|
||
|
SEARCH BY KEYWORD
|
 Tag: MassachusettsOur newsletter features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. It is emailed in an HTML format from the galen@galen.org email address, via Constant Contact, and you may have to adjust your email settings and junk mailbox to ensure that you don’t miss an issue.NewslettersApril 11, 2008
Join Us!Please mark your calendars now to join us on Tuesday, April 29, for a major address on Medicare featuring HHS Secretary Michael Leavitt. The program, which we will jointly host with several other think tanks, begins at 9:45 a.m. at the brand new Newseum at 555 Pennsylvania Avenue in Washington. This will be the secretary's major address on the massive threat that Medicare and other entitlement programs present to our nation's economy, followed by a forum featuring experts presenting their ideas and research on solutions.
 As we feared, the House Ways and Means Committee did indeed approve legislation on Wednesday that would require every expenditure from Health Savings Accounts to be approved, injecting new complexities, driving up costs, and discouraging HSA enrollment. Wisconsin Rep. Paul Ryan was the hero to HSA-advocates in leading the battle to strike the provision, but his amendment was defeated on a largely party-line vote. The measure was a tempting target for Democratic leaders in Congress who generally dislike HSAs and are always looking for new ways to raise money to pay for other spending. The Joint Tax Committee said the provision would save more than $300 million because the IRS will be collecting more penalties on HSAs and because contributions to HSAs will go down. They admitted that the HSA "substantiation" provision would have a significant impact on the HSA market. It's not clear that the Democratic leadership would have realized the damage they could do with this one seemingly small change, and there is a lot of anger at the Republican lobbyist who offered the idea on behalf of a self-interested benefits management company. And the legislation is totally unnecessary. Under current law, if people with HSAs use the money in their accounts for non-medical purposes, they have to pay taxes on the money, plus a 10% penalty — the same as if they had withdrawn the money directly. When people take a deduction for other kinds of medical expenses on their tax returns, they can claim anything they want, but if they are audited and can't validate the expense, they are subject to penalties. Chairman Rangel offered an amendment that would delay implementation by two years (until 2011) so there is still time to bring sense to this debate as it moves to a less-certain fate in the Senate. Clearly this was not a good week on Capitol Hill: The House Energy and Commerce Health Subcommittee approved legislation to block for a year the Bush Administration's rules to curb some of the fraud and abuse in the Medicaid program. You will recall that I testified on this last week, offering examples about Medicaid money being used to pay for transportation to bingo games and other non-medical expenses. The special interests won. The taxpayers lost. The measure passed on a voice vote, and Ranking Member Joe Barton signaled that it would be very difficult to override if the president were to veto to the bill. If nothing else, this shows how difficult it is to curb even documented abuse once a government health spending program is established. The only solution is to avoid expanding these programs that take on a life and constituency of their own. And I returned at 2 a.m. today from a six-day speaking trip that started last Saturday in Chicago, with a talk on transparency to the American Board of Quality Assurance and Utilization Review Physicians. Then on to Las Vegas to speak at the beautiful new Red Rock Resort to a Public Affairs conference of the National Association of Manufacturers on Monday. Then back to Harrah's on the Strip in Las Vegas for a talk on Medicare hosted by former Medicare Trustee Tom Saving at the Association of Private Enterprise Education conference on Tuesday. And finally, yesterday, a talk on "Can We Repair What's Wrong with Our Health Care System through Christian Principles?" at the Acton Institute's Lecture Series in Grand Rapids, Michigan, right after a quick visit to the beautiful President Ford Museum and Library there. These speeches and visits outside Washington are always encouraging to show, despite our problems with legislators in Washington, the wisdom and clear-headedness of the American people about the importance of keeping our health sector free and giving people new choices in a competitive economy. Grace-Marie Turner Recent News Articles and StudiesIn Massachusetts, Universal Coverage Strains Care In Massachusetts, Universal Coverage Strains Care Massachusetts' law requiring everyone to have health insurance is putting added pressure on primary care physicians and lengthening the wait for appointments — an unintended consequence of universal coverage, reports The New York Times. Physician Patricia A. Sereno said an influx of the newly insured to her practice just north of Boston has stretched her daily caseload to as many as 22 to 25 patients, up from 18 to 20 a year ago. To fit them in, she limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months. "It's a recipe for disaster," Dr. Sereno said. "It's great that people have access to health care, but now we've got to find a way to give them access to preventive services. The point of the legislation was not to get people episodic care." Universal Coverage One Head at a Time — The Risks and Benefits of Individual Health Insurance Mandates The risks associated with individual mandates suggest that they are no panacea, writes Glied. One important concern is that the government will provide insufficient funds for the subsidies intended to accompany the mandate. In that case, the mandate will act as a very regressive tax, penalizing uninsured people who genuinely cannot afford to buy coverage. This concern has led Massachusetts to create a hardship exemption for its mandate — an escape clause that effectively undoes the mandate if subsidies are inefficient. The ease with which it is possible to lift the mandate if the legislature fails to appropriate funds may make the individual mandate a rather rickety form of universal coverage. Further, if subsidies are insufficient or benefits inappropriate, the mandate will be very difficult to enforce and draconian in effect. To be effective, an insurance mandate should be in place at the beginning of an insurance term, ensuring that people have coverage when an adverse event occurs. Developing a system to promptly identify and penalize scofflaws will take effort and ingenuity, particularly in our diverse and mobile country and may require a degree of intrusiveness and bureaucracy that some will find unpalatable. Medicare Coverage and Strategies: Impact of the MMA and PBMs AEI's Joe Antos describes ways in which the Centers for Medicare and Medicaid Services exerts its influence over the health sector in the wake of the Medicare Modernization Act and in the face of evidence-based medicine standards. Medicare's outpatient prescription drug benefit has ratcheted up CMS's direct involvement and influence on every aspect of the pharmaceutical industry, from research and development of new products to pricing and distribution to the end-user. The immediate impact of Part D has largely been beneficial to manufacturers, distributors, health plans, employers, and Medicare beneficiaries, he says. However, the substantial shift in pharmaceutical spending from private payors and Medicaid to Medicare will focus intense political pressure on every part of the supply chain. A CMS veteran, Antos also provides a chronology of CMS's role, from the agency's inception to today, and offers insight into CMS's strategy and tactical effects on the American health care system. To begin to address Medicare's looming insolvency, the federal government should allow Medicare beneficiaries to take full advantage of consumer-driven reforms that exist in the private sector, such as health savings accounts, writes John R. Graham of the Pacific Research Institute. Dutch and German Health Ministers Talk With Leading U.S. Analysts In Health Affairs Web Exclusive Interviews As the United States debates health reform, the Dutch and German health systems have been increasingly put forward as potential models. These nations have achieved universal coverage through competition among non-governmental insurers within a governing regulatory framework, along with government subsidies for those with low incomes. In interviews with Prof. Uwe Reinhardt and Tsung-Mei Cheng of Princeton and Prof. Alain Enthoven of Stanford, German Health Minister Ulla Schmidt and Dutch Health Minister Ab Klink discuss their health systems, including efforts their countries are making to increase competition. For example, Klink says: "Competition now is especially at the level of the insurance companies. Still, many of the prices for care are fixed by the Dutch government. What we are trying to do in the coming years is to free prices, on the one hand, and to make insurance policies transparent, so that these two issues form pillars of the competition that we want to achieve." The Misguided War Against Medicines Government spending on prescription drugs is not to blame for the Canadian health system's lack of financial sustainability, according to the Fraser Institute. This study shows that prescription drugs accounted for only 9.3% of total government spending on health in 2006, down from 9.6% in 2005. Patented prescription drugs accounted for only 6.3% of total government health spending in 2006, down from 6.8% in 2005. After spending on drugs is subtracted, all other areas of health care accounted for 91.4% to 90.7% of total government health spending between 2002 and 2006. The study also found no statistical link between annual growth rates in total government health spending and increased spending on drugs. Additionally, the study found that Canadian government data showed average prices for existing patented prescription drugs in Canada have grown at a slower annual pace than the general rate of inflation for 17 of the last 19 years. Covering Uninsured Children in the State Children's Health Insurance Program Orszag's testimony on the State Children's Health Insurance Program (SCHIP) focuses on its impact on the number of