The Obama health care proposal issued this morning would take away from America’s senior citizens their current right to add their own money on top of the government Medicare contribution to get health insurance less likely to deny treatment through tightly controlled managed care. (See http://www.nrlc.org/MedEthics/PLPositionMedicare.html ). It would do so even as it cuts the government contribution to Medicare by hundreds of billions of dollars.
Under "Title III . . . Guaranteeing Benefits for Seniors by Ending Overpayments to Insurance Companies," the Obama proposal states that Medicare Advantage plans – the alternative that now allows older Americans, if they wish, to pay more to get insurance less likely to ration treatment– will "be prohibited from charging seniors more than they would pay for services delivered under the traditional Medicare program."
Thus, older Americans would be prohibited by law from making up the Medicare shortfall by using their own money to save their own lives. (See http://www.nrlc.org/MedEthics/JusticeArgument.html )
This means that, even as more and more doctors and other health care providers are leaving the Medicare program because of low government reimbursement rates – rates that under the Obama bill will decline still more in comparison to medical inflation– senior citizens will have nowhere to turn. Their only option will be tightly managed plans that provide less and less treatment.
In a case of genuine chutzpah, the Obama proposal then goes on to claim that "all ideas that ration care . . . will be banned" – even as it imposes what will be ever-increasing rationing on senior citizens.
Showing posts with label Medicare Cuts to Physicians. Show all posts
Showing posts with label Medicare Cuts to Physicians. Show all posts
Monday, February 22, 2010
Thursday, January 21, 2010
NRLC PRESS CONFERENCE 1/21/2010 STATEMENT ON HEALTH CARE RATIONING
STATEMENT BY BURKE J. BALCH, J.D.
DIRECTOR, ROBERT POWELL CENTER FOR MEDICAL ETHICS
National Right to Life Committee Press Conference
Zenger Room, National Press Building, Washington, D.C.
January 21, 2010
Since its inception, the pro-life movement has been just as concerned with protecting the lives of people with disabilities and older people from euthanasia as it has been with protecting unborn children from abortion, and we have regarded government-imposed rationing of lifesaving medical treatment, food and fluids as an unacceptable form of involuntary euthanasia.
Therefore, the pro-life movement has grave concerns about rationing elements in the pending health care legislation. This morning’s Washington Post quotes Harvard health policy professor Robert Blendon as saying that what Massachusetts voters heard was now Senator-elect Scott Brown’s message that the national health care bills would require Medicare cuts. Indeed, a great deal of the backlash, not just in Massachusetts but also nationally, comes from those with insurance realizing that their health care will be endangered if the proposed legislation is enacted.
That legislation is based upon a widely held but fundamentally fallacious assumption – that it is necessary to "bend the cost curve" of health care spending because America cannot afford to continue to increase health care spending in the future as it has in the past.
As it happens, foremost among the economists who have debunked this fallacy is the Obama Administration’s nominee for Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, Columbia University health care economist Sherry Glied, in her 1997 book "Chronic Condition: Why Health Reform Fails." The first two of these charts are based on data from that book, updated.
The percent of the average family budget devoted to health care (including what employers pay for employees’ health insurance) has steadily grown from 3% in 1940 to 17% in 2006. This trend, and fear that it will continue unless "the cost curve is bent," lies behind the increasingly widespread view that rationing, however unpalatable, is essential. But as Glied’s book demonstrates, the trend must be seen in context.
During that same period, the percent of the average family budget devoted to food declined from almost 30% to under 15%, because of ever-increasing improvements in agricultural productivity. We can look further at the three essentials of food, clothing, and shelter combined. From 1940 to 2006, the percent of the average family budget devoted to these necessities fell from about 53% to about 33%. Consequently, the percent for health care plus food, clothing, and shelter actually dropped from 56% in 1940 to 50% in 2006. Productivity improvements in such areas as agriculture, transportation, and the assembly of clothing freed up resources enabling Americans, on average, to put significantly more resources into obtaining better health care.
While we are presently coping with severe economic downturn, research by health care economists across the ideological spectrum, from David Cutler[1] to Robert Hall and Charles Jones, shows that there is no reason, so long as productivity growth continues, why we cannot indefinitely continue to increase the proportion of our incomes that is spent to keep us alive and healthy.
The pending health legislation contains numerous mechanisms to hold down the amount of their funds Americans are allowed to use to save their own lives. As documented on our website, both the House and Senate bills would not just limit government health care spending; they would empower bureaucrats to limit what private citizens can spend to get unrationed health insurance. Senior citizens, faced with massive Medicare cuts, could be prevented by the federal Centers for Medicare and Medicaid Services from exercising the choice current law allows them to add their own money on top of the diminishing government Medicare contribution in order to get Medicare Advantage private fee-for-service plans less likely to deny treatments and diagnostic tests. Those participating in the health insurance exchanges could see their insurance choices limited to those plans most likely to deny care if government bureaucrats exclude plans less likely to ration care on the claim that they cost too much.
