Report: Private Insurers Cost Medicare Billions In Excess Payments

(401(K) 2012/flickr)

The doctors over at Physicians for a National Health Plan, advocates of a single-payer system, sure are prolific researchers, and here’s the headline from their latest report: Private insurers have cost Medicare $282.6 billion in excess payments since 1985

From the group’s news release:

Researchers say privately run Medicare Advantage plans have undermined traditional Medicare’s fiscal health and taken a heavy toll on taxpayers, seniors and the U.S. economy

In the first study of its kind, a group of health policy experts has determined the amount of money that Medicare has overpaid private insurance companies under the Medicare Advantage program and its predecessors over the past 27 years and come up with a startling figure: $282.6 billion in excess payments, most of them over the past eight years.

That’s wasted money that should have been spent on improving patient care, shoring up Medicare’s trust fund or reducing the federal deficit, the researchers say.

The findings appear in a paper by Drs. Ida Hellander, Steffie Woolhandler and David Himmelstein titled “Medicare overpayments to private plans, 1985-2012” which they say is forthcoming in the International Journal of Health Services.

(Hellander is policy director at Physicians for a National Health Program, a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co-founders of PNHP.)

The work is timely because national proposals, notably from vice presidential candidate Paul Ryan (set to debate vice president Joe Biden tonight) rely on great expansions of private Medicare plans. Continue reading

Snapshot Of Obama, Romney Care From Guys Who Were There

(Updated at 3:50 pm with additional material.)

Let’s just get this out in the open: Jon Gruber has an agenda.

He really likes President Obama’s Patient Protection and Affordable Care Act. Heck, Gruber, the MIT economist, even wrote an entire comic book about the law (and served as an advisor to the president in developing the national plan). So, when he joins forces with Stuart Altman, professor of national health policy at Brandeis and John McDonough, director of the Harvard School of Public Health’s Center for Public Health Leadership to compare the “impacts of ObamaCare, RomneyCare, and RomneyCandidateCare on health care consumers in every state,” you’ve kind of got an idea of where they’re coming from.

Still, the comparison is useful in reinforcing their message with some numbers.

What the analysts found in comparing the president’s approach to candidate Romney’s “composite” set of health care proposals — which includes repealing the ACA — is this: ObamaCare is better all around because it helps more people gain access to health insurance and pay for their care.

As Gruber put it in a conference call with reporters today, ObamaCare and RomneyCandidateCare offer two “completely different” visions. “Rather than fixing the problem, RomneyCandidateCare will make things worse,” he said.

The full report is here. (Even the cover underscores the authors’ perspective with a photo of Obama next to two pictures of Romney, each facing a different direction. To me it screams “flip-flopper.” Am I alone here?)

(Families USA)

Still, there is serious content inside. Continue reading

Brown And Warren On Health Care: Two Views Of The Problem

He doesn’t want to turn Medicare into a voucher program (like many of his GOP colleagues) — neither does she. He wants to cut “waste, fraud and abuse.” She wants to cut costs.

GOP Sen. Scott Brown and Democrat Elizabeth Warren offer different perspectives on fixing the health care system

WBUR’s Martha Bebinger offers this portrait of the two U.S. Senate candidates from Massachusetts — Republican Sen. Scott Brown and Democrat Elizabeth Warren — and their differing views on health care:

Brown does not support the Romney-Ryan plan to turn Medicare into a premium support (some call it a voucher) program with seniors buying coverage on their own.

Nor does Warren, who says the main problem with Medicare “is the rise in health care costs, and we’ve got to bring health care costs under control for everyone. And so the question is how we provide needed medical care for all our people at a price we can afford.”

Warren says Massachusetts is coming up with answers through research and pilot programs that will help guide the country. She rolls right into the example of an asthma study at Children’s Hospital.

“What they discovered is they could do more intensive treatment at the beginning,” Warren explains. “And for every dollar spent, they saved $1.46. They got those kids healthier, they kept them out of the hospital, fewer trips to the emergency room, and to me, there’s the heart of the game.” Continue reading

Report: Health Care Job Cuts Loom If Federal Budget Cuts Take Hold


WBUR’s Martha Bebinger reports that Massachusetts would lose roughly 17,400 health care and related jobs if scheduled federal budget cuts take effect, according to a health care industry report out Wednesday.

A federal budget deal scheduled to take effect January 1 would cut Medicare spending 2% and trigger the estimated layoffs. The deal aims to shrink the national debt but Lynn Nicholas with the Massachusetts Hospital Association says targeting health care and the defense industry, as this deal does, is unfair.

“Quite frankly you have to look at the revenue side too,” Nicholas said. “We need to get our nation’s finances in order, but it needs a more balanced approach to do that and this is a very one-sided approach.”

The report says most of the job cuts would occur in hospitals and nursing homes but that real estate firms restaurants and other related sectors would also be affected.

Continue reading

KHN: Biden And Obama Talking Health Care

Kaiser Health News handily excerpts the health care-related comments from last night’s speeches by Biden and Obama. Notably, according to transcripts, Biden said:

What they didn’t tell you is that the plan they have already put down on paper would immediately cut benefits to more than 30 million seniors already on Medicare. What they didn’t tell you is that the plan they are proposing would cause Medicare to go bankrupt by 2016. And what they really didn’t tell you is, they — if you want to know — they’re not for preserving Medicare — at all. They’re for a whole new plan. It’s called “vouchercare.” Look, folks, that’s not courage. That’s not even truthful.

And Obama:

And I will never turn Medicare into a voucher. No American should ever have to spend their golden years at the mercy of insurance companies. They should retire with the care and dignity that they have earned. Yes, we will reform and strengthen Medicare for the long haul, but we’ll do it by reducing the cost of health care, not by asking seniors to pay thousands of dollars more. And we will keep the promise of Social Security by taking the responsible steps to strengthen it, not by turning it over to Wall Street.

