Social Security & Medicare Notes

Healthcare. Does America get promises of magic or real down-to-earth efforts to improve health care and lower costs?

Ezra Klein has an important posting on Ryan's health care proposals. The point he makes is that while the media has fallen in love with Ryan's vision of a new health care policy that, if implemented, would shift the increase in health care costs away from the government and onto the sick, the Democrats have an actual plan that includes many elements designed to actually lower health care costs. In short the Affordable Care Act actually includes many rational elements which will lower health care costs, Ryan offers the magic of the invisible hand and a snake-oil salesman's promise that if the insurance payments are changed, providers will change what they charge to get and keep patients well.

At the heart of Ryan’s budget are policies tying the federal government’s contribution to Medicare and Medicaid to the rate of inflation — which is far, far slower than costs in the health-care sector typically grow. He achieves those caps through cost shifting. For Medicaid, the states have to figure out how to save the money, and for Medicare, seniors will now be purchasing their own insurance plans and, in their new role as consumers, have to figure out how to save the money. It won’t work, and because it won’t work, Ryan’s savings will not materialize.

Even Ryan’s fans agree you can’t hold health-care costs down to inflation. But even if you grant that Ryan’s target is too low, his vision for reforming Medicare would like miss a more reasonabke [sic] target, too. Consider the program Ryan names as a model. He said his budget converts Medicare into “the same kind of health-care program that members of Congress enjoy.” The system he’s referring to is the Federal Employee’s Health Benefits Program, and cost growth there has not only massively outpaced inflation in recent years, but actually outpaced Medicare, too. Ryan’s numbers are so fantastic that Alice Rivlin, who originally had her name on this proposal, now opposes it.

Democrats don’t just have a proposal that offers a more plausible vision of cost control than Ryan does. They have an honest-to-goodness law. The Affordable Care Act sets more achievable targets, and offers a host of more plausible ways to reach them, than anything in Ryan’s budget. “If this is a competition betweenRyan and the Affordable Care Act on realistic approaches to curbing the growth of spending,” says Robert Reischauer, who ran the Congressional Budget Office from 1989 to 1995 and now directs the Urban Institute, “the Affordable Care Act gets five points and Ryan gets zero.”

So from Ryan we get promises of magic, smoke and mirrors that will lower health care costs if we just keep the government from paying for them. His magical vision is to shift all cost increases off to the patient. The magic does nothing to actually lower health care costs.

In constrast the Democrats have the already enacted and partially implemented Affordable Care Act which does the following

The Affordable Care Act’s central hope is that Medicare can lead the health-care system to pay for value, cut down on overtreatment, and cut out treatments that simply don’t work. The law develops Accountable Care Organizations, in which Medicare pays one provider to coordinate all of your care successfully, rather than paying many doctors and providers to add to your care no matter the cost or outcome, as is the current practice. It also begins experimenting with bundled payments, in which Medicare pays one lump-sum for all care related to the successful treatment of a condition rather than paying for every piece of care separately. To help these reforms succeed, and to help all doctors make more cost-effective treatment decisions, the law accelerates research on which drugs and treatments are most effective, and creates and funds the Patient-Centered Outcomes Research Institute to disseminate the data.

If those initiatives work, they head over to the Independent Payment Advisory Board (IPAB), which can implement cost-controlling reforms across Medicare without congressional approval — an effort to make continuous reform the default for Medicare, even if Congress is gridlocked or focused on other matters. And if they don’t work, then it’s up to the Center for Medicare and Medicaid Innovation, a funded body that will be continually testing payment and practice reforms, to keep searching and experimenting, and when it hits on successful ideas, handing them to the IPAB to implement throughout the system.

The law also goes after bad and wasted care: It cuts payments to hospitals with high rates of re-admission, as that tends to signal care isn’t being delivered well, or isn’t being follow up on effectively. It cuts payments to hospitals for care related to infections caught in the hospitals. It develops new plans to help Medicare base its purchasing decisions on value, and new programs to help Medicaid move patients with chronic illnesses into systems that rely on the sort of maintenance-based care that’s been shown to successfully lower costs and improve outcomes.

I could go on, but instead, I’ll just link to the Kaiser Family Foundation’s excellent primer (pdf) on everything the law does. The bottom line is this: The Affordable Care Act is actually doing the hard work of reforming the health-care system that’s needed to make cost control possible. Ryan’s budget just makes seniors pay more for their Medicare and choose their own plans — worthy ideas, you can argue, but ideas that have been tried many times before, and that have never cut costs in the way Ryan’s budget suggests they will.

So what will America get from the government in order to control runaway health care costs? Ryan's promises of magic, smoke and mirrors with no system of accountability for the effectiveness of health care services? Or the Affordable Care Act the Democrats have, at great cost, already crafted and begun to implement which takes a solid, working approach to actually improving the effectiveness and efficiency of the health care procedures themselves?

I'll take the output of the practical mechanic over the wild promises of the flashy "magician" any day. So will any intelligent grown up.

Labels: Affordable Care Act, Healthcare

posted by Richard @ 1:26 PM 0 comments

"Fix" Medicare? Nah, Ryan just wants it abolished.

Medical costs are climbing sustainably. No question. But America pays more than twice as much per person for health care as any other industrial nation while NOT getting as good results for what is bought as those other nations get! So what is the Republican solution as presented today by Rep. Ryan? Abolish Medicare.

Here's an excellent description of what was offered written by Josh Marshall,.

What the Republicans are proposing are not cuts. Some level of cuts and/or cost containment in Medicare are necessary because medical inflation is growing so quickly. But these aren't cuts. They're using a temporary budget crisis and the need to slow the rate of Medicare costs over long run simply to abolish the program. That's a bait and switch. It's the medical side equivalent of the "private accounts" bamboozle that President Bush used in 2005 to try to phase out Social Security.

Medicare is a federally-backed health insurance program for seniors. Why seniors? Because seniors as a group are just too sick for the private health care insurance sector to adequately provide coverage for. To rein in costs you can reduce benefits that the program provides or place more cost containment measures in place. Real pain is involved in both. But that's a legitimate area for debate. Medicare is a long term budget problem, unlike Social Security which isn't.

Or you can decide just to abolish the program altogether. Just eliminate Medicare in its entirety. This is what Rep. Ryan (R-WI) calls "fixing" Medicare, i.e., getting rid of it. Getting rid of it means abolishing the program and pushing seniors back into the private health insurance system and providing a subsidy to help pay the costs of your average 75 year old's health care. If costs go up? Well, start saving now.

This piece of Republican bamboozlement is going to get a lot of media blather in the next few weeks - even as the tea baggers shut down the federal government. But what it should get is total rejection. There is simply nothing here except a conservative primal scream shouting "We hate government except for Wars!! Government exists to Kill - kill - Kill and nothing else!!"

What no one today remembers is that when Medicare was passed in 1965 there was no insurance for anyone after age 65. If you had insurance and turned age 65 that health insurance was cancelled and there was no company in the market which would sell you a policy. People over age 65 were simply uninsurable.

This is the nature of the market that Paul Ryan wants to throw medicare beneficiaries back into.

Labels: Healthcare, Medicare

posted by Richard @ 3:35 PM 0 comments