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 Tag: MedicaidOur 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.NewslettersJuly 25, 2008
A Crystal Ball?House action on changes to government health programs this year foretell more sweeping changes that are likely to come next year if Democrats make expected gains in the November elections. First example: Rep. Henry Waxman, chairman of the House Oversight and Government Reform Committee, plans to introduce a bill soon that will extend price controls in the Medicaid program to some private Medicare Part D prescription drug plans. The legislation would target the plans that serve the six million people who qualify both for Medicare and Medicaid. House action on changes to government health programs this year foretell more sweeping changes that are likely to come next year if Democrats make expected gains in the November elections.First example: Rep. Henry Waxman, chairman of the House Oversight and Government Reform Committee, plans to introduce a bill soon that will extend price controls in the Medicaid program to some private Medicare Part D prescription drug plans. The legislation would target the plans that serve the six million people who qualify both for Medicare and Medicaid. Waxman released a report yesterday saying that U.S. drug manufacturers are reaping "windfall" profits because Medicare's private prescription drug benefit plans pay more for the same drugs than the price-controlled Medicaid program does. Rep. Thomas M. Davis III of Virginia said that Waxman's plan would be a "short-lived and painful" way to capture savings. He and others warned that such price controls would slash industry spending on research and significantly curtail development of new drugs. They argue that the Part D benefit is costing seniors and taxpayers much less than expected, largely because of the forces of private competition. According to the Department of Health and Human Services, the average senior is paying $25 a month in Part D premiums this year, 40% below the original estimate of $41, and beneficiaries are saving an average of $1,200 a year in drug spending. Compared to original projections, the cost to the taxpayers of the new drug benefit is $243.7 billion, or 39%, lower over 10 years than original estimates. A minority report said that moving those dually eligible for Medicare and Medicaid back to Medicaid drug coverage "would likely be opposed by advocates of low-income seniors, dual-eligible seniors, and states" because they have a better drug benefit under Part D. "While the Medicaid program is required to cover a broad array of drugs, states have responded to budgetary concerns by using a number of tools that effectively limit access to certain prescription drugs or quantities of drugs." But, as Congressional Quarterly reported yesterday, "The change proposed by Waxman would strike at the heart of the 2003 law, which relies on competition between private plans rather than government-mandated discounts, the tool used to keep Medicaid prices down, to control prescription drug spending in Medicare." Other actions show the lure of Congress to expand government control over the health sector with, in many cases, significant support from Republican members:
Grace-Marie Turner Recent News Articles and Studies State Fiscal Relief: Protecting Health Coverage in an Economic Downturn State Fiscal Relief: Protecting Health Coverage in an Economic Downturn Robert B. Helms, American Enterprise Institute The congressional proposal to temporarily boost the Federal Medical Assistance Percentage (FMAP) to the states is misguided, writes AEI's Robert Helms in his testimony before the House Energy and Commerce Subcommittee on Health. The open-ended nature of the FMAP formula creates a set of perverse incentives that encourages states to engage in accounting and taxing schemes to increase federal funding rather than trying harder to improve the efficiency and medical effectiveness of their programs, writes Helms. The proposed temporary increase in the FMAP does nothing to reform these perverse incentives and, in fact, makes them worse by rewarding this kind of behavior with an even higher matching rate, he writes. If additional assistance to the states is needed, it should be made available in the form of a fixed grant, concludes Helms. Further, if the funds could be allocated to the states on the basis of their economic performance and their populations of the poor and the disabled, the chances of improving the health and well-being of our most vulnerable populations would be greatly improved. Legislation should be put forward that would require states to post their Medicaid patient encounter data on the Internet for all to see, writes Jim Frogue of the Center for Health Transformation. This is administratively simple, cheap, and would have a profoundly positive impact on the quality of care delivered via Medicaid. In addition, it would dramatically increase accountability for how Medicaid dollars are spent thereby decreasing the likelihood that state leaders would return to seek still more money from Congress, writes Frogue. American Cancer Care Beats the Rest David Gratzer, Manhattan Institute A study to be published in the August issue of Lancet Oncology finds that U.S. medicine bests the cancer treatment available to people in 30 other countries, writes Gratzer. The Concord study compares five-year cancer survival rates for several malignancies and finds that the U.S. leads in the field of breast and prostate cancer. The results are in line with a study published in the Lancet last August, which compared American and European care and found that the U.S. fared better in 13 of the 16 cancers studied. Five-year survival rates for cancer care in men, for example, are 45% in England but 60% in the U.S. The British lag behind American survival rates because screening standards are different, writes Gratzer. In the U.S., internists recommend that men 50 and older get screened for colon cancer; in the U.K.'s National Health Service, screening begins at 75. British patients also wait much longer to see specialists. Further, novel drugs offered here often aren't available there, writes Gratzer. For instance, Avastin, a drug for advanced colon cancer, is prescribed more often in the U.S. than in the U.K., by some estimates as much as ten-fold more. Little Bang for the Buck: Is the Tax Code to Blame for the Paltry ROI on U.S. Healthcare Spending? Economic Research Initiative on the Uninsured, 07/08 Harvard Economics Professor Katherine Baicker, who served as a member of President Bush's Council of Economic Advisers, discusses the reasons for the disappointing return the United States gets on its health care spending, the need for tax code reforms and other changes that might boost that return, as well as the need for policymakers to look at health care spending and universal coverage together. "We need to address the problem of rising costs and the problem of the uninsured together. Proposals that focus exclusively on getting people covered by insurance run the risk of not being able to afford that coverage tomorrow if costs rise. Similarly, policies that focus just on containing costs will miss opportunities to promote much better health and more efficient use of health resources by getting people insured," said Baicker. "We should focus on policies that get higher value health care, which might then end up spending more on some people, spending less on other people…There will be fundamentally hard choices that have to be made, and policy makers have to think about who is going to make those choices. Somebody -- individuals, the government, employers, insurers -- has to decide how to allocate scarce resources. We want to set up a system where we're devoting resources to producing as much health as we can." Health Plan From Obama Spurs Debate Kevin Sack The dollar values that Sen. Barack Obama has attached to individual components of his health plan are beginning to attract scrutiny from health analysts and