US healthcare comes up short in survey of 7 nations | Thu Nov 1, 2007 | By Maggie Fox, Health and Science Editor
WASHINGTON, Nov 1 (Reuters) - Americans spend double what people in other industrialized countries do on health care, but have more trouble seeing doctors, are the victims of more errors and go without treatment more often, according to a report released on Thursday.
Patients in the Netherlands struggle the most with paperwork, while British and Canadian citizens wait the longest for elective surgery, the Commonwealth Fund reports in the journal Health Affairs.
The report, published on the Internet at http://content.healthaffairs.org/cgi/content/abstract/26/6/w717T, provides an annual comparison from the Commonwealth Fund, a private foundation that supports research on health systems.
...
The report said Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product. All the other countries spent less than half of that -- $3,128 in Australia or 9.5 percent of GDP, $3,326 in Canada or 9.8 percent of GDP, down to a low of $2,343 in New Zealand or 9 percent of GDP.
...
The report found that the United States stands out because of its expense and people's dissatisfaction.
...
"As in previous surveys, U.S. adults were most likely to have gone without care because of cost and to have high out-of-pocket costs," the report reads.
"In the U.S., nearly two of five (37 percent) of all adults and 42 percent of those with chronic conditions had skipped medications, not seen a doctor when sick, or foregone recommended care in the past year because of costs -- rates well above all other countries," it adds.
"In contrast to the U.S., patients in Canada, the Netherlands, and the U.K. rarely report having to forgo needed medical care because of costs."
Tuesday, November 6, 2007
Medicare drug (Part D) boosted the business of drug makers and pharmacists by 158 million prescriptions in 2006 ... reduced patient paid by 5.6%
Medicare Part D Pushed Drug Prescriptions Up 158 Million, Gov Cost by $32 Billion | Oldest, poorest spending a much greater share of their own income on premiums and health services than others |
Nov. 1, 2007 – The Medicare drug program (Part D) boosted the business of drug makers and pharmacists by 158 million prescriptions in 2006 and Medicare paid the bill of $32 billion, but a new study says the drug use and cost decrease to senior citizens was "relatively minor."
Many senior citizens already had prescription drug coverage, so the new benefit reduced the average amount paid by seniors per day of therapy by 18.4% and increased threir prescription drug use by only 13%, say researchers in a study published today in the 25th anniversary issue of the journal Health Affairs.
...
Lichtenberg and coauthor Shawn Sun, a researcher at Walgreens Health Services, found that Medicare patients paid about 66 cents per day of medication therapy in September 2004.
By December 2006 - after implementation of Medicare Part D - they paid about 53 cents per day of therapy.
However, with the subsequent increase in utilization that came after Part D, researchers found that the program reduced the total amount paid by patients by only 5.6 percent.
The program increased the amount that private insurers paid by 22.3 percent.
...
Nov. 1, 2007 – The Medicare drug program (Part D) boosted the business of drug makers and pharmacists by 158 million prescriptions in 2006 and Medicare paid the bill of $32 billion, but a new study says the drug use and cost decrease to senior citizens was "relatively minor."
Many senior citizens already had prescription drug coverage, so the new benefit reduced the average amount paid by seniors per day of therapy by 18.4% and increased threir prescription drug use by only 13%, say researchers in a study published today in the 25th anniversary issue of the journal Health Affairs.
...
Lichtenberg and coauthor Shawn Sun, a researcher at Walgreens Health Services, found that Medicare patients paid about 66 cents per day of medication therapy in September 2004.
By December 2006 - after implementation of Medicare Part D - they paid about 53 cents per day of therapy.
However, with the subsequent increase in utilization that came after Part D, researchers found that the program reduced the total amount paid by patients by only 5.6 percent.
The program increased the amount that private insurers paid by 22.3 percent.
...
Medicare Beneficiaries at Highest Risk, Spending More Out Of Pocket On Health Care
A related study in the November/December issue shows that the oldest, frailest, and poorest Medicare beneficiaries are spending a much greater share of their own income on premiums and health services than others, and that out-of-pocket spending as a share of income has increased over time for the Medicare population.
Kaiser Family Foundation and University of California, Los Angeles, researchers found that median out-of-pocket spending on health care increased by 50 percent, from $1,667 to $2,501, between 1997 and 2003.
The oldest Medicare beneficiaries, those in poor health, beneficiaries with low incomes, and those living in nursing homes were more likely than other Medicare beneficiaries to spend a large share of their incomes on premiums and health care services, according to the study.
The top quarter of high-spending beneficiaries spent almost 30 percent of their income on health care. The top 10 percent spent nearly 60 percent of their income on health care. Four of 10 beneficiaries spent more than 20 percent of their income on health in 2003, researchers Patricia Neuman, Juliette Cubanski, Katherine Desmond, and Thomas Rice found.
The findings “raise important questions about how much of their incomes beneficiaries can reasonably be expected to spend on their health care and whether current out-of-pocket spending levels are affordable,” the researchers say.
They warn that the overall burden of paying for health care could continue to rise for beneficiaries, and, as a result, health care could become less affordable and accessible for all but the highest-income beneficiaries. ...
Friday, November 2, 2007
So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false ... should be a major political scandal
November 2, 2007 by The New York Times | Prostates and Prejudices | by Paul Krugman
“My chance of surviving prostate cancer - and thank God I was cured of it - in the United States? Eighty-two percent,” says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. “My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.”
...
Let’s start with the facts: Mr. Giuliani’s claim is wrong on multiple levels - bogus numbers wrapped in an invalid comparison embedded in a smear.
Mr. Giuliani got his numbers from a recent article in City Journal, a publication of the conservative Manhattan Institute. The author gave no source for his numbers on five-year survival rates - the probability that someone diagnosed with prostate cancer would still be alive five years after the diagnosis. And they’re just wrong.
You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a man’s chance of dying from prostate cancer is about the same in Britain as it is in America.
So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false. In fact, there’s very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.
...
By rights, then, Mr. Giuliani’s false claims about prostate cancer - which he has, by the way, continued to repeat, along with some fresh false claims about breast cancer - should be a major political scandal. As far as I can tell, however, they aren’t being treated that way.
To be fair, there has been some news coverage of the prostate affair. But it’s only a tiny fraction of the coverage received by Hillary’s laugh and John Edwards’s haircut.
“My chance of surviving prostate cancer - and thank God I was cured of it - in the United States? Eighty-two percent,” says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. “My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.”
...
Let’s start with the facts: Mr. Giuliani’s claim is wrong on multiple levels - bogus numbers wrapped in an invalid comparison embedded in a smear.
Mr. Giuliani got his numbers from a recent article in City Journal, a publication of the conservative Manhattan Institute. The author gave no source for his numbers on five-year survival rates - the probability that someone diagnosed with prostate cancer would still be alive five years after the diagnosis. And they’re just wrong.
You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a man’s chance of dying from prostate cancer is about the same in Britain as it is in America.
So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false. In fact, there’s very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.
...
