Note: This post comes from my new blog reforminghealth.org I have left The Century Foundation and can be reached at nfreund2@gmail.com
Out of the rubble of the failed budget deficit negotiations, it seems a new movement is afoot to transform Medicare into a “premium support” program with the goal of moving more seniors and the disabled into the private insurance market.
Earlier this week, as the Supreme Court continued to mull over which of the four legal challenges to the health reform law they will choose to tackle, I found out that, in fact, there could be a “silver lining” to the repeal of the individual mandate—the requirement that all Americans purchase health insurance.
In a post on Politco, Jennifer Haberkorn writes that some “Democrats and supporters of the law” believe that if “the least popular part of the law goes away, they think what’s left could become stronger and more popular with the public.”
If the demise of CLASS has any greater meaning, perhaps it will serve as a wake-up call for Americans that we need an enduring solution to the long-term care problem. The CLASS legislation, part of the Affordable Care Act, would have created a voluntary, long-term care insurance program that could eventually provide a modest benefit to its enrollees—up to $75 per day to help pay for assistance in carrying out daily activities, a health aide, medical supplies, or to help defray the yearly costs of living in a nursing home.
Over the past decade, state laws restricting abortion have mostly focused on trying to reduce demand for the service. Some states do this simply by making abortion financially out of reach: The average cost of a first-trimester surgical abortion is $451, and in all but fifteen states Medicaid will not pay for low-income women to have the procedure.
Sen. Orin Hatch (R-UT) called it a “Ponzi scheme,” President Barack Obama held it up as a testament to the work of Ted Kennedy who wanted to ensure that the elderly and disabled would be able to afford help with simple activities of daily living; Rep. Phil Gingrey (R-Ga.) simply called the program “insolvent.”
Over the past decade or so, there have been at least 20 prescription drugs removed from the market, including several cases of high-profile blockbuster drugs that were found to be harmful only after millions of patients had taken them. Vioxx, the pain reliever sold by Merck is one example; taken by an estimated 20 million Americans, it increased the risk of heart attack and stroke in some patients. The company ended up paying out a $4.85 billion settlement after the drug was pulled from the market in 2004. The diet drug Meridia, also linked to a higher risk of heart attack and stroke, was on the market for over 12 years before it was withdrawn last year. According to the watchdog group Public Citizen, drugs taken off the market since 1993 were sold for an average 4.1 years before being pulled.
Should private citizens be allowed to sue their state Medicaid programs for imposing rate cuts on doctors and other providers? That’s the question the Supreme Court is currently considering in Douglas v. Independent Living Center of Southern California, a case that pits California’s Medicaid program against providers and beneficiaries who charge that rate cuts force so many doctors, hospitals, pharmacies and other health care providers to drop out of the program that the poor, elderly and disabled no longer have adequate access to necessary medical care.
According to a new survey, nearly half of primary care physicians believe that their patients are “receiving too much care;” mostly in the form of unnecessary tests and referrals to specialists. More than one-quarter of these doctors believe that they themselves are practicing too aggressively, and they tend to blame the fear of malpractice suits for their actions. Meanwhile, when asked about their colleagues; including nurse practitioners and medical sub-specialists like cardiologists, allergists, gastroenterologists, etc., the surveyed doctors indicated that financial incentives were most likely driving over-treatment.
When the health reform bill was passed in 2009, it looked like the end of the gravy chain for Medicare Advantage plans; the privately-run health care plans that are sold to seniors as an alternative to traditional, government fee-for-service Medicare. The Affordable Care Act cuts $136 billion over 10 years from Medicare Advantage, following years of concern over the fact that the plans cost the government about 14% more (about $12 billion a year) than traditional Medicare. These overpayments allowed MA plans to offer perks like vision, dental and prescription benefits as well as lower out-of-pocket costs for some subscribers. Now about one-quarter of all seniors are covered under these plans.
In President Obama’s new deficit reduction plan, he makes the following promise:
“Most importantly, we can make modest adjustments to strengthen Medicare and Medicaid in a way that does not undermine the fundamental compact they represent to our Nation’s seniors, children, people with disabilities, and low-income families. The Administration’s proposals will save approximately $320 billion over the next decade. As these reforms save money, they also will strengthen these vital programs so that they are robust and healthy to serve Americans for years to come.”
Saving money through modest adjustments while strengthening vital programs—sounds like a perfect vision for the future of government health care. But will this actually be the case for the beleaguered, but extremely necessary, Medicaid program?
Obama proposes to save $66 billion from Medicaid by taking the following actions: “limit State financing practices that increase Federal spending, replace complicated matching formulas with a single matching rate specific to each State, and strengthen Medicaid program integrity.”