economists, writes The New York Times. His words about lowering "premiums" by $2,500 for the average family of four have been fairly consistent, but the health policy advisers who formulated the figure say it actually represents the average family's share of savings not only in premiums paid by individuals, but also in premiums paid by employers and in tax-supported health programs like Medicare and Medicaid. A number of health policy experts have also questioned whether the $2,500 projection is either fiscally or politically realistic, writes the Times. "There is no easy money because, as the saying goes, one person's fraud and abuse is another person's income," said AEI's Joe Antos. "I wouldn't think that four years or eight years or probably 10 years will be enough to see numbers of that sort." You Get What You Pay For: A Global Look at Balancing Demand, Quality, and Efficiency in Healthcare Payment Reform PricewaterhouseCoopers' Health Research Institute, 07/08 As the pressure to control health spending increases, payers and governments face the difficult challenge of balancing quality, efficiency, and demand through payment reform, according to a report from PricewaterhouseCoopers' Health Research Institute. Key findings:
Towers Perrin, 01/08 Health care costs for U.S. employers will increase by 6% in 2007, according to Towers Perrin, a global consulting firm. The survey also finds that employers are continuing to explore account-based health plans, such as HSAs, as an attractive solution to control rising costs. Approximately half (46%) of survey respondents had account-based health plans in place in 2007 and a further 7% plan to implement them in 2008. The survey also finds that the majority of employers (84%) surveyed disagreed that the U.S. should have an exclusively government-run system and more than 60% anticipate major federal health care reforms will become law during the next two presidential terms. Roughly three-quarters of respondents view the states as drivers of change and expect that over half of the state legislatures will enact significant reforms within the next decade. Upcoming Events Grace-Marie Turner speaking on the In The Booth Show Grace-Marie Turner speaking on the Morning News Watch Show Can Consumers Save Medicare? Rising Rates of Chronic Health Conditions: What Can Be Done? Grace-Marie Turner speaking on the Mark Maxon Show An Interstate Commerce Route to a National Market for Health Insurance Reforming the U.S. Health Care System: Supporting the Role of Individuals  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 http://rs6.net/tn.jsp?t=bpphnpcab.0.0.xkzt75bab.0&ts=S0351&p=http%3A%2F%2Fwww.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.
Categories:
Medicare July 18, 2008
High StakesSen. Barack Obama this week announced a plan designed to help businesses afford health insurance, but the ideas would perpetuate today's problems and add new bureaucracy in the process. Small businesses would get refundable tax credits to offset 50% of the amount they pay for health insurance for their workers and have the government take over a portion of the catastrophic costs of high-cost employees. What's wrong with that? Several things. Sen. Barack Obama this week announced a plan designed to help businesses afford health insurance, but the ideas would perpetuate today's problems and add new bureaucracy in the process.Small businesses would get refundable tax credits to offset 50% of the amount they pay for health insurance for their workers and have the government take over a portion of the catastrophic costs of high-cost employees. What's wrong with that? Several things.
Sen. Obama also would heavily regulate health insurance companies and how they do business to the point that they would become little more than functionaries in a new federal government regulatory regime. He would, for example, require forms of guaranteed issue for health insurance and community rating of premiums that have driven up health costs in state after state experimenting with the regulations. Many of the provisions, in fact, seem borrowed from the SHOP Act (Small Business Health Options Program of 2008, S.2795) and from ideas offered by Sen. Hillary Clinton that open large new portals for a much bigger role for government in our health sector. More government or a properly functioning market in the health sector? That really is what the national debate over health reform is all about. The results of this fall's election will be decisive in determining the direction of our nation. Sen. Obama sees a much bigger role for government in trying to solve the problems in the health sector while Sen. McCain believes in unleashing incentives to create more competition in the private health sector that will give people more choices of more affordable care and coverage. The next president will be determined to do something on health care and will be directed by a vision that will have a great impact on the direction Congress takes in shaping legislation. The stakes are enormous for the future of this one-sixth of our economy represented by the health sector. We see many of the problems with the U.S. health sector as rooted in the encroachment of regulation and bureaucracy that are stifling its ability to call on the genius of our economy to create a health sector that is more responsive to demands for lower costs and higher quality. Instead of tax credits to small businesses, credits could be offered to individuals to help them purchase health insurance, as Senator McCain proposes. People eligible for the credits could purchase the health coverage of their choice, either through their places of work, on their own, or through new groups that would emerge in a market where health insurance and subsidies are more portable. Purchasing reforms would make the insurance market more competitive and policies more affordable. Taking the idea a step further, credits also could be a vehicle to move toward much-expanded or even universal health insurance coverage. If people don't take specific action to purchase a policy directly, their credit could be assigned to one of several insurers offering coverage in their state or region to buy a policy that offers the best coverage the credit can provide. It may be a higher-deductible policy or a plan with more limited benefits, but it would protect them -- and taxpayers -- against catastrophic costs. Making insurance more affordable and accessible would dramatically increase the number of Americans with coverage. Making the subsidies assignable to an insurer even if people don't take action to buy coverage would further boost coverage. And other reforms could assure that people currently shut out of the market can get coverage. These actions together would likely get us as close to universal coverage as any of the other more onerous proposals being offered, including and especially, imposition of an individual and/or employer mandate. Grace-Marie Turner Recent News Articles and Studies How to Fix Medicare: Let's Pay Patients, Not Physicians How to Fix Medicare: Let's Pay Patients, Not Physicians Roger Feldman, University of Minnesota Medicare's current method of paying physicians sets fees for more than 8,000 separate procedures and services. Health economist Roger Feldman argues that a radical shift in Medicare policy is not only possible but imperative. Under Feldman's "medical indemnity" proposal, Medicare would pay each patient a fixed amount of money, reserving larger subsidies for sicker people. Patients, in turn, would select their own medical services from providers who would set their own competitive rates. A medical indemnity system would do away with the distortion in patients' incentives wrought by conventional Medicare coverage. Given a fixed amount of money to spend on medical care, patients would have strong incentives to shop for the combination of services, providers, and prices that most closely meet their needs. Feldman's indemnity system protects patients whose conditions are much costlier than average