By rights, then, Mr. Giuliani’s false claims about prostate cancer - which he has, by the way, continued to repeat, along with some fresh false claims about breast cancer - should be a major political scandal. As far as I can tell, however, they aren’t being treated that way.
To be fair, there has been some news coverage of the prostate affair. But it’s only a tiny fraction of the coverage received by Hillary’s laugh and John Edwards’s haircut.
And much of the coverage seems weirdly diffident. Memo to editors: If a candidate says something completely false, it’s not “in dispute.” It’s not the case that “Democrats say” they’re not advocating British-style socialized medicine; they aren’t.
The fact is that the prostate affair is part of a pattern: Mr. Giuliani has a habit of saying things, on issues that range from health care to national security, that are demonstrably untrue. And the American people have a right to know that.
Wednesday, October 31, 2007
Twenty-one states will run out of money for children’s health insurance in the coming year, ... SCHIP vetoed by Bush
Federal Study Offers Dire Outlook on Child Insurance | By ROBERT PEAR | Published: October 31, 2007
WASHINGTON, Oct. 30 — Twenty-one states will run out of money for children’s health insurance in the coming year, and at least nine of those states will exhaust their allotments in March if Congress simply continues spending at current levels, a new federal study says.
The findings added urgency to bipartisan talks on Capitol Hill intended to overcome an impasse over expansion of the State Children’s Health Insurance Program.
...
Their goal is to revise a bill, vetoed by President Bush, to pick up Republican support in the House and gain enough votes to override another veto threatened by the president.
...
The Senate passed the original child health bill last month, 67 to 29, with 18 Republicans voting for it. Two of those Republicans, Senators Charles E. Grassley of Iowa and Orrin G. Hatch of Utah, helped write the bill and have been negotiating with House members of both parties to round up Republican support for a revised version of the bill. ...
WASHINGTON, Oct. 30 — Twenty-one states will run out of money for children’s health insurance in the coming year, and at least nine of those states will exhaust their allotments in March if Congress simply continues spending at current levels, a new federal study says.
The findings added urgency to bipartisan talks on Capitol Hill intended to overcome an impasse over expansion of the State Children’s Health Insurance Program.
...
Their goal is to revise a bill, vetoed by President Bush, to pick up Republican support in the House and gain enough votes to override another veto threatened by the president.
...
The Senate passed the original child health bill last month, 67 to 29, with 18 Republicans voting for it. Two of those Republicans, Senators Charles E. Grassley of Iowa and Orrin G. Hatch of Utah, helped write the bill and have been negotiating with House members of both parties to round up Republican support for a revised version of the bill. ...
What about the two to three million insurance industry employees whose sole job it is to turn down claims? ...plan for them: It’s called unemployment
Why Does Everyone Bow Down to the Health Insurance Industry? | By Barbara Ehrenreich, Barbaraehrenreich.com. Posted September 24, 2007.
...
With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health "reform" plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton -- why are we not surprised? -- has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?
..
I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”?
Yes, it is big. Leighton Ku, at the Center for Budget and Policy Priorities, gave me the figure of $776 billion in expenditures on private health insurance for this year. It’s also a big-time employer, paying what economist Paul Krugman has estimated two to three million people just turn down claims.
This in turn generates ever more employment in doctors’ offices to battle the insurance companies. Dr. Atul Gawande, a practicing physician, wrote in The New Yorker that ''a well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That’s how a doctor makes money. It's a war with insurance, every step of the way.'' And that’s another thing your insurance premium has to pay for: the ongoing "war" between doctors and insurers.
...
Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three -- every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.
Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. ...
...
And what about the two to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?
...
With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health "reform" plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton -- why are we not surprised? -- has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?
..
I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”?
Yes, it is big. Leighton Ku, at the Center for Budget and Policy Priorities, gave me the figure of $776 billion in expenditures on private health insurance for this year. It’s also a big-time employer, paying what economist Paul Krugman has estimated two to three million people just turn down claims.
This in turn generates ever more employment in doctors’ offices to battle the insurance companies. Dr. Atul Gawande, a practicing physician, wrote in The New Yorker that ''a well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That’s how a doctor makes money. It's a war with insurance, every step of the way.'' And that’s another thing your insurance premium has to pay for: the ongoing "war" between doctors and insurers.
...
Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three -- every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.
Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. ...
...
And what about the two to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?
China: not required to meet even minimal drug-manufacturing standards, there is little to stop them from exporting unapproved, adulterated or counterf
Chemicals Flow Unchecked From China to Drug Market | By WALT BOGDANICH | Published: October 31, 2007
At least 82 Chinese companies at a Milan trade show, none of them certified, said they made pharmaceutical ingredients.
...
MILAN — In January, Honor International Pharmtech was accused of shipping counterfeit drugs into the United States. Even so, the Chinese chemical company — whose motto is “Thinking Much of Honor” — was openly marketing its products in October to thousands of buyers here at the world’s biggest trade show for pharmaceutical ingredients.
... Also attending were two exporters owned by China’s government that had sold poison mislabeled as a drug ingredient, which killed nearly 200 people and injured countless others in Haiti and in Panama.
Yet another chemical company, Orient Pacific International, reserved an exhibition booth in Milan, but its owner, Kevin Xu, could not attend. He was in a Houston jail on charges of selling counterfeit medicine for schizophrenia, prostate cancer, blood clots and Alzheimer’s disease, among other maladies.
While these companies hardly represent all of the nearly 500 Chinese exhibitors, more than from any other country, they do point to a deeper problem: Pharmaceutical ingredients exported from China are often made by chemical companies that are neither certified nor inspected by Chinese drug regulators, The New York Times has found.
Because the chemical companies are not required to meet even minimal drug-manufacturing standards, there is little to stop them from exporting unapproved, adulterated or counterfeit ingredients. The substandard formulations made from those ingredients often end up in pharmacies in developing countries and for sale on the Internet, where more Americans are turning for cheap medicine. ...
...
At their worst, uncertified chemical companies contribute to China’s notoriety as the world’s biggest supplier of counterfeit drugs, which include unauthorized copies as well as substandard, even harmful, formulations. “Underregulated manufacturers are increasingly becoming the source of A.P.I.’s used in the production of counterfeit medicine,” R. John Theriault, until recently Pfizer’s head of global security, said in a statement to Congress. ...
At least 82 Chinese companies at a Milan trade show, none of them certified, said they made pharmaceutical ingredients.
...
MILAN — In January, Honor International Pharmtech was accused of shipping counterfeit drugs into the United States. Even so, the Chinese chemical company — whose motto is “Thinking Much of Honor” — was openly marketing its products in October to thousands of buyers here at the world’s biggest trade show for pharmaceutical ingredients.
... Also attending were two exporters owned by China’s government that had sold poison mislabeled as a drug ingredient, which killed nearly 200 people and injured countless others in Haiti and in Panama.
Yet another chemical company, Orient Pacific International, reserved an exhibition booth in Milan, but its owner, Kevin Xu, could not attend. He was in a Houston jail on charges of selling counterfeit medicine for schizophrenia, prostate cancer, blood clots and Alzheimer’s disease, among other maladies.