uninsured low-income children and the extent to which it displaces private coverage. According to CBO's estimates, the portion of children in families with income between 100% and 200% of the poverty level who were uninsured fell by about 25% between 1996 (the year before SCHIP was enacted) and 2006. In contrast, the uninsurance rate among higher-income children remained relatively stable during that period. CBO has concluded that for every 100 children who gain public coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children. Orszag also discusses the Administration's August 17, 2007 directive to state health officials that imposes certain minimum requirements on states seeking to enroll children in SCHIP whose families have income above 250% of the poverty level. CBO's analysis suggests that the directive's impact on enrollment is likely to be modest. Upcoming Events Cracking Down on Killer Drugs: Dora Akunyili and the Nigerian Success Story The Impact of Health Insurance in Developing Countries: Experiences from China and Colombia Health Care in Crisis: What's Driving Health Reform in Canada and the United States? Election Year 2008: Health Care Reform Debate Nudge: Improving Decisions about Health, Wealth, and Happiness Hospital CEO Roundtable: Balancing Cooperation and Competition 2008 Leadership Development Breakfast Innovations in Health Care Delivery An address by Health and Human Services Secretary Michael Leavitt Jointly sponsored by the Galen Institute, The Heritage Foundation and the American Enterprise Institute Tuesday, April 29, 2008, 9:45 a.m. Washington, DC SAVE THE DATE! Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.
Tags:
health savings accounts, substantiation, HSA, Medicaid, Massachusetts, universal coverage, individual mandate, Germany, the Netherlands, Canada, prescription drugs, SCHIP
Categories:
HSAs March 28, 2008
Healthy InsightsDr. Denis Cortese, president and chief executive officer of the Mayo Clinic, offered Washington a healthy dose of insight about the crucial importance of patient-focused care during a speech at the National Press Club on Good Friday. Mayo is renowned worldwide for its expertise in medical diagnosis, and Dr. Cortese drew on these capabilities to help policymakers think differently and more strategically about health reform.Dr. Denis Cortese, president and chief executive officer of the Mayo Clinic, offered Washington a healthy dose of insight about the crucial importance of patient-focused care during a speech at the National Press Club on Good Friday.Mayo is renowned worldwide for its expertise in medical diagnosis, and Dr. Cortese drew on these capabilities to help policymakers think differently and more strategically about health reform. Here are a few key points he made:
Having 90,000 avoidable hospital deaths a year is the equivalent of a major airliner crashing every two and a half days, Dr. Cortese said. That is unacceptable, but the lack of information is driving these mistakes. People get the right medical advice only about half the time. We need to exchange information in real time to improve, and we need transparency of outcomes, safety, and costs. We need teamwork to integrate care from diagnosis through treatment. And that care must be individually focused. Physicians need to think of themselves as team leaders and coordinators of the medical team. And Dr. Cortese concluded with some guidance for the new president, offering questions he or she should ask the new administration's health policy team every day:
It is not a coincidence that Minnesota, the Mayo Clinic's home state, ranked first in the nation in overall health care quality this year, based upon a report just issued by the Agency for Healthcare Research and Quality. Mayo offers valuable lessons for all of us interested in improvements in our health sector. Two experts writing in the Los Angeles Times offer some legal advice about current proposals to require everyone in America to obtain health insurance: They're probably unconstitutional. Karl Manheim, a law professor at Loyola Law School in Los Angeles, and Jamie Court of the Santa Monica-based Consumer Watchdog explain that a government mandate requiring people to purchase private insurance is either a constitutionally forbidden "taking" (of money) or a violation of constitutionally protected due process. They say a mandate would mean that the federal government would be requiring people to buy a good (health insurance) offered by private businesses, implicitly delegating taxing power to private business. The Constitution explicitly delegates taxing authority to the Congress (Article 1, Sec. 8). Yes, states can and do require people to buy automobile insurance or install fire sprinklers in a house. "But in such cases, the 'mandate' is discretionary -- you don't have to drive a car or build a house," they write. The same is true with requiring vaccinations for children enrolling in public schools: Parents have the option of sending their children to private schools or to home school them. But a health insurance mandate would not, by definition, be optional. "A health insurance mandate is essentially a forced contract." If government were instituting new taxing powers requiring everyone