Healthcare Reform

[Edward]

Courtesy of David Yonki:

http://lulacpoliticaletter.blogspot.com/

HEALTH CARE AND SENIORS

Vice President Joe Biden and Health and Human Services (HHS) Secretary Kathleen Sebelius hosted a town hall meeting with seniors in Silver Spring, MD and released a new report, Health Insurance Reform and Medicare: Making Medicare Stronger for America’s Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama’s health insurance reform plan. The complete report is available now at www.HealthReform.gov.
"We will protect seniors - not burden them with out of pocket costs," said Vice President Biden. "The bottom line is, seniors will be better off under what we are proposing, and not a dollar from the Medicare trust fund will be used to pay for health insurance reform." “Under health insurance reform, seniors will get better care and their health care costs will go down,” said Secretary Sebelius. “Reform will strengthen Medicare, cut drug costs, and help ensure all seniors get the high-quality, affordable care they deserve.” The report highlights several problems in the current health care system and health insurance reform solutions such as:
Preserving and strengthening Medicare. According to the Medicare Trustees 2009 report, the Medicare Part A Trust Fund will be exhausted by 2017. Health insurance reform will extend the life of the Medicare Trust Fund by an additional four to five years – and delivery system reforms included in health insurance reform have the potential to keep the Trust Fund solvent even longer into the future. Health insurance reform will also reduce overpayments to private plans and will clamp down on fraud and abuse to strengthen Medicare for all seniors. Coupled with improvements in the quality of care, expansion of the health care workforce, and reductions in out-of-pocket costs, health insurance reform will ensure that Medicare will continue to provide the high-quality, affordable coverage that America’s seniors deserve and expect. Cutting high prescription drug costs. Prescription drug costs represent a significant expense for seniors. While Medicare added a prescription drug benefit, this benefit includes a coverage gap commonly called the “donut hole.” In 2007, over 8 million seniors hit the “donut hole.” For those who are not low-income or have not purchased other coverage, average drug costs in this coverage gap are $340 per month, or $4,080 per year. Health insurance reform will close the coverage gap in Medicare Part D over time, so seniors do not have to worry about losing coverage for their drug costs. While the closure of the coverage gap is phased in, health insurance reform will also provide seniors with a discount of 50 percent on their brand name medication costs in the coverage gap, saving thousands of dollars for some seniors. Making preventive services free. Many seniors do not receive recommended preventive and primary care, leading to less effective and more expensive treatments. For example, 20 percent of women aged 50 and over did not receive a mammogram in the past two years, and 38 percent of adults aged 50 and over have never had a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent of the cost of many preventive services on their own. For a colonoscopy that costs $700, this means that a senior must pay $140 – a price that can be prohibitively expensive. Under health insurance reform, a senior would not pay anything for a screening colonoscopy or other preventive services. Reform will eliminate any deductibles, copayments, or other cost-sharing for obtaining preventive services, making them affordable and accessible. Ending overpayments to private insurance companies that cost all Medicare beneficiaries. The federal government pays private insurance companies on average 14 percent more for providing coverage to Medicare Advantage beneficiaries than it would pay for the same beneficiary in the traditional Medicare program. There is no evidence that this extra payment leads to better quality for Medicare beneficiaries, and all Medicare beneficiaries pay the price of these excessive overpayments through higher premiums – even the 78 percent of seniors who are not enrolled in a Medicare Advantage plan. A typical couple in traditional Medicare will pay on average nearly $90 next year to subsidize private insurance companies that do not provide their Medicare benefits. Health insurance reform will eliminate excessive government subsidies to Medicare Advantage plans, which could save the Federal government, taxpayers, and Medicare beneficiaries well over $100 billion over the next 10 years.

[PGLGreg]

So we will get more benefits, yet they will cost less. Yeah, sure. Although I personally favor reform, on the other hand, I don't appreciate being lied to and taken for a fool.

[girlnextdoor]

I believe in reform. Just not Obamacare.

[Edward]

The main thing I took from the article is the screening rates even at "age eligible" times. I think they are very low for people who need them and would "probably" be covered by insurance.

[Edward]

By the way, the author has undergone treatment for Colon Cancer.

[jscho]

There is so much rhetoric and hyperbole in this overly politicized debate. I don't find it constructive to say things like "obamacare", and much more helpful to criticize particular proposals so that things can move forward. I often look at the web site at http://www.factcheck.org to filter out some of the inevitable nonsense. For example, there are a number of ads that have featured cases of treatments gone wrong, cancer and otherwise, such as the case of Shona Holmes, under nationalized health care (which is not even being proposed in the U.S.) that are not fairly presented.

