Impeding changes to our Health Care system

[TheMercenary]

Originally Posted by glatt

The chart is interesting in that it says there is only 15% waste in the public funding sector. Does that mean Medicare and Medicaid? Apparently those government programs are one of the areas that are not so bad.

That is completely misleading. There are vast differences among the states.

[TheMercenary]

National Health Care Spending

In 2008, health care spending in the United States reached $2.4 trillion, and was projected to reach $3.1 trillion in 2012.1 Health care spending is projected to reach $4.3 trillion by 2016.1
Health care spending is 4.3 times the amount spent on national defense.3
In 2008, the United States will spend 17 percent of its gross domestic product (GDP) on health care. It is projected that the percentage will reach 20 percent by 2017.1
Although nearly 46 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.3
Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.4

Employer and Employee Health Insurance Costs

Premiums for employer-based health insurance rose by 5.0 percent in 2008. In 2007, small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.2
The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,700 in 2008. Workers contributed nearly $3,400, or 12 percent more than they did in 2007.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).
Workers are now paying $1,600 more in premiums annually for family coverage than they did in 1999.2
Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period.2
Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by the end of 2008.5
According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 1999.2
The average employee contribution to company-provided health insurance has increased more than 120 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.6
The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 – a 16 percent increase.7

The Impact of Rising Health Care Costs

National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage.2
Economists have found that rising health care costs correlate to drops in health insurance coverage.8
A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.9 Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.10
About 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. 11
A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.12
Retiring elderly couples will need $250,000 in savings just to pay for the most basic medical coverage.13 Many experts believe that this figure is conservative and that $300,000 may be a more realistic number.
According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care.14
The United States spends six times more per capita on the administration of the health care system than its peer Western European nations.14

http://www.nchc.org/facts/cost.shtml

[classicman]

I read somewhere (???) that most states do relatively well with the medi- but states with huge cities do REALLY poorly. Can't find that link/article tho

[TheMercenary]

Differences in costs of Medicaid spending by state. Some are obvious, largely populated states will spend more. but when you compare them in the more compareable population centers there are vast differences. Why? Again, it is multifactorial.

http://www.statehealthfacts.org/comp...?ind=177&cat=4

Vast differences among the states programs accounts for many of cost differences.

http://www.kff.org/medicaid/upload/T...ate-Survey.pdf

An example of one states experiences with costs of Medicaid that also shows where the waste goes and the differences between the states:

James Mehmet, former chief state investigator of Medicaid fraud and abuse in New York City, told The New York Times on July 18 that fraud equals about 10 percent of total Medicaid dollars spent each year. In addition, the use of medically unnecessary services and procedures that probably doesn't rise to the level of criminality siphons off an additional 20 to 30 percent, he said.

"So we're talking about 40 percent of all claims [that] are questionable," according to Mehmet. All told, nearly $18 billion of the New York Medicaid budget is spent on fraudulent or medically unnecessary services and procedures, Mehmet said.

Doctors, drug makers, hospitals, and their unions have all fought attempts to provide tighter oversight of Medicaid spending. "All of the emphasis of the coalition in New York has been on expanding the size of the program, and that's where the payoff is for politicians," said Stephen Malanga, a senior fellow at the Manhattan Institute.

Any attempts to rein in spending on unnecessary, wasteful medical services are fought bitterly by those profiting from such waste. As a result, the state has failed to experiment with reforms that other states have used successfully. "There's been little emphasis on reform or eliminating waste, so that even as the program has grown to become the largest in the nation, the state office that investigates fraud and waste in Medicaid has been shrinking," Malanga said.

Runaway Costs
New York's Medicaid program is the largest and most costly in the nation. Although the state accounts for less than 7 percent of the U.S. population, nearly 14 percent ($45 billion) of Medicaid funds nationwide will be spent there in 2005 on more than 4 million enrollees, according to the National Governors Association.

Per capita, New York Medicaid spending is 130 percent more than the national average, according to the Public Policy Institute of New York State. The state spends $10,788 per Medicaid enrollee--more than $43,000 to insure a family of four. New York spends more on almost every service category than comparable states: hospitalization, long-term care, and in-home and personal care.

New York spends about as much on Medicaid as do California and Florida combined, despite having only about a third of their combined population. The federal government pays 50 percent of New York's Medicaid costs, and the state shifts nearly one-third of its remaining costs to the counties.

