The Moral Healthcare Blog

What if Medicare’s drug benefit was more like the VA’s? | The Incidental Economist

Medicare’s inability to negotiate program-wide prices and tighten plan formularies is in stark contrast to the VA, which negotiates directly with drug manufacturers and is not bound by the same formulary rules as Part D plans. That’s why the VA has been able to implement a national formulary more restrictive than those of Medicare plans and obtains lower drug prices. If Medicare plans could implement VA-like formularies and obtain commensurately lower prices, our paper shows that enough could be saved to compensate beneficiaries for the loss of choice, with savings to spare.

To repeat, the key findings are:

The VA pays 40% less than Medicare plans for prescription drugs.
Medicare plans cover about 85% of the most popular 200 drugs on average (ranging from a low of 68% to a high of 93%).
The VA’s national formulary includes 59% of the most popular 200 drugs.
If Medicare obtained the same drug prices as the VA, it would save $510 per beneficiary per year or a total of $14 billion per year (2009 prices).
If Medicare plans tightened formularies to the level of generosity available from the VA (59% of top 200 drugs covered), beneficiaries would lose $405 of value per year associated with the loss of choice of drugs. (The right way to interpret this is that the average beneficiary would be precisely indifferent between the loss of drug choice and $405 dollars in cash.)
Because the savings ($510 per beneficiary) exceeds the loss of value to beneficiaries ($405), they could, in principle, be made whole with $105 left over (= $510 – $405).

A Possibly Fatal Mistake – NYTimes.com

But the cancer has kept growing, and I went to the E.R. again on Sept. 17 when I found that I was losing all strength in my legs. They did an M.R.I. and saw that there were tumors pressing on my spinal cord. They have been treating me with radiation for three weeks now to shrink those tumors and will continue to do so for another week.

I submitted an application to the hospital for charity care and was approved. The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.

Some doctor bills are not covered by the charity application, and I expect to spend all of my I.R.A. assets before I’m done. Some doctors have been generously treating me without sending bills, and I am humbled by their ethic of service to the patient.

Some things I have to pay for, like $1,700 for the Lupron hormone therapy and $1,400 for an ambulance trip. It’s an arbitrary and haphazard system, and I’m just lucky to live in a city with a highly competent and generous hospital like Swedish.

Everything Obama has done — and wants to do — on taxes in one post

The centrality of tax policy to the 2012 election raises the question: What has actually changed in the tax code since Obama took office?

Three of the big bills of Obama’s tenure — the American Recovery and Reinvestment Act (or the stimulus act), the Affordable Care Act, and the Bush tax cuts reauthorization/payroll tax cut deal from 2010 — contain most of the changes that have been passed since January 2009. Let’s run through them, bill by bill. Keep in mind, of course, that Congress writes the laws, and the bills that actually passed only somewhat reflect Obama’s priorities.

Medicaid’s high marks on preventive care contrary to its stingy image – amednews.com

Medicaid, with its reputation for low payment rates and fiscal instability, is far from perfect, said Stacey Mazer, senior staff associate for the National Assn. of State Budget Officers. Budget officers in particular continue to have concerns about the fact that health care spending is outpacing other services.

Kaiser’s findings highlight all of the positive benefits that Medicaid can provide, Mazer said. “The states did very well in terms of the number of preventive services that they covered, and even the states that didn’t cover as many still covered the majority of them.”

Bob Cesca: Repeat After Me: Obama Cut the Deficit and Slowed Spending to Lowest Level in 50 Years

As I’ve documented before, the CBO reported in January, 2009 that the federal budget deficit for that fiscal year, which began on October 1, 2008, was already $1.2 trillion. President Obama’s additional ’09 spending added another $200 billion to the deficit, bringing the total to $1.412 trillion. Unprecedented and huge, but given the enormity of the financial crisis and the depth of the recession, there weren’t many other options on the table. Add two wars into the mix and there you go.

But since then, deficit spending has dropped precipitously. Why? Chiefly because President Obama signed the Statutory Pay-As-You-Go Act in February, 2010, which mandates that new spending be offset with spending cuts or new revenue. Yes, a Democratic president and a Democratic Congress passed this legislation. Guess how many congressional Republicans voted for the law. Zero. Not one. Perhaps during this week’s debate, Vice President Biden could ask Rep. Paul Ryan who voted against the bill.

Consequently, the president is responsible for the lowest government spending growth in 60 years, according to the Wall Street Journal‘s Market Watch.

Wendell Potter: Romney’s Phony Answers to Tough Health Care Questions

High on the list of recommendations in Romney’s health care platform is an idea frequently touted as a silver bullet by conservatives: allow insurance companies to sell policies across state lines. Doing so, they say, will increase competition and, consequently, bring down the cost of coverage.

