A [Massachusetts] official may have gone off-script last week, but what he had to say is an important contribution to the state’s ongoing debate over reining in health care costs.
Terry Dougherty, director of MassHealth, the state’s Medicaid program, was addressing a budget hearing in Boston Friday, State House News Service reports. He noted a little-known fact that runs counter to the widespread assumption that government is more wasteful than the private sector.
MassHealth, which insures nearly 1.3 million Massachusetts residents, spends just 1.5 percent of its $10 billion budget on administration, Dougherty said, while private insurers spend about 9.5 percent of their revenue on administration.
“I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,” Dougherty said. Under a single payer system – like MassHealth or Medicare – the government pays health care providers directly, instead of an insurance company.
Unlike private insurance companies, Dougherty said later, at MassHealth “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth … who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.” Source: The Milford Daily News
From Change.org:
For transplant patients in Arizona, the warnings about death panels and health care rationing have come true, but they have nothing to do with health care reform. Instead, a Republican Governor and her allies are standing in the way of patient care, declining requests to reinstate funding for a critical, life-saving program.
Facing state budget problems, Arizona Governor Jan Brewer slashed funding for the state's Medicaid program that covered organ transplants. As a result some patients that were covered by the state and waiting for a transplant were cut from the program effective October 1st, leading to what some doctors are calling "death by budget cuts." [...]
The $1.4 million cut has had a dramatic impact on the lives of the patients and their families, but it could've been avoided. According to the Sentinel, projects that were funded include a $20 million renovation to a roof of the Arizone Veterans Memorial Coliseum and a $2 million grant for algae research.
Budget cuts have to come from somewhere, but cutting funding from a program that is integral in saving lives and preventing death? Tell Governor Brewer that her cuts to the transplant program were unconscionable and that she should immediately reinstate the $1.4 million in funding.
The bill coming out of Senate Finance is far from perfect, but they finished up last night with some key improvements adopted that mean some of the worst elements have been softened, and some of the worst Republican amendments were fought off. There's still some ugly there, though, for Harkin, Reid, and Baucus to deal with as the bills are merged, and when it eventually comes to the floor.
Probably the most significant improvement on affordability came last night when Schumer and Snowe successfully lowered the "Max Tax". The bill still has an individual mandate, but the penalties have been reduced. Here's one of the uglier ones they passed, and in basic secrecy, that would give states increasing flexibility to drop Medicaid patients, starting next year. They will meet sometime next week to vote on reporting the bill out. After that, assuming that Rockefeller, Cantwell, and Wyden feel their primary objections have been met and vote for it, it's on to the merging process, where hopefully Senator Harkin will be able to prevail on a strong public option. More details here.
The first big fight over the Senate Finance Committee’s health care legislation erupted Tuesday night: a rollicking brawl over a deal that the Obama administration cut with the pharmaceutical industry to achieve $80 billion in savings on drug costs over 10 years, money that would help pay for the legislation.
Top House Democrats have hated the deal from the get-go. Senate Democrats are now bitterly divided. And Senate Republicans are eagerly jumping into the fray to needle the Democrats over their divisions. The fight over the deal with PhRMA actually stems from the legislative battle over the Medicare prescription drug legislation that Republicans successfully pushed through Congress in 2003. As a result of that legislation, about 6 million elderly Americans who had been receiving drug benefits under Medicaid, the government insurance program for the poor, were instead shifted into the new Medicare drug program, resulting in the government paying far high prices for drugs.
Representative Henry Waxman, Democrat of California, and now the powerful chairman of the House Energy and Commerce Committee, has long complained about that switch. And the House health care legislation, of which Mr. Waxman is a main author, seeks to reverse the arrangement and to recoup the extra money that the government has been spending by restoring the old Medicaid drug discounts or “rebates” as they are known.
