Silicon Investor (SI) -- The First Internet Community

STOCKTALK

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor. We ask that you disable ad blocking while on Silicon Investor in the best interests of our community. If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.

Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: John Koligman who wrote (10562)	10/19/2009 7:50:10 PM
From: John Koligman	Respond to of 42652

Medicare Premiums to Rise 15 Percent as Costs Jump By ROBERT PEAR Published: October 19, 2009 WASHINGTON — The basic Medicare premium will shoot up next year by 15 percent, to $110.50 a month, federal officials said Monday. The increase means that monthly premiums would top $100 for the first time — - a stark indication of the rise in medical costs that is driving the debate in Congress about a broad overhaul of the health care system. About 12 million people, or 27 percent of all Medicare beneficiaries, will have to pay higher premiums. The other 73 percent will be shielded from the increase because, under federal law, their Medicare premiums cannot go up more than the increase in their Social Security benefits. And Social Security officials announced last week that there would be no increase in Social Security benefits in 2010 because inflation had been extremely low. Kathleen Sebelius, the secretary of health and human services, urged the Senate to approve a bill, already passed by the House, to block the scheduled increase in Medicare premiums. “We are in tremendously difficult economic times, and seniors are being hit particularly hard,” Ms. Sebelius said. “The last thing seniors need right now is a substantial increase in their Medicare premiums, and many seniors will see such an increase if no action is taken.” Among those who face higher premiums next year are new Medicare beneficiaries, high-income people and those whose Medicare premiums are paid by Medicaid. Premiums can be as high as $353.60 a month, or more than $4,200 a year, for Medicare beneficiaries who file tax returns with adjusted gross income greater than $214,000 for an individual or $428,000 for a couple. The higher premiums will impose “an additional and significant burden” on states because they help pay Medicaid costs, along with the federal government. The House bill was passed, 406 to 18, on Sept. 24. Among those who voted against it was the Democratic leader, Representative Steny H. Hoyer of Maryland, who said he saw no need to help multimillionaires at a time when the nation was struggling to rein in entitlement programs. While lawmakers considered whether to freeze Medicare premiums, a handful of senators met behind closed doors on Monday to work out a compromise health care bill to cover the uninsured. One participant, Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said senators were considering new ideas to finesse disagreements over whether the government should offer its own health insurance plan, in competition with private insurers. Under one proposal, he said, the government would create a public plan, but states could “opt out” if they wanted to devise and operate their own insurance programs. The meeting, convened by the Senate majority leader, Harry Reid, Democrat of Nevada, included Mr. Baucus and Senator Christopher J. Dodd, Democrat of Connecticut, who presided over the health committee when it approved a sweeping health care bill in July. Mr. Reid said he hoped to take a compromise bill to the Senate floor early next month. But that assumes rapid progress in negotiations and a quick analysis by the Congressional Budget Office, to confirm whether the 10-year cost of the bill is under the $900 billion ceiling set by President Obama. The Finance Committee approved a detailed outline of a sweeping health care bill last week. Senator Baucus formally introduced the bill, a 1,502-page document, on Monday. The Senate is debating a separate bill to prevent deep cuts in Medicare payments to doctors. The bill would not offset any of the costs, estimated at $247 billion over the next 10 years. Senator Lamar Alexander of Tennessee, the No. 3 Republican in the Senate, said: “Of course, we need to fix doctors’ reimbursement. But it needs to be paid for. We can’t just add a quarter-trillion dollars to the national debt.” Democrats said the bill simply recognized political reality. In recent years, they said, Congress has repeatedly stepped in to prevent cuts in Medicare payments to doctors, and it is likely to do so in the future. nytimes.com

To: John Koligman who wrote (10562)	10/20/2009 9:14:00 AM
From: Road Walker	Read Replies (1) \| Respond to of 42652

