How is cost compared to other developed countries?
14
Where did you think the money would come from? Is this a surprise? Of course, Medicare is taking a hit. Increased eligibility of baby boomers, and greater numbers of people accessing government sponsored/subsidized ACA programs, all force "Peter to take from Paul." That's the way it works with single payer. It is spread out among the masses. Good Luck!
8
I couldn't disagree with this more. Elections are coming up and it is to many groups' advantage to instill as much fear and dissatisfaction with just about everything in life. Pharmaceutical companies, hospitals, and doctors
organization would love for you to think you need more of everything in order to stay healthy. But people should ask themselves why is it that so many other developed countries (including our neighbor to the North) seem to be doing a pretty good job with healthcare but with much less money. If you want to live longer but not necessarily better with more pills, more tests, more procedures and more bills then go ahead a resist any real change in healthcare. But if you want to live a healthy life, free from unnecessary pills, procedures and medical bills then you need to accept that health care cannot be run as a profit-driven business.
organization would love for you to think you need more of everything in order to stay healthy. But people should ask themselves why is it that so many other developed countries (including our neighbor to the North) seem to be doing a pretty good job with healthcare but with much less money. If you want to live longer but not necessarily better with more pills, more tests, more procedures and more bills then go ahead a resist any real change in healthcare. But if you want to live a healthy life, free from unnecessary pills, procedures and medical bills then you need to accept that health care cannot be run as a profit-driven business.
53
While your sentiments a laudable , I have never seen any business model run successfully without a profit, not ever. While it may seem selfish to some, doctors nurses and healthcare providers like to get paid for the services. Why bother incurring hundreds of thousands of dollars in education debt only to lead a miserable life more in debt. By the same token, hospitals also need a reason to exist besides just doing good for others. I assume you have a job, and I assume you work, and I also assume you get compensated. This is the way things work.
5
You know what the most sad thing is. Our neighbors to the North negotiate drug prices as do most of the countries that big Pharma is relocating their business headquarters to, to avoid US taxes but keep their patents alive.
Commonly called inversions, we pay top dollar for our life-saving drugs and still so many tens of thousands of Americans die each year because they can't afford them.
Commonly called inversions, we pay top dollar for our life-saving drugs and still so many tens of thousands of Americans die each year because they can't afford them.
41
You know what the most sad thing is. Our neighbors to the North negotiate drug prices as do most of the countries that big Pharma is relocating their business headquarters to, to avoid US taxes but keep their patents alive.
Commonly called inversions, we pay top dollar for our life-saving drugs and still so many tens of thousands of Americans die each year because they can't afford them.
Commonly called inversions, we pay top dollar for our life-saving drugs and still so many tens of thousands of Americans die each year because they can't afford them.
To the NY Times: please stop using GIF moving images in your articles. It is not only very annoying, it actually makes reading the articles more difficult. We aren't chimpanzees, or small children.
Unless we put everyone in the entire country on Medicare as a way of providing a single-payer system of health insurance, we are going to get more and more expensive private health insurance, and less and less adequate public insurance for everybody in the coming decades. Count on it.
The article says that those in Congress don't necessarily hate Medicare. Well, about 20% of them, those on the far-right, actually DO hate Medicare and wish to turn it into a private insurance voucher system, a Trojan horse method of destroying it, in a manner similar to what is happening with public schools, charter schools, and the desire to give parents vouchers which allow them to choose which schools to send their children to. These approaches might work for those who keep themselves informed about such matters and have disposable income to supplement these vouchers, but not for the underclass who don't have any extra money for these matters.