"New York spends far too much on Medicaid. We can cut costs sharply and still improve quality dramatically," said Robert Ward, director of research for the Public Policy Institute of New York State. According to The New York Times, Medicaid has become "an economic engine that fuels one of the state's biggest industries."

http://healthcare.ncpa.org/commentar...-york-medicaid

The one thing that the article does not show is that Medicaid pays the least amount of all insurance programs and I think it encourages providers and organizations to attempt to recoup costs by ordering many more tests than they would on a cash paying patient or one with insurance.

[TheMercenary]

The fight begins.

Industry Groups Push Back on Kennedy's Health Bill

WASHINGTON -- Employers and health-insurance companies are pushing back against parts of a health bill proposed by Sen. Edward Kennedy, in a sign of the challenges that loom for Democratic-led legislation.

Lobbyists spent Wednesday combing through the "Affordable Health Choices Act" that the Senate Committee on Health, Education, Labor and Pensions released a day earlier. The bill would require most Americans to buy health insurance and would create government-run exchanges where they could buy policies. It also calls for a new government health-insurance plan and indicates employers would be required to help pay for employees' plans.

continues:

http://online.wsj.com/article/SB124467520516103947.html

[TheMercenary]

House Health-Care Bill to Include $600 Billion in Tax Increases

June 12 (Bloomberg) -- Health-care overhaul legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid, Ways and Means Committee Chairman Charles Rangel said.

Democrats will work on the bill’s details next week as they struggle through “what kind of heartburn” it will cause to agree on how to pay for revamping the health-care system, Rangel, a New York Democrat, said today. He also said the measure’s cost will reach beyond the $634 billion President Barack Obama proposed in his budget request to Congress as a down payment for the policy changes.

Asked whether the cost of a health-care overhaul would be more than $1 trillion, Rangel said, “the answer is yes.”

http://www.bloomberg.com/apps/news?p...d=aqLNecbH0dcg

[TheMercenary]

Remember how I said the politico's are in bed with the healthcare industry?

Key health care senators have industry ties

Influential senators working to overhaul the nation's health care system have investments and family ties with some of the biggest names in the industry. The wife of Sen. Chris Dodd, the lawmaker in charge of writing the Senate's bill, sits on the boards of four health care companies.

Members of both parties have industry connections, including Democrats Jay Rockefeller and Tom Harkin, in addition to Dodd, and Republicans Tom Coburn, Judd Gregg, John Kyl and Orrin Hatch, financial reports showed Friday. .

Jackie Clegg Dodd, wife of the Connecticut Democrat, is on the boards of Javelin Pharmaceuticals Inc. (JAV), Cardiome Pharma Corp. (CRME), Brookdale Senior Living and Pear Tree Pharmaceuticals.

Dodd is filling in for ailing Sen. Edward Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee, which will soon start work on a health care bill.

Other publicly available documents show Mrs. Dodd last year was one of the most highly compensated non-employee members of the Javelin Pharmaceuticals Inc. board, on which she has served since 2004. She earned $32,000 in fees and $109,587 in stock option awards last year, according to the company's SEC filings.

Mrs. Dodd earned $79,063 in fees from Cardiome in its last fiscal year, while Brookdale Senior Living gave her $122,231 in stock awards in 2008, their SEC filings show. She earned no income from her post as a director for Pear Tree Pharmaceuticals but holds up to $15,000 in stock in Pear Tree, which describes itself as a development-stage pharmaceutical company focused on the needs of aging women.

The annual financial disclosure reports for members of Congress are less precise. They only require that assets and liabilities be listed in ranges of values.

Dodd was granted a 90-day extension to file his report covering last year, but released it to The Associated Press.

Bryan DeAngelis, Dodd's spokesman, said, "Jackie Clegg Dodd's career is her own; absolutely independent of Senator Dodd, as it was when they married 10 years ago. The senator has worked to reform our health care system for decades, and nothing about his wife's career is relevant at all to his leadership of that effort."

DeAngelis said that Mrs. Dodd has hired a personal ethics lawyer to avoid any conflicts of interest and is not a lobbyist.

Other reports showed:

- Rockefeller, D-W.Va., reported $15,001 to $50,000 in capital gains for his wife from the sale of a stake in Athenahealth Inc., a business services company that helps medical providers with billing and clinical operations.