I think we would all agree that any reform that encourages increased coverage of screening for cancer would be nice and go a long way in limiting the devastation of the disease. It's good to hear this point discussed in the media.

Best,
Jeremy

[hannahw]

Tim Egan has an interesting column in the NYTimes today. Here's one paragraph:

With his mother’s death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel’s home and help her through her final days.

http://egan.blogs.nytimes.com/2009/09/2 ... /#more-829

His mother was 88, had a weak heart and most likely, cancer. She wanted no further treatment, but rather to be able to go home and live our her days with a little nursing assistance for safety and comfort.

I saw a similar situation starting to take shape when I was at the pharmacy the other day. The adult son of an elderly woman was finding it would be less expensive for them to have his mother hospitalized for a bunch of procedures she didn't want rather than bringing her home because medicare wouldn't pay for a hospital bed, nor a wheelchair, nor help with PT and nursing. But they would be for ridiculous treatments. The man was in tears. All he and his mom wanted was for her to come home and live out her days safely and in relative comfort.

Sad, not only the dollar cost, but the human cost.

Oh, I have a question. I read a story today about a woman who had a lump in her breast. The doc is confident it's a non-cancerous cyst but still wants the woman to get a mammogram. The woman is changing jobs later this fall so she has decided to wait on the mammogram because if it is cancerous it would be a pre-existing condition and her new insurance wouldn't cover it. Is that right? I always thought you were ok if you were changing jobs. That the new insurance had to cover you for whatever condition you're bringing with you.

[weisssoccermom]

Hannah,

I have read that IF a person is covered under a GROUP plan - not individual - and changes jobs to another GROUP plan with no lapse in coverage, AND if that person has been covered for 12 (in some instances it is 18) months in the first group insurance, then NO, there are no preexisting conditions. However, if a person, for example was only on a group plan for 4 months and had no coverage prior to this OR had an individual plan prior to this then YES, this ficticous (that's not spelled right - sorry) person would have a pre-existing condition.

Whether it is 12 or 18 months is still hazy to me. I don't know if that goes by state or what.

Jaynee

[PGLGreg]

I saw a similar situation starting to take shape when I was at the pharmacy the other day. The adult son of an elderly woman was finding it would be less expensive for them to have his mother hospitalized for a bunch of procedures she didn't want rather than bringing her home because medicare wouldn't pay for a hospital bed, nor a wheelchair, nor help with PT and nursing.

I am partially familiar with these issues, having been my mother's caregiver for her last three years, spent about 1/3 in hospitals and rehab facilities. Medicare paid for practically everything except for 6 weeks in a nursing home which the insurer claimed was custodial rather than for rehabilitation, but it did pay for several months in two other skilled nursing facilities. Medicare did pay for about 4 months of in-home visits -- about 5 per week -- from a team, to bathe her, give occupational therapy, physical therapy, an RN to give her check-ups. It did pay for her wheelchair, a commode, and would have paid for a hospital bed if she had wanted one. It paid for two periods of outpatient physical therapy. So let's not exaggerate how little Medicare helps people faced with these end of life financial problems or how "absurd" their policies are.

The article you referenced seems to me very long on talk and short on substance. What is the point of even raising the issue of assisted suicide? The article says that Oregon, with the most enlightened laws on this, had 33 such deaths in a recent year[*]. How much money did that save Medicare? It's a drop in the bucket. It's just political talk to create the impression that something constructive might possibly be done if we just vote for the right talkers.

[*] edit correction: that should have been 33 deaths since 1997 rather than "in a recent year".

[hannahw]

Greg, maybe I tend to misunderstand your tone, but I don't understand why you take such an aggressive stance on so many things. It seems most of the time you are looking to pick a fight. You even assailed another member for worrying about her mother's smoking and the impact it would have on her treatment. I'm not here for an argument. I thought it was an interesting article and I saw a similar situation begin to materialize in front of me. I'm not your enemy. You're not mine.

Because I was overhearing the conversation and not a part of it, I can't really be more specific, but from what I heard, the woman had exhausted her allotted time at a rehab facility (sounded like she had 30 days) and did not meet the requirements for medicare to pick up the bill for the equipment she needed to live safely and comfortably at home.

The point of the article seems very simple - medicare will often pay for expensive procedures but not always basic home health care. As the article points out, 1% of the population uses up about 33% of the total health care dollars spent, often on procedures that provide not real benefit and often to the exclusion of cheaper alternatives that might actually be preferred by the patient. That's not a drop in the bucket. As the article asks: “the big question is not how we pay for health care, but what are we buying.”

