As of this writing, it is impossible to know what is in the new National Health Insurance Act. The text has not been released, and even if it were, it will take months to fully analyze all of its provisions.
We have been told that the bill creates a Medical Review Board within the Medicare system. That Board has been instructed to reduce Medicare spending by half a trillion dollars. In theory, its job is to reduce "fraud and abuse" in the system. How will it really accomplish this feat? Not by reducing fraud and abuse, as we point out in our book, they will always be a part of any governmental program
It appears that this Medical Review Board will look at all 7,500 accepted diagnoses of sickness. It will then specify the treatment protocol for each diagnosis which Medicare will reimburse, (thereby limited "abuse"). In other words, you are not limited to the authorized treatment. However, neither Medicare nor your Medicare supplement policy will pay for treatment not specified in the treatment protocol. If you want further treatment, or an "experimental" drug, you will have to pay for it out of your own pocket.
The underlying premise of this protocol is likely to be "quality life years." The procedures or drugs covered will vary depending on how many "quality life years" you have remaining. It is certainly safe to say that if the intent is to reduce health care spending, the effect will be to limit access to care and drugs. Those with the fewest "quality life years"--the frail elderly--will be disproportionately affected.
How ever you look at it, it all comes back to rationing. For a practical discussion of rationing based on "quality life years" read To Tax or To Ration. An entire chapter is devoted to the pros and cons of rationing on this basis.
I wish to emphasize that, as of this writing, the actual details of the bill are yet to be revealed. However, we've been told, repeatedly, that one of the goals of the bill will be to reduce Medicare spending. If so, rationing of care is inevitable.
Monday, December 21, 2009
Trends That Should Receive Attention
There continue to be signs that America, along with all of the industrialized world, is aging. Some new numbers from the Social Security Administration, found in its Fast Facts and Figures About Social Security, 2009, bear repeating.
Between 1962, (the year I graduated from high school), and 2007, the percentage of the US population age 65 and older receiving Social Security benefits increased from 69% to 87%. The percentage of single people and couples with earned income was lower in 2007 than it was in 1962. Note: these numbers cut off before the major market recession in 2008/2009.
What do these numbers tell us? First, the population of the United States is aging, creating problems even before the so-called "baby boomers" retire. Second, older individuals are less likely, or able, to be working. Third, those who have savings are being forced to liquidate assets in their later years.
On the other end of the spectrum, Generation Y, (Americans born between 1977 and 1994), are not saving like their grandparents. In fact, according to a National Foundation for Credit Counseling survey, 45% have no savings at all. It is this same Generation which will be hit the hardest with additional taxes in order to support elderly baby boomers. With no savings of their own, how can they possibly fund the long-term care needs of the older generations?
All of the trends force us to conclude that rationing of health care for the elderly, which is already a fact of life, will continue to expand. The only real question is this: Do you want be involved in developing the solution? Are you willing to live with a solution devised by Washington bureaucrats? In To Tax or To Ration, we provide the information you will need to engage in "national conversation" on the subject of rationing. Read it. Get involved.
Between 1962, (the year I graduated from high school), and 2007, the percentage of the US population age 65 and older receiving Social Security benefits increased from 69% to 87%. The percentage of single people and couples with earned income was lower in 2007 than it was in 1962. Note: these numbers cut off before the major market recession in 2008/2009.
What do these numbers tell us? First, the population of the United States is aging, creating problems even before the so-called "baby boomers" retire. Second, older individuals are less likely, or able, to be working. Third, those who have savings are being forced to liquidate assets in their later years.
On the other end of the spectrum, Generation Y, (Americans born between 1977 and 1994), are not saving like their grandparents. In fact, according to a National Foundation for Credit Counseling survey, 45% have no savings at all. It is this same Generation which will be hit the hardest with additional taxes in order to support elderly baby boomers. With no savings of their own, how can they possibly fund the long-term care needs of the older generations?
All of the trends force us to conclude that rationing of health care for the elderly, which is already a fact of life, will continue to expand. The only real question is this: Do you want be involved in developing the solution? Are you willing to live with a solution devised by Washington bureaucrats? In To Tax or To Ration, we provide the information you will need to engage in "national conversation" on the subject of rationing. Read it. Get involved.