While these companies hardly represent all of the nearly 500 Chinese exhibitors, more than from any other country, they do point to a deeper problem: Pharmaceutical ingredients exported from China are often made by chemical companies that are neither certified nor inspected by Chinese drug regulators, The New York Times has found.
Because the chemical companies are not required to meet even minimal drug-manufacturing standards, there is little to stop them from exporting unapproved, adulterated or counterfeit ingredients. The substandard formulations made from those ingredients often end up in pharmacies in developing countries and for sale on the Internet, where more Americans are turning for cheap medicine. ...
...
At their worst, uncertified chemical companies contribute to China’s notoriety as the world’s biggest supplier of counterfeit drugs, which include unauthorized copies as well as substandard, even harmful, formulations. “Underregulated manufacturers are increasingly becoming the source of A.P.I.’s used in the production of counterfeit medicine,” R. John Theriault, until recently Pfizer’s head of global security, said in a statement to Congress. ...
Tuesday, October 30, 2007
one of every eight veterans under the age of 65 is uninsured ... 1.8M ... an increase of 290,000 since 2000
Study: More Veterans Are Uninsured | By THE ASSOCIATED PRESS | Published: October 30, 2007
WASHINGTON (AP) -- About one of every eight veterans under the age of 65 is uninsured, a finding that contradicts the assumption many have that all vets qualify for free health care through the Veterans Affairs Department, says a new study.
Researchers at Harvard Medical School projected that about 1.8 million veterans overall lack health coverage. That's an increase of 290,000 since 2000. The researchers said most uninsured veterans are in the middle class and are ineligible for VA care because of their incomes. Still others cannot afford their copayments, or lack VA facilities in their community.
''Like other uninsured Americans, most uninsured vets are working people -- too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,'' said Dr. Steffie Woolhandler, an associate professor and a physician at the Cambridge Health Alliance. ...
...
The study notes that the VA in January 2003 ordered a halt to the enrollment of most veterans who are not poor. The move was designed to reduce the backlog of patients waiting for care.
But Peter Gaytan, who monitors veterans' issues for the American Legion, said veterans now make as little as about $24,000 a year in some regions and still do not qualify for health coverage from the VA. ...
WASHINGTON (AP) -- About one of every eight veterans under the age of 65 is uninsured, a finding that contradicts the assumption many have that all vets qualify for free health care through the Veterans Affairs Department, says a new study.
Researchers at Harvard Medical School projected that about 1.8 million veterans overall lack health coverage. That's an increase of 290,000 since 2000. The researchers said most uninsured veterans are in the middle class and are ineligible for VA care because of their incomes. Still others cannot afford their copayments, or lack VA facilities in their community.
''Like other uninsured Americans, most uninsured vets are working people -- too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,'' said Dr. Steffie Woolhandler, an associate professor and a physician at the Cambridge Health Alliance. ...
...
The study notes that the VA in January 2003 ordered a halt to the enrollment of most veterans who are not poor. The move was designed to reduce the backlog of patients waiting for care.
But Peter Gaytan, who monitors veterans' issues for the American Legion, said veterans now make as little as about $24,000 a year in some regions and still do not qualify for health coverage from the VA. ...
Monday, October 29, 2007
So, insurance companies avoid people needing medical care-the Old Maids-at all costs.
Friday, October 26, 2007 by CommonDreams.org | SCHIP and the Rigged Health Insurance Game | by Eric Haas
...
There were 142 members of Congress who voted against extending health care to more poor children. Behind their rhetoric, their intentions are clear: they want to protect the health insurance market and the huge profits that go with it.
...
There were 142 members of Congress who voted against extending health care to more poor children. Behind their rhetoric, their intentions are clear: they want to protect the health insurance market and the huge profits that go with it.
But the huge profits are killing health care. We all know that now. Profit-maximizing insurance companies are bad economics. They make money by denying care, which is a terrible way to try to keep us healthy. (The Rockridge Institute’s white paper on health care security has details.)
...
Currently, we don’t spread the risk and costs evenly. Instead, we have lots of insurance companies all competing against each other to maximize their profits. Which they have-to the tune of billions of dollars a year. But they make their billions by not getting “stuck” with the people needing expensive medical treatment-sort of like avoiding the Old Maid in the children’s card game. The more sick people an insurance company ends up with, the lower their profits. “Stuck” with too many people needing medical care at any one time and an insurance company loses some of their profits. So, insurance companies avoid people needing medical care-the Old Maids-at all costs. And we know the result: over 100 million Americans who are un- or under-insured, pushed into the health care cracks between insurance companies by the companies themselves.
And those of us with insurance have been dragged into this sick game. Those of us who have health insurance get it in a system that works by excluding some of our neighbors. With the present profit imperative of our competitive health insurance system, we have created a national Sophie’s Choice: millions of people must be denied care so that the rest of us-healthier, wealthier, or fortunate enough to have employer-based insurance-can get it. ...
Wednesday, October 24, 2007
“Societies should not rely on market forces to protect the environment or provide quality health care for all citizens …”
Sunday, October 21, 2007 by the Sunday Gazette-Mail (Charleston, West Virginia) | Nobel Prize Sees What Market-Fundamentalists Don’t | by Rick Wilson
...
Three Americans, Eric Maskin, Roger Myerson and Leonid Hurwicz, shared the honor for their work in mechanism design theory, which studies under what conditions markets work well or don’t. Sneak preview: They do better with private than with public goods.
...
According to this cult, the market is like an all-wise and all-good but jealous god which becomes exceedingly wrathful when interfered with by things like coal mine or workplace safety laws, minimum wage protections, or taxes that pay for health, education or other services. Its ways are not our ways, nor are its thoughts our thoughts. And if it demands an occasional human sacrifice, we just have to deal with it.
...
... Here’s the short version of a key finding: Markets work well with what economists call private goods, like refrigerators or cars, but not for public goods, such as a clean environment or public health.
According to Maskin in an article in Bloomberg.com, “There are some things we want that are never going to be attainable by markets,” he said in a telephone interview. “If we are going to get them at all we have to find alternative ways of delivering them. That’s where mechanism design comes in.”
A Reuters report on the prize noted, “Societies should not rely on market forces to protect the environment or provide quality health care for all citizens …”
In such cases, public investments and policies should promote and protect public goods.
None of this would have come as a surprise to Adam Smith, who wrote in 1776 that there was a need of government support for “public institutions and those public works, which, though they may be in the highest degree advantageous to a great society, are, however, of such a nature that the profit could never repay the expense to any individual or small number of individuals, and which it therefore cannot be expected that any individual or small number of individuals should erect or maintain.” ...
...
Three Americans, Eric Maskin, Roger Myerson and Leonid Hurwicz, shared the honor for their work in mechanism design theory, which studies under what conditions markets work well or don’t. Sneak preview: They do better with private than with public goods.
...