In my personal experience, end of life is not discussed enough and as a result people approach the end of their road with limited information, great fear and a system that is more apt to pay for procedures that prolong life but do nothing to preserve quality and nothing to preserve choice. I don't know how I feel about the "right to die" issue, we voted it on it here in my state last year and I found the issue very perplexing, but one way or the other I believe there is an incredible lack of information out there and it's both expensive and hurtful. For example, it's fairly unusual to discuss a DNR unless the situation is quite dire and even then people don't necessarily understand what they are agreeing to be refusing or accepting. I saw a terminally ill patient resuscitated recently and it is brutal. The patient suffered, the family suffered, the doctors and nurses suffered. But since there had been no discussion and no planning, it happened the way it happened. Aside from the dollar cost is the suffering. In this particular case, the patient died a few weeks later without any meaningful recovery. Studies show that grieving family has a more difficult time recovering after a terminal family member is resuscitated.

In a sense, medicine has outpaced ethics. There are many new ways to sustain life, and I don't think anyone would argue against fostering with great care a culture of life, but just there is a procedure doesn't always mean it should be used. When we talk about culture of life are we talking about length or quality?

Part of the problem with health care reform is that there is more than one front on which change needs to occur. How we think about dying and the result impact it has on treatment and treatment costs is one issue. But so is, for example, the undue influence of the big pharma and insurance company lobbies. Politicians can say what they want, but at the end of the day I think self-interest rules for many, if not most, of them. Pharma and insurance lobbies make it profitable for politicians to back them up and keep the status quo.

[PGLGreg]

For example, it's fairly unusual to discuss a DNR unless the situation is quite dire and even then people don't necessarily understand what they are agreeing to be refusing or accepting.

How do you know it's unusual? Every time my mother was admitted to a hospital, they raised with me and settled the DNR issue, and likewise for the nursing facilities she was admitted to. When she was capable of discussing it, they went over it with her. It's a form they have to fill out -- a part of their regular procedure. There's a checklist of what procedures they may use to resuscitate and those they may not. Toward the end when it became clear she was dying, her doctor could not have been more explicit with me about the DNR order and what policy of medication and sedation the hospital would follow.

When you post information that is contrary to my own personal experience and knowledge, is it in your view unduly confrontational for me to point this out? Are you incapable of error?

[garbovatwin]

Whatever your stance or beliefs on health care reform might be, I do not believe that any reform will be passed that benefits the people of America much, if any reform is passed at all. Washington is in the grip of lobbyists and corporations, and this seemingly never ending battle will go on and on and on I fear.

http://opinion.latimes.com/opinionla/20 ... s-cut.html

When a Medicare cut isn't exactly a cut
September 24, 2009 | 5:02 pm

Max Baucus, healthcare reform, Medicare, Medicare Advantage, benefit cuts, Wall Street Journal editorialAn editorial in today's Wall Street Journal finds a new setting for the argument that the Democrats' healthcare reform bills would reduce Medicare benefits -- this time, lambasting Senate Finance Committee Chairman Max Baucus (D-Mont.) for calling on an Obama administration "crony" to punish Humana Inc. for warning customers that their Medicare Advantage benefits were at risk. According to the Journal's editorial, Humana wasn't saying anything that Congress' chief budget analyst, Doug Elmendorf, hasn't said.

The Journal's right about Baucus and the Democrats' proposals, and yet it paints a misleading picture of the policy at issue. Medicare Advantage is an HMO-style approach to Medicare, with care managed by private insurers such as Humana. The healthcare reform bills would phase out the additional subsidies that insurers receive for Medicare Advantage programs, bringing the cost into line with conventional Medicare. The reduction will almost certainly lead to the elimination of some of the extra benefits that those programs provide. But think about that for a moment.

Insurers created HMOs to cut healthcare costs by steering consumers to a network of doctors and hospitals that had agreed to charge the insurer lower fees. Hoping to tap into those savings, Medicare has been encouraging seniors to join HMOs since the 1970s. In the past decade, however, the insurance industry's allies in Congress have ratcheted up the subsidies for Medicare HMOs (dubbed "Medicare Advantage" in 2003), enabling those programs to offer extra benefits in the hope of attracting more subscribers. By MedPAC's estimate, every $1 in added benefit cost the Medicare program $1.30. Medicare Advantage no longer tries to save taxpayer dollars; instead, it exists mainly to shift the elderly into privately run plans by delivering more benefits, but in a less efficient way than the basic Medicare program does.

