Category: Uncategorized

News Analysis – With or Without Health Reform, We Pay for Others’ Bad Habits – NYTimes.com:

As a cardiology fellow, I once took care of a young man with severe congestive heart failure. We were supposed to start him on a blood thinner early in his hospitalization, but it got overlooked. Fed up with the delays in getting his blood sufficiently thinned, he left the hospital against medical advice. He said he had to go home to care for his toddler.

He came to the clinic a week later looking very embarrassed. He had left without prescriptions, so he had been taking no medications since he left, leaving him short of breath. To compound the problem, he had been eating cold cuts, cheap and readily available, which made his condition even worse. But the attending physician refused to give him prescriptions. She said that he had to go to a walk-in clinic. She said he had to learn personal responsibility.

Healthy living should be encouraged, but punishing patients who make poor health choices clearly oversimplifies a very complex issue. We should be focusing on public health campaigns: encouraging exercise, smoking cessation and so on. Of course, this will require a change in how we live, how we plan our communities.

“It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

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Ryan Plan May Lead to Single-Payer Health Care – Bloomberg:

Instead, they’ve opted to apply their old policy framework — the one the Democrats stole — to Medicare. That has left the two parties in a somewhat odd position: Democrats support the Republicans’ old idea for the under-65 set, but oppose it for the over-65 set. Republicans support the Democrats’ new idea for the over-65 set, but oppose it for the under-65 set.

This isn’t quite as incoherent as it seems. Democrats say they would prefer Medicare-for-All for the under-65 set, but they’ll take whatever steps toward universal health insurance they can get. Republicans say they would prefer a more free- market approach for the over-65 set, but that a seniors’ version of “Obamacare” is nevertheless a step in the right direction. For both parties, it’s the direction of the policy, rather than the policy itself, that matters.

There’s an added complication for Republicans. They have assumed huge savings from applying the exchange-and-subsidies model to Medicare (USBOMDCR). But they don’t assume — in fact they vehemently deny — that those same savings would result from the identical policy mechanism in the Affordable Care Act. The Democrats haven’t assumed significant savings from the exchange- and-subsidies model in either case. If the concept works as well as Ryan says it will, then the Affordable Care Act will cost far, far less than is currently projected. There’s no compelling reason to believe competitive bidding will cuts costs for seniors but fail among younger, healthier consumers who, if anything, are in a better position to change plans every few years and therefore pressure insurers to cut costs.

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3 Economic Misconceptions That Need to Die – DailyFinance:

3 Economic Misconceptions That Need to Die

Misconception No. 1: Most of what Americans spend their money on is made in China.

Fact: Just 2.7% of personal consumption expenditures go to Chinese-made goods and services. 88.5% of U.S. consumer spending is on American-made goods and services.

Misconception No. 2: We owe most of our debt to China.

Fact: China owns 7.6% of U.S. government debt outstanding.

Misconception No. 3: We get most of our oil from the Middle East.

Fact: Just 9.8% of oil consumed in the U.S. comes from the Middle East.

You can follow the link for the details and explanations…

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Medicare Payment Reform — Proposals for Paying for an SGR Repeal — NEJM:

The Medicare Payment Advisory Commission (MedPAC) has been recommending SGR repeal since 2001 but, until now, has never identified a way to cover its cost. On October 6, MedPAC voted 15-to-2 to recommend replacing the SGR with a “predictable 10-year path of legislated (physician) fee-schedule updates” and paying for the repeal by reducing Medicare payments to various providers and suppliers. Specialists’ fees would be reduced by 5.9% for each of 3 years and frozen for the next 7 years. Fees for primary care services delivered by geriatricians, internists, family physicians, pediatricians, nurse practitioners, clinical nurse specialists, and physician assistants would be frozen for all 10 years. MedPAC estimated that the lower provider payments would save Medicare about $100 billion over 10 years, although Medicare spending on physician services would almost double during that period — increasing from $64 billion to $121 billion — because Medicare’s population would expand and the volume and intensity of delivered services would continue to increase. The estimate is based in part on 73% growth of Medicare spending for physician fee-schedule services between 2000 and 2010 (from $37 billion to $64 billion) — a much faster growth rate than that of payment updates or practice costs (see graphGrowth in Medicare Spending for Physician Services, 2000–2010.). Other organizations would face the following payment cuts over 10 years: pharmaceutical companies, $75 billion; post-acute-care facilities, $45 billion; hospitals, $25 billion; clinical laboratories, $10 billion; durable medical equipment makers, $13 billion; and health plans, $13 billion. Medicare beneficiaries would be subject to increased cost-sharing requirements and, for those who carry supplemental coverage, a Medigap excise tax ($33 billion).

