Sunday, 18. April 2010
Here are some of the groups on the menu if anything like the existing Senate or House health plans become law:
•?Young people. If the government mandates that everyone must have health insurance, healthy young people will have to buy policies that don’t reflect the low risk they have of getting sick. The House and Senate bills do let insurers set premiums based on age, but only up to a 2-to-1 ratio, versus a real-world ratio of 5 to 1. This means lower prices for older (and wealthier) folks, but high prices for the young. “They’ll have sticker shock,” says Rep. Paul Ryan, ranking Republican on the Budget Committee.
•?Small Businesses. Employers who don’t provide coverage will have to pay a tax up to 8% of their payroll. Yet those who do provide coverage also have to pay the tax—if the law says their coverage is not “adequate.” Amazingly, even if a small business provides adequate insurance but its employees choose coverage in another plan offered through the government, the employer still must pay.
•?Health Savings Account (HSA) holders. Eight million Americans, according to the Treasury Department, are covered by plans with low-cost premiums and high deductibles that are designed for large, unexpected medical costs. Money is also set aside in a savings account to cover the deductibles, and whatever isn’t spent in one year can build up tax-free. Nearly a third of new HSA users, according to Treasury figures, previously had no insurance or bought coverage on their own.
These policies will be severely limited. The Senate plan says a policy deemed “acceptable” must have insurance (rather than the individual) pay out at least 76% of the benefits. The House plan is pegged at 70%. That’s not the way these plans are set up to work. Ray Ramthun, who implemented the HSA regulations at the Treasury Department in 2003, says the regulations are crippling. “Companies tell me they could be forced to take products off the market,” he said in an interview.
•?Medicare Advantage users. Mr. Obama and Congressional Democrats want to cut back this program—care provided by private companies and subsidized by the government. Medicare Advantage grew by 15% last year; 10.5 million seniors, or 22% of all Medicare patients, are now enrolled.
The program is especially popular with those in badly served urban areas and with those who can’t afford the premiums for Medicare supplemental (MediGap) policies. A total of 54% of Hispanics on Medicare have chosen Medicare Advantage, as have 40% of African-Americans, according to the Centers for Medicare and Medicaid Services at the Department of Health and Human Services.
These plans tend to provide better coordinated and preventive care, and richer prescription drug coverage. But Democrats dislike Medicare Advantage’s private-sector nature, and they have some legitimate beefs with its unevenly generous reimbursement rates. This week Mr. Obama told the Washington Post that the program was “a prime example” of his efforts to cut Medicare spending, because he claims people “aren’t getting good value” from it.
That’s not what others say. In January, Oregon’s Democratic Gov. Ted Kulongoski wrote the Obama administration expressing his concern about its efforts “to scale back Medicare Advantage” because the plans “play an important role in providing affordable health coverage.” He noted that 39% of Oregon’s Medicare patients had chosen Medicare Advantage, and that in “some of our Medicare Advantage plans . . . with proper chronic disease management for such conditions as heart disease, asthma and diabetes, hospitalization admission rates have declined.”
The $156 billion in Medicare Advantage cuts over the next decade proposed by Mr. Obama will force many seniors to go back to traditional Medicare at greater expense. A new study for the Florida Association of Health Plans found that because Medicare Advantage plans have richer benefits and lower deductibles and copayments than traditional Medicare, seniors in that state would face dramatically higher payments if forced to give up their Medicare Advantage plans. Cost increases would range from $2,214 a year in Jacksonville to $3,714 a year in Miami.
There are reasons that Blue Dog Democrats in Congress are leery of their party’s health-care reform plans. Many are in districts or states carried by John McCain, and they worry about the political fallout when these groups realize they will be paying for health-care reform.
They also know that every government entitlement winds up becoming a money pit. In 1965, Sen. Allen Ellender (D., La.) dismissed promises that Medicare would be a modest program to save seniors from bankruptcy. “Let us not be so naïve as to believe that the Medicare program will not be increased from year to year to the point that the government will have to impose more taxes on the little man or else take the necessary money out of the Treasury,” he told colleagues.
Ellender was right, and
Ellender was right, and his warning is even more relevant in our era of skyrocketing deficits and Medicare costs. The only way the House and Senate health plans can pass is if the costs they impose on vulnerable parts of the population continue to be hidden.
http://online.wsj.com/article/SB20001424052970203517304574306303720472842.html
What do you think?
Posted in Answers by Prescription Savings -
Monday, 12. April 2010
Let’s just say that doing nothing is not an option. OK
And that Obama-Care is a crappy option that will be hugely expensive, that will steal people’s Medicare Trust Fund, and that will only make a small dent in the problem of the Uninsured.
