Medicare Moves to More Cuts

It is announced that another 21% cut in reimbursement to health care providers will begin soon according to a report on NPR this morning. What Health Law Didn't Fix: Medicare Doctor Pay

You may wish to look for one of our informative "Healthy Options" classes.  You can book a program for your community too.  We've been teaching these community and corporate wellness programs since 1995.

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Health Insurance Reform: ACTUARIAL IMPACT ON MEDICARE

UPDATE: How Health Care Is Hampering Economic Recovery

by GoozNews ~ 27 Aug 2010 09:02am

Reed Abelson over at the New York Times' Prescription blog has an interesting reporton a new study questioning Detroit's strategy of relying on health care to bolster its lagging economy. I posted the following comment:
Detroit is merely a microcosm of the nation as a whole. Health care is the only sector that has added jobs throughout the Great Recession, just as it added jobs throughout the previous two decades (see my article in The Fiscal Times here).
What nobody wants to look at is how it continues to do so regardless of economic conditions. The answer is simple. There are no constraints on spending. Providers through insurers pass on rising costs to businesses and consumers in a marketplace where demand elasticity is very low because demand is dictated by the supply side (i.e., doctors/hospitals/input industries prescribe, patients obey).
It's like Keynesian stimulus with one vital exception, which turns it into its opposite. When the government engages in deficit spending to stimulate demand, it borrows from the future. When the health care sector engages in automatic demand-driven cost increases, it takes its cash in real time from every other sector of the economy, including the government. That may be acceptable when the rest of the economy is growing. During recessions, like now, it becomes a major drag that hampers economic recovery.

UPDATE: 25 August
Anthem Blue Cross allowed to move ahead with rate hikes

California insurance regulators cleared the way Wednesday for Anthem Blue Cross to implement scaled-back rate hikes after a previous rate increase was canceled amid an uproar over its size.
Anthem said it intends to put the new rates -- averaging 14% and as high as 20% -- into effect Oct. 1 for nearly 800,000 individual California policyholders.
The Woodland Hills company backed off its initial plan to increase premiums in March as much as 39% after consumers, regulators, lawmakers and even President Obama criticized it. Insurance regulators say the six-month delay saved policyholders $180 million. Anthem is the state's largest for-profit insurer.

from John Goodman's Health Policy Blog, 21 August
For the first time in Medicare history, the Medicare Chief Actuary has called the projections in a Medicare Trustees Report “unreasonable” and “implausible” and encouraged everyone to ignore them and view instead an “Illustrative Alternative” report. The alternative opens this way:
The Trustees Report is necessarily based on current law; as a result of questions regarding the operations of certain Medicare provisions, however, the projections shown in the report do not represent the “best estimate” of actual future Medicare expenditures.

and from the FDA

Slight Increase for Medicare Drug Premiums Next Year
Medicare beneficiaries enrolled in Part D will pay an average of $30 per month for their prescription drug benefit premiums in 2011, a $1 increase over what they paid this year, according to Centers for Medicare and Medicaid Services (CMS) officials.
Premiums stayed relatively stable because of a discount program in the the healthcare reform law, Jonathan Blum, deputy administrator of CMS' Center for Medicare, told reporters Wednesday.Cost will remain about steady, and so will benefits, said CMS Administrator Don Berwick, MD.
The low rates will "add stability" to the Medicare Part D program, which has an enrollment of about 27 million seniors, Berwick said.
When Part D first began, the program was projected to cost $634 billion for fiscal 2004 through 2013. Instead, it will cost $373 billion for those same years, Paul Spitalnic, of CMS' Office of the Actuary told reporters.
The main reason for the program coming in $261 billion under projected costs is that the rising costs of prescription drugs slowed in the early 2000s and more people switched to generics, explained Spitalnic.
In addition, Part D plans have been able to negotiate more drug rebates than anticipated, and fewer beneficiaries enrolled than the government originally predicted.

More to consider re: Health Reform

A time to consider taking responsibility for your health.  You can do it!

Seniors wary of health overhaul impact on Medicare

N.Y. Times columnist: Death panels will save 'a lot of money'

Health Care Battle Ends; War on Social Security Begins 

Refer to this article for more information.

