Tag: "health insurance"
The editors at Bloomberg explain:
Here’s how the system works: When a doctor administers a drug in his or her office, Medicare pays 106 percent of its average selling price. The doctor keeps the extra as compensation for administering the injection.
What has this got to do with eye doctors? The drug Lucentis, used to treat macular degeneration, cost Medicare almost $2,000 a shot in 2012. Another drug, Avastin, which works just as well, costs about $50. If you were the doctor, faced with a system that pays you 6 percent of the drug’s cost, which would you choose? That Medicare spent a total of about $1 billion on Lucentis in 2012 suggests most ophthalmologists went with the more expensive one.
It gets worse:
This problem goes beyond a single drug. Of the $20 billion Medicare spent on drugs administered by doctors in 2010, 85 percent went to the 55 most expensive ones. In what seems unlikely to be a coincidence, 42 of those drugs also showed an increase in use from 2008 to 2010.
Just two small issues need to be resolved before the state gets to all systems go: First, it needs the federal government to grant waivers allowing Vermont to divert Medicaid and other health-care funding into the single-payer system. And second, Vermont needs to find some way to pay for it.
Although Act 48 required Vermont to create a single-payer system by 2017, the state hasn’t drafted a bill spelling out how to raise the additional $1.6 billion a year (based on the state’s estimate) the system needs. The state collected only $2.7 billion in tax revenue in fiscal year 2012, so that’s a vexingly large sum to scrape together…
Paying for this program would likely make Vermont the highest-taxed state in the nation, by quite a lot.
But so is access to doctors and hospitals in the plans offered on the health insurance exchanges.
A Congressional Budget Office report estimates lower federal spending (see the figure). The reason: Health plans in the exchanges look more like Medicaid than like employer-based coverage. Jason Millman reports:
The CBO report points out that it previously thought ObamaCare’s exchange plans would look more like employer-based coverage, but that hasn’t turned out to be the case so far — hence, the cheaper premiums. “The plans being offered through the exchanges this year appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans,” CBO wrote.
The CBO projects 42 million people will remain uninsured this year. In fact, the ACA will never cover more than 45% of the uninsured.
Posing as patients, researchers made almost 13,000 calls to doctors’ offices in ten states, seeking appointments for a variety of ailments. For those posing as privately insured patients, they got appointments 85 percent of the time. For those posing as patients on Medicaid, they only got appointments 58 percent of the time. Researchers also posed as uninsured patients who were willing to pay in full at the time of the appointment.
The result? 78 percent were successful (for appointments costing more than $75) — 36 percent better than those posing as Medicaid patients and quite close to those posing as privately insured.