Friday, December 18, 2009
The Perils of an Infinite Progress Model
In an interview by Beth Baker of the Kaiser Foundation, published on December 10, 2009, Ethicist Daniel Callahan makes some interesting observations about the American health care system. Initially, he describes it in this fashion:
"Our whole health care system is based on a witch's brew of sacrosanct doctor-patient autonomy, a fear of threats to innovation, corporate and (sometimes) physician profit-making, and a belief that, because life is of infinite value, it is morally obnoxious to put a price tag on it."
He is quoted in the interview as saying:
"Cost is a symptom of a deeper problem. We have an "infinite progress" model. Nothing is ever good enough. The standard of care is raised higher and higher--but death always wins.
"The National Institutes (sic)of Health is always giving priority to the most lethal diseases--cancer, heart disease, strokes. Things that really make you miserable like mental health [problems] or arthritis don't get nearly as much money. The fight against death has been a very central part of American medicine. It's a weird system where you get saved from heart disease at 65, treated for cancer at 75, and then after that end up with Alzheimer's at 85--this is progress?"
Just this week, researchers announced the complete decoding of the genome for two forms of cancer. They are excited that this will lead to more successfuly treatments for cancer, and this is exciting. But it also means that hundreds of thousands of additional people will reach old age.
His concluding comment mirrors our concerns. "Medicare is going to run out of money shortly, and we're finding more and more expensive ways to keep people alive. So we have to find ways to set some limits." To Tax or To Ration. That's what it keeps coming down to.
"Our whole health care system is based on a witch's brew of sacrosanct doctor-patient autonomy, a fear of threats to innovation, corporate and (sometimes) physician profit-making, and a belief that, because life is of infinite value, it is morally obnoxious to put a price tag on it."
He is quoted in the interview as saying:
"Cost is a symptom of a deeper problem. We have an "infinite progress" model. Nothing is ever good enough. The standard of care is raised higher and higher--but death always wins.
"The National Institutes (sic)of Health is always giving priority to the most lethal diseases--cancer, heart disease, strokes. Things that really make you miserable like mental health [problems] or arthritis don't get nearly as much money. The fight against death has been a very central part of American medicine. It's a weird system where you get saved from heart disease at 65, treated for cancer at 75, and then after that end up with Alzheimer's at 85--this is progress?"
Just this week, researchers announced the complete decoding of the genome for two forms of cancer. They are excited that this will lead to more successfuly treatments for cancer, and this is exciting. But it also means that hundreds of thousands of additional people will reach old age.
His concluding comment mirrors our concerns. "Medicare is going to run out of money shortly, and we're finding more and more expensive ways to keep people alive. So we have to find ways to set some limits." To Tax or To Ration. That's what it keeps coming down to.
Thursday, December 17, 2009
Why Medicaid is Failing Already
A new Eljay, LLC, analysis of the Medicaid financing system projects that the states will underfund the actual cost of long term care by nearly $4.7 billion in 2009. This is one of the key problems with Medicaid--it never pays 100% of the actual cost to provide care.
As a reminder, Medicaid is a federal/state partnership program in which the federal government picks up, on average, 50% of the amount paid out by the states. The balance is paid out of state resources. While the federal government can run budget deficits, states must balance their budget each year. In order to accomplish this feat, they traditionally reimburse care providers for less than the actual cost of care.
The recession has significantly reduced state revenues. Robert Van Dyke, Chair of the American Health Care Association, but it bluntly: "With our national and state economies in an historic downturn, this state data serves as a stark reminder of the vital importance to evaluate both Medicare and Medicaid funding as a final federal health care reform bill takes shape. At stake is seniors' ongoing access to quality care, sustaining a strong long term care workforce and local jobs base, and the very ability of our sector to remain strong in the face of challenging demographic realities."
This emphasizes the point we are trying to make in To Tax or To Ration. The system is already showing major cracks. It will crumble soon. Even faster if the new national health insurance program adds more individuals to its rolls while reducing available funding. It's time to start talking about where we go from here. We cannot wait for Washington to solve the problem.
As a reminder, Medicaid is a federal/state partnership program in which the federal government picks up, on average, 50% of the amount paid out by the states. The balance is paid out of state resources. While the federal government can run budget deficits, states must balance their budget each year. In order to accomplish this feat, they traditionally reimburse care providers for less than the actual cost of care.