Those extra benefits, by the way, typically consist of lower co-payments, although they occasionally take the form of additional services. Medicare Advantage plans aren't as generous as Medigap policies, but those have monthly premiums and Medicare Advantage doesn't. If the healthcare reform legislation drains the extra subsidies from Medicare Advantage, those enrollees will feel the pinch. But they won't receive less than their counterparts in the basic Medicare program -- most likely, there will still be some advantage to Medicare Advantage. Which brings us back to the issue here. Are the Democrats proposing to cut Medicare benefits? No, they're proposing to trim the sweeteners that had been used to draw the elderly into privately managed plans. And if the private plans cost taxpayers more than basic Medicare, why do we have them?

OR

http://www.cnn.com/2009/POLITICS/07/28/ ... alth.care/

Obama: No reduced Medicare benefits in health care reform

WASHINGTON (CNN) -- President Obama tried Tuesday to alleviate senior citizens' concerns about health care reform, saying his plan will maintain Medicare benefits and allow people to keep the coverage and doctors they now have.
President Obama says the current health care system is broken and needs immediate changes.

President Obama says the current health care system is broken and needs immediate changes.

At a town hall teleconference organized by AARP, the nation's largest senior-citizen advocacy group, Obama said the goal of reform is to end waste and inefficiency in a system that provides poor value and threatens to drain the federal budget.

"The more we can reduce those unnecessary costs in health care, the more money we have to provide people with the necessary care," Obama said. "This is pretty straightforward, it's pretty logical."

He compared the concept to insulating a house to reduce heating bills, noting that it will still be warm inside without "wasting money by sending it to the electric company."

"You're still going to be healthy; you're just going to be saving some money," Obama said.

Questions from people in the audience and via telephone from around the country focused on concerns that Medicare benefits would be cut or people would be denied coverage based on government decisions. Learn more about the health care debate »

Obama repeatedly insisted his plan would improve the value of spending on Medicare, so that the quality of coverage would remain the same while the cost would go down. Insurance companies also would no longer be able to deny coverage for pre-existing conditions, he said.
Don't Miss

* House Dem leaders: No vote on refoms as recess nears
* GOP ratchets up debate
* Interactive: Examining the health care debate
* Ticker: Democrats hail new report

"Nobody is talking about trying to change Medicare benefits," he said. "What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund."

He cited $177 billion of what he called government subsidies paid to insurance companies participating in Medicare Advantage, an enhanced Medicare benefits program.

Making health insurers compete to participate in Medicare Advantage, rather than paying them do so, is one way to cut costs and improve benefits, the president said.

"If you've got health care, the only thing we're going to do is we're going to reform the insurance companies so that they can't cheat you," he said.

Republican opponents, and some Democrats, say the Democratic reform plan being pushed by Obama would cost too much and expand the government's role in health care without providing long-term stability.

"You cannot add millions of new baby boomers now retiring to the Medicare rolls and at the same time cut Medicare by $500 billion ... without cutting their benefits," Sen. Jon Kyl, R-Arizona, said Tuesday.

Obama rejected such criticism, noting the current system is broken and needs immediate changes to prevent even greater problems within a decade.

He said that Tuesday was the 44th anniversary of when Congress passed the first Medicare bill. The debate back then was the same as today, Obama said, with reform opponents saying Medicare would lead to government rationing of benefits.

"I know there are folks who will oppose any kind of reform because they profit from the way the system is right now," Obama said. "They'll run all kinds of ads to make people scared."
advertisement

Obama noted that the United States spends $6,000 more per person on health care each year than other industrialized nations, such as Denmark, but the American people are no healthier.

"We shouldn't be paying 50 percent more, 75 percent more than other countries that are just as healthy or healthier than we are," he said.

[hannahw]

Obama noted that the United States spends $6,000 more per person on health care each year than other industrialized nations, such as Denmark, but the American people are no healthier.

Dollars spent seems fairly straight forward but I wonder how they measure the term "healthier"?

[garbovatwin]

Obama noted that the United States spends $6,000 more per person on health care each year than other industrialized nations, such as Denmark, but the American people are no healthier.

Dollars spent seems fairly straight forward but I wonder how they measure the term "healthier"?

Really, especially since most care in America is Disease Care not Health Care.

There is an interesting article out today that shows Colorectal Cancer to be the #1 cause of cancer deaths in a part of India, and they attribute it to their changing, more western diet.

[Candyys03]

Thank you for sharing Edward and everyone else.It is good to stay informed especially when the health care reform is so important.
Candy