while avoiding the proliferation of costly individual indemnities. As Arizona Goes, So Goes the Nation: How Medicaid Ruins the States' Fiscal Health Michael S. Greve, AEI and Philip Wallach, Princeton University The fiscal balances of state and local governments will rapidly deteriorate in less than a decade and Medicaid spending is the principal culprit, according to a new AEI report based upon a Government Accountability Office study. Measured as a percentage of the state's fiscal year 2008 general fund, Arizona's projected FY 2009 deficit was the most serious shortfall of any state, due chiefly to the state's expansion of its Medicaid program and the perverse incentives created by Medicaid's inordinately generous transfers to the states, write Greve and Wallach. By making program expansions look cheap and making cuts look outrageously expensive, federal matching grants ratchet up spending and taxes and tend to exacerbate the states' boom-and-bust budget cycles. With a Medicaid matching rate of 66.2%, for each dollar Arizona spends on Medicaid, the federal government sends the state $1.96. Medicaid spending in Arizona now exceeds the average spending level and has increased from roughly 8% of general fund spending to a projected 14.4% in FY 2009. Patients Curb Prescription Spending Shirley S. Wang and Avery Johnson In an ominous sign for drug makers, the number of prescriptions dispensed by pharmacies in the U.S. is growing at its lowest rate in at least a decade, writes The Wall Street Journal. Data from IMS Health show growth in prescription volume for the first five months of this year slowed to 1.5%. By comparison, annual volume growth averaged 3% from 2003 to 2007. Flagging prescription growth comes at a period of particular vulnerability for the drug industry. Several blockbuster products have lost patent protection in the past two years, the main reason industry sales growth is at its lowest level since the 1960s, and more patent expirations loom. Further, there are few new drugs in late-state development to take up the slack, the Journal reports. Making a Killing: The Deadly Implications of the Counterfeit Drug Trade Roger Bate Roger Bate traces pharmaceutical counterfeiting around the world in his new book, from developed nations, where counterfeits often target "lifestyle" drugs such as Viagra, to developing countries, where counterfeiters favor therapeutic medicines such as antimalarials and antibiotics. Enforcement in developing nations is hampered by inadequate education, feeble regulation, and sluggish policing of existing laws, writes Bate. And the U.S. is struggling to thwart an insidious Internet market. Bate champions greater cooperation between wealthy and poor nations to quash the trade in counterfeit pharmaceuticals. He calls for fortified policing resources, harsher penalties for counterfeiters, widespread public education, and commonsense consumer vigilance against this danger. Western policymakers must act immediately to quell the deadly counterfeit market in developing countries -- and to ensure the integrity of their products at home. CMPI's Peter Pitts writes that California's recent decision to delay implementation of a controversial law to create an electronic chain of custody for pharmaceuticals is welcome news. The law's aim was noble -- beat back the rising tide of counterfeit drugs -- but it would have imposed back-breaking costs on pharmaceutical manufacturers and dramatically inflated drug prices for consumers while doing little to undermine counterfeiters. Patent Gridlock Suppresses Innovation L. Gordon Crovitz For the third year in a row, Congress has just given up on passing a law reforming how patents are awarded and litigated, writes columnist Crovitz. This despite growing evidence that for most industries, today's patent system causes more harm than good. Litigation costs, driven by uncertainty about who owns what rights, now are so huge that they outweigh the profits earned from patents. New empirical research by Boston University law professors found that the value of pharmaceutical patents outweighed the costs of pharmaceutical-patent litigation. But for all other industries combined, they estimate that since the mid-1990s, the cost of U.S. patent litigation to alleged infringers ($12 billion in legal and business costs in 1999) is greater than the global profits that companies earn from patents (less than $4 billion in 1999). These are shocking findings, but they point to a solution, writes Crovitz. New drugs require great specificity to earn a patent, whereas patents are often granted to broad but vague innovations in software, communications and other technologies. It's true that defining intellectual property is hard at a time when new technologies upset the traditional ways of protecting rights, but our patent system is a disincentive at a time when we expect software and other technology companies to be the growth engine of the economy, concludes Crovitz. HSAs' Reign Among Consumer-Driven Plans May Come to an End Jerry Geisel There are signs that Washington's five-year honeymoon with health savings accounts may be coming to an end among lawmakers and, depending on the outcome of the November presidential election, the White House, writes Geisel. One sign came in April when the House passed legislation to require banks and other financial institutions that administer HSAs to substantiate that account distributions are for health-care related expenses, such as prescription drug copayments. And Sen. Barack Obama, the presumptive Democratic presidential candidate, is at best lukewarm about HSAs. By contrast, Sen. John McCain, the presumptive Republican presidential candidate, has been more supportive, saying he would work to encourage and expand HSAs if elected. The contrasting views mean the future of HSAs could depend on the outcome of the November elections, said Galen's Grace-Marie Turner. Tax Subsidies for Health Insurance Kaiser Family Foundation, 07/10/08 Today almost 160 million people in the United States obtain health insurance through an employer in large part because the tax system subsidizes the purchase of employer-sponsored coverage. The current subsidy costs the U.S. Treasury more than $200 billion in lost revenue since premiums for employer-provided health coverage are excluded from income taxes and from payroll taxes. This issue brief uses examples of workers with different earnings to illustrate how the current tax code affects families depending on whether they have health coverage, and whether that coverage is provided through their employer. By excluding the value of employer-sponsored health benefits from taxable income, the current law generally provides a larger subsidy to higher-income families, since higher-income workers pay federal and state income taxes at a higher marginal tax rate than lower-income workers. The brief also looks at several other tax provisions that affect the treatment of insurance, including the itemized deduction for medical expenses, which can help offset the cost of individually purchased (non-group) health insurance, and the special tax deduction for health insurance premiums for self-employed taxpayers. The analysis compares the tax treatment of premiums under these scenarios and concludes that they are generally less generous than the treatment of premiums for employer-sponsored coverage. Upcoming Events Making Medicare Sustainable: Transforming Our Health Program for America's Seniors Beyond More Health Insurance Coverage, toward Better Health Outcomes IRS HSA Grab Bag Webinar Emerging Issues Roundtable: Meeting Today's Challenges through Innovation and IP Rights Health Care Reform Task Force Meeting Small Market Drugs, Big Price Tags: Are Drug Companies Exploiting People with Rare Diseases? Grace-Marie Turner speaking on the In The Booth Show Grace-Marie Turner speaking on the Morning News Watch Show Can Consumers Save Medicare? Rising Rates of Chronic Health Conditions: What Can Be Done? 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.
