Faulty Math in CBO Senate Healthcare Bill Analysis
Published October 08, 2009 @ 06:00AM PT
Well, the CBO definitely got one thing right in its financial analysis of the Senate Finance Committee’s health bill. In commenting on Kent Conrad’s nonprofit co-op idea, it wrote that they "seem unlikely to establish a significant medical presence in many areas of the country." I already shared my opinion on co-ops as destined-to-fail recycling attempts.
Other than that, though, here is their 10 year breakdown of the bill:
- Cost: $829 billion
- Benefit: $81 billion in reduced federal deficits
- Coverage: Increase from 83% to 94% of Americans
- Uninsured Reduction: 29 million
- Missing: $200 billion in Medicare physician payment increases
- Risk: 15% low-income subsidy cuts to abide by Obama’s budget-neutral failsafe mechanism
The SFC bill’s lower cost sent House Democrats scrambling to reduce HR 3200’s cost under the $900 billion limit set by the president, even though their plan would cover 8 million more people than the SFC’s. Part of their strategy may be to move 7 million low-income individuals onto Medicaid instead of providing subsidies for private insurance.
Which brings me to my point. They realized something most of us haven’t. Much of the budgeting exercise has been based on faulty math because the largest cost factor is an unknown – private insurance costs. Higher education provides a useful, though painfully similar, example.
Whistleblowers Expose Hospitals Fleecing the Public's Back
Published October 07, 2009 @ 09:00AM PT
What happens when two whistleblowers separately expose widespread Medicare fraud to authorities? Other than nearly $90 million in fines, one wrongdoer loudly protests that she just lacked supporting documentation for the fraud.
Such is life in the case of medical device maker Medtronic Spine LLC and its hospital customers. After two former employees alerted the Justice Department of a scheme that ran from 2002-2008, Medtronic’s acquisition of Kyphon Inc. came back to haunt it with a $75 million fine. Kyphon made equipment and materials used to perform kyphoplasty. It promoted the procedure as a hospital money-maker if clients billed Medicare for inpatient rather than outpatient surgery.
Yes, in a cringe-worthy twist, hospitals were making decisions on inpatient versus outpatient status based on financial gain, not medical necessity. Just not according to Pamela Jones, St. Francis Hospitals’ chief legal eagle: "It is important to note that the probe had nothing to do with quality of care, patient safety or medical necessity ... the issue is that the documentation did not support the inpatient stay." Well Pamela, as for medical necessity, receipt of the lawsuit’s largest hospital fine for fraud ($3,158,629) would suggest otherwise. And I would hope St. Francis wasn’t jeopardizing patient safety and providing low-quality care while fleecing the public.
Senate Finance Committee Weakens Insurance Exchanges
Published October 06, 2009 @ 06:00AM PT
Goings-on in Maine are taking a deserved media hammering this week. First Brave New Films puts out a hard-hitting clip about Wellpoint suing the state to increase its profits. Then it leaks out that last Thursday, Maine Senator Olympia Snowe was the main reason Massachusetts Senator John Kerry's amendment to strengthen insurance exchange consumer protections in the Senate Finance Committee (SFC) bill didn't pass. I'd hate to find out those two things are related.
First, a little background. Maine is a guaranteed issue state, meaning insurers may not deny you coverage based on health status. They must also offer policies with standard benefits, co-payments, and co-insurance, and may only exclude pre-existing conditions for 6 months (this is sounding pretty good, no?) Anthem, a Wellpoint subsidiary, in return asked the state of Maine to guarantee it at least a 3% profit margin off its just 12,000 members. Maine said no. So Anthem is suing the state.
Now, about Kerry's proposed SFC bill amendment. Called "Empowering State Exchanges to be Prudent Purchasers," it sought to protect consumers with stronger state standards for insurance exchanges. HR 3200 and the Senate HELP bill have these protections built in; the SFC bill creates more of a Wild West of insurance exchanges. Just what we need.
3 Recycling Blunders in Failed Healthcare Policy
Published October 05, 2009 @ 06:00AM PT
Washington, D.C. denizens have done it again. Under the guise of innovative compromise, they have recycled Bush Jr.’s failed “Great Healthcare Bailout of 2002.” Never heard of it? Well, bailouts weren’t the Hollywood stars then that they are today. They called them strategies instead. This one went straight into the failed policy bucket.
Observe: In 2002, Bush tried giving away $40 million in grants to high-risk pools "as part of the Bush Administration's broad strategy for expanding access to health care for the more than 40 million Americans without health insurance." Um, the plan was to spend $1 per person? Really? But I digress.
Insurance Companies Are Cutting Their OWN Benefits: The Best of the Weekend
Published October 04, 2009 @ 10:10PM PT
Every weekend, I present the three articles or videos that best enhanced my own understanding of the myriad issues wrapped up in our national health care debate. All three selections this weekend made the list for one simple reason: much like the Spanish Inquisition, I don’t think anyone ever expected stories like these!
1.) Bloomberg, “WellPoint Cuts its Own Health Benefits as Recession Trims Sales”
In Will Ferrell’s celebrity-studded and satirical public service announcement, “Protect Insurance Companies,” actor Jon Hamme pointed out that health insurance companies needed to make millions and billions in profits... to pay for health insurance for their employees. Well, it turns out that’s not a joke. Given that WellPoint has also been at the forefront of creating “astroturf” consumer-friendly Web sites, ad campaigns and push polls to activate its customer base against health care reform, one could be forgiven for thinking this is but poetic justice.