57
Rob L777
I guess I'd have a hard time placing Oregon's Senator Wyden in the far right wing 20% of Congress yet he is strongly in favor of making Medicare voucher based (to use your term). That's not to mention that very slight majorities of the 2009 Congress voted to put everyone in the country not on Medicare or Medicaid on a voucher based system (all were Democrats but not all Democrats in Congress at the time voted this way and a lot fewer Democrats are now in Congress than were there in 2010--all of this is related)
I guess I'd have a hard time placing Oregon's Senator Wyden in the far right wing 20% of Congress yet he is strongly in favor of making Medicare voucher based (to use your term). That's not to mention that very slight majorities of the 2009 Congress voted to put everyone in the country not on Medicare or Medicaid on a voucher based system (all were Democrats but not all Democrats in Congress at the time voted this way and a lot fewer Democrats are now in Congress than were there in 2010--all of this is related)
2
I follow my father's rules. Stay away from hospitals & you'll live longer. Hospitals are where the sick people are. Same goes for doctor's offices. You have a better chance of contracting an infection, cold, the flu in the cramped environment of a waiting room than you do from shopping cart handles in your local grocery store. Add to that, the fact, that doctors give you medications that can have side-effects that can totally screw you up. Doctors work in a for-profit system. Therefore everything they do is aimed at bringing in cash & cutting their expenses. That doesn't change because of the ACA. Insurance companies are for-profit ... again cash in, cut costs = profit. Probably the worst part of our whole system is that many of the same companies that produce processed foods, etc are subsidiaries of holding companies that have other companies involved in pharmaceuticals, insurance & health care. So on one hand they produce foods that are known to contain addictive substances & on the other hand they are selling the drugs & care that's supposed to treat the issues caused by their sister company.
13
How does Frakt - more accurately, whichever NYT editors were responsible for clearing this article - compose an entire article on Medicare spending & ramifications of payment reductions without mentioning the new financial consequences to hospitals of unjustified readmissions?
Frackt asserts cuts will very likely mean comprehensive cuts in needed care, without a single mention that so doing with the proverbial meat ax could well put hospitals at severe financial risk. Readmission penalties are intended to provide a compelling incentive for hospitals to do the good job of treatment they should always do, the first time - and in the process save lives, bolster health, AND save money for all concerned.
Surely an "expert" like Frackt is aware of the readmission penalties. While their existence is inconvenient for the thrust of Frackt's narrative, there's no excuse for the Times to brook this kind of sloppy, insinuating alarmism.
Frackt asserts cuts will very likely mean comprehensive cuts in needed care, without a single mention that so doing with the proverbial meat ax could well put hospitals at severe financial risk. Readmission penalties are intended to provide a compelling incentive for hospitals to do the good job of treatment they should always do, the first time - and in the process save lives, bolster health, AND save money for all concerned.
Surely an "expert" like Frackt is aware of the readmission penalties. While their existence is inconvenient for the thrust of Frackt's narrative, there's no excuse for the Times to brook this kind of sloppy, insinuating alarmism.
8
I am not much of a fan of Frakt's analysis concerning Medicare but in his defense, the readmission penalties are very small part of the 1.1% in annual cuts in hospital payments that Frakt is analysing in this article, such a small part that I guess he didn't think it was worth mentioning
3
2
Across the board Medicare cuts unfairly penalize low cost areas like Minneapolis and Seattle, while barely impacting highest cost areas like Miami and McAllen, TX. There is a 2x difference in per capita cost across the country, after demographic adjustment. The US map shows the high cost areas concentrated in the South, NYC and Chicago.
According to the Dartmouth Atlas of Health Care, this is the result of greater health care intensity in hospital days and doctor visits.
Eventually, we will have to confront the enormous cost disparities in health care, disability and other Federal programs that are causing massive revenue shifts to states with poor social statistics and exploding profiteering.
Perhaps we should simply allocate Federal revenue by head and let Mitch McConnell figure out how to manage Kentucky and the legacy of his Coal sponsors.
According to the Dartmouth Atlas of Health Care, this is the result of greater health care intensity in hospital days and doctor visits.
Eventually, we will have to confront the enormous cost disparities in health care, disability and other Federal programs that are causing massive revenue shifts to states with poor social statistics and exploding profiteering.
