December 7, 2016

Posts on medicare

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Sunday, January 24, 2010 - 8:06 PM

As the White House and congressional leaders rethink health care reform after the Republican upset in the Massachusetts Senate race, there is a growing danger that Congress will jettison comprehensive health care reform altogether. Even worse, they might pass stripped-down measures that eliminate politically difficult cost-containment, while popular but costly provisions are kept.

President Obama has suggested narrowing the focus of national reform, advising that Congress should “try to move quickly to coalesce around those elements of the package that people agree on.” Some members of Congress have also expressed support for a limited bill.

However, most policy experts agree that a limited bill is nearly impossible to construct without running into some major issues with short and long-term costs. That is because the easier elements -- the ones that “people agree on” -- are interlocked with elements whose benefits are far less apparent to many voters.

The key reforms for the health insurance industry are popular -- for instance, prohibiting discrimination based on pre-existing conditions. Yet, just doing that would lead to an insurance "death spiral" where only the sick would get insurance when needed, driving up the cost of premiums. The only way around this spiral is to have an individual mandate to...

Tuesday, January 12, 2010 - 10:48 AM

In my previous post, I spent some time clarifying how “advance care planning” is in no way, shape or form the same as a “death panel,” and how palliative care does not equate to any "rationing of care." Rather, both these health care interventions are patient-centered and improve the value of the health care experience for severely, chronically, and terminally ill patients and their families.

As Congress resumes its work and health reform continues to dominate talks on Capitol Hill, I'd like to put these in context given the status of health reform today.

The philosophy behind advance care planning fits nicely with the promotion of an Independent Payment Advisory Board tasked to make recommendations to Congress on slowing future Medicare cost growth. Similarly to advance care planning, where potential treatment options and often difficult decisions are discussed prior to a health crisis, the Independent Payment Advisory Board (IPAB) is being asked to evaluate the tough choices facing the longevity and fiscal health of the Medicare program in advance of a federal budget crisis. The Advisory Board would be made up of health care experts, people who entered their professions because...

Friday, January 8, 2010 - 3:15 PM

When discussing health care reform, if we cannot even be clear that “advance care planning” is in no way, shape or form the same as a “death panel,” how will we ever be able to talk about the real (and factual) challenges facing the Medicare program and its long-term sustainability?

Ugh….

Let’s be clear: there are no “death panels” included in the health reform bills adopted by the House of Representatives and the Senate, although misinformation on this topic has been swirling for months. For example, last August during the Congressional recess I was quite distraught when my own Senator Charles Grassley stated in an Iowa town hall meeting that he was worried that efforts to increase the efficiency of Medicare or to create an Independent Medicare Advisory Commission would indeed mean that the federal government would be making decisions about when to “pull the plug on Grandma.” More recently, the clause in the House bill that allowed reimbursement to Medicare providers who hold “advanced care planning consultations” with their patients has been equated with a “death panel” deciding when a senior would die.  Nothing could be further from the truth.

Having studied end of life care in graduate school and...

Wednesday, January 6, 2010 - 9:57 AM

When we finished our issue brief on the health care reform "endgame" before the holidays, we had a difficult time trying to isolate the key 10-year costs and savings of different components of the legislation. Now that we have had a bit more time with the final House and Senate versions of the legislation and the CBO analyses, we wanted to present the following table:

 House BillSenate Bill
Insurance Coverage Expansion1052871
   
Minus Offsets  

Spending Cuts

352413
CLASS Act10272
Tax Increases570474
Penalties16843
Subtotal (offsets)1,1921,002
   
Deficit Reduction-138...
Wednesday, December 23, 2009 - 3:07 PM

With the House having passed its version of health care reform (H.R. 3962) and the Senate on the verge of passing its version (H.R. 3590), the outline of a final bill is beginning to take shape. In our new Issue Brief, we look ahead at the fiscal considerations that will likely be the subject of conference committee discussions and “end game” negotiations. These include the cost of expanding coverage, the methods used to prevent that cost from adding to the deficit, and the prospects for systemic reforms to reduce cost growth over time. 