According to this cult, the market is like an all-wise and all-good but jealous god which becomes exceedingly wrathful when interfered with by things like coal mine or workplace safety laws, minimum wage protections, or taxes that pay for health, education or other services. Its ways are not our ways, nor are its thoughts our thoughts. And if it demands an occasional human sacrifice, we just have to deal with it.
...
... Here’s the short version of a key finding: Markets work well with what economists call private goods, like refrigerators or cars, but not for public goods, such as a clean environment or public health.
According to Maskin in an article in Bloomberg.com, “There are some things we want that are never going to be attainable by markets,” he said in a telephone interview. “If we are going to get them at all we have to find alternative ways of delivering them. That’s where mechanism design comes in.”
A Reuters report on the prize noted, “Societies should not rely on market forces to protect the environment or provide quality health care for all citizens …”
In such cases, public investments and policies should promote and protect public goods.
None of this would have come as a surprise to Adam Smith, who wrote in 1776 that there was a need of government support for “public institutions and those public works, which, though they may be in the highest degree advantageous to a great society, are, however, of such a nature that the profit could never repay the expense to any individual or small number of individuals, and which it therefore cannot be expected that any individual or small number of individuals should erect or maintain.” ...
Tuesday, October 16, 2007
"Use of private insurers to deliver Medicare drug coverage is driving up costs ... six times higher than administrative costs of traditional Medicare
Report criticizes of Medicare drug plan costs | By Lisa Richwine | Oct 15, 2007
WASHINGTON (Reuters) - U.S. taxpayers and Medicare patients could have saved almost $15 billion in 2007 if private health insurers had cut expenses for prescription drug coverage and negotiated bigger discounts, a report from Democratic staff of a House of Representatives panel said on Monday.
The Medicare prescription drug benefits offered by private insurers operate with "high administrative costs, sales expenses and profits," the report said.
...
"Use of private insurers to deliver Medicare drug coverage is driving up costs and producing only limited savings on drug prices," the report said.
...
The report said administrative expenses, sales costs and profits of private insurers offering Medicare drug plans are almost six times higher than the administrative costs of traditional Medicare coverage, costing almost $5 billion or about $180 per beneficiary in 2007. The insurers' profits will account for $1 billion, the report said. ...
...
The companies failed to negotiate significant rebates from drug makers, the report also said. Insurers did get discounts in the form of rebates that reduced spending by 8.1 percent in 2007. But that was less than the 26 percent the Medicaid program secured from drug manufacturers. ...
WASHINGTON (Reuters) - U.S. taxpayers and Medicare patients could have saved almost $15 billion in 2007 if private health insurers had cut expenses for prescription drug coverage and negotiated bigger discounts, a report from Democratic staff of a House of Representatives panel said on Monday.
The Medicare prescription drug benefits offered by private insurers operate with "high administrative costs, sales expenses and profits," the report said.
...
"Use of private insurers to deliver Medicare drug coverage is driving up costs and producing only limited savings on drug prices," the report said.
...
The report said administrative expenses, sales costs and profits of private insurers offering Medicare drug plans are almost six times higher than the administrative costs of traditional Medicare coverage, costing almost $5 billion or about $180 per beneficiary in 2007. The insurers' profits will account for $1 billion, the report said. ...
...
The companies failed to negotiate significant rebates from drug makers, the report also said. Insurers did get discounts in the form of rebates that reduced spending by 8.1 percent in 2007. But that was less than the 26 percent the Medicaid program secured from drug manufacturers. ...
Sunday, October 14, 2007
Conservatives who want to repeal the estate tax on large fortunes ... the Frosts is that they are expected to sell their investment property ...
Meanies And Hypocrites | By E. J. Dionne Jr. | Friday, October 12, 2007; Page A17
Conservatives claim to be in favor of stable families, small businesses, hard work, private schools, investment and homeownership. So why in the world are so many on the right attacking the family of Graeme Frost?
The kids were treated, thanks to SCHIP. The Frosts spoke out so the public would know that real people lie behind the acronym.
Their reward was to be trashed on right-wing blogs and talk radio as if they were multimillionaires ripping off the system. The assault on the Frosts apparently began on the Free Republic Web site and quickly spread to National Review Online, Power Line and Michelle Malkin's blog, as well as Rush Limbaugh's radio show.
...
Conservatives claim to be in favor of stable families, small businesses, hard work, private schools, investment and homeownership. So why in the world are so many on the right attacking the family of Graeme Frost?
The kids were treated, thanks to SCHIP. The Frosts spoke out so the public would know that real people lie behind the acronym.
Their reward was to be trashed on right-wing blogs and talk radio as if they were multimillionaires ripping off the system. The assault on the Frosts apparently began on the Free Republic Web site and quickly spread to National Review Online, Power Line and Michelle Malkin's blog, as well as Rush Limbaugh's radio show.
...
Most conservatives favor government-supported vouchers that would help Graeme attend his private school, but here they turn around and criticize him for . . . attending a private school. Federal money for private schools but not for health insurance? What's the logic here?
Conservatives endlessly praise risk-taking by entrepreneurs and would give big tax cuts to those who are most successful. But if a small-business person is struggling, he shouldn't even think about applying for SCHIP.
Conservatives who want to repeal the estate tax on large fortunes have cited stories -- most of them don't check out -- about farmers having to sell their farms to pay inheritance taxes. But the implication of these attacks on the Frosts is that they are expected to sell their investment property to pay for health care. Why?
Oh, yes, and conservatives tell us how much they love homeownership, and then assail the Frosts for having the nerve to own a home. I suppose they should have to sell that, too.
The real issue here is whether uninsured families with earnings similar to the Frosts' need government help to buy health coverage. With the average family policy in employer-provided plans now costing more than $12,000 annually -- the price is usually higher for families trying to buy it on their own -- the answer is plainly yes. ...Sen. John McCain health car: Is a $5,000 tax credit going to guarantee they afford and access health insurance? Of course not
They Just Don't Get It | Submitted by Bill Scher on October 11, 2007 - 7:48pm.
Sen. John McCain rolled out his health care plan today, and said:
Right now, too many of our citizens don't have an insurance policy at all, and those who do are afraid they will lose the one they have - afraid they will get too sick, afraid to stay home and not work full-time, and afraid their benefits will disappear along with their job.
I believe that everyone should get a tax credit of $2500, $5000 for families.
Let's look again at the brave yet struggling Frost family of six.
Their combined income, before taxes, is $45,000. Mrs. Frost recently priced private insurance at $14,400 a year. And they can't even get a private company to accept them because of pre-existing medical conditions.
Is a $5,000 tax credit going to guarantee they afford and access health insurance? Of course not.
Sure, McCain paid some lip service to reducing the cost of health care, but he didn't propose much specific besides "greater competition" and caps on malpractice lawsuits (which only amount to 2% of all health care spending). The only significant reform he offered was reiterating his support for importing cheaper prescription drugs.
This is very much in line with what Joe Paduda wrote last month:
The GOP programs are not 'reform'. There is no evidence that these tax breaks will significantly improve the number of people with coverage, the quality of the care they get, or reduce the cost of insurance or medical care. None. Zippo. Nada. The GOP platforms are actually tax breaks, marketed as health care reform.