Rockefeller is honorary chairman of the Alliance for Health Reform, a Washington nonprofit whose board includes representatives from the UnitedHealth Group health insurance company; AFL-CIO labor union; the AARP, which sells health insurance; St. John Health, a nonprofit health system that includes seven hospitals and 125 medical facilities in southeast Michigan; CIGNA Corp., an employer-sponsored benefits company; and the United Hospital Fund of New York.

- Coburn, R-Okla., is a practicing physician. He reported slight business income, $268, from the Muskogee Allergy Clinic last year; $3,000 to $45,000 in stock in Affymetrix Inc. (AFFX), a biotechnology company and pioneer in genetic analysis; $1,000 to $15,000 in stock in Pfizer Inc. (PFE), a pharmaceutical company; and a $1,000 to $15,000 interest in Thomas A. Coburn, MD, Inc.

Under Senate ethics rules, Coburn can't accept money from his patients.

- Gregg, R-N.H., disclosed $250,001 to $500,000 in drug maker Bristol-Myers Squibb Co. (BMY) stock and $1,000 to $15,000 each in stock in pharmaceutical companies Merck & Co. (MRK) and Pfizer, the Johnson & Johnson (JNJ) health care products company and Agilent Technologies, which is involved in the biomedical industry.

- Kyl, R-Ariz., the Senate minority whip, reported $15,001 to $50,000 in stock in Amgen Inc. (AMGN), which develops medical therapeutics. Kyl's retirement account held stakes in several health care businesses, including the Wyeth, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer and AstraZeneca pharmaceutical companies; medical provider Tenet Healthcare Corp.; CVS Caremark prescription and health services company; Genentech, a biotherapeutics manufacturer; and insurer MetLife Inc.

- Harkin, D-Iowa, has a joint ownership stake in health-related stocks. Harkin and his wife, Ruth Raduenz, own shares of drug makers Amgen and Genentech, Inc., each stake valued at $1,001 to $15,000; Their largest health care holding, Johnson & Johnson, was valued at $50,001 to $100,000.

- Hatch, R-Utah, a member of the Finance and Health committees, reported owning between $1,001 and $15,000 worth of stock in drug maker Pfizer Inc. He spoke to two pharmaceutical industry conferences last year. Sponsors of the conferences donated $3,500 to charities instead of speaking fees, as required by Senate rules.

Like millions of Americans, several senators took a financial hit in 2008. A sampling:

_Sen. Dick Durbin, D-Ill., lost some $100,000 in equity in his home in Springfield and $35,000 in his Chicago condominium. Durbin, who released his tax returns, reported losing $32,259 in various investments last year, including more than $10,400 in Berkshire Hathaway and $5,535 in Fidelity stock.

_Kennedy in 2007 had four trusts each valued between $5,000,001-$25 million. In 2008, only one trust was still in that category while the rest had slipped in value to $1,000,001-$5 million.

_Hatch's investments suffered from the banking crisis. In 2007, he reported assets of between $2,002 and $30,000 in Countrywide Credit Industries Inc. stock. His 2008 financial disclosure lists the value at less than $1,000.

One of Dodd's investments showed a vast improvement.

A new appraisal more than doubled the value of his vacation cottage in Ireland, which has been subject of a Senate ethics complaint filed by a conservative group questioning if the undervalued property was really a gift.

The property is valued at 470,000 euros, or about $660,000, on Dodd's disclosure report.

The previous year's report valued the seaside home, located in County Galway, at between $100,001 and $250,000.

http://apnews.myway.com/article/20090612/D98PBGU03.html

[TGRR]

Originally Posted by TheMercenary

Remember how I said the politico's are in bed with the healthcare industry?

Key health care senators have industry ties




http://apnews.myway.com/article/20090612/D98PBGU03.html

Actually, if you spend some time tooling around the Senate website, they're ALL basically owned by big pharma.

[classicman]

The system we have isn't perfect. We all agree on that. But to me, to dismantle it and replace it with a system that is a complete unknown without a VERY SPECIFIC design (which we are not getting now) It will more than likely be worse and cost more, much much more - especially in a recession.
This is very unwise and is a dangerous proposal. Why are we rushing into this? I think we should take care and study the alternatives very carefully. I agree to we should do something, but increasing the number of insured by as much as 25% and reducing the overall task is and extremely daunting task, if not impossible.
We all know far too well how inefficient our government is. To mandate coverage to private industry makes no sense. The government has never run a profitable enterprise - EVER. Therefore it is crystal clear how this ambitious new plan will be payed for - tax increases. To even consider it ignores that reality.

