Healthcare

[Legacy]

For life expectancy, money matters (Harvard Gazette)

Being poor in the United States is so hazardous to your health, a new study shows, that the average life expectancy of the lowest-income classes in America is now equal to that in Sudan or Pakistan.

A Harvard analysis of 1.4 billion Internal Revenue Service records on income and life expectancy that showed staggering differences in life expectancy between the richest and poorest also found evidence that low-income residents in wealthy areas, such as New York City and San Francisco, have life expectancies significantly longer than those in poorer regions.

Study: After Medicaid expansion, 17 percent drop in cardiac arrests (Oregon live)

When researchers compared the number of sudden cardiac arrests in Multnomah County before and after the Medicaid expansion under the Affordable Care Act, they expected to see a decline.

They did – but it was bigger than expected.

"The real surprise is not that it dropped," said Dr. Eric Stecker, a cardiologist at Oregon Health and Science University and lead author on the study. "It was the magnitude – about a 17 percent reduction."

The study, published Wednesday in the Journal of the American Heart Association, confirms other research showing that an expansion of insurance coverage reduces mortality rates.

 

[connor_in]

<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">Heartbreaking statement from Chris Gard, father of <a href="https://twitter.com/hashtag/CharlieGard?src=hash">#CharlieGard</a> <a href="https://t.co/LWJDFpFuy1">pic.twitter.com/LWJDFpFuy1</a></p>— Jake Tapper (@jaketapper) <a href="https://twitter.com/jaketapper/status/889506321850085376">July 24, 2017</a></blockquote>
<script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>

 

[Legacy]

State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion (Kaiser family foundation)

Medicaid Expansion States bt Governor's Party Affiliation, July 2017

The Senate is currently considering the Obamacare Repeal Reconciliation Act of 2017. While there are a number of provisions that affect Medicaid, the primary change would be the elimination of the statutory authority to cover childless adults up to 138% FPL ($16,643 for an individual in 2017) as well as an elimination of the enhanced match rate for the Medicaid expansion.

A repeal of the Medicaid expansion would have significant coverage and financing implications for the 31 states and the District of Columbia that have implemented the expansion (Figure 1). We estimated changes in federal Medicaid funds and Medicaid coverage for adults covered through the ACA expansion, assuming that the Medicaid expansion would be repealed as of 2020. We assume all states drop all expansion/Group VIII coverage, and the analysis does not account for continuation of expansion coverage in states that had waivers prior to the ACA (more detail on the methods underlying the estimates is in the Methods box below).

Our analysis shows that states would see a $700 billion reduction in federal Medicaid funds over the 2020-2026 period due to the loss of the ACA expansion (Table 1). In the last year of this analysis, 2026, states would see a reduction in federal Medicaid funds of $121 billion and estimated reductions in coverage of 17.6 million (19% of total Medicaid enrollment that year). In 11 states, the loss of the expansion would reduce Medicaid enrollment by 30% or more in 2026. In the absence of other affordable coverage, it is likely that most of these people would become uninsured, which would affect their access to health care services

.

Article continues with state by state breakdown.

 

[Legacy]

The Skinny Repeal Gets a Score (Atlantic)

But Wednesday evening, some of the effects of a bill like the skinny repeal became more clear. Democrats submitted a draft of what they expect in the skinny repeal to the Congressional Budget Office for a score estimate on the deficit, the number of people covered, and premiums. The CBO score found that their proto-skinny repeal would increase the number of uninsured people by 16 million over baseline estimates by 2026, would decrease the projected federal deficit by $142 billion over the same time period, and would increase premiums in the exchanges by 20 percent.

Health Plans Rip 'Skinny Repeal' As Disaster For Insurance Markets (Forbes)

 

[Buster Bluth]

So $14.2 billion while we spend, what, $50 billion in Afghanistan?

 

[tussin]

There should be an equally large effort by Congress to take measures to address the cost of healthcare and not limit their focus solely on insurance.

The lack of price transparency and litigation risk for doctors is driving up costs unreasonably. I had an outpatient ACL surgery two years ago - 90 minutes long - and the bill was $95K! Something isn't right...

 

[wizards8507]

There should be an equally large effort by Congress to take measures to address the cost of healthcare and not limit their focus solely on insurance.

The lack of price transparency and litigation risk for doctors is driving up costs unreasonably. I had an outpatient ACL surgery two years ago - 90 minutes long - and the bill was $95K! Something isn't right...

This. Sadly, the GOP has conceded the Democrat talking point that "number of people uninsured" is the only metric that matters. To hell with health outcomes or costs.