Perhaps we should simply allocate Federal revenue by head and let Mitch McConnell figure out how to manage Kentucky and the legacy of his Coal sponsors.
9
The deal between Obama and the hospitals was supposed to be that providers would get less from Medicare, but at the same time would lose less in uncompensated care, because the numbers of uninsured would drop. Overall, the effect on revenue to providers was supposed to be roughly nil. The only providers that should be under stress are those in states that rejected Medicaid expansion and so are still being bled by indigent patients and at the same time being hit with Medicare cuts.
22
What about some cuts to government spending? Why do we read several times a year, about government projects that fail or are abandoned, on our tax dollars, and nothing ever happens to those responsible? There has to some sort of penalties imposed on those contractors, whether or not they're government or civil contractors. Yet we are the ones that are stuck with the bill. I love especially the one episode on the Fleecing of America, where they reported that our government has been stealing billions of dollars out of social security and leaving nothing more than IOU's in it's place. Then they have the audacity to say it's because of overpayments in medicare or that there are more and more people eligible for medicare. When is someone going to butt heads with this fraudulent government and demand the truth about their careless spending? Probably never I presume. I guess the old cliche still stands strong between the government and those who want to expose them, "scratch my back, and I'll scratch yours."
6
Medicare is not special. I do not see why those with lower incomes should be expected to bear the burden of cuts – cuts that will do much greater harm. For instance, the decision not to extend higher Medicaid reimbursement rates. Many millions will see their care options severely curtailed and many will be unable to access medical care outside of a hospital / clinic. Concurrently, the odds are high that CHIP will not be renewed this year. Many children will therefore lose access to health insurance. Cuts to Medicare do not exist in a bubble.
The federal government seems to exist solely to benefit the elderly and defense contractors. Yes – that money has dramatically reduced poverty among the elderly over time (from greater than 30% at the beginning of the War on Poverty to less than 10% today), but at the expense of the population at large, which has seen cut after cut to maintain federal spending close to the imaginary limit of 20% of GDP. If you limit what you spend and tax, you limit what you can fund. The federal government appears to have decided that only elder care programs are worth funding. If that limit is to remain in place, the elderly should have to bear part of the burden as well. IF there is nothing wrong when those under 65 have their programs cut, there should be nothing wrong when the elderly have their programs cut.
The federal government seems to exist solely to benefit the elderly and defense contractors. Yes – that money has dramatically reduced poverty among the elderly over time (from greater than 30% at the beginning of the War on Poverty to less than 10% today), but at the expense of the population at large, which has seen cut after cut to maintain federal spending close to the imaginary limit of 20% of GDP. If you limit what you spend and tax, you limit what you can fund. The federal government appears to have decided that only elder care programs are worth funding. If that limit is to remain in place, the elderly should have to bear part of the burden as well. IF there is nothing wrong when those under 65 have their programs cut, there should be nothing wrong when the elderly have their programs cut.
5
How about the fact that the elderly can't work? How about the fact that we, most of us will be elderly, so we are looking out for ourselves!!!
(Children's care shouldn't be cut either!)
(Children's care shouldn't be cut either!)
25
"There's no question that the Affordable Care Act is milking that cow." Along with every hospital in America. Anyone who has been in a hospital under Medicare or has had a family member in hospital can attest to the fact that Medicare is the "milking parlor". Any conceivable test or procedure that can be billed to Medicare is performed or proposed without regard to efficacy or outcome. Over billing Medicare is a standing joke among hospital staff and without it, most hospitals would be in serious financial straits right now. Yes, Virginia, there is Medicare fraud; and it's perpetrated by the hospitals.
38
The paperwork and redtape of healthcare is so ridiculous. Ask any nurse or doctor or physical therapist how much of her time is spent providing actual healthcare and how much is spent doing and redoing paperwork.
