The Moral Healthcare Blog

Romney’s theory of the “taker class,” and why it matters

For what it’s worth, this division of “makers” and “takers” isn’t true. Among the Americans who paid no federal income taxes in 2011, 61 percent paid payroll taxes — which means they have jobs and, when you account for both sides of the payroll tax, they paid 15.3 percent of their income in taxes, which is higher than the 13.9 percent that Romney paid. Another 22 percent were elderly.

So 83 percent of those not paying federal income taxes are either working and paying payroll taxes or they’re elderly and Romney is promising to protect their benefits because they’ve earned them. The remainder, by and large, aren’t paying federal income or payroll taxes because they’re unemployed. But that’s a small fraction of the country.

Mitt Romney Thinks “$200 – $250K or less” is middle income!

Full Transcript: George Stephanopoulos and Mitt Romney – ABC News

GEORGE STEPHANOPOULOS: Is $100,000 middle income?
MITT ROMNEY: No, middle income is $200,000 to $250,000 and less.

Reality:

Ahh, another MBA in the White House. Hooray!

RAND Institute for Civil Justice | RAND

Most Physicians Will Face Malpractice Claims, But Risk of Making Payment Is Low

The most comprehensive analysis of the risk of malpractice claims by physician specialty in more than two decades finds that U.S. physicians have a greater than 75% career-long risk of facing litigation. In some specialties, doctors can be virtually certain of a lawsuit over the course of their careers. However, the vast majority of those claims will not result in payment to a plaintiff.

JAMA Network Controlling Health Care Costs in Massachusetts With a Global Spending Target

The new legislation builds on the far-reaching health insurance reforms that Massachusetts enacted in 2006, including the mandate on state residents to carry a minimum level of insurance or to pay a tax penalty.⁶The reforms became the model for key aspects of the US Patient Protection and Affordable Care Act of 2010.¹The many features of the 2012 state act include provisions to improve transparency and accountability for health care providers with regard to cost, financial performance, quality, and competition within markets and to improve the clarity for consumers of information about the out-of-pocket costs of care. The provisions also include reforms to medical malpractice laws that would allow a physician, hospital, or others who provide health care to admit to a mistake or error, without the acknowledgment being used in court as an admission of liability.⁵Attention, however, is likely to focus on the global spending target and its potential value as a cost-containment tool. From 2004 to 2009, health care spending in Massachusetts increased by 5.8% per year, regularly exceeding economic growth.⁷
The act creates a Health Policy Commission to implement the new law and a Center for Health Information and Analysis to collect and analyze data on health care costs and quality. The commission is charged with establishing by April 15 of every year “a health care cost growth benchmark for the average growth in total health care expenditures . . . for the next calendar year.” Total health care expenditures are defined as “all health care expenditures in the commonwealth from public and private sources,” including “all categories of medical expenses and all non-claims related payments to providers . . . all patient cost-sharing amounts, such as, deductibles and copayments,” and “the net cost of private health insurance.” The “growth rate of potential gross state product” is defined as the “long-run average growth rate of the commonwealth’s economy, excluding fluctuations due to the business cycle.”

JAMA Network | JAMA: The Journal of the American Medical Association | Controlling Health Care Costs in Massachusetts With a Global Spending Target Controlling Health Care Costs in Massachusetts

An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

Ryan and Mitt Romney have called for the most profound, radical changes in the program’s history. But rather than clarifying the differences between their position on Medicare and President Obama’s, they’ve done their best to obscure them. They’ve accused Obama of “raiding” Medicare when Ryan’s own budget calls for reducing the program’s funding by the same amount of money. They have insisted they won’t do anything to affect current retirees, even though they have pledged to repeal the Affordable Care Act, which bolsters Medicare’s drug coverage and makes preventative care available without out-of-pocket expenses.

Romney and Ryan have also been less specific than you might have heard. That’s particularly true for Romney, whose “proposal” consists of a fact sheet, plus a few speeches, statements, and op-eds. This allows them to escape responsibility for the inevitable trade-offs that their vision, like every effort to reform Medicare, would require. And it gives them a political advantage over President Obama, who must defend reforms of Medicare in the Affordable Care Act and his latest budget—right down to the last legislative clause and dollar figure.

Yes, I keep reading that Romney and Ryan have been “brave” and “serious” about Medicare, while Obama has ducked hard choices. I would say it’s the other way around.

An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

’Informed Decision’ May Irk Surgeons as It Cuts Costs – HealthLeaders Media

But consider just a few recent headlines to see the paving of the large runway that may enable this plane to take off.

• A New York Times story last week revealed some 1,200 patients underwent unnecessary invasive cardiology procedures in one South Central Florida hospital, and many other facilities in the large HCA chain are under federal investigation.

• A Grand Rapids surgeon’s study in September’s Journal of Clinical Oncologysays far too many patients undergo unnecessary surgery to remove tumors in patients with advanced colon cancer when chemotherapy and a drug have a better success rate.

• A report in the New England Journal of Medicine found many women with breast cancer are unnecessarily undergoing a second surgery to remove more tissue for wider margins.

National blindspot

Some surgeons themselves think this is an idea whose time has come.

“We have a major national blindspot, and that blindspot is unnecessary medical care, and there’s a ton of it that goes on,” says Martin Makary, MD, a gastroenterology surgeon and researcher at Johns Hopkins School of Medicine.

Makary is the author of an upcoming and extremely controversial book, Unaccountable, about dangerous practices that persist in a culture that is allowed to hide its mistakes. He tells me that preliminary results of his research project reveal that when asked, surgeons think the amount of unnecessary surgery that hospital culture chooses to ignore is huge, “in the ballpark of 10% to 20%.”

These are the big drivers of cost, Makary says. ” [They are] big ticket items, like coronary artery bypass graft surgeries, colectomies, hysterectomies, and back surgeries. They not only have the biggest price tags, but they also have the highest complication profiles of anything we do in healthcare.”