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Hanley on Health Care: Backlash on government-provided coffee; blame the robots for more expensive meds

Mar 23

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3/23/2012 1:50 PM  RssIcon

Worth a reprise in light of reader emails … I heard from several folks over the past week who disagreed with the writer’s satire (and with my description as clever). Really respect the opinions of the folks who flipped back a note. I think, however, the point was missed … the piece was of course “silly,” as one person replied … but I think the point of the satire was it’s no sillier than the government ordering private companies to furnish a benefit for FREE, any benefit, whether it be contraceptives, physician services, a hospital visit … many things important to health and PRETENDING that the cost won’t be passed on in premiums and elsewhere in the cost of business … I thought this a clever, without being offensive, rebuttal of the Obama mandate for insurers to cover contraceptives free to the patients.  Coffee Is an Essential Benefit Too, Allysia Finley, WSJ, 03/12/2012 — Here are some other health-care mandates that government should impose on employers…. Dear President Obama, Can you believe the nerve of employers? … Really, it's amazing that we aren't all dead. Now, thanks to you, we'll enjoy free and universal access to preventative care just like workers do in Cuba. Even so, there are still many essential benefits that the government must mandate to make the U.S. the freest country in the world.
 

 

Vindication on the “nothing is free” point ..., over the weekend the Obama administration seemingly is acknowledging this … proposing now a complex accounting idea that might have the insurance companies provide birth control at no cost but keep track of the actual cost and then recoup from HHS by credits for fees the insurance companies might otherwise owe HHS. This still won’t deal with the many institutions that self-insure ... (1) The Associated Press: Admin. Outlines Options On Birth Control Coverage The Obama administration signaled Friday it's willing to help insurance companies offset the cost of providing free birth control to women working at church-affiliated institutions like hospitals and colleges. By finding a way to make the middlemen whole, the administration may be able to extricate itself from an unexpected political furor over birth control that has mobilized partisans across the political spectrum a half-century after the advent of the pill (Alonso-Zaldivar, 3/16). The Obama administration signaled Friday it's willing to help insurance companies offset the cost of providing free birth control to women working at church-affiliated institutions like hospitals and colleges. By finding a way to make the middlemen whole, the administration may be able to extricate itself from an unexpected political furor over birth control that has mobilized partisans across the political spectrum a half-century after the advent of the pill (Alonso-Zaldivar, 3/16). (2) Politico: HHS Spells Out New Options For Contraception Coverage Rule Self-insured employers always presented one of the biggest problems with the policy. They directly cover employees' health costs out of their own funds, rather than paying premiums to an insurer (Feder, 3/16). Self-insured employers always presented one of the biggest problems with the policy. They directly cover employees' health costs out of their own funds, rather than paying premiums to an insurer (Feder, 3/16).

 


Impact on insurance industry if only the individual mandate is struck down by Supreme Court,
leaving the rest of law intact, i.e. ban on pre-existing condition, etc.? The insurance spokesman seems to assume Congress would subsequently strike things like the ban on pre-existing conditions, lifetime limits, etc. I think that is an over-optimistic view on the part of the insurance industry. I don’t see the politicians of EITHER party voting to remove, say, the ban on pre-existing coverage for children ... The Wall Street Journal: Insurers Set Plans In Case Mandate Is Quashed —The insurance industry and advocates of the health-care overhaul are sketching out contingency plans in case the Supreme Court strikes down a central part of the law in the coming months (Radnofsky, 3/18).