That's fine, but rather disingenuous.
It's also detached from reality.
Sen. John McCain rolled out his health care plan today, and said:
Right now, too many of our citizens don't have an insurance policy at all, and those who do are afraid they will lose the one they have - afraid they will get too sick, afraid to stay home and not work full-time, and afraid their benefits will disappear along with their job.
I believe that everyone should get a tax credit of $2500, $5000 for families.
Let's look again at the brave yet struggling Frost family of six.
Their combined income, before taxes, is $45,000. Mrs. Frost recently priced private insurance at $14,400 a year. And they can't even get a private company to accept them because of pre-existing medical conditions.
Is a $5,000 tax credit going to guarantee they afford and access health insurance? Of course not.
Sure, McCain paid some lip service to reducing the cost of health care, but he didn't propose much specific besides "greater competition" and caps on malpractice lawsuits (which only amount to 2% of all health care spending). The only significant reform he offered was reiterating his support for importing cheaper prescription drugs.
This is very much in line with what Joe Paduda wrote last month:
The GOP programs are not 'reform'. There is no evidence that these tax breaks will significantly improve the number of people with coverage, the quality of the care they get, or reduce the cost of insurance or medical care. None. Zippo. Nada. The GOP platforms are actually tax breaks, marketed as health care reform.
That's fine, but rather disingenuous.
It's also detached from reality.
children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults ...
U.S. children often lack quality medical care | By Tony Pugh | McClatchy Newspapers | * Posted on Wednesday, October 10, 2007
WASHINGTON — In the largest study of its kind, researchers found that America's children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults and raising serious questions about the quality of care delivered by the world's most expensive health system.
...
It followed the health care experiences of 1,536 children from 12 metropolitan areas over a four-year period. By interviewing the youngsters' parents, reviewing the children's medical records and comparing their treatments to established care standards, researchers found that even basic care was a hit-or-miss proposition for children who visit hospitals and pediatricians.
The study found only 19 percent of seriously ill infants with fevers had the right lab tests done, only 44 percent of youngsters with asthma were on the right medications and only 38 percent of youngsters were screened for anemia in their first two years of life.
In addition, only 31 percent of children ages 3-6 have their weight measured at annual checkups.
...
A 2006 RAND study found that adults get appropriate medical care about 55 percent of the time.
...
But the new study found that youngsters get appropriate care for acute illnesses, such as fevers, only 68 percent of the time and proper care for chronic conditions, such as attention deficit disorder, only 53 percent of the time.
Proper preventative care, the bread and butter of pediatric practice, was provided in only 41 percent of check-ups. Researchers gauged quality of treatment against 175 standards of care that cover 12 clinical areas.
"It is unconscionable that we spend $2 trillion on health care, more than any nation in the world, and get these results," said co-author Elizabeth McGlynn, an associate director of RAND Health. "We can do better, but this will not happen without serious sustained effort. This study tells us that it is time to begin." ...
WASHINGTON — In the largest study of its kind, researchers found that America's children received appropriate medical care only 46 percent of the time when they visit health professionals, faring even worse than adults and raising serious questions about the quality of care delivered by the world's most expensive health system.
...
It followed the health care experiences of 1,536 children from 12 metropolitan areas over a four-year period. By interviewing the youngsters' parents, reviewing the children's medical records and comparing their treatments to established care standards, researchers found that even basic care was a hit-or-miss proposition for children who visit hospitals and pediatricians.
The study found only 19 percent of seriously ill infants with fevers had the right lab tests done, only 44 percent of youngsters with asthma were on the right medications and only 38 percent of youngsters were screened for anemia in their first two years of life.
In addition, only 31 percent of children ages 3-6 have their weight measured at annual checkups.
...
A 2006 RAND study found that adults get appropriate medical care about 55 percent of the time.
...
But the new study found that youngsters get appropriate care for acute illnesses, such as fevers, only 68 percent of the time and proper care for chronic conditions, such as attention deficit disorder, only 53 percent of the time.
Proper preventative care, the bread and butter of pediatric practice, was provided in only 41 percent of check-ups. Researchers gauged quality of treatment against 175 standards of care that cover 12 clinical areas.
"It is unconscionable that we spend $2 trillion on health care, more than any nation in the world, and get these results," said co-author Elizabeth McGlynn, an associate director of RAND Health. "We can do better, but this will not happen without serious sustained effort. This study tells us that it is time to begin." ...
they are willing to do their part to make it happen. 72% support the expansion of SCHIP, and 60% are willing to pay more in taxes ... for health insur
More Conservative Honesty Please | Submitted by Bill Scher on October 11, 2007 - 12:20pm.
...
I did overstate one point. I said Bush is proposing "less money" for SCHIP, which isn't quite right. He is proposing nominally more money, just not enough to maintain the number of kids currently in the program. It's essentially less money, but not literally.
...
Instead of thinking of ways for entrepreneurs to pursue the American Dream without having to worry about the basics in life, conservatives like Riehl are quick to make assumptions and mock them for their career choices -- at least, when the solution involves pooling our resources through our government to solve problems the private market hasn't tackled.
Apparently, entrepreneurs are only awesome when wealthy Americans are demanding tax giveaways.
Instead of helping Americans have more career choices, conservatives like Riehl would force more Americans to choose between their career and the health of their families. If millions of working class children remain at risk, so be it.
...
Because most Americans believe everyone should have health insurance and everyone should have a real opportunity to pursue the American Dream.
And they are willing to do their part to make it happen. 72% support the expansion of SCHIP, and 60% are willing to pay more in taxes so our government can guarantee health insurance for everyone.
The more honest conservatives are about their cold and callous vision for America, the easier it will be for American voters to make informed decisions about where we should go as a nation. ...
...
I did overstate one point. I said Bush is proposing "less money" for SCHIP, which isn't quite right. He is proposing nominally more money, just not enough to maintain the number of kids currently in the program. It's essentially less money, but not literally.
...
Instead of thinking of ways for entrepreneurs to pursue the American Dream without having to worry about the basics in life, conservatives like Riehl are quick to make assumptions and mock them for their career choices -- at least, when the solution involves pooling our resources through our government to solve problems the private market hasn't tackled.
Apparently, entrepreneurs are only awesome when wealthy Americans are demanding tax giveaways.
Instead of helping Americans have more career choices, conservatives like Riehl would force more Americans to choose between their career and the health of their families. If millions of working class children remain at risk, so be it.
...
Because most Americans believe everyone should have health insurance and everyone should have a real opportunity to pursue the American Dream.
And they are willing to do their part to make it happen. 72% support the expansion of SCHIP, and 60% are willing to pay more in taxes so our government can guarantee health insurance for everyone.
The more honest conservatives are about their cold and callous vision for America, the easier it will be for American voters to make informed decisions about where we should go as a nation. ...
forms from our health insurance company inexplicably denying payment — or only partly paying — for something we believed was covered.