Let's say as a healthcare provider you want to order some tests or therapy or equipment for your patient. There's all this documentation and paperwork, sometimes from multiple healthcare providers. But you didn't use the right words or phrase or you didn't rule out something else. So you have to redo it. Now it's past the deadline. You have to see the patient again. Oh and you need to rewrite the order because it wasn't worded correctly or you signed in the wrong place or your NPI number isn't on the order.
Even though you are a healthcare provider and those are your patient charts, you're not charting for you. You're charting for insurance companies and non-healthcare people who read submitted chart notes and approve or deny claims based on your notes. Because even though you document your patient had their leg amputated, you didn't state they couldn't walk and they are now being denied by their insurance company a prosthesis. And now your patient either has to pay for their $30,000 leg or the prosthetist who made it is out $30,000.
And THAT'S why the cost of healthare is going up and quality of care being provided is going down. Of course, the government's response is to create more red tape. Because that is the mother of all band-aids.
Let's say as a healthcare provider you want to order some tests or therapy or equipment for your patient. There's all this documentation and paperwork, sometimes from multiple healthcare providers. But you didn't use the right words or phrase or you didn't rule out something else. So you have to redo it. Now it's past the deadline. You have to see the patient again. Oh and you need to rewrite the order because it wasn't worded correctly or you signed in the wrong place or your NPI number isn't on the order.
Even though you are a healthcare provider and those are your patient charts, you're not charting for you. You're charting for insurance companies and non-healthcare people who read submitted chart notes and approve or deny claims based on your notes. Because even though you document your patient had their leg amputated, you didn't state they couldn't walk and they are now being denied by their insurance company a prosthesis. And now your patient either has to pay for their $30,000 leg or the prosthetist who made it is out $30,000.
And THAT'S why the cost of healthare is going up and quality of care being provided is going down. Of course, the government's response is to create more red tape. Because that is the mother of all band-aids.
26
That's why, for the many reasons you listed and some you didn't, what we need is an IT framework that captures WHAT the 860,000 medical providers are doing. So we can determine "Best Medical Practices" and the easiest way to do that is through a bio-metrically audited, voice activated smartphone.
Think of a paper medical record that is electronic. Now your particular health record is one thing: a series of data points through out your lifetime. But what is important is to capture what medical providers do. An event and then a remedy. And remember bloodletting was once "Best Medical Practices" and medical knowledge changes every five years or less. Much too short a period of time to get an ROI on IT architecture unless you design it that way on the front end.
Think of a paper medical record that is electronic. Now your particular health record is one thing: a series of data points through out your lifetime. But what is important is to capture what medical providers do. An event and then a remedy. And remember bloodletting was once "Best Medical Practices" and medical knowledge changes every five years or less. Much too short a period of time to get an ROI on IT architecture unless you design it that way on the front end.
1
The elephant in the room is always the same. Our national private economic interests are in absolute contradiction to what long-term "health" would indicate: less fat, less salt, less sugar, smaller portions, more walking etc. etc. Why do healthy people have to keep paying the freight for people whose life choices put them in need of excess amounts of healthcare? Hate to sound like Ayn Rand but if you choose to damage the body you are given, there needs to be a extra cost associated with it. When this mindset is in force, we will see costs drop and people get healthier.
6
Does anyone know who is really practicing medicine ? Is it the insurance companies, the doctors or Mr. Obama ?
If it is "really" the ACA (which is fraudulently "affordable"), then ACA or the federal government had better buy some good malpractice insurance.
If it is "really" the ACA (which is fraudulently "affordable"), then ACA or the federal government had better buy some good malpractice insurance.
11
Am I the only one who can see that the eventual goal of ACA is to have one, single payer health program in the U S? In other words, no more Medicare. Simplistically, if the country wants national health care, then one giant single payer program would be theoretically practical. However, with the ineptness and gross inefficiency of the federal government, the net result has been an economic disaster and will only get worse.
4
Medicare is national insurance. If you oppose national insurance, you should vehemently oppose Medicare. You do not. Hypocrisy. National insurance for the elderly – the dregs for everyone else, eh?