Under the Senate bill, an almost omnipotent commission would be directed not only to hold Medicare increases below the rate of medical inflation, but also to recommend to the HHS Secretary measures to keep increases private health care spending below medical inflation as well. The HHS Secretary would be empowered to impose so-called "quality" and "efficiency" standards on ALL health care providers governing the health care they provide not only under government programs but also under private insurance.
We don’t need this U.K.-style rationing, and the National Right to Life Committee will be working to prevent or repeal it. Last night, in an interview with George Stephanopoulos, the President suggested the possibility of a stripped-down bill, but one of the three items he mentioned as being in such a bill was "cost-containment." We will be carefully watching any such stripped-down measure to determine whether it includes provisions that, like the pending bills, would ration health care, and will be quick to publicize and oppose them.
[1] David M Cutler, Your Money or Your Life: Strong Medicine for America's Healthcare System (Oxford: Oxford University Press, 2004).
DIRECTOR, ROBERT POWELL CENTER FOR MEDICAL ETHICS
National Right to Life Committee Press Conference
Zenger Room, National Press Building, Washington, D.C.
January 21, 2010
Since its inception, the pro-life movement has been just as concerned with protecting the lives of people with disabilities and older people from euthanasia as it has been with protecting unborn children from abortion, and we have regarded government-imposed rationing of lifesaving medical treatment, food and fluids as an unacceptable form of involuntary euthanasia.
Therefore, the pro-life movement has grave concerns about rationing elements in the pending health care legislation. This morning’s Washington Post quotes Harvard health policy professor Robert Blendon as saying that what Massachusetts voters heard was now Senator-elect Scott Brown’s message that the national health care bills would require Medicare cuts. Indeed, a great deal of the backlash, not just in Massachusetts but also nationally, comes from those with insurance realizing that their health care will be endangered if the proposed legislation is enacted.
That legislation is based upon a widely held but fundamentally fallacious assumption – that it is necessary to "bend the cost curve" of health care spending because America cannot afford to continue to increase health care spending in the future as it has in the past.
As it happens, foremost among the economists who have debunked this fallacy is the Obama Administration’s nominee for Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, Columbia University health care economist Sherry Glied, in her 1997 book "Chronic Condition: Why Health Reform Fails." The first two of these charts are based on data from that book, updated.
The percent of the average family budget devoted to health care (including what employers pay for employees’ health insurance) has steadily grown from 3% in 1940 to 17% in 2006. This trend, and fear that it will continue unless "the cost curve is bent," lies behind the increasingly widespread view that rationing, however unpalatable, is essential. But as Glied’s book demonstrates, the trend must be seen in context.
During that same period, the percent of the average family budget devoted to food declined from almost 30% to under 15%, because of ever-increasing improvements in agricultural productivity. We can look further at the three essentials of food, clothing, and shelter combined. From 1940 to 2006, the percent of the average family budget devoted to these necessities fell from about 53% to about 33%. Consequently, the percent for health care plus food, clothing, and shelter actually dropped from 56% in 1940 to 50% in 2006. Productivity improvements in such areas as agriculture, transportation, and the assembly of clothing freed up resources enabling Americans, on average, to put significantly more resources into obtaining better health care.
While we are presently coping with severe economic downturn, research by health care economists across the ideological spectrum, from David Cutler[1] to Robert Hall and Charles Jones, shows that there is no reason, so long as productivity growth continues, why we cannot indefinitely continue to increase the proportion of our incomes that is spent to keep us alive and healthy.
The pending health legislation contains numerous mechanisms to hold down the amount of their funds Americans are allowed to use to save their own lives. As documented on our website, both the House and Senate bills would not just limit government health care spending; they would empower bureaucrats to limit what private citizens can spend to get unrationed health insurance. Senior citizens, faced with massive Medicare cuts, could be prevented by the federal Centers for Medicare and Medicaid Services from exercising the choice current law allows them to add their own money on top of the diminishing government Medicare contribution in order to get Medicare Advantage private fee-for-service plans less likely to deny treatments and diagnostic tests. Those participating in the health insurance exchanges could see their insurance choices limited to those plans most likely to deny care if government bureaucrats exclude plans less likely to ration care on the claim that they cost too much.
Under the Senate bill, an almost omnipotent commission would be directed not only to hold Medicare increases below the rate of medical inflation, but also to recommend to the HHS Secretary measures to keep increases private health care spending below medical inflation as well. The HHS Secretary would be empowered to impose so-called "quality" and "efficiency" standards on ALL health care providers governing the health care they provide not only under government programs but also under private insurance.
We don’t need this U.K.-style rationing, and the National Right to Life Committee will be working to prevent or repeal it. Last night, in an interview with George Stephanopoulos, the President suggested the possibility of a stripped-down bill, but one of the three items he mentioned as being in such a bill was "cost-containment." We will be carefully watching any such stripped-down measure to determine whether it includes provisions that, like the pending bills, would ration health care, and will be quick to publicize and oppose them.
[1] David M Cutler, Your Money or Your Life: Strong Medicine for America's Healthcare System (Oxford: Oxford University Press, 2004).
Thursday, November 19, 2009
RATIONING IN THE REID BILL - ISSUE BY ISSUE - Medicare Commission
Rationing Issues with the Reid Senate Bill:
With the various concerns related to rationing and euthanasia, we will post a series of concerns - the following analysis being one among several.