This issue brief gives The Concord Coalition’s perspective on how the bills measure up, what the risks are and how these risks could be lessened. We conclude that:

•    Both bills establish...
Tuesday, December 1, 2009 - 9:51 PM

As you have read here, here, and here, The Concord Coalition firmly believes that having an independent Medicare commission is one of the most important elements being considered in current health care reform legislation. Without the commission -- which would be empowered to continuously evaluate Medicare costs and propose changes to the delivery of care that might be able to help reduce system-wide health care costs -- it is doubtful that current legislation will succeed in reducing long-term health care inflation. 

Unfortunately, the bill currently being debated in the Senate has effectively neutered the commission's powers (and the House didn't even have a commission in their bill). As pointed out by David Leonhardt in the New York Times, the Senate directs that the commission leave doctors and hospitals untouched by its recommendations for the first four years of its...

Friday, October 30, 2009 - 10:52 AM

Here are a few initial thoughts from The Concord Coalition about the House of Representatives health care bill (H.R. 3962) and the preliminary scoring of that bill by the Congressional Budget Office (CBO):

  • It does not appear that this bill would alter the unsustainable trend of federal health care spending, often referred to as “bending the cost curve.” [1] According to CBO, “On balance, during the decade following the 10-year budget window, the bill would increase both federal outlays for health care and the federal budgetary commitment to health care, relative to the amounts under current law.” [2]
  • CBO does not make a projection of national health care expenditures (public and private) and it’s unclear if the bill would have a major impact on lowering private costs. All the usually discussed efforts to accomplish that are present in the bill, (accountable care demonstration project; medical home pilot, comparative effectiveness research and wellness,) but these score as a cost in the first 10 years. CBO does not include a specific analysis of how these initiates might play out over time and it would, in fact, be very difficult to do so. Thus, the long-term effect of these policies is highly uncertain, at best. This is the risk of expanding...
Tuesday, July 28, 2009 - 4:13 PM

Yesterday, experts from the Iowa Committee for Value in Healthcare -- a diverse group of Iowa health care providers, purchasers, payers, patient advocates, and policy analysts -- sent a letter to President Obama and Congressional leaders indicating the principles for value-based health care reform that should be considered in any health care legislation. 

This committee was established as part of The Concord Coalition's Fiscal Stewardship Project to suggest ways that health reform could be enhanced to create a more value-based system. As Congressional efforts toward health reform continue through the summer, value, cost and long-term savings have become more prominent aspects of the debate. Achieving value in the health care system is essential for the ...

Thursday, July 23, 2009 - 8:19 PM

While the President's press conference Wednesday night got a lot of attention and focused substantially on health care, he also did an interview with Washington Post editorial page editor Fred Hiatt earlier in the day. The wide-ranging interview touched on health care reform, but also on a lot of the other subjects Concord Coalition members are interested in -- like deficits, debt, Social Security reform and a BRAC-like fiscal commission. It is worth a read.

Thursday, July 16, 2009 - 1:25 PM

Health Care reform is moving quite quickly on the Hill and it is almost impossible to keep up with all of the developments in Congress and all of the great reporting in the media on what is needed for fiscally responsible health care reform. So, over the next 90 days as health care dominates the political agenda, we are going to try to briefly highlight developments as they occur by linking to other sources and throwing in Concord material as it is published.

The links brought to you today cover the fundamental cost control issues being discussed (or unfortunately not discussed) as legislation makes its way through the House and Senate Committees.

  • The big news today, as reported in The Washington Post, CNN and elsewhere, is that CBO director Elmendorf testified in front of the Senate Budget Committee and proclaimed that the legislative developments he has seen (the House bill and the Senate's HELP committee bill) seem to "significantly expand the...