That would save the government at least $86 billion over 10 years, but would potentially cost the drug industry far more. The White House has said that its deal with PhRMA would help narrow a gap in Medicare coverage of prescription drugs that is know as the doughnut hole, which forces people to pay some of their drug costs after a certain level. But there are also questions about the extent to which the drug industry also benefits, because the increased drug coverage for seniors means that the government will pay for more medication on their behalf, particularly brand-name drugs. In some cases, seniors now stop taking medication or switch to generics when they reach the doughnut hole.
Since the White House reached its deal with PhRMA in June there has been some disagreement between the industry and the administration over the precise terms of the arrangement. PhRMA has insisted that the White House agreed not to seek any additional concessions from drug manufacturers and to block Mr. Waxman’s plan in the House legislation. And the industry said that its support of the health overhaul was specifically aimed at Mr. Baucus’s proposal.
Mr. Baucus had previously announced that the first votes on amendments would not take place until Wednesday, so a final outcome of the fight was postponed. Read it all at NYTimes.com
U.S. health insurers whine about being "gagged" after being told not to violate marketing rules or improperly use protected Medicare mailing lists.
The Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program for the elderly and disabled as well as privately run Medicare alternatives, said on Monday it was investigating a letter Humana Inc (HUM.N) sent enrollees about efforts to overhaul the nation's healthcare system.
Humana's letter, sent in an envelope citing important plan information, told customers the Democrats' bills could hurt "millions of seniors and disabled individuals who could lose many of the important benefits and services that make Medicare Advantage health plans so valuable," according to CMS.
The agency also warned other insurers against sending potentially misleading health reform mailings to customers. REad it all at Reuters
The Census Bureau released health insurance numbers for 2008 today. On the surface it appears that things haven't gotten much worse, and that for children they've gotten better. On the surface.
You really need to dig a little deeper than what's presented to get the whole picture and understand that, in addition to all the personal insurance horror stories out there, there is also the national horror story of how millions of people in our country, more than the entire population of Canada, lack health coverage.
If you look at the insurance rate changes by age group, you quickly see that the picture is not at all rosy. Children's insurance did indeed improve -- about 800,000 fewer uninsured children and a drop of 1.1 points in percentage uninsured from 2007 to 2008. Great! (And you can give grudging thanks to the terrible horrible no-good very bad gov'mint bureaucrat-ruled Medicaid and Children's Health Insurance Program). (But note -- 7.3 million children under 18 -- 8.1 million if you include the 18-year-olds, lack coverage and that's considered a major improvement!).
Elderly rates also improved marginally -- but they were very good to begin with (due to that other awful government-run scary socialist Obama-like Medicare program). 1.7% of the elderly were uninsured in 2008 as compared to 1.9% in 2007 (not a statistically significant difference).
For all other age groups, that is all groups within the category "non-elderly adults," things got worse. Over all, for people aged 18 through 64, the percentage uninsured went from 19.6 (pretty bad already) to 20.3%. And the number of uninsured non-elderly adults increased by 1.5 million. Just think, more than one out of every 5 people between the ages of 18 and 64 was uninsured in 2008.
Now isn't that interesting -- the two age groups with a "public option" (limited for children to the lower income children who are eligible for either Medicaid or the Children's Health Insurance Program) had stable or improved coverage, while the group reliant on employer & private coverage fared badly. Gee, do you think that could possibly mean that government-run programs might actually work?
So the improvement in children's coverage masks how bad things are for the non-elderly adults -- people like the woman I just talked to on the phone who said "I'm in that funny age group, no longer working at a salaried job with benefits and too young for Medicare. My insurance premiums have just doubled and I don't know if I can keep affording to pay for health insurance."
What we really have is a steadily worsening health coverage picture for the adult population. That picture is different for the young and old only because of much maligned public safety-net programs (and for children, this is a very limited safety net). From where I stand, a "robust public option" looks pretty damn good! Read it all here.