 

A very interesting read comparing the health coverage/access in Massachusetts and Texas. The Lone Star State has a 25% uninsured rate; Mass. is at 2% ... a remarkable achievement … BUT one that does come with a price tag … But there is also a huge price tag, albeit a lot scattered and hidden, with the 25% uninsured rate in Texas ...  Kaiser Health News/NPR: A Tale Of Two Health Insurance Extremes, Reporting for Kaiser Health News and NPR, Nicole Cohen, Carrie Feibel and Martha Bebinger write: “The U.S. spent $2.6 trillion on health care in 2010 — more than the entire economy of France or Britain. But the amount spent and how it's used varies from state to state. And, at the opposite ends of the spectrum: Texas and Massachusetts. At 25 percent, Texas has the highest rate of uninsured people in the nation. Massachusetts, where a 2006 law made coverage mandatory, has the lowest rate — less than 2 percent of people are uninsured. Here's a look at two Americans who are living the reality of that difference” (Cohen, Feibel and Bebinger, 3/19).

 

Blame the $20 aspirin on the robots? Insurance companies won’t pay more for robotic-assisted procedures, so hospitals forced to charge more for everything else to recoup? Kaiser Health News: Capsules: Why Are Health Costs So High? The Robot Knows, KQED’s Sarah Varney, working in partnership with Kaiser Health News and NPR, reports: “Americans have always loved the next big thing: the newest iPhone, the freshest hi-def television, and the latest and greatest … medical technology. But that quick embrace of new innovations has come at a cost: It’s driving up the prices hospitals charge insurance companies who in turn raise premiums for the rest of us” (Varney, 3/19).

 

Health care is the nation’s third largest employer … little known I think. All that money spent by government and private payers employs a LOT of Americans … which of course changes not at all the need for the delivery system to become more efficient in how it delivers care ... NPR Shots Blog: Health Care In America: Follow The Money, Some know how much we pay for our own medical care, but many aren't aware of how immense an industry health care is in the U.S. Our trips to the doctor employ a lot of people, and our schools play an important role in preparing those people to take care of us (Jones, 3/19). This story is part of a series.

GOP budget might move duals (those having both Medicaid and Medicare) fully into Medicare. Moot point for 2012 as the budget will be DOA in Senate, but who knows come 2013 after elections … (1) Politico Pro: House GOP May Move 'Duals' Into Medicare, Once you crack the code words, the House budget blueprint contains another potential big change to health policy: having Medicare take over the "dual eligibles." House Budget Committee Chairman Paul Ryan's proposal doesn't say it outright, but a committee staffer confirms that the document hints at this policy change by saying, "Medicare will provide additional assistance for lower-income beneficiaries and those with greater health care needs" (Feder, 3/20).   , Once you crack the code words, the House budget blueprint contains another potential big change to health policy: having Medicare take over the "dual eligibles." House Budget Committee Chairman Paul Ryan's proposal doesn't say it outright, but a committee staffer confirms that the document hints at this policy change by saying, "Medicare will provide additional assistance for lower-income beneficiaries and those with greater health care needs" (Feder, 3/20).   (2) The same budget would cut Medicaid, or reduce the rate of growth, by some $770 billion over 10 years ... However, if this were accompanied by Medicare picking up the duals …and hence most of the LTC tab, there would be a lot of offset. The Washington Post: Paul Ryan, Helping The Poor By Hurting Them, Ryan would cut $770 billion over 10 years from Medicaid and other health programs for the poor, compared with President Obama's budget. He takes an additional $205 billion from Medicare, $1.6 trillion from the Obama health-care legislation and $1.9 trillion from a category simply labeled "other mandatory." Pressed to explain this magic asterisk, Ryan allowed that the bulk of those "other mandatory" cuts come from food stamps, welfare, federal employee pensions and support for farmers (Dana Milbank, 3/20). , Ryan would cut $770 billion over 10 years from Medicaid and other health programs for the poor, compared with President Obama's budget. He takes an additional $205 billion from Medicare, $1.6 trillion from the Obama health-care legislation and $1.9 trillion from a category simply labeled "other mandatory." Pressed to explain this magic asterisk, Ryan allowed that the bulk of those "other mandatory" cuts come from food stamps, welfare, federal employee pensions and support for farmers (Dana Milbank, 3/20).