KHN: Everything You Want To Know About Paul Ryan And Health Policy

Paul Ryan (Talk Radio News Service/flickr)

Paul Ryan addresses the Republican National Convention tonight. Ahead of the speech, Kaiser Health News offers a clear primer detailing Ryan’s positions on a range of health policy matters, from national health reform (repeal it) to retooling Medicare (use vouchers) to funding for Planned Parenthood (end it).

Here’s a snippet of KHN’s analysis of Ryan’s health reform philosophy:

Supports repeal of much of the 2010 health law, including the Independent Payment Advisory Board, Medicaid expansion, subsidies and the individual mandate. However, his House-passed budget plan included many of the Medicare trims that are now hot-button items in the campaign. Ryan has said that those Medicare cuts, totaling $716 billion, are included in his budget because they are part of the budgetary baseline.
Throughout his career and most recently in the Roadmap for America’s Future, supported market-based reforms such as interstate insurance purchasing and the creation of association health plans, as well as efforts to decouple health coverage from the workplace, including removing tax incentives for employer-sponsored insurance and providing tax credits to individuals to purchase their own insurance.
Backed a 2009 proposal – the Patients’ Choice Act – which emphasized proposals such as health promotion and disease prevention and included, among other provisions, state-based health exchanges, protections against pre-existing condition exclusions as well as insurance denials based on age or health status, and expanded health savings accounts.

A Checkup On One Of America’s Most Expensive Patients

Sue Beder is among the 5 percent of American patients who account for half of all the nation’s health care dollars (Photo: Martha Bebinger/WBUR)

By Martha Bebinger

In April, we introduced you to one of America’s most expensive patients. Stoughton’s Sue Beder is 66 and has had multiple sclerosis since she was 18. She sees half a dozen doctors, takes 21 prescribed medications, and is typically in and out of the hospital twice a year. You can listen to her story here.

Beder is one of the 5 percent of patients we often hear about who account for half of all health care dollars in the United States. As one of the most expensive patients, Beder is at the epicenter of Massachusetts’ efforts to save money while improving her care.

Late last year, Beder signed up with an agency, Senior Whole Health, that receives the money Medicare and Medicaid expect to spend on Beder and pools that into one budget. It’s an approach the state plans to expand to 110,000 disabled patients across Massachusetts. Senior Whole Health pledges to spend less than the government would spend and, in exchange, the agency gets to decide how best to spend the money to keep Beder healthy.

Beder couldn’t have been happier with the move. The agency put handrails in her bathroom and started buying all her vitamins and lotions. It supplied adult diapers so that she wouldn’t get out of bed at night and risk a fall. The agency is doing all this to help Beder stay home. That’s where she wants to be, and it’s cheaper than moving her into a nursing home.

So is this idea working? Is spending more money up-front on this home-based care helping Beder avoid costly medical care? Continue reading

KHN: Medicare Penalizes Hospitals (Some Near You) For High Readmission Rates


Kaiser News Reports that Medicare is penalizing more than 2,000 hospitals across the nation, including in Massachusetts, for readmitting too many patients shortly after they are discharged.

“Together,” the report says. “these hospitals will forfeit about $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.”

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. Several of those are top-ranked institutions, including Hackensack University Medical Center in New Jersey, North Shore University Hospital in Manhasset, N.Y. and Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.

“A lot of places have put in a lot of work and not seen improvement,” said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. “It is not completely understood what goes into an institution having a high readmission rate and what goes into improving” it.

Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths…

Massachusetts General Hospital in Boston, which U.S. News last month ranked as the best hospital in the country, will lose 0.5 percent of its Medicare payments because of its readmission rates, the records show.

Heavyweights Propose Top Health Care Cost-Saving Strategies

(Tax Credits/flickr)

Frankly, I’d prefer crashing a dinner party with these guys to reading their insightful, timely (but, let’s face it, a little dry) paper in the August 1 issue of The New England Journal of Medicine titled “A Systematic Approach To Containing Health Care Spending.”

Still, the piece by these health policy luminaries (including Ezekiel Emanuel, M.D., Ph.D., Stuart Altman, Ph.D., Donald Berwick, M.D., M.P.P., David Cutler, Ph.D., Tom Daschle, B.A., Arnold Milstein, M.D., M.P.H., John D. Podesta, J.D., Uwe Reinhardt, Ph.D., Meredith Rosenthal, Ph.D., Joshua Sharfstein, M.D., and Peter R. Orszag, Ph.D., among others) is worth reading, as it lays out numerous smart strategies for cost-saving and quality improvement as part of the medical journal’s election 2012 coverage. The piece also comes, coincidentally, as Massachusetts approves its own first-in-the-nation health cost savings plan, with many similar strategies. Continue reading

Why Is Health Care Expensive? It’s the Prices, Stupid.

Sometimes the simplest answer is the right one.

At least that’s the thesis here, in this concise analysis by Matthew Yglesias in Slate, who argues that the real reason health care is so expensive in the U.S. is laughably clear: prices are high.

That sounds almost tautological at first, but it’s genuinely not. And you can see it in a variety of ways. One is the comparison of Medicare to private health insurance. Medicare is a very expensive government program, but it’s actually cheaper than private health insurance. Liberals sometimes point to administrative efficiencies and lack of advertising and executive compensation as the reason for this, but the main reason is simply that the prices are lower. Medicare is a bulk purchaser of health care services, and offers providers an offer they can’t refuse—perform medicine relatively cheaply, or get locked out of the Medicare client base. Continue reading