Medicare, Medicaid and veterans' benefits have become an indispensible part of our health care system providing valuable services and benefits to people, many of whom would have very few health care options were it not for these government programs. This is something which should be kept in mind when scare tactics about government takeover of health care are used. These programs also demonstrate the inaccuracy, or perhaps nuttiness, of some of the more outlandish claims about Obama's proposed programs. For example, if the government were really going to ration health care or set up "death panels" as part of government health care programs, wouldn't the government have started by doing these things to the poor, the elderly or disabled veterans-precisely the people who rely on the government for health care today. Read it all.
From the Associated Press:
The percentage of Americans with private health insurance has hit its lowest mark in 50 years, according to two new government reports.
About 65 percent of non-elderly Americans had private insurance in 2008, down from 67 percent the year before, according to preliminary data released Wednesday by the U.S. Centers for Disease Control and Prevention.
"It's bad news," said Kenneth Thorpe, a health policy researcher at Emory University.
In the 1970s and early 1980s, nearly 80 percent of Americans had private coverage, according to CDC officials.
Some experts blamed the faltering economy and corporate decisions to raise health insurance premiums _ or do away with employee coverage _ as the main drivers of the recent data. They say coverage statistics for 2009 may look even worse.
However, public coverage of adults is rising in some states, due to programs like Medicaid expanding eligibility. So not all the adults without private coverage are uninsured, Thorpe said.
Indeed, the CDC estimated that about 44 million Americans were uninsured last year _ nearly the same as CDC estimates for other recent years.
The CDC is one of at least three U.S. agencies that estimate the number of Americans without health insurance. The U.S. Census Bureau puts out what is perhaps the best-known number, but that agency's 2008 estimate is not due out until August.
Like the Census Bureau, the CDC's estimate is based on a survey. The CDC interviewed about 75,000 Americans last year, asking if they were uninsured at the time. About 15 percent said yes, leading to the estimate that about 44 million Americans were uninsured.
The drop in non-elderly adults with private health insurance was statistically significant, but the drop in children without private coverage was not. Health officials noted that public coverage of children has risen dramatically in the last ten years, and now more than one in three children are covered by a public plan.
The CDC also reported on insurance coverage in the 20 largest states, and found the percent of uninsured people ranged from 3 percent in Massachusetts to 23 percent in Texas. Lack of health insurance was greatest in the South and West.
Private coverage rates for people under age 65 ranged from 79 percent in Massachusetts to 56 percent in Florida, the CDC reported. Source
A Senate source just passed me the latest outline of the Senate Finance Committee's health reform proposal. This is the post-CBO revision. Apparently, after the committee staff received the scores, they dug deep and quickly developed this proposal to circulate among members and then send back to CBO. It was presented earlier today at a closed-door meeting.
Sources say that it's a major scale-back of the outline they had before. Specifically, subsidies have dropped from 400 percent of the poverty line to 300 percent. Medicaid eligibility has been tightened to 133 percent of poverty for children and pregnant women and 100 percent of poverty for parents and childless adults. The plans being offered in the exchange have seen their actuarial values sharply lowered. read more from Ezra Klein
Fast Facts On Rural Health Insurance - June 12, 2009 ·
* Percentage of noncorporate farmers and ranchers with health insurance: 95
* Percentage of all Americans with health insurance: 84.7
* The likely rate of underinsurance in rural areas compared with cities and suburbs: double
* Percentage of the rural poor covered by Medicaid: 45
* Percentage of the urban poor covered by Medicaid: 49
* Percentage of all Americans dependent on individual health insurance policies with reduced benefits and high deductibles: 8
* Percentage of farmers and ranchers dependent on individual health insurance policies: 33
* Percentage of farmers and ranchers carrying medical debt: 20
* Percentage of all Americans carrying medical debt: 28
* Percentage of rural workers who have jobs with small businesses: 50
* Percentage of urban workers who have jobs with small business: 37
* The likely rate of having no insurance for small-business workers compared with all workers: double
* Percentage of non-elderly urban workers insured at work: 72
* Percentage of non-elderly rural workers insured at work: 61
* Percentage of U.S. physicians working in rural America: 10
* Percentage of U.S. population defined as rural: 25
* Number of dentists practicing in urban areas per 100,000 people: 60
* Number of dentists practicing in rural areas per 100,000 people: 40
Sources: National Rural Health Association, The Access Project, Office of Rural Health Policy, U.S. Census Bureau, The Commonwealth Fund and Center for Rural Affairs
Read the rest and listen at NPR
To the Editor:
As a family physician for 47 years, I totally agree with Paul Krugman’s May 22 column, “Blue Double Cross.” Health care insurers are more bureaucratic than any government agency. They often deny choice of doctor, and refuse to pay for care.
