Tag Archives: health care

“New Rule: the Republicans have to stop saying that if the Obamacare website doesn’t work that must mean Obamacare itself doesn’t work.  That is like saying the ice cream’s no good because you can’t find a spoon.  And the ice cream is good!  That’s why you can’t find any spoons; they’re all in the dishwasher.”

Bill Maher – November 15, 2013

obamacare_Republican sledgehammer

Conservatives and the media are gleefully focusing on the Health Insurance Marketplace’s rocky rollout while ignoring the rest of the Affordable Care Act’s provisions.  They’re also hypocrites for condemning the $70 million “wasted” on the Marketplace’s computer system, which is only 3% of the $24 BILLION Congressional Republicans wasted by shutting down the government for 16 days.

I edited the Health and Human Services’ overview, Key Features of the Affordable Care Act by Year , for easier reading.  Here’s what we will give up if “Obamacare” is repealed.

2010

  • Insurers can’t deny coverage for children under 19 because of pre-existing conditions
  • Insurers can’t rescind coverage because of a “technical mistake” on an application.
  • Lifetime coverage limits  have been eliminated.
  • Annual coverage limits have been restricted.
  • Provided for an external review mechanism for denied claims.
  • Provided a one-time, tax-free $250 rebate check to seniors in the Medicare D “donut hole.”
  • New health plans have to provide preventive care services without charging a deductible, co-pay or coinsurance,
  • Gave a tax credit for up to 35% of the premium costs for small employers and up to 25% for small non-profits.
  • Allocated more money and staff to combat fraud and waste in Medicare, Medicaid and CHIP.
  • Awarded grants for the state insurance navigators program (October 2010).
  • People with pre-existing conditions who were uninsured for >6 months got access to state or DHHS insurance coverage.
  • Allowed adult children to stay on their parents’ insurance until they turned 26.
  • Created a $5 billion dollar program to continue employee coverage for early retirees.
  • Created incentives to increase the number of primary care physicians, nurses and physician assistants.
  • Allocated $250 million in grants to states plans to require insurance companies in the individual and small business markets to justify rate hikes of >10%.
  • Banned companies with excessive or unjustified rate hikes from participating in the new exchanges in 2014.
  • Provided federal funds for states expanding Medicaid coverage.
  • Increased payments to rural health care providers.
  • Allocated funds to support construction and expansion of community health centers.

2011 

  • Provided 50% discount on brand-name drugs for seniors reaching the “donut hole”
  • Provides additional savings on brand-name and generic drugs through 2020 when the “donut hole” will close.
  • Provided for certain free preventive services for seniors on Medicare.
  • Created Center for Medicare and Medicaid Innovation to test new care delivery models, improve care quality and slow the rate of growth of health care costs.
  • Established the Community Care Transitions Program to coordinate care for high-risk Medicare patients after hospital discharge.
  • Established the Independent Payment Advisory Board to recommend ways to target waste, reduce costs, improve health outcomes, expand care access and extend the life of the Medicare Trust Fund.
  • Allowed states to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes through the Community First Choice Option.
  • Required insurers for large employers to spend at least 85% and individual and small employer plans to spend at least 80% of all premium dollars on health care services and health care quality improvement and provide rebates if profits or administrative costs are too high.
  • Gradually eliminates overpayment to Medicare Advantage plan insurers; will give bonuses to Medicaid Advantage plans providing “high-quality care.”

Part 2 will look at 2012-present.

Health Care Expenditures: Show Me The Money!

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Any substantive discussion of health care requires a solid foundation.  So here’s a primer on health care expenditures – where the money came from and where it went – prior to the ACA.

Who provides our insurance: in 2007, a little more than half of us (54%) had employer-provided health insurance. Medicare, Medicaid and SCHIP covered another 26%, and 4% of people purchased their own insurance. Sixteen percent of us had no insurance.

Who provides insurance 2007

Source: Kaiser Family Foundation State Health Facts – 2007

But three years later, things had changed significantly.  Less than half of us got insurance from our employers.  Medicaid and Medicare coverage rose to 16% and 13%; private insurance covered 5%.   The percentage of uninsured remained the same.

Who provides insurance 2010

Source: Kaiser Family Foundation – State Health Facts

Government employees get their insurance with taxpayer dollars, not employer revenue.  The American Federation of State, County and Municipal Employees (AFSCME) has 1.6 million members. The American Federation of Government Employees (AFGE) and the National Federation of Federal Employees (NFFE) together have 700,000 members. There are 1.8 million active duty service men and women, many with dependent families, receiving “government-run health care.”   Add veterans and their families covered by TRICARE and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and we are much closer to “socialized medicine” than any politician will ever admit.

 Who pays for health care: Government is already the single largest health care purchaser; In Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP) and other public funds paid 40% of health care costs in 2011.  And just to clear up any misconceptions, two thirds of Medicaid funds go for care of the elderly and disabled.  Yep, Medicaid pays for your grandmother’s nursing home, not Medicare, which only covers skilled nursing care.

Private insurance paid for 33% of expenditures; out-of-pocket spending and other private funds accounted for 11% and 7%, respectively.

