JustCare

Tag: Medicare

  • Government drug price negotiation is top policy issue for a strong majority of Democrats and Republicans

    Government drug price negotiation is top policy issue for a strong majority of Democrats and Republicans

    A new poll of likely voters shows that allowing government drug price negotiation ranks as the top policy issue for Americans.  A Medicare buy-in for all ranks eighth and expanding Social Security benefits ranks 13th.  Based on poll results, economic security issues are of paramount concern to Americans.

    More than three quarters of likely voters, 79 percent, support government negotiation of drug prices.  Almost 90 percent of Democrats (89 percent) support government drug price negotiation and more than three-quarters of Republicans (76 percent). Of note, the question posed concerned lower drug prices for people with Medicare and Medicaid and not everyone in the country.  Every other wealthy nation negotiates drug prices for all its residents.

    Seven out of ten likely voters (71 percent) support giving all Americans the choice of buying into Medicare as a way to drive competition in the health insurance marketplace. More than three quarters of Democrats (77 percent) support this policy, along with a healthy majority of Republicans (63 percent).

    Seven out of ten likely voters (70 percent) also support expanding Social Security by having wealthy Americans pay Social Security contributions throughout the year, like everyone else.  Eighty-five percent of Democrats support this policy, as do a 62 percent of Republicans.

  • Significant drop in hospital infection rates since 2010

    Significant drop in hospital infection rates since 2010

    When we’re hospitalized, most of us worry about getting good treatment for the condition for which we were admitted. But, it’s important to understand that far too many people acquire an infection while hospitalized that is completely unrelated to the reason for their admission. The good news is that a new report from the Agency for Healthcare Research and Quality (AHRQ) reveals a 17 percent drop in hospital infection rates and other hospital-acquired conditions (HACs) between 2010 and 2013.

    According to AHRQ, about 1.3 million fewer people contracted HACs during that time, and about 50,000 fewer people died in hospital as a result.  Though the exact causes for this drop in HACs is not known, AHRQ believes that Medicare payment incentives and HHS’s Partnership for Patients Initiative led to heightened hospital attention to patient safety.

    Hospital-acquired conditions can take several forms and be costly to treat.  Among other things, they can be falls, pressure ulcers, adverse drug events, surgical site infections, central line infections, catheter-induced urinary infections or ventilator-induced pneumonia. AHRQ attributes different costs to treating each HAC. For example, AHRQ estimates that each case of pressure ulcers costs  $17,000 to treat and each adverse drug event costs $5,000. Reducing their frequency in 2011, 2012 and 2013 led to a cumulative cost savings of just shy of $12 billion.

    The reduction in adverse drug events was almost as big as the reduction in all other HACs.  Hospital rates of adverse drug events dropped almost 44 percent over three years.  By comparison, pressure ulcer rates fell 22 percent.But, the reduction in pressure ulcers contributed most significantly to the number of lives saved.  The 22 percent reduction in pressure ulcers saved an estimated 20,272 lives; the 44 percent reduction in adverse drug effects saved an estimated 11,540 lives.

    Medicare’s focus on addressing the HAC problems that the HHS Office of the Inspector General surfaced in 2010 seems to have paid off.  Back then, the Office of the Inspector General reported that almost three in 10 Medicare patients (27 percent) had been harmed as a result of care they received in hospital.

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  • Most Americans want the choice of a government-administered health plan, like Medicare

    Most Americans want the choice of a government-administered health plan, like Medicare

    A December 2014 New York Times/CBS News poll shows that almost six in ten Americans (59 percent) favor the choice of a government-administered health plan like Medicare. Health-care costs have become prohibitive for many. Americans want to see new solutions to rising costs.

    Today, almost half of all Americans (46 percent) are finding it a hardship to afford medical care. That’s up nearly 30 percent from last year (36 percent).   Out-of-pocket costs have risen in the last few years, according to about half of the survey respondents.  And, one third of Americans say they have risen a lot.

    Almost three quarters of those surveyed say that treatments have become more expensive. Increasingly, health plans are requiring people to pay a percentage of the cost of care rather than a small flat rate.

    Slightly more than half of respondents (56 percent) said that they were as likely to go to the doctor now as a few years ago.  And, some (18 percent) said that they were more likely to get care.  But, almost one in four (24 percent) said that they were less likely to see the doctor today.

  • Americans with Medicare are most satisfied with our health care system

    Americans with Medicare are most satisfied with our health care system

    According to two Gallup polls over the last year, people over 65 with Medicare are more satisfied with their health insurance than people under 65 with commercial insurance.