The company will also raise deductibles and premiums for some of its employee health benefits, the Indianapolis-based insurer told workers in a memo today obtained by Bloomberg.
WellPoint, like its competitors, has seen health plan enrollment shrink this year as employers cut jobs and benefits amid the recession… In the memo from Randy Brown, WellPoint’s chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. “Your cost per paycheck will probably increase,” the memo said. WellPoint has 42,000 employees.
(By the way, in case you’re wondering what the heck the picture on this post is, it’s a “Medical Data Loss Dress,” designed to incorporate private medical data that WellPoint carelessly left unsecured on its Web site for 13 months. Good times.)
Read the full article on Bloomberg’s Web site.
2.) Swampland, “Bill Frist on Health Bill: I'd Vote For It”
So let me get this straight. Former Senate Majority Leaders for the G.O.P. Bob Dole and Howard Baker not only have spoken in favor of health care reform (and endorsed a plan through the Bipartisan Policy Center that closely tracks the proposals in Congress), but now Bill Frist has, too? This would be the same Bill Frist who was not only one of the Republican Congressional leaders for years, but also was a heart and lung transplant surgeon? The one whose conservative credentials are so rock-solid he nearly ran for president last year? That Bill Frist?
And yet we’re thinking the chances of a Republican not from Maine voting for this same reform bill is between slim and none?
OK, just checking.
However, he strongly supports other aspects of the bill--most notably, its requirement that individuals be required to purchase coverage, if they do not receive health insurance through their employers or under government programs. And he also lauds the provisions that would eliminate practices that allow insurance companies to discriminate against people based on their health history, including pre-existing conditions.
Frist also faults some in his own party for injecting alarmism into the debate. "Clearly, the death panels and public plan arguments have been overblown," he says. Frist noted that Republicans themselves voted for a Medicare prescription drug bill that would have established a version of a public plan--with the government negotiating directly with drug companies--if private-sector competition had failed to materialize.
Read the whole blog post on Swampland.
3.) Nicholas Kristof, “Dad’s Life or Yours? You Choose”
There are so many basic injustices and indignities with the way our insurance industry operates, it’s hard to know where to begin. But clearly at the top of the list is the injustice of rejecting coverage for those with pre-existing conditions -- discriminating against the very population most likely to need health care, because they’re most likely to need care. Kristof today supplies a dramatic example where pre-existing conditions actually impeded two generations from getting the care they need and the preventative care they still might need.
Mr. Waddington has polycystic kidney disease, or PKD, a genetic disorder that leads to kidney failure. First he lost one kidney, and then the other. A year ago, he was on dialysis and desperately needed a new kidney. Doctors explained that the best match -- the one least likely to be rejected -- would perhaps come from Travis or Michael, his two sons, then ages 29 and 27.
Travis and Michael each had a 50 percent chance of inheriting PKD. And if pre-donation testing revealed that one of them had the disorder, that brother might never be able to get health insurance. As a result, their doctors had advised not getting tested. After all, new research suggests that lack of insurance increases a working-age person’s risk of dying in any given year by 40 percent.
“At the time David needed a transplant, the people closest to him couldn’t even offer a lifesaving donation -- for insurance reasons,” said Mr. Waddington’s wife, Susan.
Read the full column at NYTimes.com
[Programming note: This is my last blog post as the primary editor of this cause for Change.org. Thanks for reading! However, I’m leaving you in the more than capable hands of Gillian Hubble. I’ll be guest blogging in this space in the weeks and months to come, though not at my usual frequency. Whether you’re a health care reform skeptic or activist, we are truly in unprecedented times. There simply has never been as good a chance of having a comprehensive health care reform bill passed by Congress and signed by a president. But stay vigilant and stay active -- we still have a long way to go, and much work to do to ensure it’s a bill we can all be proud of.]
(Photo credit: http://www.flickr.com/photos/plurimus/ / CC BY 2.0)
Making the Opposition to Reform a Punchline
Published October 04, 2009 @ 07:33AM PT
The disruptive town halls made for good theater on the nightly news, but scarcely seem to have made a dent in the momentum for health care reform. Once the hot August was over, the president made his address to Congress, Sen. Max Baucus got off the dime and released his bill, and we were back in business. A march on Washington by some million 100,000 50,000 people with a somewhat incoherent message that didn’t do anything to impede progress, or even slow it down. And now that the Senate Finance Committee has all but completed its work, we’re moving to unprecedented floor debates in the House and the Senate.
So what did they accomplish, other than ratings? Well, they seem to really have challenged progressives to open up their vast reservoir of sarcasm.
The rock video “We’re Number 37” was of course a direct reaction to the town halls. This new video, “Don’t Ruin American Healthcare” is more of a direct-to-camera PSA, in the style of Will Ferrell’s “Protect Insurance Companies.” But it doesn’t take much to take some of the actual talking points you hear from regular people whipped into a furor over the prospects of reform, and make them laugh-out-loud funny.
When Healthcare Polls Go Bipolar
Published October 03, 2009 @ 06:00AM PT
Color me confused. First I encounter the headline “Poll: Support for Government Health Insurance Declines a Bit”, released just in time to justify the Senate Finance Committee voting down the public option. Then I discover another headline, “Public Support for Reform Legislation Shows Small Rise”.
So which is it? Are we climbing the hill or sliding back down?
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