Good article; thanks John. Don't know how that translates to public policy. Indeed, across the board, costs are going up. And between the millstones of fee-for-service and pressure from insurers to curb all the extra billing, family doctors are being ground into paste. "We've made it systematically as unpleasant to be a PCP as it is to be a primary-school teacher," says Gene Lindsey, president of Atrius Health, a nonprofit alliance of medical providers in Massachusetts. "We're real adept at that." But there are ways to fix what ails the docs — and repair the health-care system in the process. In the rolling hills of central Pennsylvania, the Geisinger Health System is trying something different. The 726 physicians and 257 residents and fellows who work there don't do piecework. They are paid a salary — benchmarked against the national average — plus potential bonuses based on how well their patients do under their care. One result is that Geisinger is able to hang on to its PCPs while other hospitals are losing theirs. Another is that Geisinger makes money, and, oh yes, the patients get well. (Read "Can New Doctors Be Harmful to Your Health?") In his Sept. 9 speech to Congress, President Obama singled out Geisinger and Utah's Intermountain Healthcare as examples of organizations that are learning to do things right. He could have cited others too: the Cleveland Clinic, the Mayo Clinic, Kaiser Permanente. What these providers have in common are the creative ways they're doing away with fee-for-service and replacing it with an imaginative mix of systems that cost less, keep patients healthier and make doctors happier. "We need a transition to rewarding the actual value of care," says Dr. Elliott Fisher, director of population health and policy at the Dartmouth Institute. "For now, our payment system is getting in the way." (See the Cleveland Clinic's smarter approach to health care.)

To: John Koligman who wrote (10562)	10/20/2009 10:12:38 AM
From: Peter Dierks	3 Recommendations Respond to of 42652

Health Costs and History Government programs always exceed their spending estimates. OCTOBER 20, 2009. Washington has just run a $1.4 trillion budget deficit for fiscal 2009, even as we are told a new health-care entitlement will reduce red ink by $81 billion over 10 years. To believe that fantastic claim, you have to ignore everything we know about Washington and the history of government health-care programs. For the record, we decided to take a look at how previous federal forecasts matched what later happened. It isn't pretty. Let's start with the claim that a more pervasive federal role will restrain costs and thus make health care more affordable. We know that over the past four decades precisely the opposite has occurred. Prior to the creation of Medicare and Medicaid in 1965, health-care inflation ran slightly faster than overall inflation. In the years since, medical inflation has climbed 2.3 times faster than cost increases elsewhere in the economy. Much of this reflects advances in technology and expensive treatments, but the contrast does contradict the claim of government as a benign cost saver. .Next let's examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing. Thanks in part to expansions promoted by California's Henry Waxman, a principal author of the current House bill, Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that's before the health-care bill covers millions of new beneficiaries. Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren't small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion. The Medicare program for renal disease was originally estimated in 1973 to cover 11,000 participants. Today it covers 395,000, at a cost of $22 billion. The 1988 Medicare home-care benefit was supposed to cost $4 billion by 1993, but the actual cost was $10 billion, because many more people participated than expected. This is nearly always the case with government programs because their entitlement nature—accepting everyone who meets the age or income limits—means there's no fixed annual budget. One of the few health-care entitlements that has come in well below the original estimate is the 2003 Medicare prescription drug bill. Those costs are now about one-third below the original projections, according to the Medicare actuaries. Part of the reason is lower than expected participation by seniors and savings from generic drugs. But as White House budget director Peter Orszag told Congress when he ran the Congressional Budget Office, the "primary cause" of these cost savings is that "the pricing is coming in better than anticipated, and that is likely a reflection of the competition that's occurring in the private market." The Centers for Medicare and Medicaid Services agrees, stating that "the drug plans competing for Medicare beneficiaries have been able to establish greater than expected savings from aggressive price negotiation." It adds that when given choices "beneficiaries have overwhelmingly selected less costly drug plans." Yet liberal Democrats fought that private-competition model (preferring government drug price controls), just as they are trying to prevent private health plans from competing across state borders now. The lesson here is that spending on nearly all federal benefit programs grow relentlessly once they are established. This history won't stop Democrats bent on ramming their entitlement into law. But every Member who votes for it is guaranteeing larger deficits and higher taxes far into the future. Count on it. online.wsj.com