Hands to Hold When Health Care Becomes a Maze | By ALINA TUGEND | Published: October 13, 2007
I HAVE not dreaded thin envelopes so much since applying to college.
They are showing up with alarming regularity lately: forms from our health insurance company inexplicably denying payment — or only partly paying — for something we believed was covered.
We read the codes and try to figure out why we are paid $30 for a $300 visit; they may as well have been written in Latin.
And when we try calling, all too often we end up in a voice mail maze.
...
Mr. Claxton noted, for example, that the anesthesiologist assigned to your operation may be out of network and then “that’s extra money.” You can ask about getting one in your network, but it is not always clear whom to ask or if that request will be honored, he said.
Also, be sure to ask when making any appointment if the doctor is currently in the network. Just because it says so in your plan’s book or online does not mean the doctor is still in the plan. Avoid a nasty surprise when the bill comes.
...
Or, as happened to Karen Pollitz, a research professor at the Health Policy Institute at Georgetown University, an insurer can process a 12-year-old’s broken elbow as a workers’ compensation claim rather than as a sports accident — and then refuse to pay for it — simply because the doctor checked accident on the insurance form. ...
I HAVE not dreaded thin envelopes so much since applying to college.
They are showing up with alarming regularity lately: forms from our health insurance company inexplicably denying payment — or only partly paying — for something we believed was covered.
We read the codes and try to figure out why we are paid $30 for a $300 visit; they may as well have been written in Latin.
And when we try calling, all too often we end up in a voice mail maze.
...
Mr. Claxton noted, for example, that the anesthesiologist assigned to your operation may be out of network and then “that’s extra money.” You can ask about getting one in your network, but it is not always clear whom to ask or if that request will be honored, he said.
Also, be sure to ask when making any appointment if the doctor is currently in the network. Just because it says so in your plan’s book or online does not mean the doctor is still in the plan. Avoid a nasty surprise when the bill comes.
...
Or, as happened to Karen Pollitz, a research professor at the Health Policy Institute at Georgetown University, an insurer can process a 12-year-old’s broken elbow as a workers’ compensation claim rather than as a sports accident — and then refuse to pay for it — simply because the doctor checked accident on the insurance form. ...
US has a far higher death rate than the European average: ... one in 4800 dies vs. one in 16,400 for top 10 Euro countries
U.S. maternal death rate higher than Europe's: report | Sat Oct 13, 2007 7:03pm EDT
WASHINGTON (Reuters) - The United States has a sharply higher rate of women dying during or just after pregnancy than European countries, even some relatively poor countries such as Macedonia and Bosnia, according to the first estimates in five years on maternal deaths worldwide.
The United States has a far higher death rate than the European average, the report shows, with one in 4,800 U.S. women dying from complications of pregnancy or childbirth, the same as Belarus and just slightly better than Serbia's rate of one in 4,500.
Just one out of 47,600 women in Ireland die during or just after childbirth, the report found. Bosnia had the second-lowest rate, with 1 in 29,000 women dying during pregnancy and childbirth.
"Among the ten top-ranked European and other industrialized countries, where women are guaranteed good-quality health and family planning services that minimize their lifetime risk, fewer than one in 16,400 will die from complications of pregnancy and childbirth," the United Nations, which issued the report along with the World Bank, said in a statement. ...
WASHINGTON (Reuters) - The United States has a sharply higher rate of women dying during or just after pregnancy than European countries, even some relatively poor countries such as Macedonia and Bosnia, according to the first estimates in five years on maternal deaths worldwide.
The United States has a far higher death rate than the European average, the report shows, with one in 4,800 U.S. women dying from complications of pregnancy or childbirth, the same as Belarus and just slightly better than Serbia's rate of one in 4,500.
Just one out of 47,600 women in Ireland die during or just after childbirth, the report found. Bosnia had the second-lowest rate, with 1 in 29,000 women dying during pregnancy and childbirth.
"Among the ten top-ranked European and other industrialized countries, where women are guaranteed good-quality health and family planning services that minimize their lifetime risk, fewer than one in 16,400 will die from complications of pregnancy and childbirth," the United Nations, which issued the report along with the World Bank, said in a statement. ...
Wednesday, October 10, 2007
[Swift-boating SCHIP parents]::: "Let the parents get second jobs, let their state foot the bill or let them seek help from private charities."
Family under fire: Rush and Co. hit on healthcare | by Matthew Hay Brown
Halsey and Bonnie Frost, in front of their Butchers Hill home in Baltimore, have come under fire from conservative commentators for promoting the State Children's Health Insurance Program. Sun photo by Barbara Haddock Taylor .
...
But while the Frosts were helping a bipartisan majority in Congress sell a plan to expand the program, they were not prepared for comments such as this one, posted over the weekend on the conservative Web site Redstate:
"If federal funds were required [they] could die for all I care. Let the parents get second jobs, let their state foot the bill or let them seek help from private charities. ... I would hire a team of PIs and find out exactly how much their parents made and where they spent every nickel. Then I'd do everything possible to destroy their lives with that info."
...
It was the news coverage of that broadcast that set off the blogo- sphere. A pseudonymous contributor to Free Republic cataloged the $20,000 cost of tuition at the Park School, the $160,000 Halsey Frost paid for his warehouse in 1999 and the $485,000 for which a neighbor sold his home in March. Links were provided to photos of the Park School's 44,000-square- foot Wyman Arts Center and the Frosts' 1992 wedding announcement in The New York Times.
...
The four Frost children depend on financial aid to attend private school, the Frosts say. In addition, they say, Gemma receives money from the city for special education made necessary by her injuries.
...
The Frosts say the description of their family's circumstances now circulating is misleading. Halsey, they say, is a self-employed woodworker - he has no employees - while Bonnie works part time for a medical publishing firm. Together, they say, they earn between $45,000 and $50,000 a year.
...
Pelosi fired back yesterday.
"I think that the attack on this family is just breaking new ground and stooping to new lows in terms of what happens in Washington, D.C.," she told reporters. "I think it's a sad statement about how bankrupt some of these people are in their arguments against SCHIP that they attack a 12-year-old."
Most Americans may also have noticed that corporate bureaucracy and corruption .. are not preferable to government bureaucracy
Right-Wing Health Care Mythology | by Joe Conason Published: October 9, 2007
Once among the most frightening and effective epithets in American political culture, “socialized medicine” seems to have lost its juju. ...
...
Most Americans may also have noticed that corporate bureaucracy and corruption, which both figure largely in the present health care system, are not preferable to government bureaucracy. The same doctors who used to wail about the dangers of Medicare have learned how unpleasant it is to deal with dozens of insurance companies, each of which is creating different rules to cut costs and deny care as often as possible. So have their patients.
This corporate model is more expensive and less efficient than the government plans that provide care in every other industrialized nation.
And most Americans may have learned by now that such systems prevail in Western countries that aren’t normally categorized as “socialist,” including the United Kingdom, Japan, Spain, Canada, Germany, France, Denmark, Norway and Sweden. All these nations manage to provide their citizens with high living standards, industrial and technological innovation, and broad political and economic freedom, even after 50 years of national health insurance in some form.