The recession has significantly reduced state revenues. Robert Van Dyke, Chair of the American Health Care Association, but it bluntly: "With our national and state economies in an historic downturn, this state data serves as a stark reminder of the vital importance to evaluate both Medicare and Medicaid funding as a final federal health care reform bill takes shape. At stake is seniors' ongoing access to quality care, sustaining a strong long term care workforce and local jobs base, and the very ability of our sector to remain strong in the face of challenging demographic realities."
This emphasizes the point we are trying to make in To Tax or To Ration. The system is already showing major cracks. It will crumble soon. Even faster if the new national health insurance program adds more individuals to its rolls while reducing available funding. It's time to start talking about where we go from here. We cannot wait for Washington to solve the problem.
Wednesday, December 9, 2009
Why Aren't Women More Concerned?
56% of all Medicare beneficiaries are women. Among the oldest, 85 and older, 70% are women. 76% of nursing home residents are female. 60% of those are single and 55% are over 85. Medicaid, not Medicare, pays for 80% of all nursing home days. It is obvious that women have the most at stake in the battles over Medicare and Medicaid.
Proposals in the new National Health Care plan include several provisions which hit women disproportionately. For example, there is a 5% surtax on cosemetic surgery which is expected to raise $5 billion in new revenue to pay for national health care. Of the 9.3 million cosmetic surgeries in 2008, women accounted for 92%. In other words, this tax falls disproportionately on women. Beyond that, one needs to ask whether reconstructive surgery after breast cancer, for example, should be taxed as a luxury? (Should there be a counterpart surtax on ED drugs for men?) Women, where are your voices?
The same bill prposes drastic cuts in Medicare and Medicaid funding. According to the Centers for Medicare and Medicaid Services, these will inevitably lead to fewer health care options for seniors--primarily women.
Our president has promised not to sign any plan which does not reduce the over-all cost of health care services. Unfortunately, what is becoming clear is that this can be accomplished only by rationing care, a conclusion we sadly reached in our book on this topic.
Women, you need to find your voices and express your concerns. Someday you will be directly affected. If not you, your mothers and grandmothers are certain to be impacted significantly. It is time to get involved in the discussion.
Proposals in the new National Health Care plan include several provisions which hit women disproportionately. For example, there is a 5% surtax on cosemetic surgery which is expected to raise $5 billion in new revenue to pay for national health care. Of the 9.3 million cosmetic surgeries in 2008, women accounted for 92%. In other words, this tax falls disproportionately on women. Beyond that, one needs to ask whether reconstructive surgery after breast cancer, for example, should be taxed as a luxury? (Should there be a counterpart surtax on ED drugs for men?) Women, where are your voices?
The same bill prposes drastic cuts in Medicare and Medicaid funding. According to the Centers for Medicare and Medicaid Services, these will inevitably lead to fewer health care options for seniors--primarily women.
Our president has promised not to sign any plan which does not reduce the over-all cost of health care services. Unfortunately, what is becoming clear is that this can be accomplished only by rationing care, a conclusion we sadly reached in our book on this topic.
Women, you need to find your voices and express your concerns. Someday you will be directly affected. If not you, your mothers and grandmothers are certain to be impacted significantly. It is time to get involved in the discussion.
Tuesday, December 1, 2009
Affinity Groups
Is it possible for a group of friends to provide end-of-life care for one another? One of our readers thinks we are being totally unrealistic when we reply, "Yes, they can."
As Exhibit A in support of this response, one needs look no further than the current edition of Reader's Digest (Dec. 2009/Jan. 2010). In an article entitled, "The Good-News Guide to Caregiving" authored by Camille Peri, among other true life stories, it includes the story of a group of unrelated friends who banded together to provide care for a mutual friend.
The article shows that while caregiving can be demanding and difficult, it also can be rewarding. In the future, will everyone be cared for in this manner? No. However, we know from this true story, and from others, that as it becomes increasingly necessary to ration care for the elderly, some can be cared for in this way.
As Exhibit A in support of this response, one needs look no further than the current edition of Reader's Digest (Dec. 2009/Jan. 2010). In an article entitled, "The Good-News Guide to Caregiving" authored by Camille Peri, among other true life stories, it includes the story of a group of unrelated friends who banded together to provide care for a mutual friend.
The article shows that while caregiving can be demanding and difficult, it also can be rewarding. In the future, will everyone be cared for in this manner? No. However, we know from this true story, and from others, that as it becomes increasingly necessary to ration care for the elderly, some can be cared for in this way.
Subscribe to:
Posts (Atom)