The problem is that no one had done a study to determine definitively whether the across-state-lines idea would work — until now. And the conclusion of that study, conducted by the Georgetown University Health Policy Institute, is that allowing coverage to be purchased across state lines is much more of a blank than a bullet.

The study also finds that no new federal law is even needed to allow insurance companies to sell policies across state lines.

“With or without changes to federal law, states already have full authority to decide whether or not to allow sales across state lines and, if so, under what circumstances,” the study noted.

Of course, you wouldn’t know that from listening to Romney and other politicians who seem to believe than an act of Congress is needed. It isn’t. State legislatures can make it happen whenever they want, but, so far, only six have decided to try it. Georgia, Maine and Wyoming have enacted legislation in recent years to allow out-of-state insurers to sell policies within their borders. Lawmakers in Kentucky, Rhode Island and Washington passed bills requiring their insurance departments to research the idea and determine interest from out-of-state insurers.

The lawmakers who championed the legislation expected their states would be inundated with applications from insurers far and wide eager to sell their policies. But it hasn’t happened. In fact, not a single insurance company has expressed the slightest interest in doing business in any of those six states.

Study: When health insurance costs rise, productivity drops

A new working paper from Truven Healthcare’s Teresa Gibson, Harvard’s Michael Chernew and the University of Michigan’s A. Mark Fendrick find that as co-payments go up, productivity drops — most likely as a result of employees skipping out on care altogether.

The team focused on those with chronic pain such as arthritis. They then looked at how much employees had to pay for prescription medication under their various benefit structures. Previous research has shown that as the cost of health-care services increases, usage decreases — workers simply don’t fill as many prescriptions when prices get higher.

On average, employees with chronic pain had 76.7 hours absent from work. But with every $5 increase in cost-sharing for pain medications, they saw an increase in absenteeism somewhere in the ballpark of 1.3 to 3.1 percent.

Obama’s healthcare law: Historic reform and signature failure – latimes.com

His [Obama’s] one condition was a healthcare plan that would protect Americans and could pass,” said Neera Tanden, a former senior White House health advisor.

Several Republican lawmakers signaled interest in working with Obama. But almost at the outset, the GOP leadership was dug in.

“There were legitimate policy disagreements,” said John McDonough, a former aide to the late Sen. Edward M. Kennedy (D-Mass.), “but the clear message we heard from the GOP staffers was they couldn’t move without a signal from McConnell.”

The Republican Senate leader pressured GOP senators to stop negotiating with Obama. “It was intense and it was constant,” said one former Republican aide, who asked not to be identified discussing internal party tensions.

Healthcare leaders got a similar message. One executive said he received several calls from senior GOP lawmakers warning that he would regret participating in the process. Another said he was told that Republicans would not do anything to make the legislation better. “Republicans were going to vote against the law, no matter what,” a third executive said.

All three declined to speak publicly for fear of angering GOP congressional leaders.

Despite the hostility, Obama spent most of 2009 pursuing Republican votes.

🙁

I am a job creator: A manifesto for the entitled – The Washington Post

I am the misunderstood superhero of American capitalism, single-handedly creating wealth and prosperity despite all the obstacles put in my way by employees, government and the media.
I am a job creator and I am entitled.
I am entitled to complain about the economy even when my stock price, my portfolio and my profits are at record levels.
I am entitled to a healthy and well-educated workforce, a modern and efficient transportation system and protection for my person and property, just as I am entitled to demonize the government workers who provide them.
I am entitled to complain bitterly about taxes that are always too high, even when they are at record lows.
I am entitled to a judicial system that efficiently enforces contracts and legal obligations on customers, suppliers and employees but does not afford them the same right in return.
I am entitled to complain about the poor quality of service provided by government agencies even as I leave my own customers on hold for 35 minutes while repeatedly telling them how important their call is.
I am entitled to a compensation package that is above average for my company’s size and industry, reflecting the company’s aspirations if not its performance.
I am entitled to have the company pay for breakfasts and lunches, a luxury car and private jet travel, my country club dues and home security systems, box seats to all major sporting events, a pension equal to my current salary and a full package of insurance — life, health, dental, disability and long-term care — through retirement.

There’s lots more and it is all dead on!

Bush-Appointed Judge Upholds Obama Administration’s Birth Control Coverage Rules | ThinkProgress

The crux of the argument, from the beginning, is reenforced by the Judge:

[Federal religious freedom law] is a shield, not a sword. It protects individuals from substantial burdens on religious exercise that occur when the government coerces action one’s religion forbids, or forbids action one’s religion requires; it is not a means to force one’s religious practices upon others. [It] does not protect against the slight burden on religious exercise that arises when one’s money circuitously flows to support the conduct of other free-exercise-wielding individuals who hold religious beliefs that differ from one’s own.