The Moral Healthcare Blog

The Republican ticket’s big Medicare myth

Obama’s Medicare reform plan isn’t that hard to find. It’s largely in Title III of The Patient Protection and Affordable Care Act. The basic strategy has three components: First, figure out what “quality” in health care is. Second, figure out how to pay for quality rather than paying for volume. Third, make it easier for Medicare to quickly update itself to reflect both advances in knowledge about what quality is and how to pay for it.

And so, in Title III, you’ll find dozens of different efforts to achieve these goals. The most famous of them is Section 3403, which establishes the Independent Payment Advisory Board (IPAB). But there’s also Section 3021, which creates the Center for Medicare and Medicaid Innovation, and Section 3025, which cuts hospital reimbursements if too many of their patients are readmitted, and Section 3001, which establishes value-based purchasing for hospital services, and Section 3015, which collects data on quality, and Section 3502, which advances the medical home model.

Some of the efforts are outside Title III. The Patient-Centered Outcomes Research Institute is actually in Title VI of the law. And then there are the subsequent reforms the administration has proposed to save more money. Those can be found on pages 33-37 of the president’s 2013 budget proposal. They include expanding IPAB’s mandate such that it can change Medicare’s benefit package and setting a growth cap on Medicare of GDP+0.5 percentage points — which is, by the way, the same growth cap that Rep. Paul Ryan imposes in the latest iteration of his budget.

‘Socialized’ or not, we can learn from the VA – RAND

‘Socialized’ or Not, We Can Learn from the VA | RAND

In a recent post on the New York Times’ Economix blog, Princeton economics professor Uwe E. Reinhardt addresses the common characterization of the British health care system as “socialized medicine.” The label is most often used pejoratively in the United States to suggest that if anything resembling Great Britain’s National Health System (NHS) were adopted in the U.S., it would invariably deliver low-quality health care and produce poor health outcomes.

Ironically, Reinhardt notes, the U.S. already has a close cousin to the NHS within our borders. It’s the national network of VA Hospitals, clinics and skilled nursing facilities operated by our Veterans Healthcare Administration, part of the Department of Veterans Affairs. By almost every measure, the VA is recognized as delivering consistently high-quality care to its patients.

Among the evidence Reinhardt cites is an “eye-opening” (his words) 2004 RAND study from in the Annals of Internal Medicine that examined the quality of VA care, comparing the medical records of VA patients with a national sample and evaluating how effectively health care is delivered to each group (see a summary of that study).

RAND’s study, led by Dr. Steven Asch, found that the VA system delivered higher-quality care than the national sample of private hospitals on all measures except acute care (on which the two samples performed comparably). In nearly every other respect, VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up.

Papa John’s: ‘Obamacare’ will raise pizza prices – POLITICO.com

If you thought Obamacare was going to be expensive, Papa John’s is here to show exactly how little an effect on businesses it will be to buy health insurance for employees – less than 15 cents a pizza! As Pete Townshend once said, “I call that a bargain, the best I ever had!”

Pizza chain Papa John’s told shareholders that President Obama’s health care law will cost consumers more on their pizza.

On a conference call last week, CEO and founder John Schnatter (a Mitt Romney supporter and fundraiser) said the health care law’s changes — set to go into effect in 2014 — will result in higher costs for the company — which they vowed to pass onto consumers.

“Our best estimate is that the Obamacare will cost 11 to 14 cents per pizza, or 15 to 20 cents per order from a corporate basis,” Schnatter said.

Truman and the fight for health care – Hawley, PA – The News Eagle

In fact, Medicare enacted only a part of what President Truman had advocated two decades earlier. In the 1940s, Truman was shocked and saddened by the poor state of the nation’s health care, which effectively excluded millions of middle-class Americans from access to the world’s most advanced medical technologies.

“That’s all wrong in my book,” Truman stated, “I’m trying to fix it so people in the middle-income bracket can live as long as the very rich and the very poor.”

Poor health was particularly a problem among young people. Nearly 8.5 million young men and women had been found physically or mentally unfit for military service during World War II – nearly half of those examined for their induction physicals. Truman saw this situation as “a crime.”

Noting that his predecessor, President Franklin D. Roosevelt, had advocated a national health initiative in his “Economic Bill of Rights,” Truman sent Congress a message on Nov. 19, 1945, proposing compulsory health insurance through payroll deductions and other revenue.

Truman supported complex legislation in a bill advanced by Democrats in the U.S. House and Senate. However, the president felt their effort had little chance for success in Congress. He proposed less complicated legislation that called for:

– Prepayment of medical expenses through compulsory insurance premiums and general revenues.

– Protection against lost wages due to illness or disability.

– Expansion of public health, prenatal care and child health services.

– Federal aid for medical schools and research institutions.

– Funding for local hospitals, clinics and medical institutions.

Truman proposed that the U.S. surgeon general set fees and administer the program. Doctors could choose whether or not to participate. He believed his plan would provide insurance for hospital and doctor costs for all working Americans and their families.

PolitiFact | Mitt Romney says ‘Obamacare’ adds trillions to the deficit

Here, we’re fact-checking Romney’s claim that “Obamacare adds trillions to our deficits and to our national debt.” It’s a topic we’ve researched before.

We asked the Romney campaign for their evidence for this statement, but we didn’t hear back.

For claims about laws that are not yet fully enacted, our go-to source is the Congressional Budget Office. It’s a nonpartisan, widely respected agency with an expert staff that generates projections and reports about how proposed laws affect the federal budget.

