Tag: "consumer driven health care"

Scary Facts about Antibiotics

What is indisputable is that the status quo is untenable. An estimated 48,000 people die in Europe and the U.S. each year from infections caused by antibiotic-resistant bacteria, and this number is very likely to increase in years to come. “This is a global issue and a moral issue that needs to be dealt with in collaboration,” says Otto Cars, of the Swedish Institute for Communicable Disease Control in Solna.

From Nature Medicine via Kevin Outterson.

Medicaid Expansion Caused Most of the Economic “Growth” in January and February

We’ve already noted that health spending last quarter climbed at the highest rate in ten years, according to the Bureau of Economic Analysis’ latest quarterly GDP report.

Ben Casselman of FiveThirtyEight puts that spending spurt in another context. Examining the BEA’s February income report, he concludes that Medicaid expansion explains most of the growth:

The government’s definition of income includes not just salaries and other cash payments but also non-cash benefits such as employer-paid health insurance premiums and government programs such as Medicare and Medicaid. The health law has a particularly big impact on that last category because it made millions more people eligible for Medicaid. As a result, Medicaid payments increased $11.4 billion in February, representing 24 percent of the total increase in income. In January, Medicaid benefits represented an even bigger 47 percent of the increase in income.

In other words, the Bureau of Economic Analysis does not take into account whether people earned their income, or whether it was a welfare payment.

The Enrollment Numbers Aren’t What You Think

Confident BusinesswomanA new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere. Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income. (Kaiser Health News)

Giving “Insanity” a Whole New Meaning

This is from The Wall Street Journal:

woman-scaredInside the U.S. Department of Health and Human Services sits an agency whose assignment since its creation in 1992 has been to reduce the impact of mental illness and target services to the “people most in need.” Instead the Substance Abuse and Mental Health Services Administration, known as Samhsa, uses its $3.6 billion annual budget to undermine treatment for severe mental disorders…

For instance, Samhsa’s Guide to Mental Illness Awareness Week suggests schools invite as speakers such radical organizations as MindFreedom, which rejects the existence of mental illness and stages “human rights” campaigns against drug treatment and commitments. Or the National Coalition for Mental Health Recovery, which “holds that psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.”

Imperial Presidency

index1The Obama administration has decided that the sequester’s mandatory spending cuts no longer apply to part of ObamaCare.

The health care law provides subsidies to help low-income people cover some of their out-of-pocket costs. Last year, the administration said those subsidies were taking a 7 percent cut because of the sequester, which imposed across-the-board reductions in federal spending.

But now, the White House has changed its mind. It removed the cost-sharing subsidies from its list of programs that are subject to the sequester, eliminating the 7 percent cut for 2015.

The Committee for a Responsible Federal Budget, which noticed the change, said the reversal would likely restore about $560 million to the subsidies — and require $560 million in cuts to other programs to make up for it. (National Journal)

The cost-sharing subsidies are expected to total $8 billion this year and $156 billion over the next decade.

More Evidence That the Exchange Plans Don’t Want the Chronically Ill

woman-in-hospitalBrian Rosen, senior vice president for public policy for The Leukemia & Lymphoma Society, said the group studied premiums and benefits for patients with blood cancer in seven states, including Florida, California, Texas and New York. They found 50 percent co-insurance rates for specialty drugs on several plans in Florida and Texas, while the highest co-insurance rates on California plans were 30 percent and in New York, co-pays were typically $70.

Under the law, insurers can’t charge an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy. But patients advocates warn those with serious illnesses could pay their entire out-of-pocket cap before their insurance kicks in any money. (AP)

What Happens When Medicare Overpays Medicare Advantage Plans?

The Medicare Payment Advisory Commission (MedPAC) figures that Medicare Advantage plans cost 6 percent more than if beneficiaries had been in fee-for-service Medicare. New research concludes that beneficiaries only get a small fraction of these increased payments in benefits. According to Scott Duggan and colleagues:

…[O]nly about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures. Our results have implications for a key feature of the Affordable Care Act that will reduce reimbursement to MA plans by $156 billion from 2013 to 2022.

A Better Way to Cut Medicare Spending

Over the next 10 years, the Affordable Care Act (ObamaCare) is scheduled to cut Medicare spending by $716 billion, primarily by reducing payments to doctors and hospitals. Further, those cuts in spending will continue indefinitely into the future. By 2060, one-fifth of Medicare will be gone. The Medicare actuaries and others have warned that these cuts will reduce access to care for seniors.

iStock_000002100130XSmallFortunately, there is a better way ― proposed by Liqun Liu, Andrew J. Rettenmaier, Thomas R. Saving and Zijun Wang in a study for the National Center for Policy Analysis: The reform consists of two changes to current law: (1) raising the Medicare eligibility age to the same age as Social Security (and thereafter indexing it to increases in longevity) and (2) requiring higher income seniors to pay a greater share of their medical costs (or so-called means testing). This reform ensures that low income workers receive full benefits (defined as the average benefits retirees would receive if the ACA’s cost-cutting provisions are not realized) upon attaining the new eligibility age. Once seniors reach the new eligibility age:

Surgical Checklists Don’t Save Lives

Atul Gawande has become famous for The Checklist Manifesto, which makes the case for delivering medical care like The Cheesecake Factory delivers cheesecake. However, David R. Urback and colleagues reported these results:

Implementation of surgical safety checklists in Ontario, Canada, was not associated with significant reductions in operative mortality or complications…

During 3-month periods before and after adoption of a surgical safety checklist, a total of 101 hospitals performed 109,341 and 106,370 procedures, respectively. The adjusted risk of death during a hospital stay or within 30 days after surgery was 0.71% (95% confidence interval [CI], 0.66 to 0.76) before implementation of a surgical checklist and 0.65% (95% CI, 0.60 to 0.70) afterward (odds ratio, 0.91; 95% CI, 0.80 to 1.03; P=0.13). The adjusted risk of surgical complications was 3.86% (95% CI, 3.76 to 3.96) before implementation and 3.82% (95% CI, 3.71 to 3.92) afterward (odds ratio, 0.97; 95% CI, 0.90 to 1.03; P=0.29).

Atul Gawande responds to the checklist study. So does Aaron Carroll.

Does ObamaCare Deserve The Credit (or Blame) For Rising Deductibles?

become-richGalen Benshoof, a guest blogger at The Incidental Economist, writes that rising deductibles are not entirely a consequence of ObamaCare, but also the rise of Health Savings Accounts and associated high-deductible, consumer-driven health plans over the last decade.

However, Benshoof’s description of the effect of consumer-driven health plans suffers from misunderstanding:

In the 1990s, some conservatives gravitated to a health insurance scheme that shifted costs and responsibility onto workers. They called this consumer-directed health care (CDHC), although the real beneficiaries were employers.