Who paid for health care 2011

 

 

 

 

Source: California Health Care Foundation

Where our health care dollars go: Hospitals receive 31.4% of our health care dollars; doctors get 19.9% and drugs consume another 10.1%.  Nursing homes receive 5.5% and we spend 2.7% on home health care. “Other Personal Health Care Spending” includes goods and services such as dental, vision and durable medical equipment. “Other Health Spending” includes administrative costs, research, public health services, buildings and equipment.

KFF NHE 2010

Sources: Kaiser Family Foundation and Centers for Medicare & Medicaid Services

Who do we spend it on? The good news is half of us rarely need medical care, accounting for about 3 percent of all health care spending.  The bad news is 5 percent of us are responsible for almost half of expenditures.  The top 1% of people are “super-utilizers,” whose chronic, poorly managed illnesses account for 22% of our annual bill.

Population Consuming Health Care

Source: Agency for Healthcare Research and Quality

One would expect caring for the elderly to be more expensive, but the United States spends far more than other countries.

Health Care costs by age

I’ll try to explain WHY we spend so much money in my next post.

Freedom’s Just Another Word For Everything To Lose

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September 27, 2013

Ted Cruz’s phony filibuster on September 24, 2013, was ostensibly about “freedom.” Tony Perkins of the Family Research Council said, “… the greatest threat to our faith, our families and our freedom is Obamacare”  And one internet troll complained, “Thanks to Obamacare, I’m losing all my choices?

Oh, really? And what freedoms are you losing?

The freedom to let other people absorb that $79 billion a year in uncompensated care for the uninsured?

The freedom to wait several hours in someone’s emergency room for routine care because you are uninsured and none of the doctors in town will see you?

The freedom to go bankrupt because the cost of the care for your catastrophic illness exceeded your insurance policy’s lifetime cap?

The freedom to be uninsurable because you developed cancer, lost your job and then lost your insurance?

The freedom to put a pickle jar on the local convenience store counter asking for donations for your child’s surgery because you make too much to qualify for Medicaid but can’t afford insurance on the individual market?

The freedom to stay in a soul-crushing job under a boss you hate and you would leave in a heartbeat if it wasn’t for the the health insurance benefits you desperately need?

If you are fortunate enough to have heavily subsidized health insurance through the generosity of your employer you can keep it. Thanks to Obamacare, you have additional proctections – insurance companies can’t drop you because you actually needed your insurance. So stop complaining that 30 million people will now get something you’ve taken for granted.

The Sky Is Falling! Obamacare is Coming!

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A physician shortage is one of the many catastrophes conservatives claim will befall the country if Obamacare isn’t repealed.  Alyene Senger, in a Heritage Foundation Issue Brief, thinks declining Medicare and Medicaid reimbursement rates combined with obnoxious bureaucratic oversight will cause already dissatisfied physicians to retire in droves and dissuade younger people from becoming doctors. Jeff Tangney, CEO of the physician social media site Doximity, Inc., predicts we’ll be short 90,000 to 150,000 physicians by 2025 as 30 million people obtain health insurance.  The unstated implication is “You’re screwed because some undeserving, lazy moocher is getting the health care you worked so hard for, and YOU’RE paying for it.”

This is wrong on so many levels I’m not sure where to start.

 Overwhelming the system?

The uninsured have always been there but now they will have health insurance. Barring an unexpected pandemic, thirty million people aren’t going to become sick on October 1, 2014. People won’t be trampling each other in a Black Friday-like rush to the doctor’s office. More may now seek preventative care, but not necessarily.  My well-insured sister-in-law hasn’t had a Pap smear in 24 years.

 The scourge of Medicare and Medicaid?

Physicians were predicting disaster before Medicare was enacted in 1965. Ronald Reagan railed against “socialized medicine” in 1961. Now, they love it because it pays them for taking care of old people. My late father-in-law’s internist got a hundred bucks for each five minute visit.

More people on insurance means more revenue for physicians and hospitals instead of bad debt write-offs.  The same holds for Medicaid. Many physicians refuse to see Medicaid patients; those that do accept those patients out of necessity or a sense of moral obligation. More people will be eligible for Medicaid but the Feds will be throwing more money into the pot, so what’s not to like?

 Doctors leaving in droves?  I don’t think so.

The independent, solo practitioner is almost extinct. More than half of all physicians are employed by a hospital or a healthcare system and don’t have to worry about the bureaucratic headaches of private practice. Younger physicians find this attractive because they want a life outside of practice.  Employers like them because their young minds can be molded into the corporate way. Established physicians like the idea of a guaranteed salary and potential productivity bonuses.  And many, if not most, physicians will shut up and endure for the right price. Those of us nearing retirement may get out early because we’re tired, but Obamacare provides a convenient excuse for the complainers.

For the past thirty years I’ve heard physicians complain that “the practice of medicine isn’t fun anymore.” But they are also bound by the golden handcuffs. The average physician income is $259,000/year and even primary care physicians average a healthy $189,000/year.  It’s hard to walk away from all that money. Trust me; I still see a lot of luxury cars in doctors’ parking lots, including one Tesla Model S.

You will still get the medical care you need.  Everyone should.