15
Clearly the author is not reading the Obama administration's presentation concerning the Patient Protection and Affordable Care Act (PPACA). PPACA's big cuts are to "blood-sucking, for-profit, private insurance companies," not to things like hospitals and skilled nursing facilities and home health care agencies that actually affect Medicare beneficiaries. PPACA will not affect beneficiaries at all. (But the author must have read something from the Obama administration because he faithfully calls PPACA's trillion dollars in Medicare cuts "savings.")
(As a side note to those of you on Medicare, your private Medigap supplement does not help you overcome these PPACA cuts to hospitals, skilled nursing facilities and home health care agencies. Medigap simply pays the 20% of the government-fixed cost that the Medicare bureaucracy does not pay. If Medicare pays nothing, Medigap pays nothing. So these PPACA cuts actually help the "for-profit, blood-sucking private insurance companies," not those of us on Medicare.)
(As a side note to those of you on Medicare, your private Medigap supplement does not help you overcome these PPACA cuts to hospitals, skilled nursing facilities and home health care agencies. Medigap simply pays the 20% of the government-fixed cost that the Medicare bureaucracy does not pay. If Medicare pays nothing, Medigap pays nothing. So these PPACA cuts actually help the "for-profit, blood-sucking private insurance companies," not those of us on Medicare.)
10
You are mistaken. Medicare was due to be insolvent in 2016 because of Obamacare it's now solvent until 2030. In addition it closes the doughnut hole and pays for preventive care.
If you don't believe me look up "Medicare Trustees Report XXXX" where XXXX is the year, start with 2009.
If you don't believe me look up "Medicare Trustees Report XXXX" where XXXX is the year, start with 2009.
19
Jay Belieau
I am not sure what you think I am mistaken about since I did not mention any of the subjects in your comment in my comment? But because you brought them up
1. When you talk about the years 2016 and 2030, you are referring to the Part A trust fund only. The years mentioned assume the massive cuts to hospitals, skilled nursing facilities and home health care discussed by Austin Frakt in the main article are in fact sustained, something the Actuary Reports you mention say is unlikely to happen (see appendices of those reports until most recent report, at which point the opinion was incorporated into the main report)
2. The donut hole does not close. What happens is that the co-pay for the relatively few seniors not on SS Extra Help or an SPAP whose out of pocket drug costs exceed about $750 (for $3000 worth of drugs) in a year gets reduced from 50% to 25% on the next about $4000 worth of drugs. But unfortunately it appears the prices of drugs are being raised to make up the difference and these few seniors affected are no better off (still none are low income so those affected can afford it)
3. Medicare has always paid for some preventive care but still does not pay for an annual physical, probably the most important preventive medical service. PPACA did eliminate co-pays on some not that well respected screening tests such as PSA tests for men but has kept the co-pay on the much more useful DRE for the same condition (not that I object to paying a co-pay)
I am not sure what you think I am mistaken about since I did not mention any of the subjects in your comment in my comment? But because you brought them up
1. When you talk about the years 2016 and 2030, you are referring to the Part A trust fund only. The years mentioned assume the massive cuts to hospitals, skilled nursing facilities and home health care discussed by Austin Frakt in the main article are in fact sustained, something the Actuary Reports you mention say is unlikely to happen (see appendices of those reports until most recent report, at which point the opinion was incorporated into the main report)
2. The donut hole does not close. What happens is that the co-pay for the relatively few seniors not on SS Extra Help or an SPAP whose out of pocket drug costs exceed about $750 (for $3000 worth of drugs) in a year gets reduced from 50% to 25% on the next about $4000 worth of drugs. But unfortunately it appears the prices of drugs are being raised to make up the difference and these few seniors affected are no better off (still none are low income so those affected can afford it)
3. Medicare has always paid for some preventive care but still does not pay for an annual physical, probably the most important preventive medical service. PPACA did eliminate co-pays on some not that well respected screening tests such as PSA tests for men but has kept the co-pay on the much more useful DRE for the same condition (not that I object to paying a co-pay)
4
This just can't be correct. The President, NY Times reporters and editorial and opinion writers and outside "experts" continually told us how ACA would improve health care access and results all the while saving us money ($2500 per family per year). Any time someone questioned those mistruths they were labeled and discounted. Now the truth is coming out. Shame on all those who blindly sold this pack of lies. More reckoning coming over the next two years culminating in 2016. Couldn't happen to a more deserving political group.