to enroll in a government program, that would actually pose less of a constitutional problem, they say. But that's not politically popular. In fact, Sen. Hillary Clinton would mandate insurance but would give people the "choice" of buying highly-regulated private coverage. It actually is this choice of private coverage that could trip up her plan with the court, as Manheim and Court explain. So is Massachusetts' individual mandate unconstitutional? Probably. "These 'unfunded mandates' are unlike any form of government regulation we've seen," they write. But someone has to take it to court first, and I'm not aware of any court challenges, at least yet. So here's an interesting prospect: Do we want to spend the next 10 years battling in the courts over the constitutionality of an individual mandate for health insurance? Or do we want to actually spend that time trying to give people more options of more affordable, private coverage? And the Harvard School of Public Health has a new poll out that underscores the huge partisan divide over health reform. More than twice as many Republicans (68%) as Democrats (32%) believe that the U.S. health system is "the best in the world." Further, more than half of Democrats (56%) say they would be more likely to vote for a candidate who advocates moving toward a system more like Canada's, France's, or Great Britain's. In contrast, only a fifth (19%) of Republicans say they would be more likely to vote for a candidate that advocates moving toward such systems. Interestingly, even though many people want to import other countries' health systems, they don't know much about them: 53% of all of those responding to the survey, for example, say that they aren't sure how our system compares to France's, for example. So it shows that people do think that the grass is greener. But maybe they need to learn a bit more about what it's really like living under those systems before they throw out the one health care system that is driving innovation in new medicines, new treatments, and new medical technologies, and that many people think is the best in the world. And we're going to help with that education: We welcome Brian Lee Crowley to the Galen Institute as our newest visiting senior fellow. Brian is the president of the Atlantic Institute for Market Studies in Nova Scotia, where he will continue working while he also helps us educate the debate over market-based solutions to problems in the health sector -- including a clearer picture of the challenges of Canada's health care system. Grace-Marie Turner Recent News Articles and Studies Loose Political Lips Can Sink Our Economy Loose Political Lips Can Sink Our Economy Grace-Marie Turner, Galen Institute The Wall Street Journal, 03/28/08 It would take much more than a weak dollar and the sub-prime mortgage collapse to shake confidence in an economy as strong as the United States is. Unfortunately, other forces are at play that could lead to just such a crisis, including: 1) Continual talk by Sens. Hillary Clinton and Barack Obama about huge future tax increases, including the expiration of President Bush's income and capital gains tax cuts; 2) The anti-immigration sentiment that could severely constrain the future labor pool; and 3) The erosion of our leadership in the investment world because of the insidious impact of Sarbanes-Oxley. Investors do look to the future, and taken together, these and other bad policy decisions could indeed undermine even the strongest economy in the world. It's time for political leaders to wake up and understand the damage caused by these anti-growth policies. Checking into Bumrungrad Hospital
This photo from a BusinessWeek report on the growing trend of medical tourism tells the story about how big this industry is becoming. Last year, 65,000 Americans went to Bumrungrad Hospital in Bangkok for in-patient or outpatient treatment, up from just 10,000 in 2001. Many of the patients from the U.S. were uninsured, taking advantage of medical costs that are a fraction of those in American hospitals. Last month, Bumrungrad announced an alliance with Blue Cross & Blue Shield of South Carolina, with the American insurer agreeing to cover expenses for members who travel from the U.S. to the Thai hospital. Other hospitals, including some in Singapore and India, have also teamed up with the South Carolina insurer, which is betting that some members would be willing to travel abroad rather than pay thousands more for operations in American hospitals. Bumrungrad's revenue from foreign patients rose 14% last year, and non-Thais now account for 55% of Bumrungrad's business. Who Really Pays for Health Care? Employers like to say -- and often believe -- that they pay for health care, write Emanuel and Fuchs. And union leaders want members to think that health benefits are a bonus on top of wages. But wages and fringe benefits, such as health insurance, are simply components of overall worker compensation. This cost-wage trade-off is usually well hidden from employers and workers, but it is nonetheless a painful reality for average Americans. The increasing cost of health care has resulted in American workers receiving relatively flat wages for 30 years, they write. The reality is that individuals bear the full cost of health care through lower wages and higher taxes. 