Categories:
Small Business July 11, 2008
Outside the BoxThere really wasn't a controversy about whether to delay Medicare's scheduled cuts in physician fees, but you'd never know it from reading about this issue in the mainstream media over the last month. Both sides wanted to undo the cuts, but the real debate was over how to pay for the "fix" since the cuts were built into the federal budget. The leadership's solution was to get the money from the popular Medicare Advantage program, particularly private Medicare fee-for-service plans. There really wasn't a controversy about whether to delay Medicare's scheduled cuts in physician fees, but you'd never know it from reading about this issue in the mainstream media over the last month.Both sides wanted to undo the cuts, but the real debate was over how to pay for the "fix" since the cuts were built into the federal budget. The leadership's solution was to get the money from the popular Medicare Advantage program, particularly private Medicare fee-for-service plans. This is yet another example of the growing politicization of the health sector in the U.S. And it shows how the congressional leadership used the issue of delaying the cuts to obscure a secondary agenda of trimming private plan participation in Medicare. Republicans who voted against the measure earlier because they objected to the "pay for" were hammered when they went home for recess last week. Both houses of Congress now have passed legislation to delay for 18 months the scheduled 10.6% reduction in physician fees, with a promise that fees would be increased by 1.1% in 2009. President Bush has threatened the veto the bill because he believes it is so important to keep private, competing plans in Medicare, but both houses have passed the legislation by veto-proof margins, so it will be an uphill fight. Battles like this will continue as long as we have a massive spending program dominated by price controls and politically-motivated decisions. The silver lining in this may be to show physicians what would be in store for them under a government-run health care system. Do they really want to have to wage a national fight every year to literally get an Act of Congress passed just to keep their fees level? And is a 1.1% pay increase next year — which will be another battle, by the way — really worth much of a celebration? There has to be a better way! Visionary reform And there is: Congressman Paul Ryan (R-WI) has developed a Roadmap for America's Future that moves us off the field of these small battles and into the larger arena of visionary reform. He has developed a legislative plan that would put Medicare, Medicaid, and Social Security on a sustainable pathway while transforming our hopelessly complex and burdensome income tax code so America can be competitive in a 21st century global economy. And he would modernize the financing of private health insurance along the way. The stakes are enormous, and these skirmishes over physician payments completely obscure the meteorite heading toward us because of uncontrolled entitlement spending. A recent analysis by Peter Orszag, director of the Congressional Budget Office, says that Congress has three options to address the unsustainable growth of entitlement programs:
I have long believed that we must get outside the box of battles over spending cuts to individual programs to focus on much larger and transformative changes. For the first time, a legislative plan has actually been developed that does just that, with the very able assistance of Ryan's terrific staff on the House Budget Committee, where he serves as ranking Republican. I have known Paul Ryan since he was an intern in Jack Kemp's office more than 15 years ago where he was imbued with the passion for free-market ideas. Now, as a leader in Congress, Ryan has developed a plan that would allow the U.S. to survive and even thrive in a 21st century economy, fulfill the promise of the entitlement programs, and lift the incredible burden of debt the country — and our children and grandchildren — are facing. "In the history of our country, each generation has confronted the challenges before it so that the next generation will be better off and have a more prosperous future," he told a Capitol Hill briefing on Tuesday sponsored by the National Center for Policy Analysis. The current trajectory is unsustainable. Without change, our economy will collapse and the next generation will be poorer, and the light of liberty that has been America for more than two centuries will surely fade. "Entitlement spending is the seminal economic fight of our time," Ryan told a gathering at The Heritage Foundation yesterday. And he has offered a plan to let that light continue to shine. The Congressional Budget Office, in a May 19, 2008 letter to Mr. Ryan, said that his plan would slow the growth of budget deficits from entitlement spending and eventually eliminate them. Importantly, the plan also includes significant reductions in federal income tax rates that would spur economic growth. Economic growth would continue to grow, rising from $45,000 per capita in 2007 to $165,000 in 2082 — a dramatic reversal from the projections under the tax-increase/deficit spending scenario described by CBO. Here's a brief overview of the Roadmap:
Grace-Marie Turner Recent News Articles and Studies Congress Is Trying to Limit Your Health Care Choices Congress Is Trying to Limit Your Health Care Choices Grace-Marie Turner, Galen Institute In New Hampshire, more than 35,000 people who are trying to save money on health insurance could get slapped with new paperwork requirements from Congress, writes Grace-Marie Turner. Under a measure recently passed in the House, federal regulators would need proof that each withdrawal from an HSA is spent on qualified medical expenses. The prospect of navigating an administrative labyrinth would scare many away from HSAs as substantiation would be costly and time-consuming, writes Turner. Supporters of the measure claim HSAs are prone to abuse because expenditures are self-reported, but there are safeguards in place. Most HSA payments are made with a specially designated debit card, so it's easy to track where the money goes. And unqualified withdrawals are subject to taxes plus a 10% penalty. Lawmakers shouldn't be throwing up administrative hurdles to keep Americans away from HSAs, concludes Turner. How Good Is Our Health Care System? Grace-Marie Turner, Galen Institute The World Health Organization's rankings of international health systems, which put the U.S. at 37th, are a poor reflection of reality, writes Grace-Marie Turner. Countries with tax-funded, socialized systems tend to be ranked higher simply because citizens are treated equally — even when the quality of care is much poorer than in the U.S. The most crucial reading of a health care system is how well you do if you get sick, but, amazingly, the WHO chose not to include that data in its survey. For key diseases that respond to medical care, an American patient's chances of surviving are much better than a patient in countries with much higher WHO rankings. For example, the prestigious journal Lancet Oncology compared cancer survival rates and found:
Have Health Reformers Forgotten Medicare? Joseph Antos The current debate over physician payments in Medicare should be used as a starting point for a larger discussion on Medicare reform, writes Antos. It is uncertain whether broad health system reform will be accomplished in the next four years, but it is clear that reform will fail — or fall short of its goals — if Medicare is not an integral part of the proposal. Medicare is caught in a dilemma of its own making, writes Antos. It is hugely popular with the public, which does not want to see substantial changes in the program that could reduce benefits or impose additional costs on beneficiaries. Yet, if strong actions are not taken, Medicare soon will be unable to fulfill the public's expectation of generous health coverage that guarantees to millions of Americans access to the latest medical treatments. More regulations will not solve this problem, and neither will more money, if that means repeating the mistakes we are now making, concludes Antos. Code on Interactions with Healthcare Professionals Pharmaceutical Research and Manufacturers of America (PhRMA), 07/10/08 PhRMA this week released a stricter marketing code to ensure that pharmaceutical marketing practices comply with the highest ethical standards. The code reaffirms that interactions between company representatives and healthcare professionals "should be focused on informing the healthcare professionals about products, providing scientific and educational information, and supporting medical research and education." Among the changes, the revised code:
From Heart Transplants to Hairpieces: The Questionable Benefits of State Benefit Mandates for Health Insurance John R. Graham Workers pay for health benefit mandates through reduced wages, working longer hours, and sometimes losing health insurance altogether, Graham concludes after surveying 28 original articles that attempt to estimate the cost of benefit mandates. The impact of this encroachment of mandates falls hardest on those buying health insurance on their own or firms that can't afford to self insure to escape the mandates. But that isn't stopping state legislators from passing more mandates. Mandates introduced since the year 2000 include: hearing aids, hormone replacement therapy, and reimbursement for clinical trial participation. In 2007, 13 states mandated coverage for the human papillomavirus vaccine. Meanwhile, only two mandated benefits were repealed between 1949 and 2002. Health Care Reform in Massachusetts: Medicaid Waiver Renewal Will Set a Precedent Greg D'Angelo and Edmund F. Haislmaier The core principle of the Massachusetts Medicaid demonstration waiver is an experiment in shifting from targeting government funds to health care providers to redirecting those funds to patients to help them buy insurance, write D'Angelo and Haislmaier. As Massachusetts applies for a waiver extension for its major reform program, this policy precedent should remain in place and apply to other states requesting waivers as well, D'Angelo and Haislmaier conclude. A report from the Government Accountability Office finds that the Centers for Medicare and Medicaid Services should review the billions of dollars being spent on supplemental Medicaid payments in all states. A separate report from the Department of Health and Human Services Office of Inspector General provides examples of fraud within the Medicaid program. When Things Go Wrong, It's Better To Be at Home Suz Redfearn The Washington Post reports on the potential disadvantages of medical tourism. When things go badly after an overseas operation, a patient may be left facing a host of challenges: lack of access to follow-up care at home; doctors who won't get involved in corrective procedures; extra money that must be spent to undo what has been done; and a complicated legal picture if they want to try to recoup costs, writes the Post. "Aftercare is one of the most important issues and problems in medical tourism," said Jonathan Edelheit, president of the Medical Tourism Association. Edelheit said that his organization is trying to educate U.S. doctors so that they will not discriminate against patients who are coming home from surgeries abroad and may be in need of care, writes the Post. The trade group is also trying to raise standards and increase transparency in the now wide-open and unregulated field. Karlyn Bowman, American Enterprise Institute While Americans are satisfied with their own health care, they worry about increasing costs and how well the system is serving others, writes Bowman. Recent polls on health care find:
Upcoming Events Innovations in Patient Care: Lessons from the Field The Premier Biotech and Pharmaceutical Public Policy Congress State Coverage Initiatives: Lessons for the Nation Getting Better Value in Health Care The Birth of Freedom Prevention for A Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities Making the Grade: Improving the U.S. Health System Health Care Quality: Thumbs up in Oregon? Emerging Issues Roundtable: Meeting Today's Challenges through Innovation and IP Rights 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.
Tags:
Medicare, physician fees, Paul Ryan, Roadmap for America's Future, HSAs, World Health Organization, international health systems, Joe Antos, Medicare, PhRMA, mandates, John Graham, The Heritage Foundation, Greg D'Angelo, Edmund Haislmaier, Medicaid, fraud, medical tourism, health care polls
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Medicare April 25, 2008
Single Payer Utopia?The American Prospect, a magazine of liberal thought, carries an article in its current issue by Marcia Angell, M.D., of Harvard and former editor-in-chief of The New England Journal of Medicine that does indeed offer fuel for thought. HighlightsThe American Prospect, a magazine of liberal thought, carries an article in its current issue by Marcia Angell, M.D., of Harvard and former editor-in-chief of The New England Journal of Medicine that does indeed offer fuel for thought. Her article, "Health Reform You Shouldn't Believe In," examines the universal health coverage law in Massachusetts, criticizing "incremental efforts to increase coverage by expanding private insurance." She concludes that a single-payer system is the only viable option. Dr. Angell's earlier diatribes against the pharmaceutical industry are evidence of her animosity toward any private involvement in the health sector. And this latest article shows her clear hostility toward private insurance. While I agree with some of her assessment of the flaws in the Massachusetts health reform experiment, I could not disagree more about her conclusions. In a section of her article subtitled "Massachusetts miracle or mirage?," she acknowledges a truth that Massachusetts politicians are reluctant to admit: "While those beneath the poverty level signed up for free insurance in even greater numbers than anticipated, very few people who were required to pay for their own insurance signed up. Even those eligible for partial subsidies were slow to enroll," Angell says. "The deadline to purchase insurance had to be extended, and 60,000 uninsured people were exempted from the mandate because — yes, that's right — they couldn't afford it (so much for universality)," according to Angell. "Don't get me wrong," she says. "Massachusetts is to be congratulated for seeking to extend health care to everyone in the state. Every decent society should ensure health care, just as it does education, clean water, and police and fire protection. Massachusetts' plan is an ambitious and well-intentioned effort. But unfortunately, it's extremely unlikely to work for three main reasons," she says. To summarize her points:
All incremental efforts at reform are doomed because they leave "our current dysfunctional system essentially intact," Angell concludes. Her verdict: "The only workable solution is a single-payer system (there, I said it), in which everyone is provided with whatever care he or she needs regardless of age and medical condition. There would no longer be a private insurance industry, which adds little of value yet skims a substantial fraction of the health-care dollar right off the top. Employers, too, would no longer be involved in health care. Care would be provided in nonprofit facilities. The most progressive way to fund such a system would be through an earmarked income tax, which would be more than offset by eliminating premiums and out-of-pocket expenses." Angell says the reason this has not happened is because "the private insurance industry has managed to convince many political leaders, including progressives, that a single-payer system is unrealistic. But what is truly unrealistic is anything else," she says. "My greatest concern about the Massachusetts plan is that when it unravels, people will draw the wrong lesson. They will assume that universal care at a cost we can afford is impossible, and give up on it. It's not impossible; it's just unlikely to be achievable while leaving our dysfunctional system in place." So she envisions a utopia where "everyone is provided with whatever care he or she needs regardless of age and medical condition," with care "provided in nonprofit facilities" and funded by "an earmarked income tax." The lack of understanding of economic and political forces is alarming. And there also is no indication that she recognizes the positive forces in our health sector today that are advancing medical progress, such as:
And the list could go on and on. Are we really so polarized? We agree on the problem, but we have such vastly different views on the solution that you wonder if we ever will make progress. An article in the section below links to a story from The Hill as evidence of the difficulty of sweeping reform. Starting with a good diagnosis is important. But, my goodness, we will need to reach some agreement on a treatment plan.