10
If you think healthcare is too expensive, wait till its free.
7
Saving 1% a year is easy.
1) The delivery system is fixed by using Peter Orszag's “Best Medical Practices”, interactive-electronic diagnostic and treatment workbooks and a smartphone.
The diagnostic workbooks would come back with an efficacy, statistical prognosis and cost to the patients for all the different treatment options so they can make an informed choice. Savings $750 billion a year.
2) Once you have the workbooks than billing is easily automated. Savings $400 billion a year.
3) If a medical provider is using "Best Medical Practices" and can prove it, a malpractice case should never go to court. Savings $100 billion a year.
4) Health care rebates for shopping around, positive living, etc. Similar to the way rebates work for car insurance. Based on the statistical normal cost of treatment for all the different therapies. And offer the choice of quality-of-life at the end-of-life.
5) Giving away the patents paid for by the taxpayer and then not letting Medicare negotiate prices is wrong. But the workbooks I mentioned in #1 could have registered steps in them that would allow a business model like a 900 number. Innovation is not limited to producing a pill but only a better outcome and could be patented.
6) Medicare expansion is a market-based solution to the cost of the uninsured in this country and is far superior to the current DSH grant system. Savings tens of thousands of American lives a year.
1) The delivery system is fixed by using Peter Orszag's “Best Medical Practices”, interactive-electronic diagnostic and treatment workbooks and a smartphone.
The diagnostic workbooks would come back with an efficacy, statistical prognosis and cost to the patients for all the different treatment options so they can make an informed choice. Savings $750 billion a year.
2) Once you have the workbooks than billing is easily automated. Savings $400 billion a year.
3) If a medical provider is using "Best Medical Practices" and can prove it, a malpractice case should never go to court. Savings $100 billion a year.
4) Health care rebates for shopping around, positive living, etc. Similar to the way rebates work for car insurance. Based on the statistical normal cost of treatment for all the different therapies. And offer the choice of quality-of-life at the end-of-life.
5) Giving away the patents paid for by the taxpayer and then not letting Medicare negotiate prices is wrong. But the workbooks I mentioned in #1 could have registered steps in them that would allow a business model like a 900 number. Innovation is not limited to producing a pill but only a better outcome and could be patented.
6) Medicare expansion is a market-based solution to the cost of the uninsured in this country and is far superior to the current DSH grant system. Savings tens of thousands of American lives a year.
3
If you think any of this is going to work, I have a bridge over the East River to sell you.
Peter Orszag, like Gruber are just political hacks, who for large consultation fees will tell you anything you want to hear.
Someone once asked Henry Kissinger how to be become an expert, and his reply was "Find someone in power and tell them what they want to hear."
The US healthcare is anything but market based. So many lobbies, particularly Pharma, Insurance and Hospital lobbies distort the market. According to classical economic theory, competition breeds quality and lower pricing. Well we have more insurance companies than almost the whole world combined, are are outcomes better and less expensive? Free markets and capitalism are just terms that those in power use while they are picking your pockets.
Peter Orszag, like Gruber are just political hacks, who for large consultation fees will tell you anything you want to hear.
Someone once asked Henry Kissinger how to be become an expert, and his reply was "Find someone in power and tell them what they want to hear."
The US healthcare is anything but market based. So many lobbies, particularly Pharma, Insurance and Hospital lobbies distort the market. According to classical economic theory, competition breeds quality and lower pricing. Well we have more insurance companies than almost the whole world combined, are are outcomes better and less expensive? Free markets and capitalism are just terms that those in power use while they are picking your pockets.