My experience with the government programs, Medicare and Medicaid, is that the reimbursement for services may be low, but there is one uniform set of rules to follow.
Each health care insurer has a different set of rules. The reimbursement for services varies widely and the doctor sometimes doesn’t know where to send the patient for laboratory or other tests. Furthermore, the physician often doesn’t know whether the prescriptions he or she writes will be covered.
As Mr. Krugman reports, insurance companies are still bad for your health.
Melvin H. Kirschner
Granada Hills, Calif., May 22, 2009 • To the Editor:
I am a dual citizen, born and raised in Canada. After attending graduate school in the United States, I returned to Canada, first of all because of its much better health system. During my time in the United States, I heard many astonishing lies about Canadian health care.
Someone said that Canadians can’t choose their own doctors. Sorry, wrong. It’s Americans whose choice is constrained, by health maintenance organizations.
Another person said Canadian-style care is more expensive. In fact, Canadians pay far less and still get a high standard of care and are healthier and live longer than Americans.
Someone else said that Canadian health insurance involves tons of paperwork. Wrong again. Canadian medical insurance and billing is a miracle of simplicity and economy. Anyone who has ever been to an American hospital knows how much paperwork — mostly financial — is involved, and how many different bills they get from how many different parties.
Americans deserve far better than their current system, because most of them can’t simply move to a country with a rational, humane vision of health care.
James Harbeck
Toronto, May 22, 2009
By Robert Reich | Salon
Symbolism counts in Washington, and Obama's request that his Cabinet officers come up with $100 million in spending cuts will be played up by the White House as the beginning of a major effort to trim unnecessary government spending. It's part of the president's effort to reach out to Republicans (and calm the nerves of "blue-dog" Democrats) worried about all the money the administration has spent and still wants to spend -- $787 billion on the stimulus, $700 billion committed to the bank and auto bailouts, and, most important, $3.5 trillion for the next 10 years, including universal healthcare. Throw in the cost of a cap-and-trade system to control climate change and you're talking big money. Over the longer term, Obama must be careful not to put entitlement programs on the chopping block as part of a "grand bargain" to elicit Republican support for healthcare and cap-and-trade. Social Security is not in dire straits; it can be made flush for the next 75 years by ever-so-slightly lifting the ceiling on the portion of income subject to Social Security payroll taxes (and if Democrats are reluctant to do that on incomes over $100,000, then they could do so on incomes over $250,000).
Medicaid and Medicare are in trouble because healthcare costs are rising so fast, which argues for healthcare reform rather than cuts in these important programs. Yet if healthcare reform has any prayer of controlling the rising tide of healthcare costs, the plan must allow beneficiaries to opt into a public insurance plan -- something Republicans and the healthcare establishment are determined to fight. So it's critically important that the Senate wrap healthcare into a reconciliation bill that can be enacted by a majority vote in the Senate.
Obama should fast-track healthcare and stop trying to court Republicans. Every House Republican and all but three Senate Republicans voted against the stimulus; all Republicans in both houses voted against the budget. During the recess they hosted "tea parties" claiming that Americans are overtaxed. Over the weekend, House Minority Leader John Boehner called the idea of carbon-induced climate change "almost comical."
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