The Congress is in a showdown over legislation that would block seven Medicaid rules designed to reduce some of the most obvious fraud and abuse of the program. The White House said that President Bush will veto the legislation if it comes to his desk. The House this week passed the legislation by a veto-proof 349-62. And Senate Majority Leader Harry Reid is planning to fast-track the legislation to the floor, bypassing the Senate Finance Committee, where the bill could face resistance. Here is the short version of my testimony before the House Energy and Commerce Committee about this issue. If nothing else, this shows how difficult it is to curb even documented abuse once a government health spending program is established. We must avoid expanding these expensive programs that take on a life and constituency of their own.
And you won't want to miss our major Spring conference, the big Medicare Forum we are co-hosting on Tuesday at the Newseum in Washington, D.C. This is a significant program, featuring a major address by HHS Secretary Michael Leavitt and a very distinguished panel of Medicare experts. You should have received an invitation earlier this week, but if not, you can still register. It's going to be a major event which will be webcast by the Kaiser Family Foundation. If you can join us, please do! Secretary Leavitt previews his remarks in today's Washington Times. See you there! Grace-Marie Turner Recent News Articles and Studies Clinton and Obama Agree — And They're Both Wrong Clinton and Obama Agree — And They're Both Wrong
Sens. Hillary Clinton and Barack Obama are exchanging blows almost daily over whether the government should require everyone to have health insurance or not, writes Grace-Marie Turner. But their debate over an individual mandate has obscured the fact that — in almost every other area — the candidates have nearly identical visions and plans for health reform. Both want to require insurers to accept all applicants. Both candidates want a national "pay or play" mandate, forcing employers to cover a preset percentage of their workers' health insurance or pay a fine. And both would massively expand Medicaid and the State Children's Health Insurance Program. The list goes on, but the overriding principle for Sens. Obama and Clinton is clear — toward a much bigger role for the government over health care decisions. But that thinking is what caused many of the problems in our health sector today. What the insurance market actually needs is more competition — not more regulation. The Hill reports that Congressional Democrats are backing away from healthcare reform promises made by Clinton and Obama, saying that even if their party controls the White House and Congress, sweeping changes will be difficult. Markets Without Magic: How Competition Might Save Medicare Mark V. Pauly, Wharton School of the University of Pennsylvania Wharton economist Mark Pauly's new book argues that unavoidable limits on Medicare financing can best be imposed through market-based choices rather than through government direction. In the short run, bringing competition to Medicare will save money for beneficiaries and improve the quality of health care; in the long run, it may save Medicare. Pauly suggests we build upon the success of the Medicare Advantage program, which gives beneficiaries private insurance alternatives to the traditional government-managed Medicare program. Pauly proposes converting the traditional Medicare program to an explicit voucher, operating under the same rules as the private plans. This would create a neutral Medicare market and provide a mechanism for setting realistic limits on the growth in spending. Competition would promote efficiency and give seniors the freedom to decide how to economize on spending growth. The Wall Street Journal, 04/19/08 Legislation passed recently by the House of Representatives would require every health savings account transaction to be reviewed and verified as a legitimate medical expense, adding a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs, The Wall Street Journal writes in an editorial. Having lost the policy argument when HSAs were created, Democrats now are trying to kill them with regulatory subterfuge, the editorial says. The new scheme purports to ensure that money saved tax-free in an HSA is actually used for health expenses. But this is a nonproblem: Any withdrawal from an HSA is already subject to a federal tax audit, just as individual tax returns are. In any case, if people cheat on their HSAs, they are only cheating themselves. When a medical expense arises below the insurance deductible, they will be the ones paying for it, whether from their HSA or another bank account. The Senate should stop this one dead in its tracks. Today's Wall Street Journal features several letters in response to the editorial. The Wisdom of Patients: Health Care Meets Online Social Media Jane Sarasohn-Kahn, M.A., M.H.S.A., THINK-Health Online technologies and practices that people use to share opinions, insights, and experiences with each other are empowering, engaging, and educating consumers and providers in health care, writes Jane Sarasohn-Kahn, a health care economist and management consultant. Consumers are quickly adopting such social networks: One in three Americans used some form of social media online for health in 2007. People with chronic health conditions are sharing their stories with each other, not just for emotional support, but also for the clinical knowledge they gain from participating with "patients like me" in an online community. Doctors are meeting up online to discuss challenging cases with colleagues. Researchers are coming together with patients to learn about side effects in real-time to improve therapeutic regimens. In the next few years, Sarasohn-Kahn says we will see countless social media projects focusing on specific diseases and sub-specialty areas, built by and for patients, caregivers, and providers. The ongoing demands of a consumer-driven health marketplace will inspire innovation in applications that integrate clinical and financial information and ratings sites will grow in number and type. Only a consumer-centered health care system offers the incentives needed to maximize value and produce more for less systemically and consistently over the long term, writes Ed Haislmaier of The Heritage Foundation. State Health Care Reform: Key Questions and Answers Linda Gorman, Independence Institute, and R. Allen Jensen, Independent Life and Health Insurance Broker Gorman and Jensen examine key issues that many state initiatives have failed to adequately address, including universal coverage, consumer-directed health reforms, electronic medical records, guaranteed issue and community rating, and health insurance mandates. From an individual's point of view, a mandate is tax, write the authors. By forcing people to buy a product they may not want at a price they cannot control, the individual mandate functions as a potentially unlimited tax for health insurance. It also ignores the fact that having health insurance does not guarantee medical care — which is a particular problem in government programs with reimbursement rates so low that physicians and hospitals choose not to participate. Excessive government regulation cripples markets for individual health insurance, increases health insurance costs for large numbers of people, expands dependence on government programs, and slows innovation in health care delivery and coverage, conclude Gorman and Jensen. Sound health reform should include the key elements of competition, consumer control, and deregulation. The Heritage Foundation's Bob Moffit describes six key tests for state health reform and writes that there is one overarching