    One poll found that people with government-provided health insurance, including people with Medicare and VA coverage, are more satisfied with their health care coverage than other Americans.  Almost four out of five people 65 and older are satisfied with their treatment by the health care system (79 percent of people with Medicare, Medicaid and VA coverage) as compared with about three out of five people between 18 and 45 (61-66 percent).

    More specifically, people without health insurance are the least satisfied with the health care system (36 percent). People with military or veterans coverage are the most satisfied (77 percent) and people with Medicare or Medicaid are the next most satisfied (76 percent).For this survey, Gallup did not separate out satisfaction rates for people newly insured in the health insurance exchanges.  They plan to do so in future polls as soon as practicable.

    The survey also does not speak to the reasons why people over 65 are more satisfied with the health care system than the rest of the population.  Joe Baker, president of the Medicare Rights Center, speculates it’s because Medicare and Medicaid coverage are easier to use than private insurance and in most cases provides better protection against financial risk.  “For sure, Congress can improve Medicare.  But, compared with the hassles of referrals and huge copays and deductibles with private insurance, Medicare is relatively simple.”

    The second survey reveals again that people over 65 are more satisfied (79 percent) with our health care system than any one else.  It further shows that people with health insurance are far more satisfied with the health care system (70 percent) than people without health insurance (37 percent). Interesting, Democrats and Democratic-leaning independents are more satisfied with the health care system (74 percent) than Republicans and those who lean Republican (60 percent).

  • Medicare’s future is bright

    Medicare’s future is bright

    In the second part of his presentation to the National Academy on Social Insurance, Medicare and Medicaid: The Next 50 Years, Princeton health economist Uwe Reinhart sees great promise in Medicare’s future.  He makes mincemeat of all the “serious people” who worry about Medicare’s sustainability because the U.S. population is aging.Today, people over 65 represent 14.7 percent of the population and in 35 years, 2050, that percentage will jump to 20.3 percent. If real inflation adjusted GDP per capita grows at 1.5 percent annually, Medicare spending will account for 8.7 percent of the nation’s gross domestic product (GDP) in 2050, up from 3.6 percent in 2005.  The “serious people” suggest that this is a serious problem. However, few of them publicly acknowledge that just as Medicare spending will grow, GDP will grow. In 2005, per capita GDP was $40,000; by 2050, per capita GDP will grow to $73,000.

    So, even with Medicare spending at 8.7 percent of GDP, in 2050, there will be a lot of additional money to spend to provide a financially secure, healthful retirement for Americans. We will have $66,600 of non-Medicare GDP per capita, up from $38,600.  In short, Reinhardt makes the case that we have the resources and the reason to strengthen benefits for people with Medicare if we want true retirement security to be part of the social contract.

    Not only that, there’s room for us to raise taxes without impeding economic growth.  In 2012, we had lower taxes as a percent of GDP than every country in the Organisation for Economic Co-operation and Development (OECD) except Mexico, at 24.3 percent.  Denmark’s is 48 percent and Canada’s is 30.7 percent.  And, the US has had lower economic growth than many other OECD countries with higher taxes.

    Most cynically, Reinhardt suggests that the moneyed interests may be our best allies in ensuring that Medicare remains strong – as long as they get a slice of the larger economic pie.  After all, Congress passed both Medicare and the Affordable Care Act after paying off powerful industries. Who knows – that just might get the serious people to change their tune.

  • Medicare controls costs while private insurers sit idly by

    Medicare controls costs while private insurers sit idly by

    In a presentation to the National Academy on Social Insurance that traces Medicare’s 50-year history, influential Princeton health economist Uwe Reinhardt explains how Medicare controls costs, despite the overwhelming influence of special interests in shaping Medicare when it was passed into law in 1965.

    We hear a lot of talk from the health insurance industry about how hard it works to hold down health care costs, but that claim doesn’t stand up to scrutiny. The surprising truth is that when insurance companies adopt new techniques to rein in health costs, they take their cues from the phenomenally successful Medicare program – all run by Uncle Sam.

    Congress was able to pass Medicare only by satisfying the demands of the American Medical Association and the American Hospital Association that doctors and hospitals be paid whatever they wanted to charge. You know what that gave us, exorbitant prices. In Reinhardt’s words these special interests made Congress “surrender to them the key to the Treasury.”

