Monday, March 27, 2006

This is what Part D has done

From a good diary at dKos, here is what is happening to drug costs to the consumers under Part D of Medicare:
  • The drug prices offered here in Southern Maine by the ten leading private insurance plans for the ten prescription drugs with the highest sales are, on average:
  • Almost 80 percent higher than the prices the federal government negotiates for the Veterans Administration;
  • More than 60 percent higher than what consumers pay in Canadian pharmacies; and
  • More than 5 percent higher than what they cost when purchased from a reliable Internet dealer.

Why is this bad for Maine seniors who now receive the Medicare Part D benefit?

Because their out-of-pocket costs are higher and the purchasing power of the benefit is lower than they should be.

Because they will reach the so-called "donut hole" sooner.

That's the gap, between $2,250 and $5,100 in drug expenditures, where seniors are responsible for 100 percent of the cost of their prescription drugs.
There is no question that Medicare needed an associated drug benefit in order to provide the best treatments at the lowest overall cost. That's why Bush promised such a benefit when he first ran for President, and that's why he twisted the arms of the Republican Congressional leadership to get something - anything with that title - passed.

But the Republican Congressional leadership operated like, well, Republicans. They allowed the lobbyists for the Drug companies to write the bill in a way that they would not lose money. Also, since fulfilling Bush's campaign promise and the profitability of the Pharmaceutical companies were the priorities, little thought was given to how the plan would be implemented. The results has been what would be expected.

The plan is overpriced for the government while the conversion of beneficiaries from Medicaid has been a disaster for many beneficiaries who have the least abilitiy to deal with such problems. The problem is made worse because two days after the Part D was implemented the Department of Homeland Security started intercepting pharmaceutical shipments to individuals from Canada, apparently in an effort to force more elderly people to sign up for Part D.

Ultimately the plan will have to be made workable, and Medicare will have to start negotiating prices with the drug companies. The solutions will require more legislation, though, and the Republican Congressional leadership seems to have very little heart to consider and actually pass the necessary legislation.

So it is bad now, it will get better because it cannot be simply cancelled, and the solutions will take time to put into place. How much time?

My guess is that it won't be this year, and the real pressure to do something will start after Summer when a lot of people hit the "doughnut hole."

Tuesday, March 21, 2006

Americans get appropriate care only 55% ot Time

Knight Ridder describes the results of a new study that shows Americans get the appropriate medical care only 55% of the time.

So, think this means that wealthy and well-insured people get better care, and poor people get bad care? Nope.
WASHINGTON - U.S. patients receive proper medical care from doctors and nurses only 55 percent of the time, regardless of their race, income, education or insurance status, according to a national study published Thursday in The New England Journal of Medicine.

A well-functioning health care system should provide recommended levels of care 80 to 90 percent of the time, the study's authors said.

In a performance review of preventive services and care for 30 chronic conditions, including hypertension, diabetes and heart disease, researchers found that it's almost a coin flip as to whether patients get the recommended care from doctors and nurses - even though the standard treatments are widely known.

The findings show that everyone is at roughly equal risk of inadequate care from medical professionals. However, small differences did occur in the care given male and female patients and those from different racial and ethnic groups.

"Not only is no place safe, no one is safe from poor quality," said Dr. Steven M. Asch, the lead author and senior natural scientist at Los Angeles-based RAND Health, the nation's largest independent health-policy research organization. "No matter what group we looked at, whether they were black, white, rich or poor, uninsured, insured, educated, uneducated, all of them were receiving mediocre care."

He blamed the nation's "fragmented and chaotic" health care system for making it difficult to deliver quality care. Greater use of computers could improve care by helping doctors track patients' medical histories, he said. In addition, computers could provide electronic reminders about needed tests and appointments. Electronic medical records could log information on other caregivers' thoughts about a patient's condition.

The Department of Veterans Affairs has incorporated some of these improvements, and a study has found that VA patients get proper recommended care about 66 percent of the time.

The RAND study, funded by The Robert Wood Johnson Foundation, used telephone surveys and patient medical records to follow the health care of nearly 7,000 adults in 12 metropolitan areas.
[Underline is mine.]

So the problem is not money, it is a lack of a decent medical care system.

Saturday, March 18, 2006

Krugman on healthcare

Paul Krugman writes in the March 23, 2006 New York Review of Books [and, for some odd reason, suggests three books on how we need to structure American healthcare.]