OK — those are just assumptions for the sake of argument, they are not final conclusions, they are just set up for my question, which is “What Could the Government fo Instead of Obama-Care?”
Here are some possibilities:
1. Very small Federal primary care clinics staffed by 3 or 4 doctors and supervised on a monthly basis by ultra-highly qualified doctors who visit every month or so to make sure the primary care is good or very good. These clinics would be operated on a “Good Samaritan” basis, and on a “Sovereign Immunity” basis, so if mistakes were made the Federal government could not be sued. It could however pay fair and reasonable compensation for gross negligence by the doctors it hired and supervised. Fair and reasonable would be decided by a formula, and by a panel of expert supervising physicians. So these primary care clinics would operated in a limited liability zone — not subject to local state jury trials for medical malpractice, and all patients seeking care in such clinics would have to knowingly sign a waiver of their right to sue. No waiver, no care, back out on the street, no Good Samaritan here to save you, try County General.
These little clinics should number about 10,000. They should basically be in the business of taking the primary care load off emergency rooms. They should do preventative medicine, and help clients get further care as needed. So your basic heart pills, and diabetes pills, and athsma treatments don’t have to be done for $1000 in a busy emergecy room, they can be done for $75 in a micro-clinic run by the Federal government. That’s a savings of $925 for each patient. Figure 20 patients a day, 300 days a year, pretty soon you’re talking real money (like $550,000 per year saved for each doctor on the staff). You could actually pay the doctors pretty well out of that saved amount, right? Let’s say $150,000 per year starting salary. You still clear $400,000 of societal savings for each doctor working.
This is all based on the idea that if the government wants there to be more healthcare, it should “just do it”
If the government wants the leaves raked off the White House lawn, it should “just do it”
The doing concept only seems strange in a world where the government has gotten used to writing 16,000 pages of detailed commands and instructions for anything it wants done — so that other people can do it.
I say skip the paperwork — if you want something done — do it! The Doing Concept, part of what made America great.
How about this idea for a second concept: Let the VA Pharmacy fill prescriptions for Vets based on the orders of the Vets’ own doctors, so long as those doctors are: (1) Board Certified (2) America Educated and (3) in Good standing as Physicians (their licenses are fully in operational and valid and current). So there’s no reason whatsoever to imagine that the Vets own doctor is not good enough to write the prescription. OK — then just fill it! It’s like the Just Do It concept.
Don’t fuss, don’t make the vet get a whole new doctor and come into your system, just let them have the benefit of government buying power, so the meds go out to the vet at about 20% of retail which is what the VA pays for them. The VA can charge for postage too.
Again this would be on a “Sovereign Immunity” “Malpractice Waiver” basis so the U.S. government would take no legal risk in this program. No chance of being sued. Fraud is still possible, but liability from lawsuits is not. The fraud can be squeezed out of the system by investigation and relentless prosecution of malfeasors — bad doctors who use their position to cheat Uncle Sam.
These are just two ideas. My basic idea is to take the problem down by layers, starting with the easy layers. More primary care — do it. More meds at fair prices — do it.
It’s the Doing Concept.
Over time this will make the problem smaller. Not vanish — but smaller. Instead of 45 million uninsurables — maybe in 10 years just 25 million. That’s way better than Obama-Care is likely to do. And at 10% of the cost of Obama-Care. And without stealing the Medicare Trust Fund.
It’s better policy because it’s a better value. It impacts the problem at low cost and low risk by using “doing” instead of “commanding” as its method of proceeding. Raking the leaves up, instead of writing a 16,000 page set of commands to get the leaves raked up. Doing — wow there’s a thought!
I have never watched FOX News. I have never read any FOX publication. I never listen to FOX radio.
Any resemblance between anything I say, and anything said on FOX is either coincidental or it arises from FOX people reading my posts (here and elsewhere) picking up the ideas, and making media talk with my ideas, without giving me credit for them, which I don’t mind. I’m with Rabidranath Tagore, the Indian poet, when he said, “Whatever isn’t given … is lost!” So pick my brain,, pick my bones .. it’s all given freely. But it is irritating when people think I get my ideas from FOX. It’s really unjust — a bad rap. The next person who says that should include a quote from FOX that is the paraphrase of what I say in my posts. You have to show that they said it first, then I said it second. Otherwise, I couldn’t possibly be getting my stuff from FOX, you see that, right? Just bring the quotes, or stop the bad rap. Thanks.
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