The Congressional Budget Office is not always right in its projections. In recent years, for example, it overestimated how much it would cost to cover prescription drugs for seniors in Medicare. The program actually came in under projections.

But for claims about deficits, we consider the Congressional Budget Office, often called the CBO, to be the standard by which we fact-check claims.

The CBO said this about the health care law back in 2010: It lowers the deficit, by about $124 billion over 10 years.

And in 2011, when Republicans offered a bill to repeal the health care law, the CBO said that increased the deficit, by about $210 billion over 10 years.

Now, is the CBO infallible? Certainly not. And good questions have been raised about some of the CBO’s methods in accounting for the health care law’s effects. We reported on some those concerns in great detail in a fact-check of statement from U.S. Rep Paul Ryan, R-Wisc. He said the law was “accelerating our country toward bankruptcy.” We rated that Mostly False.

The CBO itself acknowledges the uncertainty surrounding its estimates. Its reports regularly warn that uncertainty increases as it makes projections farther into the future.

Medicaid Expansion Reduces Mortality, Study Finds – Capsules – The KHN Blog

As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move.

The research published in the New England Journal of Medicine found a 6.1 percent reduction in mortality among low-income adults between the ages of 20 and 64 in Maine, New York and Arizona — three states that expanded coverage since 2000, compared with similar adults in New Hampshire, Pennsylvania, Nevada and New Mexico, neighboring states that did not do so.

The decline in mortality, by an overall 19.6 deaths per 100,000 adults, was especially pronounced among older individuals, minorities and residents of the poorest counties. The researchers analyzed data spanning five-year periods before and after the three states extended their Medicaid coverage to poor, childless adults.

The study also found “improved coverage, access to care and self-reported health” among the newly covered adults.

Incivility Is a Partner in Health Care Reform Indicates Benepath CEO | Jul 23, 2012

There is another glitch looming large in the health care system. It is called incivility. “Incivility is the latest, but not the newest, issue to come to the fore in the health care system,” Clelland Green, RHU, CEO, and president of Benepath, Pennsylvania, indicated. “It is not new, but it does seem to be getting worse over time. Medical health professionals hand it out and conversely, put up with it, so it’s a two-way street with a dead end if this keeps escalating.”

Most know incivility to be intimidating, rude, disruptive or unwanted behavior aimed at someone else. It is typically an offensive, hostile or intimidating action that charges the environment in a highly negative manner. It has always been around, but seems to be getting worse. Victims of the potshots taken at them suffer real and distressing symptoms that may include humiliation, stress, depression, anger and an inability to sleep. “Call it what you want, incivility, relational aggression, lateral violence, or call a spade a spade and say that incivility is really bullying, by a slightly nicer name, but not by much,” Green added.

Bullies exist in every walk of life and for those who have the misfortune to run across them, they find themselves on the receiving end of abnormally aggressive actions and behavior that allows the individual to get control and power over others. Bullying exits in the workplace, in groups and in individual interactions. In a medical setting, it may be one nurse bullying another, management bullying a nurse, a nurse bullying a patient and vice versa, and the list goes on.

The hard, cold fact of incivility is that it shreds workplace morale and interferes with patient safety. This type of behavior in a medical setting is far more widespread than we may imagine. The end result of working in this kind of hostile atmosphere is lower productivity, less inclination to take the initiative and fear, anger and stress and an increase in medical malpractice.

The statistics that show that bullying in workplaces across the nation is highly prevalent, with roughly 37 percent affected by it, at least 12 percent who have seen it transpire, 45 percent whose health has been impacted by bullying and a disturbing number of 40 percent who are subjected to it, but do not report it. “As it relates to the medical health profession,” said Green, “the bottom line is civility must be present for there to be professionalism. It is just that simple. Patients do not go to hospital to be subjected to this kind of behavior or attitude. Medical professionals need to get a grip.”

The Fiscal Facts about Medicaid Expansion – Doctors for America

Currently, the federal government requires that Medicaid be available to adults who 1) fall under the federal poverty line and 2) who have children, are pregnant, or are disabled. Although Medicaid is almost entirely administered by the states, including actual enrollment of beneficiaries and reimbursement to health care providers, the cost is split between the federal and state governments, with the federal government shouldering, on average, about 57% of cost.

There are two ways that the ACA will expand enrollment in Medicaid. First, the ACA makes more Americans eligible for the program by 1) increasing the income standard to 133% of the federal poverty level (in 2011 this was $10,890 for individuals and $22,320 for a family of four), and 2) doing away with the requirement that you must have children, be pregnant, or be disabled. The ACA ensures that the Federal government would pay for 100% of this the first 3 years, then phase down to 90% after 2020 and beyond. According to the Congressional Budget Office and the Center for Budget and Policy Priorities, this averages to the Federal government paying for 93-94% of the expansion over the rest of the decade.

The second way is that the ACA simply makes it easier for eligible Americans to enroll in the program. The little known truth is that there are millions of Americans who are already eligible for Medicaid but are not enrolled because of complicated paperwork for potential beneficiaries and for state agencies and providers. In fact, a New England Journal of Medicine paper reports that only 62% of all eligible individuals are enrolled in Medicaid, with some states like Oklahoma, Texas, and Florida enrolling under 48%. The issue is even more is true for children; 60-70% of uninsured children are eligible for Medicaid or State Children’s Health Insurance Programs (CHIP) eligible but are not enrolled.