    For Medicare to become law, it would have to be a cash cow for doctors and hospitals. Wilbur Cohen, one of Medicare’s chief architects said: “I was required to promise before the final vote in the Executive Session of the House Ways and Means Committee that the Federal Agency [to be in charge of administering Medicare] would exercise no control.”  No one could question the necessity of the care provided or the prices charged.Despite these constraints, Medicare has still managed to do a far better job of containing costs than private insurance.

    Per capita health costs for people with Medicare have grown at an average annual rate of about 1.5 percentage points less than private insurance from 1969 through 2012.

    Reinhardt attributes Medicare’s slower cost growth to what the ultra-conservative American Enterprise Institute bitterly calls “Soviet-style pricing” – even though the pricing schemes were imposed by Ronald Reagan and George H.W. Bush. As a result, Medicare today has cast off the shackles of the 1960s and now controls most of the prices it pays. This is in sharp contrast to private insurance companies, who until the Affordable Care Act simply raised rates any time they pleased.Some people object to the way Medicare sets prices.

    But, Reinhardt notes that the methodology and the prices are fully transparent, unlike with private insurance. Medicare has been the chief innovator on pricing, leading the way for everyone else. Private insurers and other nations have copied many of our government’s approaches to pricing for Medicare.

    Yet that that doesn’t prevent hospitals from setting their prices for everyone not yet eligible for Medicare arbitrarily, driving up costs. Reinhardt shares a 2004 quote from William McGowan, then chief financial officer of University of California-Davis Health System, a 30-year veteran of hospital financing: “There is no method to this madness. As we went through the years, we had these cockamamie formulas. We multiplied our costs to set our charges.”

    And as we often have seen, insurers have little negotiating power with the hospitals—especially the biggest and most prestigious ones. That’s why prices for the same procedure vary considerably in different regions and often within only a few miles.

    Because insurers cannot or will not rein in provider fees, those not yet eligible for Medicare are left holding the bag as deductibles and copayments climb. Some call that consumer-directed health care.  We might want to call that insurer-mandated costs.

    This slide speaks volumes:6317357_orig

    In part two, we share Reinhardt’s insights on Medicare’s future.
  • How Obama’s 2016 proposed budget hurts older Americans

    How Obama’s 2016 proposed budget hurts older Americans

    The President’s 2016 proposed budget hurts older Americans with Medicare. While it contains many commendable proposals, it mistakenly buys into the philosophy that it’s OK to tax older Americans (make them pay more) and keep them from getting care if they are unable to afford the Medicare deductible or the copays.  President Obama proposes to raise the Medicare deductible, impose a copay on home health care services and increase premiums for many older adults already at risk.  If that’s not bad enough, he wants people to pay extra for a Medicare supplemental (Medigap) policy that ensures full coverage for their care.

    Think again, Mr. President. High deductibles and copays are simply ways to ration care based on people’s ability to pay. They impede access to needed care for the most vulnerable Americans in two sinister ways.  First, they keep many older adults from getting care altogether, essentially forcing them to endure a poor quality of life and possibly contributing to their premature death.  Second, they undo the larger purpose of insurance, concentrating risk and costs among those who need a lot of care rather than spreading risk among everyone.

    People with Medicare already typically spend a large chunk of their incomes on health care costs Medicare does not cover.  The latest data from Kaiser Family Foundation reveals that in 2010 the typical person with Medicare spent almost $5000 out of pocket.  People over 85 spent an average of nearly $6000.  And, people with Alzheimer’s spent an average of $8305.

    There’s a just and fair way to reduce Medicare spending further without shifting more costs onto older adults—insist the government negotiate with pharmaceutical and medical device companies on the prices we taxpayers pay for prescription drugs and devices, now the highest prices in the world. That would save Medicare billions of dollars. Yes, the President proposes giving the Department of Health and Human Services the authority to negotiate prices for biologics and select high-priced drugs. This is good but the authority needs to be comprehensive and include all drugs.

    Imposing additional costs on America’s oldest generation, the overwhelming majority of whom live on small fixed incomes, is unconscionable. Look at the data. Isn’t it time we limited out-of-pocket costs for people with Medicare to ensure they receive needed care. Increasing their costs only guarantees that more of them will struggle to get by.

  • Hospitals poor on patient safety that you might want to avoid

    Hospitals poor on patient safety that you might want to avoid

    You should think twice before using hospitals poor on patient safety. Medicare recently penalized 721 hospitals in the United States for their high rates of avoidable infections and complications.  These hospitals ranked in the bottom 25 percent of hospitals surveyed.