Meanwhile, the credibility of conservatives has diminished steadily.
These days they seem to have trouble achieving clarity on the meaning of their favorite clichés. For instance, the president hates federalized health care, but sponsors a Medicare prescription drug program that wastes hundreds of billions on drug companies and private insurers.
Right-wing definitions no longer seem so clear, either. When the government awards a billion dollars in sweetheart mercenary contracts to a wealthy Republican family in Michigan, that’s “private enterprise.” But when the government helps a struggling middle-class family in Maryland to send its children to the doctor, that’s creeping socialism. ..
Once among the most frightening and effective epithets in American political culture, “socialized medicine” seems to have lost its juju. ...
...
Most Americans may also have noticed that corporate bureaucracy and corruption, which both figure largely in the present health care system, are not preferable to government bureaucracy. The same doctors who used to wail about the dangers of Medicare have learned how unpleasant it is to deal with dozens of insurance companies, each of which is creating different rules to cut costs and deny care as often as possible. So have their patients.
This corporate model is more expensive and less efficient than the government plans that provide care in every other industrialized nation.
And most Americans may have learned by now that such systems prevail in Western countries that aren’t normally categorized as “socialist,” including the United Kingdom, Japan, Spain, Canada, Germany, France, Denmark, Norway and Sweden. All these nations manage to provide their citizens with high living standards, industrial and technological innovation, and broad political and economic freedom, even after 50 years of national health insurance in some form.
Meanwhile, the credibility of conservatives has diminished steadily.
These days they seem to have trouble achieving clarity on the meaning of their favorite clichés. For instance, the president hates federalized health care, but sponsors a Medicare prescription drug program that wastes hundreds of billions on drug companies and private insurers.
Right-wing definitions no longer seem so clear, either. When the government awards a billion dollars in sweetheart mercenary contracts to a wealthy Republican family in Michigan, that’s “private enterprise.” But when the government helps a struggling middle-class family in Maryland to send its children to the doctor, that’s creeping socialism. ..
Sunday, October 7, 2007
New Medicare Drug program: 10,000's victims of deceptive sales tactics, improperly denied claims ...
Medicare Audits Show Problems in Private Plans | By ROBERT PEAR | Published: October 7, 2007
WASHINGTON, Oct. 6 — Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.
...
UnitedHealth, which serves more than six million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. ...
WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. ...
In March, Sierra Health Services ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS, saying they had not paid their premiums. In many cases, the premiums had been paid, and beneficiaries had canceled checks to prove it. ...
Humana, which covers more than 4.5 million people on Medicare, promised to investigate every complaint about its marketing practices, but it received so many complaints that it could not keep up. ...
The Sterling Life Insurance Company, a subsidiary of the Aon Corporation, did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. ...
Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. ...
WASHINGTON, Oct. 6 — Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.
...
UnitedHealth, which serves more than six million Medicare beneficiaries, did not have an “effective program” to supervise its marketing representatives, agents and brokers. In some cases, United improperly denied claims without giving any explanation to beneficiaries. ...
WellPoint, one of the nation’s largest insurers, had “a backlog of approximately 354,000 claims” at certain Medicare plans offered through its UniCare subsidiary. ...
In March, Sierra Health Services ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS, saying they had not paid their premiums. In many cases, the premiums had been paid, and beneficiaries had canceled checks to prove it. ...
Humana, which covers more than 4.5 million people on Medicare, promised to investigate every complaint about its marketing practices, but it received so many complaints that it could not keep up. ...
The Sterling Life Insurance Company, a subsidiary of the Aon Corporation, did not pay claims correctly or handle appeals in a timely way. The company has “a demonstrated pattern of failure” to meet Medicare performance standards. ...
Two sponsors of popular Medicare drug plans, MemberHealth and Bravo Health, did not act on requests for coverage of specific drugs within 72 hours, as required by the government. ...
Saturday, October 6, 2007
Either Bush didn't understand the bill he vetoed or he's just being petulant -- with the health of 4 million children at stake.
Bush's Veto Lies | By Eugene Robinson | Friday, October 5, 2007; Page A21
To say that George W. Bush spends money like a drunken sailor is to insult every gin-soaked patron of every dockside dive in every dubious port of call. If Bush gets his way, the cost of his wars in Iraq and Afghanistan will soon reach a mind-blowing $600 billion. Despite turning a budget surplus into a huge deficit, the man still hasn't met a tax cut he doesn't like. ... And for him to make his stand on a measure that would have provided health insurance to needy children is a punch line that hasn't left many Republicans laughing.
...
The program Congress voted to expand provides health insurance for children who fall into a perilous gap: Their families make too much money to qualify for Medicaid but don't make enough to afford health insurance. The cost of covering an additional 4 million children was estimated at around $35 billion over five years. That's a lot of money. But in the context of a $13 trillion economy -- and set against Bush's history of devil-may-care, "buy the house another round" spending -- it's chump change. ...
...
... Either Bush didn't understand the bill he vetoed or he's just being petulant -- with the health of 4 million children at stake.
To say that George W. Bush spends money like a drunken sailor is to insult every gin-soaked patron of every dockside dive in every dubious port of call. If Bush gets his way, the cost of his wars in Iraq and Afghanistan will soon reach a mind-blowing $600 billion. Despite turning a budget surplus into a huge deficit, the man still hasn't met a tax cut he doesn't like. ... And for him to make his stand on a measure that would have provided health insurance to needy children is a punch line that hasn't left many Republicans laughing.
...
The program Congress voted to expand provides health insurance for children who fall into a perilous gap: Their families make too much money to qualify for Medicaid but don't make enough to afford health insurance. The cost of covering an additional 4 million children was estimated at around $35 billion over five years. That's a lot of money. But in the context of a $13 trillion economy -- and set against Bush's history of devil-may-care, "buy the house another round" spending -- it's chump change. ...
...
... Either Bush didn't understand the bill he vetoed or he's just being petulant -- with the health of 4 million children at stake.
Sunday, September 30, 2007
Brain injuries from war worse than thought ..."These soldiers could have hidden injuries with long-term consequences,"
Scientists: Brain injuries from war worse than thought
Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.
They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.
...
This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.
...
To make matters worse, whatever damage occurred was so microscopic that it could not be found with imaging tests.
...
The microscopic damage changes brain cell metabolism, Cernak says, creating a cascading effect that leads to the premature aging and death of neurons that cannot be replaced. ...
Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.
They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.
...
This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.
...
To make matters worse, whatever damage occurred was so microscopic that it could not be found with imaging tests.
...
The microscopic damage changes brain cell metabolism, Cernak says, creating a cascading effect that leads to the premature aging and death of neurons that cannot be replaced. ...
Sunday, September 23, 2007
More Profit and Less Nursing at Many Homes ... serious health deficiencies ... almost 19 percent higher at homes owned by large investment companies
More Profit and Less Nursing at Many Homes | By CHARLES DUHIGG | Published: September 23, 2007
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
...
The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
...