There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.
Krugman presents three facts to consider.
  • First, health care spending is rising rapidly "regardless of the source of its funding." Typically, Medicare increases have been lower than those of private health insurance.

  • Second, "new medical technology" is the major factor in rising spending: we spend more on medicine because there's more that medicine can do.
  • Third, in medical care, "technological advances have generally raised costs rather than lowered them": although new technology surely produces cost savings in medicine, as elsewhere, the additional spending that takes place as a result of the expansion of medical possibilities outweighs those savings.
So the fact that healthcare expenses are going up means that there is more that the healthcare system can do for our health, not that it is getting more inefficient. The problem is the crazy-quilt of fragmented systems we have created to deliver the medical care. Medicare provides the same excellent care at lower cost than private insurers do, and the Veteran's Administration has clearly demonstrated that a better organized system can provide both better care and do it at lower cost.

Krugman has a lot more to say. Go read it. [Be sure after the first couple of paragraphs to scroll down past the large blank space that apparently should have an advertisment in it.]

Krugman also recommends three books on the subject.

Can We Say No? The Challenge of Rationing Health Care

by Henry J. Aaron and William B. Schwartz, with Melissa Cox
Brookings Institution, 199 pp., $44.95; $18.95 (paper)

The Health Care Mess: How We Got into It and What It Will Take to Get Out

by Julius Richmond and Rashi Fein
Harvard University Press, 320 pp., $26.95

Healthy, Wealthy, and Wise: Five Steps to a Better Health Care System

by John F. Cogan, R. Glenn Hubbard, and Daniel P. Kessler
American Enterprise Institute/Hoover Institution, 130 pp., $18.00

I have not yet read any of them yet, but if Krugman recommends them they probably have a lot to say. Click on the icons on the right side of this blog to order them from Barnes & Noble.

Wednesday, March 15, 2006

American healthcare is mediocre for all

Anyone who has a passing awareness of the cost of American healthcare is aware that we pay over twice as much per person (including the uninsured in those figures) as the next most expensive healthcare system in the world. So we should have great healthcare, right?

We aren't getting what we are paying for, and a new study reported by the Boston Globe shows how badly our so-called free market health "system" is shafting us.
BOSTON --Startling research from the biggest study ever of U.S. health care quality suggests that Americans -- rich, poor, black, white -- get roughly equal treatment, but it's woefully mediocre for all.

"This study shows that health care has equal-opportunity defects," said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.

The survey of nearly 7,000 patients, reported Thursday in the New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics actually got slightly better medical treatment than whites.

While the researchers acknowledged separate evidence that minorities fare worse in some areas of expensive care and suffer more from some conditions than whites, their study found that once in treatment, minorities' overall care appears similar to that of whites.

"It doesn't matter who you are. It doesn't matter whether you're rich or poor, white or black, insured or uninsured," said chief author Dr. Steven Asch, at the Rand Health research institute, in Santa Monica, Calif. "We all get equally mediocre care."
America can get better results at less cost for 100% of Americans, but it is going to take a single-payer system like that of Germany or France to do it.

Nor will a single-payer system be perfect. It will have flaws. But the flaws are unlikely to be as expensive as the current so-called system, nor will it keep our industries from being able to compete internationally.

Saturday, March 11, 2006

California is also considering universal health care

Another state is working to provide universal healthcare to all its residents.

Here is the legislative summary of the universal healthcare proposal submitted to the California legislature Feb 22, 2006:
SB 840, as introduced, Kuehl.
Single-payer health care coverage.

Existing law does not provide a system of universal health care coverage for California residents. Existing law provides for the creation of various programs to provide health care services to persons who have limited incomes and meet various eligibility requirements. These programs include the Healthy Families Program administered by the Managed Risk Medical Insurance Board, and the Medi-Cal program administered by the State Department of Health Services. Existing law provides for the regulation of health care service plans by the Department of Managed Health Care and health insurers by the Department of Insurance.

This bill would establish the California Health Insurance System to be administered by the newly created California Health Insurance Agency under the control of an elected Health Insurance Commissioner. The bill would make all California residents eligible for specified health care benefits under the California Health Insurance System, which would, on a single-payer basis, negotiate for or set fees for health care services provided through the system and pay claims for those services. The bill would impose limits on deductibles or copayments that the commissioner would be authorized to establish. The bill would require the health care system to be operational within 2 years of enactment, and would enact various transition provisions. The bill would require the commissioner to seek all necessary waivers, exemptions, agreements, or legislation to allow various existing federal, state, and local health care payments to be paid to the California Health Insurance System, which would then assume responsibility for all benefits and services previously paid
for with those funds.