Health Insurance: Update on Current Issues

If you believe this is just a fluke with or without health insurance reform, be prepared for more.
Blue Shield of California is accused of overcharging for safety-net insurance
A Los Angeles woman says in a lawsuit that the health plan exceeded the state's maximum rates for policies sold to people who have lost their jobs or who have preexisting medical conditions.

By Duke Helfand, Los Angeles Times
July 8, 2010

A Los Angeles woman sued Blue Shield of California on Wednesday, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety-net insurance for people who were sick or jobless.

Amalia Lample said in her lawsuit that Blue Shield, the state's second-largest not-for-profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.

Lample, 64, argued that she is owed $4,475 in excess charges she paid from 2007 to 2009. She said that more than 6,000 Blue Shield policyholders with similar coverage also were overcharged since 2001.

"This is for justice. It's not only for the money," said Lample, who decided to file her lawsuit in Los Angeles County Superior Court after reading a story in The Times about Blue Shield's rates. "It's not right what they do."

Blue Shield spokesman Tom Epstein said the San Francisco company had no immediate comment on the lawsuit, which seeks class-action status.

Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.

But Wednesday a department spokeswoman said the law's definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much.

The department is sponsoring a bill in the Legislature to "eliminate any question" on rates insurers can charge, said the spokeswoman, Lynne Randolph.

At issue is health coverage available under the federal Health Insurance Portability and Accountability Act, or HIPAA. Insurers are required by the federal law to sell insurance to people who have lost their jobs or who would otherwise be ineligible because of preexisting medical conditions.

HIPAA policyholders maintain that Blue Shield and one of its chief competitors, Anthem Blue Cross, have substantially overcharged subscribers for several years.

Blue Shield has long maintained that its HIPAA rates comply with state guidelines.

Anthem determined that it had overcharged customers between 2006 and 2009, and agreed to issue refunds.

But one policyholder, Culver City attorney Les Greenberg, accused Anthem of returning only a fraction of what was due. Anthem had given Greenberg a $12 refund. He took the company to Small Claims Court. A judge agreed in September, awarding Greenberg more than $7,300.

Greenberg filed a lawsuit in December on behalf of another Anthem subscriber, saying the insurer owed additional refunds to more than 10,000 HIPAA policyholders. Anthem issued a statement Wednesday saying its refunds were "appropriate."

Greenberg also is representing Lample in the lawsuit filed against Blue Shield on Wednesday.

"They have gone off on a lark of their own to overcharge their subscribers," he said of the two insurers. "I would call it egregious behavior."

duke.helfand@latimes.com
latimes.com/news/la-fi-blue-shield-20100708,0,1302403.story Copyright©2010, The Los Angeles Times

And at the same time Big Insurance is taking you to the cleaners, the new "health czar" at Medicare/Medicaid wants redistribution of wealth -

You looking to boil your own blood this morning, watch this video. Donald Berwick, Obama’s recess appointment to be the administrator of the Centers for Medicare and Medicaid Services says (with a straight face) “Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
http://www.thetradingreport.com/2010/07/08/your-new-healthcare-czar-we-must-redistribute-wealth/

Health Insurance Rewards More for Procedures Than Real Care

Are you wondering why Congress blocked Medicare reimbursements?

I thought this was quite a good report on the current state of health care.  The problem as I see it is that this mentality has been the mainstay of Medicare and Big Insurance since the "managed care" movement moved in with gusto in the 80s.

I just hop my readers will take heed and realize this is what you are up against in regard to REAL health care reform.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

Complete article:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html

Medicare: Coming Accessibility Crisis

In 1995 I started teaching a series of health education programs for Elders known and well-respected as "Healthy Options".  The program originally were sponsored by Secure Horizons and later were offered at community colleges, for business and government, as well as community organizations. One of the most popular versions was "Healthy Options for Seniors".  I even had 'groupies' that would go from place to place to hear me speak.  Of course this is what I have been advocating for decades, learn what you can do for your health, and please learn it from the best resources!   Learn more about "Healthy Options"

Access to medicine in question for future Medicare patients who suffer from disabling hip and knee arthritis

ScienceDaily (2010-06-01) -- Healthcare reform -- and the many options for fixing a broken system -- have appeared in the news headlines for months. According to a new article, Medicare patients -- many who suffer from disabling arthritis of the hip and knee, among other age-related ailments -- may end up facing an accessibility crisis to medical care. ... > read full article