    Medicare looked at two different types of avoidable infections–certain blood-stream infections and certain urinary tract infections. It also looked at avoidable complications that result from eight different types of injuries, including bed sores, falls, and blood clots.

    For a list of the hospitals penalized, click here.  Earlier this year, Medicare penalized 2610 hospitals for high readmission rates.  In Medicare’s view, these hospitals should have done a better job of caring for patients when they were first hospitalized so as to avoid their need for readmission.

  • A crash course in 5 important health insurance terms

    A crash course in 5 important health insurance terms

    As if you didn’t already have enough to think about, you need to understand a sea of insurance concepts to keep your health care costs down. Here are five terms you should definitely know.

    1. Premium—what you have to pay each month for your health insurance.
      • If you have Medicare and are receiving Social Security benefits, the government will take your Part B premium out of your Social Security check—nothing to think about there.  But, if you have Part D drug coverage, you’ll likely have to pay that premium by check directly to the insurance company.  And, if you’re buying your own supplemental insurance, you’ll need to pay that premium as well.
      • If you’re in a Medicare Advantage plan, you’ll probably need to pay an additional premium to the insurance company offering that plan.
      • If you have coverage through the Affordable Care Act (ACA), you’ll have to pay that premium but may be eligible for a government subsidy based on your income.  Use this tool from the Kaiser Family Foundation to calculate the amount of your premium that the government will pay for.
    2. Deductible—what you have to pay out-of-pocket for your care before the insurance starts paying. 
      • If you have traditional Medicare, there is a small deductible for your Part B coverage for medical services and a large hospital deductible as well, both of which you’ll have to pay unless your supplemental coverage picks those up.
      • If you’re in a Medicare Advantage plan, an ACA plan, or an employer HMO or PPO, you’ll need to check on deductibles.  Often, insurers charge a deductible for in-network care and a separate deductible for out-of-network care.  And, if you’re premium is very low, your deductibles could be very high.
    3. Copay—a fixed fee that you pay for a particular service.
      • If you’re in a Medicare Advantage plan or an ACA or employer plan and seeing an in-network doctor, your copay will be a set amount of money that represents your share of the doctor’s charge.
    4. Coinsurance—a fixed percentage that you pay, based on the amount your insurer pays. 
      • If you have traditional Medicare and supplemental insurance, the supplemental insurer will pick up the coinsurance for all the services it covers.
      • If you are in a Medicare Advantage plan or an ACA or employer plan and seeing an  out-of-network doctor, your coinsurance will be a percentage of the doctor’s bill.
    5. Covered services: Insurers only pay for the services they cover.  Before you see a doctor, go to a hospital or use an ambulance, check to make sure that the insurer covers services from those providers and under what conditions.
      • Traditional Medicare covers services from most doctors and hospitals anywhere in America.
      • But, if you are in a Medicare Advantage plan or an ACA HMO or PPO, your coverage for routine care may be limited to your providers in your community. Sometimes, you will need prior approval from the insurer or a referral from your doctor in order for your services to be covered.
    If you like this, you might like these:
    Many Americans do not have a good understanding of how their health insurance works 
    How to keep your out-of-pocket costs down if your income is low and you have Medicare
    How to choose between traditional Medicare and a private Medicare Advantage plan
    What’s your Medicare Part B premium and deductible?
    What’s your Medicare Part A deductible?
  • Medicare Trustees project Medicare Trust Fund to last until 2030 

    Medicare Trustees project Medicare Trust Fund to last until 2030 

    Medicare is in relatively good financial health for the moment. In their 2014 report, the Medicare Trustees project Medicare’s trust funds to last four years longer than projected a year ago.  Medicare is succeeding at reining in health care costs.  Medicare Part A, whose costs are covered by the Medicare trust fund, spent less per individual with Medicare in 2013 than in 2009.

    Thanks in large part to lower than expected Medicare costs in 2013, the Trustees project that Medicare will continue to have adequate financing until 2030.  Put differently, the Medicare trust fund, which covers Medicare Part A costs—primarily for hospital and nursing home services—is projected to last longer than ever before projected.

    And, even if nothing changes between now and 2030, which is highly unlikely, the trust fund will still have funds to pay 85 percent of Medicare’s costs from people’s payroll taxes and other revenues after 2030.  

     

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    Note that Congress has always stepped in to shore up Medicare’s finances and guarantee older and disabled Americans health security.  Since 1970, the Trustees have made annual projections regarding the Medicare trust fund’s financial health and either the growing economy has extended the life of the trust fund or Congress has stepped in to ensure Medicare remains strong.