responds to timely intervention.

The possible bad outcomes, he said, are results that falsely indicate cancer and cause needless anxiety and unnecessary procedures that can lead to complications; that fail to diagnose an existing cancer, which could lull a patient into ignoring real symptoms as the cancer progresses; that detect slow-growing or stable cancers that are not life-threatening and would not otherwise have required treatment; and that detect aggressive life-threatening cancers whose outcome is not changed by early detection.

And:

No one advocates that people eschew tests if they have symptoms or special risk factors. “Once something bothers you or changes or is unusual, this is no longer routine screening,” Dr. Calonge said.

But, for otherwise healthy people with no symptoms, he said, only a few routine tests have proven to significantly reduce cancer deaths among certain age groups. The task force recommends pap smears for cervical cancer beginning no later than age 21; regular mammograms to screen for breast cancer in women starting at age 40; and tests for colon cancer starting at age 50. And the task force notes that the evidence supporting the breast cancer screening is not as strong as for cervical and colon cancers.

Links:

The National Cancer Institute has a web site that describes the risks and benefits of various cancer screens.

Does preventive care save money? New England Journal of Medicine

Posted by Donald E. L. Johnson on 07/17/09 at 10:00 AM
Health insurance • Health Insurance Reform • Preventive Care • Permalink