policy goal that should unite legislators seeking to develop and implement conservative or free-market reform: The legislative changes would shift the locus of decision-making to individuals and families, and they — not insurers or the government or employers — should control the flow of health care dollars. A Bush Success (not that he gets credit) James C. Capretta and Peter Wehner, Ethics and Public Policy Center The success of the Medicare prescription drug benefit will rank as one of George W. Bush's best domestic legacies, write Capretta and Wehner. Now in its third year, the drug benefit is working better than predicted. More than 1,800 private plans are competing for enrollment and independent surveys show 85% of beneficiaries are satisfied with their coverage. The program's competitive design is holding down costs for the government as well. There are important lessons to draw from this experience, write Capretta and Wehner. For liberals it is that the greatest threat to public support for their ideology is reality. It's been said that you can prove the possible by the actual — and in this case, the "actual" is that sensible public policy can liberate markets to work in health care just as they work in every other area. For conservatives, they say there is a need to accept the reality of measured steps in health and entitlement reform. The best approach is to gradually introduce markets and individual choice and ownership without threatening the security of the known. To his credit, President Bush recognized early on that adding a new drug benefit to Medicare presented a rare opportunity to introduce competition into the program, and he seized it. The Risky Business of Regulating Risk Henry I. Miller, Hoover Institution Congress has been in a regulating mood for the past few years, spurring federal agencies directly or indirectly to pile new regulatory requirements (and inflated costs) onto myriad consumer products and activities, writes Henry Miller. But regulation has costs — both monetary and through the inhibition of innovation — which must be weighed against benefits. Some of the worst regulatory excesses occur when the government is exercising its "gatekeeper" role, in which it must grant permission before a product can be marketed, as is the case for pharmaceuticals and pesticides. Regulators of these products are highly risk-averse, often discounting or ignoring the costs of life-saving products that are delayed or abandoned. As a result of pharmaceutical regulators constantly raising the bar for approval, bringing a new drug to market now requires 12 to 15 years and costs more than $1 billion. Instead of overreacting to acknowledged failures of oversight, Congress and federal regulatory agencies should consider carefully how we can come closer to the ideal of finding the amount of regulation that is necessary and sufficient for a given product, process or activity, and of imposing costs that are commensurate with the societal benefits. Upcoming Events Medicare Forum Featuring HHS Secretary Michael Leavitt Grace-Marie speaking on The Dave Elswick Show The LBJ Centennial Conference: Medicare — Past, Present and Future Does Intellectual Property Benefit Public Health in Developing Countries? Bridging the Gap: Affordable Health Care for New York's Uninsured Concho Valley Community Media Relations Training on the Uninsured Engineering a Learning Healthcare System: A Look at the Future Grace-Marie Turner speaking on the Talkback Show Grace-Marie Turner speaking on the Unraveling The New World Order Show National Walk@Lunch Day Ask the Experts: A Public Plan Option Under Health Reform Consumer Health World Conference Is the Grass Really Greener? A Look at International Health Care Systems Public Forum on Medicare & Medi-Cal Building Blocks for Universal Health Care in New York: Bridging Coverage Gaps with Information Technology 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.
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single payer, Medicaid, Medicare, Angell, HSA, Clinton, Obama, Grace-Marie Turner, Mark Pauly, social media, state reform, President Bush, Part D, prescription drug program, regulation, Leavitt
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Single Payer April 18, 2008
Good News and BadThe House passed legislation on Tuesday, the mis-named "Taxpayer Assistance and Simplification Act," that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts. But the good news is that the White House sent a letter to Congress warning that President Bush would veto the tax bill if it contains the HSA provision.
Upcoming Event And be sure to mark your calendars to join us for our major Medicare forum in Washington on April 29. It will feature an address by HHS Secretary Michael Leavitt on "Drifting toward Disaster" and a distinguished panel of experts offering diverse ideas on "Solutions for Sustainability." We will send you a separate email shortly with your invitation, but please do mark your calendars now to join us — 9:45 a.m., Tuesday, April 29, at the Newseum in Washington. HSA Threat The House passed legislation on Tuesday, the mis-named "Taxpayer Assistance and Simplification Act," that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts. But the good news is that the White House sent a letter to Congress warning that President Bush would veto the tax bill if it contains the HSA provision. Also, the Senate has shown no interest in the provision that would require verification of every HSA transaction in real time. At the very least, it should hold hearings on this measure to find out the real costs and implications. We may dodge a bullet this year, but it clearly shows that HSAs are vulnerable. The NFIB was not helpful on an issue that should be of great interest to small business. They issued a key vote letter that encouraged passage of the tax bill containing the HSA provision. Their letter offered an ambiguous statement about HSAs, but by saying this was a "key vote" that will determine how members are ranked in the NFIB rating, it put pressure on members to vote yes. The policy community is once again confused and upset about NFIB's position.
Real Insurance A new study from the Kaiser Family Foundation looks at the resources available to people who are uninsured and finds that "households with few assets cannot handle the cost-sharing requirements of many high-deductible health plan options." The study, by Paul Jacobs and Gary Claxton of Kaiser, is flawed in a number of ways:
Bottom line: Don't believe every headline you read!
Medicaid You will recall my testimony of two weeks ago about the administration's rules designed to curb some of the most obvious abuse of the Medicaid program. Well, the House Energy and Commerce Committee on Wednesday approved by a vote of 46-0 a bill that would stop the new rules from going into effect. Health and Human Services Secretary Leavitt warned that President Bush will veto the bill if it reaches his desk. The ranking Republican on the committee, Joe L. Barton of Texas, said he did not think Republicans would vote to sustain the veto. "I don't think the veto threat was appropriate, and I don't think it will be successful if vetoed, because the votes simply aren't there," Barton said. The wild card could be the Senate. Sen. Charles Grassley, ranking Republican on the Senate Finance Committee, does not support blocking the rules. "We ought to let them move forward instead of just delaying all of these Medicaid regulations all at once," Grassley said. So the Senate, of all places, may be the place we look to protect taxpayers from having Medicaid dollars be used for expenses that clearly are not medically-related, like transportation to bingo games, and for states determined to game the system.