49
I seem to remember something along the lines that care would remain the same; that there would be no reduction in quality of care. There was also promises thatthere would be no "death panels". This administration has failed miserably about the promises of no reduced care, people being able to retain their own policies,.. that things would not change, much, if at all. Now it appears that we ARE heading head long into the death panels & rationing of care. We all knew this was coming, it was inevitable. Those that say they didn't or don't know, do not know because they don't WANT to know. Close the eyes & cover the ears & it won't be true. People are now having to choose between purchasing healthinsurance policies they can't afford, and if they could, could not afford to use with the outrageous deductables that must be met first, & feeding & housing their families. Now not only does the average middle class citizen have to pay extra each month to buy a policy they can not even use,...they must go bankrupt to reach the deductible. Wasn't this what Obamacare was "designed" to prevent? Oh, yeah..... silly me it was actually designed to create a captive audience for the insurance companies to fatten there profit margins. Our government just hoodwinked us again.
15
There are no death panels nor does there need to be, to reduce costs. A study done in England recently showed 50% of people would opt for extreme care and 50% wouldn't. There is no reason that the same proportions would not happen here, if people where given enough information and support so they can make an informed choice.
4
Now imagine a system where medicine isn't delivered for a profit.
Hospitals still cling to the "good old days", awash in wealth, still paying their CEO's six and even seven figure salaries, buying up physician practices as fast as they can to eliminate competition and charge higher fees. All they need is a mask and a gun, then their outfit would be complete.
Hospitals still cling to the "good old days", awash in wealth, still paying their CEO's six and even seven figure salaries, buying up physician practices as fast as they can to eliminate competition and charge higher fees. All they need is a mask and a gun, then their outfit would be complete.
38
They already can't get people to enter the medical field... Who would spend 8-10 years of their lives working to become a doctor so that they can come out of school earning $75-80k? I know I wouldn't... We have a massive shortage of primary care physicians, and the government's answer to the shortage is to pay them less... Sure, that'll work...
25
I wouldn't be too concerned about the correlation between Medicare cuts for hospitals and outcomes. Or as economists like to say, correlation isn't causation. Hospitals are, without a doubt, the most inefficient of health care providers. And the most costly (i.e., reimbursement rates for hospitals are much higher than reimbursement rates for other facilities, such as outpatient facilities). That sucking sound you hear is hospitals sucking on health care dollars. Hospitals (as well as other providers) have grown fat from providing diagnostics, expensive diagnostics, unnecessary diagnostics, diagnostics for every possible malady. Hospitals (and other providers) focus on diagnostics for the same reason Willie Sutton robbed banks: because that's where the money is. And it doesn't help that patients demand diagnostics. It wouldn't be too much of an exaggeration to observe that there hasn't been a significant innovation in treatment since penicillin. It's human nature to fear the future, and diagnostics give patients the illusion of knowing their future. Changing the behavior of hospitals (and other providers) requires changing the behavior of patients, not an easy task. It doesn't help to suggest that cuts in Medicare spending causes worse medical outcomes.
4
As you belatedly point out towards the end of the article, the medicare cuts will only adversely affect medical care if they are not offset by increased revenues elsewhere. The additional revenue that hospitals receive from the millions of patients newly covered by the ACA should do that. These additional revenues were, in fact, the reason that Medicare was cut.
Predominantly red states that chose not to expand Medicaid (100% Federal funded for the first several years, 90% after that) and who have discouraged enrollment under the health exchanges may fall short of these increased revenues, but that is hardly the fault of the ACA. Their citizens, hospitals, and health care providers will suffer the consequences.
Predominantly red states that chose not to expand Medicaid (100% Federal funded for the first several years, 90% after that) and who have discouraged enrollment under the health exchanges may fall short of these increased revenues, but that is hardly the fault of the ACA. Their citizens, hospitals, and health care providers will suffer the consequences.
29
Two points.