The bill would create a health insurance policy board to establish policy on medical issues and various other matters relating to the health care system. The bill would create the Office of Consumer Advocacy within the agency to represent the interests of health care consumers relative to the health care system. The bill would create within the agency the Office of Health Care Planning to plan for the health care needs of the population, and the Office of Health Care Quality, headed by the chief medical officer, to support the delivery of high quality care and promote provider and patient satisfaction. The bill would create the Office of Inspector General for the California Health Insurance System within the Attorney General's office, which would have various oversight powers. The bill would prohibit health care service plan contracts or health insurance policies from being issued for services covered by the California Health Insurance System. The bill would create the Health Insurance Fund and the Payments Board to administer the finances of the California Health Insurance System. The bill would prohibit payment of shareholder dividends from system revenues by participating private companies. The bill would extend the application of certain insurance fraud laws to providers of services and products under the health care system, thereby imposing a state-mandated local program by revising the definition of a crime. The bill would enact other related provisions relative to budgeting, regional entities, federal preemption, subrogation, collective bargaining agreements, compensation of health care providers, conflict of interest, and associated matters.
The need is clearly recognized when this many states have begun to take this action. The only problem is, it would work a lot better if it were done nationally as Medicare is done.

Friday, March 10, 2006

The absence of universal healthcare reduces the Middle Class

This paper (.pdf) describes the middle class as being broad, politically powerful and the source of new businesses which innovate and replace older, large ossified businesses. It is important to recognize that middle class societies have realtitively little income inequality.

The paper focuses on the differences between the development of Poland and Russia since the end of Communism. Poland has maintained broad relatively equal incomes, while Russia has developed a much greater degree of income inequality. This can be seen in the low level of new firm development in Russia and a resulting continuation of very high rates of profit.
The specter of this constituency was joined by the predictions of the creation of an oligarchic elite based on the rents accruing to the new monopolies resulting from large scale privatization. These oligarchs would then use their positions and resources to capture the government and restrict the entry of domestic or foreign enterprises that would reduce their rents.
One thing about both Russia and Poland is that both have what we would describe as universal health care. The problem with Russia is that the oligarchs bought the massive soviet enterprises rather than developing them and were for the most part members of the government before that. They automatically looked to government to protect their monopolies from foreign and home-developed competitors.

In America, we are moving towards the Russian form of oligarchy. That is the lesson of the Republican corruption in Congress and the federal government. One element that makes this easier for the would be monopolistic oligarchs is the employer-based health care. People with employer-based health care who have chronic helath problems such as diabetus or high-blood pressure in their family are tied to their large employer. No matter what their abilities or ideas, they cannot afford to leave the monopolistic employer and start their own business.

The problem is not financial insecurity, it is health insecurity. We want Americans to take on financial insecurity and start new businesses, but if they also face health insecurity in their families, they can't. Most entrepreneurs fail the first two, three or four tries. If they also have health insecurity, they cannot afford this level of risk even the first time. Failing even once is too high a cost for sensible people to accept. So the American economy loses.

Keep this in mind as you read this article on universal health care from the TNR.

Thursday, March 09, 2006

Massachusetts also to improve workers health care some

Massachusetts is looking at an incremental improvement in health care for workers. The question is, does the proposal go far enough to be useful?

New York State Repubs propose improved heatlh care benefits in the state

The Republican-dominated New York state legislature has proposed a major expansion of health care benefits for workers in the state:
The bill would require all companies in the state with one hundred employees or more to provide health care to their employees, or pay a tax of $3 an hour per worker to cover the states expenses in caring for uninsured workers. If enacted, this would be a serious expansion of coverage, extending health care to an estimated 450,000 working New Yorkers, and helping preserve coverage for 3.5 million more where large employers are increasingly threatening to drop coverage.
This is a strong indication of how bad the American health system is.

Too many employers are dropping coverage and leaving health care to whatever the state provides. It's just a money-saving project that gives the companies that do it a cost advantage over their competitors who don't act similarly. That is the classic description of the race to the bottom in employee costs.

What country's healthcare systems should be compared to?

Kevin Drum discusses (too briefly) which other country's healthcare systems should be compared with the broken American system. Hint - Canada and Britain are not the best examples.