BlackBerry Friendly I know when I am trying to read newsletters like this on my BlackBerry, the text is interrupted by strings of annoying links. But, when you read the newsletter on your desktop, the links and the nice graphics are welcome. We'd like to offer you a choice: If you would like to receive the newsletter in a text-only, BlackBerry-friendly format, we'd be happy to send it to you that way. Just send a quick note to Tara Persico at tara@galen.org and she will make the change here. Grace-Marie Turner Recent News Articles and Studies Medicare's Bad News: Is Anyone Listening? Medicare's Bad News: Is Anyone Listening? Unlike the mortgage crunch, Medicare's fiscal crisis does not seem real to most people. The difference in the public reaction to these two serious financial problems reveals three major issues with the way Medicare's bad news is communicated and perceived: it fails to connect on a visceral level with the public and the press; the trust fund concept in Medicare instills a misleading sense of confidence in the program's financing; and, no simple, easily understood number adequately captures the magnitude of Medicare's financing crisis. Yet, if the current trends continue, Medicare's Hospital Insurance trust fund will be depleted in 2019 and future generations will face a tax bill of $85 trillion to make good on the health care benefits promised to Americans. Antos suggests that structural reform — not merely tinkering around the edges of the current program — is needed. We need to replace Medicare's culture of entitlement, which distorts the decisions of patients and providers alike, with a culture of individual responsibility and efficient delivery of care. George Shultz and John Shoven's Big Fix Economist and former Secretary of State, Treasury, and Labor George P. Shultz has leapt into the reform fray with a bold new plan that aims not just to fix the health care system but also to solve the impending entitlement cost crisis and even to reinvigorate the economy, reports ReformPlans.com. Shultz and Stanford University economist John B. Shoven are co-authors of the new book, Putting Our House in Order. Their prescription includes more responsibility and authority for individuals, greater competition among insurers, and new kinds of "smart" means testing for public programs. Former Senators Tackle Health Issues Former Senate majority leaders Bob Dole, a Republican, and George Mitchell, a Democrat, may be facing their biggest challenge to date — reforming the nation's health care system, writes The Washington Post. The two senators said this week they would be joined by two other former Senate majority leaders, Democrat Tom Daschle and Republican Howard Baker, in crafting a series of health policy recommendations that would be delivered in 2009 to a new president and Congress. The senators will each oversee forums on four key pillars for reform: improving quality and value, improving access, ensuring a strong role for consumers, and finding a way to finance it. They will get technical advice from Dr. Mark McClellan, who recently oversaw the Centers for Medicare and Medicaid Services under President Bush, and Chris Jennings, former health advisor to President Clinton. While advisers will provide technical expertise, the senators stressed that they will be the ones responsible for the recommendations and will have final say on what's in the package. Sen. Daschle will lead the project's first health care forum on April 24 in Washington, D.C. 'Evidence-Based' Rx Miscues Hillary Clinton, Barack Obama and John McCain all favor increased federal funding for so-called "evidence-based" medicine to address the problem of escalating health-care costs, writes Pitts. The theory behind evidence-based medicine is simple: If government were to run clinical trials testing the effectiveness of drugs and medical technologies, and then use the results to determine what to cover, taxpayers would avoid paying for treatments that aren't effective enough to justify their price tag. Too bad that in practice, evidence-based programs are largely driven by the political imperative to cut costs — not the medical imperative to give patients the best care possible. Medical treatment should be based on the specific genetic, clinical and demographic factors of an individual patient. In an era of personalized medicine, one-size-fits-all health care strategies are dangerously outdated. Dollars to Doughnuts Diagnosis Many physicians feel that it's their mission to serve as many patients as possible rather than to provide the best care possible, writes Beverly Hills internist Albert Fuchs. Most significantly, doctors today are preoccupied with the bureaucracy of insurance companies. When Fuchs began his own private practice in internal medicine, volume grew quickly and so did his work hours. So he dropped an insurance plan — one that gave him the least compensation. Almost immediately, he had fewer patients but more time and energy for those he maintained. Like hundreds of doctors across the country, Fuchs now does not receive a single dollar from any insurance company. When doctors break free from the shackles of insurance companies, they can practice medicine the way they always hoped they could, he writes. And they can get back to the customer service model in which the paramount incentive is providing the best care. Code Red A few weeks ago, the Washington Post broke the dramatic medical news that as many as one third of all people waiting for an organ transplant are actually ineligible to receive one. Suggesting that the organ shortage is a manufactured crisis is misleading, write Satel and Hippen. Strikingly, most patients who are designated by their physicians as ineligible for immediate transplant were once fit enough to receive an organ. Tragically, they deteriorated during the years-long wait and became too sick to transplant. According to the United Network for Organ Sharing (UNOS), there are 98,517 people — transplant candidates — waiting for an organ. By summer, the queue will reach a daunting 100,000, with three quarters seeking kidneys. And the waiting time to renal transplantation is getting longer. Today it is five to eight years in major cities and by 2010 it will be ten years for some patients. With about one in three waitlisted patients on dialysis not surviving beyond five years, the majority of candidates just don't have that kind of time. This very trend is potent evidence why those who say the need is not so pressing are dead wrong. If the list had so many ineligible patients, then time-to-transplantation would be getting shorter not longer. Single-Payer Health Care for Maryland: Two Analyses This paper responds to a bill proposed by Maryland State Delegate Karen S. Montgomery (D-Montgomery), which would have established a "single payer" system in which the state would pay for all Marylanders' health care and no Marylander would be permitted not to participate in the system. Although the General Assembly did not adopt the Montgomery proposal, special interest pressure remains strong in Annapolis for government-financing of Marylanders health care. This report offers two analyses that address the flaws in a statewide universal health care system, including the high cost to the state budget that would inevitably lead to rationing of services by government officials. The study also issues strong warnings to Maryland from Cana | |