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PolitiFact | The Obameter: Invest in electronic health information systems:

Quote from ONC Coordinator David Brailler on whether the 2009 stimulus bill had helped overcome the market failure that was preventing wider adoption and innovation in health IT, particularly electronic health record systems:

“I think the investment that the Congress and the administration have made was meant to correct a market failure, which stemmed from the fact that we don’t sufficiently reward providers of care for high-performance, lower- cost, higher-quality. We pay them by piece work, whether it’s a high-quality or high-cost product or a low-quality product,” Blumenthal said. “We will very soon, I think, see that (health information technology) becomes an essential part of doing body care to the American people, one that physicians, nurses, health care institutions don’t feel they can afford not to have. And at that point I think the federal government and my office can pass the baton to the professional community, to the hospitals, the nurses of the country, and the market will take off and do its own work for the American people.”

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High-Deductible Health Insurance Pinches Workers From Both Sides:

This just in: High deductible health plans are like death panels!

Like many Americans, Debbie Bass’ health insurance policy is utterly confounding: It’s more expensive than it used to be, but the coverage is worse and the rules just seem to get more arcane.

Last year, her health plan paid for surgery, chemotherapy and radiation to treat her colorectal cancer. This year, her employer switched to a new plan, which won’t even pay for a $39 box of ostomy bags.

Bass, a 57-year-old school bus driver from Hazlehurst, Ga., is among a rising number of Americans with shrinking health benefits and expanding deductibles. Bass said her new plan costs $333 per month to cover her and her husband, up from $210. The plan also comes with a staggering $3,000 deductible. Though her employer put $1,000 into an account to help pay for medical bills, Bass has already spent half of it on prescription drugs and other expenses. She’ll soon need to find an extra $2,000 before her insurance kicks in.

Easier said than done. Bass takes home $395 a month. Her husband’s disability benefits bring in another $1,285. “We are completely broke,” she said. Her oncologist ordered a PET scan to check whether the cancer has stayed away, but she doesn’t know how much it costs or whether her plan will cover it. She’s going in for the test anyway.

High-deductible health insurance is becoming more common, according to survey data reported by the Employee Benefit Research Institute last December. In 2011, 27.7 million working-age people were enrolled in a health plan with a deductible of at least $1,000 for individuals and $2,000 for families. The proportion of insured Americans who have this type of coverage has more than doubled since 2005, the report says.

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Soaking the Poor, State by State | Mother Jones:

The Corporation for Enterprise Development recently released a scorecard for all 50 states, and it has boatloads of useful information. That includes overall tax rates, where data from the Institute on Taxation and Economic Policy shows that in the median state (Mississippi, as it turns out) the poorest 20 percent pay twice the tax rate of the top 1 percent. In the worst states, the poorest 20 percent pay five to six times the rate of the richest 1 percent. Lucky duckies indeed. There’s not one single state with a tax system that’s progressive.

Follow the link to see the chart with all the states.

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The States Doing The Most (and Least) To Spread The Wealth – 24/7 Wall St.:

24/7 Wall St. examined government spending by state in a number of categories to identify those that give the most and least in money and benefits to their residents. Our analysis has found that states that provide the most services and benefits have high income inequality. In order to finance these programs, the states that offer the most to their residents also have among the highest tax burdens in the country. While all income levels benefit from government assistance, the poor and the dispossessed benefit the most, in the form of welfare, medicare, and unemployment insurance.

Tax burden refers to the average amount a person pays in taxes as a percentage of his or her income. The Tax Foundation calculates each state’s tax burden by taking the total amount paid by the state’s residents in taxes, and dividing it by the total income of the state’s residents. Eight of the ten states that are most generous are among the top fifteen states with the highest tax burdens. New York, New Jersey, and Connecticut are all included on the list and also fill the top three slots for largest tax burdens in the country.

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PERRspectives: Perry Calls Texas’ 46th-Ranked Health System Best in U.S.:

Everything, they say, is bigger in the Texas. So it is with the failure of the health care system. Leading the nation with a horrifying 25% of its residents uninsured, Texas ranked 46th in the Commonwealth Fund’s 2009 scorecard of state health care performance. Nevertheless, that dismal performance was no barrier to Governor Rick Perry proclaiming that the Lone Star state has the best health care in the country.
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The answer, of course, is quite poorly. While from 2007 to 2009 Texas nudged its way from a horrific 48th to a merely miserable 46th in the Commonwealth Fund rankings, the health care system there remains an ongoing calamity for its residents. Among the poster children for the failure of red state health care, Perry’s state brought up the rear across the five indicators measured. When it comes to health care access and equity, Texas is dead last.

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Address to the members of different Churches and Christian Communions, 14 September 1984:

“For instance, the needs of the poor must take priority over the desires of the rich; the rights of workers over the maximization of profits; the preservation of the environment over uncontrolled industrial expansion; production to meet social needs over production for military purposes.”

John Paul II, at an address given in Canada in 1984.

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