With the various concerns related to rationing and euthanasia, we will post a series of concerns - the following analysis being one among several.
The Medicare Commission
The Reid bill provides for an “Independent Medicare Advisory Board,” given the task of ensuring senior's Medicare meets budget goals (that will tighten each year).
For fiscal years 2015 through 2019, the bill sets a target rate of growth for Medicare midway between medical inflation and average inflation; for subsequent years the target is the growth in Gross Domestic Product per capita plus 1%.[1]
To the extent the Center for Medicare and Medicaid Services project that Medicare growth rates would exceed these targets, the Board would have to act to reduce the gap by specified percentages varying by year. This gap-reducing would likely come at the expense of reduction of Medicare Advantage benefits, and reductions in payments to doctors and so forth.
The Congressional Budget Office notes, “The provision would place a number of limitations on the actions available to the board, including a prohibition against modifying eligibility or benefits, so its recommendations probably would focus on [r]eductions in subsidies for non-Medicare benefits offered by Medicare Advantage plans; and [c]hanges to payment rates or methodologies for services furnished in the fee-for-service sector by providers other than hospitals [but hospitals would be included beginning in 2020], physicians, hospices [but hospices would be included beginning in 2020], and suppliers of durable medical equipment that is offered through competitive bidding.[2]
The recommendations of the Board would automatically go into effect unless Congress, through an expedited procedure, adopted another means resulting in the same reductions; to waive this would require a 3/5 vote. It would also require a 3/5 vote to repeal or amend the provisions of the Reid bill establishing the Board and its duties and authority; in 2017 there would be an expedited procedure essentially guaranteeing a vote on a proposal to repeal the Board, but this vote would require 3/5 of each House to pass.
[1] Section 3403, beginning on page 1000.
[2] Letter from Douglas Elmendorf, Director, Congressional Budget Office to Senate Majority Leader Harry Reid (November 18, 2009), p. 11.
Tuesday, October 13, 2009
ALL COMMITTEES HAVE REPORTED BILLS WITH RATIONING CONCERNS - NEGOTIATIONS NOW MOVE BEHIND CLOSED DOORS
Health care restructuring cleared another hurdle when it was voted favorably out of the Senate Finance Committee 14-9 this afternoon. Republican Olympia Snowe (ME) along with every Democrat, voted to move the bill forward. Sen. Snowe, while maintaining that “My vote today is my vote today. It does not predict my vote tomorrow,” ultimately concluded that inaction was riskier than the “imperfect bill.” Several Republican senators continued to warn of the dangers of rationing – with Senator Roberts(KS) in particular noting that the bill contains “robust tools to ration your healthcare.” A good deal of time was spent in committee today by Democrats criticizing an industry-commissioned report by PriceWaterhouseCoopers that found health insurance premiums would increase faster under the Senate's bill than they would without it. Also, Sen. Rockefeller (D-WV) again lamented the lack of inclusion of end-of-life planning. The Senator will likely offer a related amendment on the Senate floor. For more on similar end-of-life planning provisions in the house bill see here.
The Finance committee product contains 1. cuts to Medicare, 2. the dangerous "Death Spiral" provision, 3. a grant of nearly unlimited power to the Medicare Commission to reduce Medicare payments to fit with the limits on growth, and 4. verbal promises to consider price controls.
Negotiations will now shift into a closed-door setting. After today’s vote, Sen. Baucus (D-MT), majority leader Reid (D-NV), and Sen. Dodd (D-CT), along with and a handful of top White House officials, will meet to meld the Finance bill alternative bill that Dodd led through the HELP committee in July.
Leaders in the House have been meeting over the past months in an effort to merge three bills passed out of committees and to bring down projected costs. House Speaker Pelosi (D-CA), has said she expects a final version for consideration by the full chamber soon, although she has not provided a specific timetable. While attempting to shave their $1.2 trillion plan down to $900 billion, the final bill is likely to reduce subsidies, place more people into state Medicaid programs, and employ several of the taxes raised in the Senate Finance Committee. However, House leaders have rejected the Senate Finance plan’s tax on high-value plans – the one financing mechanism that would keep pace with the rising resources devoted to health care would be the 40% levy on health insurance premiums. For more on this see here. House leaders are instead relying on a modified version of their original plan to impose a surcharge on higher income Americans.
It has also been reported today by the Washington Post that in order to come in under $900 billion dollars, House Democrats will cut out a provision that ensures that doctors receive their Medicare payment update formula. This would then be addressed in an expensive stand-alone bill. In the Senate version, the billions required to stop those same scheduled cuts in Medicare payments to physicians is only addressed for one year (then docs take a drastic 25% pay cut if no other action is taken). Not addressing this very integral and expensive aspect of healthcare in these comprehensive bills can give the incorrect appearance that the bills are able to be paid for - when that is not the case. And when inadequate financing is present, coupled with the dangerous mechanisms, rationing becomes a very real threat.
How soon floor action will occur in either chamber is unclear- though leadership insists that they mean to act soon.
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