2008 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds The financial outlook for the Medicare program continues to raise serious concerns, and a "Medicare funding warning" is triggered again by the findings of this report. Total Medicare expenditures were $432 billion in 2007 and are expected to increase in future years at a faster pace than either workers' earnings or the economy overall. The HI trust fund will be exhausted by 2019. As a percentage of Gross Domestic Product, expenditures are projected to increase from 3.2% in 2007 to 10.8% by 2082. Growth of this magnitude, if realized, would substantially increase the strain on the nation's workers, Medicare beneficiaries, and the federal budget. The American Enterprise Institute hosted a briefing this week to discuss the Medicare Trustees' report and the policy challenges facing the program. The Hazards of Harassing Doctors: Regulation and Reaction in Trans-Atlantic Healthcare Beyond its impact on the quality of care and on the invisible costs of illness, government tampering with doctor autonomy and patient choice raises crucial questions related to human liberty, writes Alphonse Crespo, a Swiss physician. Doctors have yet to make their voice heard in the battle of ideas between the guardians of obsolescent socialized medicine and proponents of a free society. But this is changing as bureaucratic interference with medical practice has reached a threshold that now pushes doctors to engage in protest movements in various parts of Europe. Enlightened health-policy makers can minimize the transition costs of change by deregulation of health insurance services, gradual privatization of public healthcare infrastructures, and fiscal incentives for medical savings accounts and health banking capital. In a separate essay, American physician Marc Siegel cautions that medicine is moving further in the direction of shrinking reimbursements and insurance company-controlled strategies which put a stranglehold on a doctor's decision-making. Five Myths of Health Care Sally Pipes debunks the five most prominent health-care myths: forty-seven million Americans do not have health insurance; universal health-care coverage can be achieved through an individual mandate; expensive prescription drugs are a big reason health-care costs increase; drug importation will save patients a fortune; and the state-run health-care systems in Europe and Canada are better and cheaper than America's. In a separate op-ed, Pipes writes that Thailand's misuse of compulsory licensing to obtain patented prescription drugs allowed corrupt officials to steal millions. Sick Thai citizens have yet to see any benefits and the move has set a dangerous precedent that will stifle innovation and endanger the health of millions. The newly elected Thai government is wisely examining this issue and appears more interested in pursuing a thoughtful, long-term policy of economic development that will serve its citizens far better than quick-fix political schemes that result in Thailand becoming a hero to anti-capitalist activists, but a pariah to the world economic community. Why McCain Has the Best Health-Care Plan Sen. John McCain's health care plan is the only one of the candidate proposals that has a chance of getting medical costs under control, writes Fortune Magazine. McCain's plan would eliminate the employer exclusion for health care and allow people to buy insurance plans on their own, including across state lines. In essence, he wants to create a kind of national insurance market that puts more decision-making power into the hands of consumers. John McCain's health care plan would create a world where health care is treated as the precious resource that it is, rather than a costless entitlement, and where nationwide competition pushes down prices and consumers focus their attention and spending on what's really crucial to their health. The price of health care is never going to get under control until patients get what they deserve: the right to be customers too. McCain bemoans the high cost of pharmaceuticals and, with a heavy dose of anti-corporate rhetoric, he champions the idea of drug reimportation. But McCain would be better served by abandoning this idea and speaking out instead in favor of reforms that will help Americans pay a fair price for prescription drugs, writes the Manhattan Institute's Dr. David Gratzer. McCain should offer Americans a way forward to lower drug prices, without endangering the innovation that has sparked the pharmaceutical revolution.
Upcoming Events Taking Back Our Fiscal Future H.R. 5613, Protecting the Medicaid Safety Net Act of 2008 Can Tax Credits Be a Linchpin for Health Reform? Lessons from the Factory Floor Enhancing Quality Performance Measurement: A New Paradigm for Health Care Accountability Has Arrived Is Free Trade Good for Your Health? Can We Repair What's Wrong with our Health Care System through Christian Principles? Whose Healthcare is it Anyway? Understanding the Patient as a Consumer Cracking Down on Killer Drugs: Dora Akunyili and the Nigerian Success Story Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. |
|