 

George Washington’s support for the Affordable Care Act? USA Today: Health Care Law's Defenders Look To George Washington, The father of our country could play a key role in defending what opponents of President Obama's health care law call the mother of all mandates. Seeking precedents for the law's requirement that Americans buy health insurance, some constitutional scholars are reaching back 220 years to a law signed by George Washington: the Militia Act of 1792 (Wolf, 3/20)., The father of our country could play a key role in defending what opponents of President Obama's health care law call the mother of all mandates. Seeking precedents for the law's requirement that Americans buy health insurance, some constitutional scholars are reaching back 220 years to a law signed by George Washington: the Militia Act of 1792 (Wolf, 3/20).


Good consumer-worded guide to the Affordable Care Act … what’s already in effect, what is coming when absent Supreme Court repeal ...
Kaiser Health News: Two Years In, A Consumer Guide To Health Reform Law Kaiser Health News staff writer Mary Agnes Carey writes: “Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented. While some of the key features don't kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits" (Carey, 3/21). Kaiser Health News staff writer Mary Agnes Carey writes: “Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented. While some of the key features don't kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits" (Carey, 3/21).


Interesting overlay of four hypothetical people’s situation and the Affordable Care Act
USA Today: Obama’s Health Care Law From 4 Real People’s Perspectives — One is a young, healthy paramedic who can't afford health care coverage for himself. Another is a breast cancer survivor with leukemia bouncing from private insurance to Medicaid to Medicare. A third is an ailing ex-smoker who believes citizens, not the government, should buy insurance or pay the consequences. And then there is the feed store owner who cannot offer insurance to her employees (Wolf, 3/21). — One is a young, healthy paramedic who can't afford health care coverage for himself. Another is a breast cancer survivor with leukemia bouncing from private insurance to Medicaid to Medicare. A third is an ailing ex-smoker who believes citizens, not the government, should buy insurance or pay the consequences. And then there is the feed store owner who cannot offer insurance to her employees (Wolf, 3/21).


There seems an explosion in health apps calling for you to download into your handheld devices. Interested to see Hopkins' effort here to ascertain which actually work to advantage … 
Hopkins researchers aim to uncover which mobile health applications work, Baltimore Sun, 3/14/12 - Those looking to lose weight, quit smoking or keep tabs on a malady have a lot of choices in the smartphone app stores.  Choosing one that's beneficial is more of a problem.  Science is still trying to catch up to the market for mobile health applications, software that runs on mobile devices such as iPhones, Androids and tablets, which has produced tens of thousands of possible ways to achieve better health for free or a fee.  There already are more than 40,000 mobile health apps contributing to the $718 million global industry, according to Research2Guidance, an international market research firm.  One of the broadest efforts to assess "mHealth" strategies is being made by dozens of faculty, staff and students in multiple departments at the Johns Hopkins University, which has 49 official studies under way in Baltimore and around the world as part of its Global mHealth Initiative (Meredith Cohn, Baltimore Sun).

 

CMS regs intended to streamline enrollment into Medicaid for eligible recipients in 2014 … looks like they would do that, but the reg leaves for later work very key things … like how states can calculate who qualifies under the enhanced rate (those at 100% federal funds) vs. those at the existing matching rates. Medicaid Expansion Rule Aims for Vastly Simpler Enrollment Process A final rule released Friday spells out the terms for the expanded Medicaid eligibility in 2014 under the health care law and requires "real-time" enrollment that documents income, citizenship, and other data without the applicant having to bring in paperwork. [Read more]

Turning away new Medicare patients a growing trend? Set against a private practice in Wisconsin, I think the interview with this doctor forebodes a mounting challenge for Medicare access. It’s Wisconsin in the story but I think it can just as easily be any state, if not now, then in the not too distant future. I think absent serious reform there is a monumental train wreck coming on the access to care front for Medicare patients. It is the start of another busy day at the Wildwood Family Clinic, Madison, Wis., and Dr. Paul Wertsch is going through his morning stack of prescription orders. "It must be a big weekend," he muses. "Everybody wants erectile drugs." FULL STORY » - The Cap Times -