The Byzantine structures established at homes owned by private investment firms also make it harder for regulators to know if one company is responsible for multiple centers. And the structures help managers bypass rules that require them to report when they, in effect, pay themselves from programs like Medicare and Medicaid.
...
Some families of residents say those structures unjustly protect investors who profit while care declines.
When Mrs. Hewitt sued Habana over her mother’s death, for example, she found that its owners and managers had spread control of Habana among 15 companies and five layers of firms.
As a result, Mrs. Hewitt’s lawyer, like many others confronting privately owned homes, has been unable to establish definitively who was responsible for her mother’s care. ...
...
But in recent years, large private investment groups have agreed to buy 6 of the nation’s 10 largest nursing home chains, containing over 141,000 beds, or 9 percent of the nation’s total. Private investment groups own at least another 60,000 beds at smaller chains and are expected to acquire many more companies as firms come under shareholder pressure to sell.
The typical large chain owned by an investment company in 2005 earned $1,700 a resident, according to reports filed by the facilities. Those homes, on average, were 41 percent more profitable than the average facility.
...
The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services reveals that at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law. (At 19 percent of those homes, staffing has remained relatively constant, though often below national averages. At 21 percent, staffing rose significantly, though even those homes were typically below national averages.) During that period, staffing at many of the nation’s other homes has fallen much less or grown
...
The typical number of serious health deficiencies cited by regulators last year was almost 19 percent higher at homes owned by large investment companies than the national average, according to analysis of Centers for Medicare and Medicaid Services records. ..
====================================
September 22, 2007 | Layers of Ownership
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
...
The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
...
The Byzantine structures established at homes owned by private investment firms also make it harder for regulators to know if one company is responsible for multiple centers. And the structures help managers bypass rules that require them to report when they, in effect, pay themselves from programs like Medicare and Medicaid.
...
Some families of residents say those structures unjustly protect investors who profit while care declines.
When Mrs. Hewitt sued Habana over her mother’s death, for example, she found that its owners and managers had spread control of Habana among 15 companies and five layers of firms.
As a result, Mrs. Hewitt’s lawyer, like many others confronting privately owned homes, has been unable to establish definitively who was responsible for her mother’s care. ...
...
But in recent years, large private investment groups have agreed to buy 6 of the nation’s 10 largest nursing home chains, containing over 141,000 beds, or 9 percent of the nation’s total. Private investment groups own at least another 60,000 beds at smaller chains and are expected to acquire many more companies as firms come under shareholder pressure to sell.
The typical large chain owned by an investment company in 2005 earned $1,700 a resident, according to reports filed by the facilities. Those homes, on average, were 41 percent more profitable than the average facility.
...
The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services reveals that at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law. (At 19 percent of those homes, staffing has remained relatively constant, though often below national averages. At 21 percent, staffing rose significantly, though even those homes were typically below national averages.) During that period, staffing at many of the nation’s other homes has fallen much less or grown
...
The typical number of serious health deficiencies cited by regulators last year was almost 19 percent higher at homes owned by large investment companies than the national average, according to analysis of Centers for Medicare and Medicaid Services records. ..
====================================
September 22, 2007 | Layers of Ownership
Saturday, September 22, 2007
Bush renews threat to veto children’s health legislation: SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded coverage
Bush renews threat to veto children’s health legislation | By Elana Schor | September 21, 2007
As negotiators closed in on a $35 billion deal to extend health insurance coverage for children, President Bush defied lawmakers with a fresh threat to veto the bipartisan bill that aggravated one senior Senate Republican.
...
Sen. Chuck Grassley (Iowa), senior Republican on the Finance Committee, had implored Bush to reconsider his veto vow. But after Bush incorrectly described the children’s health bill as providing coverage for families earning up to $80,000 a year, Grassley fired back.
“The president’s understanding of our bill is wrong,” Grassley said, his voice rising with anger. “I urge him to reconsider his veto message based on a bill we might pass, not something someone on his staff told him wrongly is in my bill.”
The SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded health coverage while taking aim at a Bush administration directive that would restrict states’ ability to raise income eligibility levels for the program. ...
As negotiators closed in on a $35 billion deal to extend health insurance coverage for children, President Bush defied lawmakers with a fresh threat to veto the bipartisan bill that aggravated one senior Senate Republican.
...
Sen. Chuck Grassley (Iowa), senior Republican on the Finance Committee, had implored Bush to reconsider his veto vow. But after Bush incorrectly described the children’s health bill as providing coverage for families earning up to $80,000 a year, Grassley fired back.
“The president’s understanding of our bill is wrong,” Grassley said, his voice rising with anger. “I urge him to reconsider his veto message based on a bill we might pass, not something someone on his staff told him wrongly is in my bill.”
The SCHIP deal would raise cigarette taxes by 61 cents per pack to pay for expanded health coverage while taking aim at a Bush administration directive that would restrict states’ ability to raise income eligibility levels for the program. ...
Emergency Care Is Limited by U.S. Rule ... Bush administration ... increasingly denying state claims for federal payment for some emergency services
Immigrants’ Emergency Care Is Limited by U.S. Rule | By SARAH KERSHAW | Published: September 22, 2007
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined. ...
...
Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said. ...
...
... Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment. ...
The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined. ...
...
Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said. ...
...
... Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment. ...
Friday, September 14, 2007
no rational reason for the rising costs, and that there are huge disparities across the country ... $11,352 in Miami, #4,273 in Oregon
Expensive and divisive: how America is losing patience with a failing system | Suzanne Goldenberg in Washington | Thursday September 13, 2007 | The Guardian
...
Between the two extremes is where America's healthcare system has unravelled. A patchwork of employer benefits and government assistance for the very poor and elderly has produced distinct differences. Those with very good jobs and generous benefits packages enjoy extensive, often almost wasteful, health cover. Meanwhile, tens of millions regularly put their health on hold because they cannot afford basic treatment, prescriptions, or even a visit to the doctor.
...
The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.
It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.
"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.
...
Healthcare experts say that there is sometimes no rational reason for the rising costs, and that there are huge disparities across the country. In Miami, for example, it will cost $11,352 a year to treat the average pensioner, but just $4,273 to treat one in Salem, Oregon, says the Dartmouth Atlas of Health Care. The cost of dying also varies from hospital to hospital, and state to state, the study found.
...
Between the two extremes is where America's healthcare system has unravelled. A patchwork of employer benefits and government assistance for the very poor and elderly has produced distinct differences. Those with very good jobs and generous benefits packages enjoy extensive, often almost wasteful, health cover. Meanwhile, tens of millions regularly put their health on hold because they cannot afford basic treatment, prescriptions, or even a visit to the doctor.
...
The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.
It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.
"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.
...
Healthcare experts say that there is sometimes no rational reason for the rising costs, and that there are huge disparities across the country. In Miami, for example, it will cost $11,352 a year to treat the average pensioner, but just $4,273 to treat one in Salem, Oregon, says the Dartmouth Atlas of Health Care. The cost of dying also varies from hospital to hospital, and state to state, the study found.
Subscribe to:
Posts (Atom)