[Happy Monkey]

Originally Posted by classicman

To mandate coverage to private industry makes no sense.

That's how car insurance works.

The government has never run a profitable enterprise - EVER. Therefore it is crystal clear how this ambitious new plan will be payed for - tax increases. To even consider it ignores that reality.

If the government ran something at a profit, it should either spin it off to private industry or decrease its budget. One of the reasons for a government to run something is if the profit motive is insufficient (e.g. pure science) or corrupting (e.g. the military).

If there were a way to set up private health insurance in such a way that the profit motive incentivized low premiums and paying claims, maybe that could work. Unfortunately, it's the other way round. Is there even a theoretical way for health insurance companies to be run at a profit without incentivizing the denial of claims?

All I can think of are from the other direction, placing more restrictions on the various reasons insurance companies give for denials, such as "preexisting conditions" or "experimental". But as long as the incentive is still for denial, they'd just make up new classifications.

[Clodfobble]

Originally Posted by classicman

We all know far too well how inefficient our government is. To mandate coverage to private industry makes no sense. The government has never run a profitable enterprise - EVER.

But isn't mandating private coverage better than running the coverage program themselves? I agree that I don't know if it's the best time or not to be instituting any changes, but IMHO running the program through existing private insurers is far better than trying to copycat the Medicare program on a larger scale.

Think of it this way: if an illegal immigrant comes into an ER without insurance, and it is law that you must have a basic minimum of health coverage, then now that issue can be addressed in a legal fashion. No more people (of any immigration/citizen status) using the ER as a revolving door free clinic.

[DanaC]

I don't think there is ever a 'good' time to institute change. Either there's a recession....or you're in 'recovery'...or the economy is strong and you wuoldn't want anything to upset that...There is always an argument to wait.

There are far too many people struggling with medical bills, or inadequate/no insurance. There are far too many people unable to get insurance because of existing medical conditions. It needs a solution. Though a recession may not be the best time to institute change, it's also the time it's likely to be most needed, as that's when people are losing jobs and employer based insurance. It's during a recession that the gaps show most keenly in people's lives.

[xoxoxoBruce]

Originally Posted by DanaC

There are far too many people struggling with medical bills, or inadequate/no insurance.

But providing insurance for all removes the incentive, the reward, for being rich.

[classicman]

There is always a good time to make a positive change. This change doesn't appear initially to be one though. It appears that we are going to get saddled with increasing costs and taxes, not decreasing. Yes,we will cover more people, but the rush to get another major plan done is disconcerting. This is huge and for the administration to come out and put a deadline on when this "has to be done" is foolish to me. If you think it should be done right then that should be the goal, not just getting something done by a certain date for what appears to be political reasons.
Thats BS.
Also, there are some very basic issues not being addressed - just off the cuff - Will medicare and/or medicaid be replaced, eliminated or modified?

Exactly how are we increasing the # of insured while decreasing costs SPECIFICALLY.
How are we going to provide services without rationing increase demand by as much as 25% while not increasing the supply of providers.

HM - With car insurance, which the Gov't DOES NOT PROVIDE, we are each assessed on our own risks/history. There are plenty of those who still drive without.

"If I am not paying for it what is the incentive for me to change my unhealthy behaviors?" If I am obese, diabetic or have clogged arteries because of my diet - Who is being penalized with the increased cost for my health care costs? Not me if I'm not paying for it.

[glatt]

Originally Posted by classicman

There is always a good time to make a positive change. .....This is huge and for the administration to come out and put a deadline on when this "has to be done" is foolish to me. If you think it should be done right then that should be the goal, not just getting something done by a certain date for what appears to be political reasons.
Thats BS.

It's been 15 years since the last time anyone talked about fixing health care in the US. If this doesn't get done now, while the Obama horse is still charging out of the gate, it simply isn't going to get done during his term. His administration, like all administrations, will get bogged down and run out of steam. Most likely, after Obama, the pendulum will swing back to the Republicans, who won't bring up health care reform. So it won't come up again until the Democrat after that. Perhaps in 16 years. Basically, it's a situation where we fix it now, or we wait another 16 years before bringing it up again. The question is, if you really believe there are huge problems with the US health care system, would you rather rush to fix them now, or let those problems exist for the next 16 years and be facing the same difficult prospect of fixing it then? That's the choice the country faces.