First, I don't fully share your optimism regarding the benefits of today's electronic medical record systems. These do indeed have great potential for enhancing patient care, cutting down on medical errors, and improving the efficiency with which care is delivered. But before they do so, computer based systems need to improve. A lot. Presently, they are all too often hard to use, and detract from the time a physician can spend actually delivering medical care.
And many of the "quality improvement" standards mandated by the ACA and other Federal legislation, particularly legislation impacting Medicare and Medicare reimbursement, is poorly conceived and poorly implemented. Many of the rules and regulatory requirements will do little to improve the quality of care, while compliance with them will impose time consuming burdens that may negatively impact the provision and accessibility of medical care, especially for Medicare beneficiaries.
First, I don't fully share your optimism regarding the benefits of today's electronic medical record systems. These do indeed have great potential for enhancing patient care, cutting down on medical errors, and improving the efficiency with which care is delivered. But before they do so, computer based systems need to improve. A lot. Presently, they are all too often hard to use, and detract from the time a physician can spend actually delivering medical care.
And many of the "quality improvement" standards mandated by the ACA and other Federal legislation, particularly legislation impacting Medicare and Medicare reimbursement, is poorly conceived and poorly implemented. Many of the rules and regulatory requirements will do little to improve the quality of care, while compliance with them will impose time consuming burdens that may negatively impact the provision and accessibility of medical care, especially for Medicare beneficiaries.
17
I agree that the that the current crop of EHR systems only help a little. However phase II is on the way as outlined here by HHS:
http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-p...
http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-p...
Why should this surprise anyone. Only government can operate at a deficit year after year propped up by borrowing. Hospitals need to have a balanced bottom line or they slowly go out of business. Cuts to Medicare slowly ring out inefficiencies while regulations from Medicare add inefficiencies. Our local hospital has an army of new employees working on compliance - not a single one of them benefits the patients,
11
More to the point: challenge anyone from the White House (and NYTimes, for that matter) to go through all the treatment and payment steps in this huge mess, on live TV.
Prediction: they can't, and they won't. Why, even a "smart" M.I.T. "economist" could not do it.
Prediction: they can't, and they won't. Why, even a "smart" M.I.T. "economist" could not do it.
3
The post does not make clear that Medicare and Social Security have their own funding stream through the Federal Insurance Contributions Act. That is, if Medicare costs are reduced, this does not make more funds available for the general fund of the federal government.
26
It is only partially accurate to say that FICA funds United States Medicare. The payroll tax (I think that is what is being referred to) funds Part A of Medicare only (and only fully for a few more years). Part B, including Part D, is funded by general government revenue, monthly premiums from about 80% of the beneficiaries, and round robin payments from other parts of American government that started as general revenue (e.g., the other 20% or so of Medicare beneficiaries get their Part B premiums paid for by Medicaid; states partially pay for Part D in lieu of the costs they used to expend on Medicaid patient's drugs before 2006).
I am of the philosophy that my 50 years of income taxes (come July of this year) should be counted as my contribution to what I cost the Part B trust fund. I bought LBJ's and Wilbur Mills 1965 claims that that's the way Medicare would work. But I admit that that's just a philosophy and that I was a fool to believe LBJ and Mills; the Part B money really goes out as fast as it comes in. Happily I have parents and grandparents who live/lived well into their 90s so at least we kept the money in the family. My kids and grandkids will not be as lucky.
I am of the philosophy that my 50 years of income taxes (come July of this year) should be counted as my contribution to what I cost the Part B trust fund. I bought LBJ's and Wilbur Mills 1965 claims that that's the way Medicare would work. But I admit that that's just a philosophy and that I was a fool to believe LBJ and Mills; the Part B money really goes out as fast as it comes in. Happily I have parents and grandparents who live/lived well into their 90s so at least we kept the money in the family. My kids and grandkids will not be as lucky.
6
Exactly. The only bottom line cuts in Medicare help is that of the Medicare fund.