 

[greyhammer90]

There should be an equally large effort by Congress to take measures to address the cost of healthcare and not limit their focus solely on insurance.

The lack of price transparency and litigation risk for doctors is driving up costs unreasonably. I had an outpatient ACL surgery two years ago - 90 minutes long - and the bill was $95K! Something isn't right...

 

[Legacy]

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly? (Annals of Internal Medicine)

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

Alaska needs its very own health care solution (Alaska Dispatch News, Opinion piece)

 

[Legacy]

The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments (KFF)

Controversy has emerged recently over federal payments to insurers under the Affordable Care Act (ACA) related to cost-sharing reductions for low-income enrollees in the ACA’s marketplaces.

The ACA requires insurers to offer plans with reduced patient cost-sharing (e.g., deductibles and copays) to marketplace enrollees with incomes 100-250% of the poverty level. The reduced cost-sharing is only available in silver-level plans, and the premiums are the same as standard silver plans.

To compensate for the added cost to insurers of the reduced cost-sharing, the federal governments makes payments directly to insurance companies. The Congressional Budget Office (CBO) estimates the cost of these payments at $7 billion in fiscal year 2017, rising to $10 billion in 2018 and $16 billion by 2027.

We estimate that the increased cost to the federal government of higher premium tax credits would actually be 23% more than the savings from eliminating cost-sharing reduction payments. For fiscal year 2018, that would result in a net increase in federal costs of $2.3 billion. Extrapolating to the 10-year budget window (2018-2027) using CBO’s projection of CSR payments, the federal government would end up spending $31 billion more if the payments end.

This assumes that insurers would be willing to stay in the market if CSR payments are eliminated.

 

[Legacy]

As some in Congress look to move past the Obamacare standoff, states offer a more bipartisan model . (LA Times)

“I don’t think anyone here — Democrat or Republican — didn’t believe that we needed to make sure our residents could get healthcare,” said Lori Wing-Heier, Alaska’s nonpartisan insurance commissioner, who worked with state legislators from both parties last year to help control insurance premiums.

“You have to compromise and put the people most in need first,” said Indiana state Rep. Charlie Brown, a Democrat who supported conservative Medicaid expansions under two Republican governors, including Mike Pence, who is now vice president.

“Government shouldn’t destroy people’s lives,” said Minnesota state Rep. Greg Davids, a Republican and chairman of the state House tax committee. “Anything we can do to help people, we should do it.”

ACA Round-Up: Governors Offer Individual Market Stabilization Proposals And More (Health Affairs Blog)

Bipartisan group of governors calls on Congress to shore up parts of Affordable Care Act (Wash Post)

Minnesota Finds a Way to Slow Soaring Health Premiums (NY Times)

The outlook now is much better. Rate increases requested for 2018 are relatively modest, thanks in part to a new program under which the state will help pay the largest claims. The program, known as reinsurance, and the efforts that led to its creation hold lessons for other states where rates are rising rapidly, and for Congress, where lawmakers are considering the introduction of a similar program.

“The individual insurance market is stabilizing under the program here,” said Allison L. O’Toole, the chief executive of Minnesota’s state-run insurance marketplace. “Health plans are very happy about it.”

State officials and insurers say that, as a result of the program, premiums next year will be about 20 percent lower than they would otherwise have been. The program — for which Minnesota has budgeted about $270 million in each of the next two years — potentially benefits all of the 160,000 people buying insurance on their own, not just those with large claims.

 

[irishroo]

https://www.vox.com/policy-and-politics/2017/9/13/16296656/bernie-sanders-single-payer

So basically we're going to provide the most generous healthcare package in the world to all 350 million Americans and we'll figure out how to pay for it later? Genius!

 

[IrishLax]

https://www.vox.com/policy-and-politics/2017/9/13/16296656/bernie-sanders-single-payer

So basically we're going to provide the most generous healthcare package in the world to all 350 million Americans and we'll figure out how to pay for it later? Genius!

To be honest, I've always thought some version of "Medicare for all" is the way to go.

I haven't read any part of this bill yet, so I have no clue whether what is proposed is smart/effective legislation though.

 

[wizards8507]

To be honest, I've always thought some version of "Medicare for all" is the way to go.

Even if I weren't against it on principled grounds, Single yayer fails the pragmatic test in every conceivable way. The Business 101 model to evaluate a marketplace is Porter's Five Forces Analysis. Single payer fails to hold up to scrutiny under every single criterion.

1. Threat of new entrants - There obviously isn't a threat of new entrance since insurance alternatives would be prohibited by law.

2. Threat of substitutes - Same.

3. Bargaining power of customers - None.

4. Bargaining power of suppliers - Infinite.

5. Industry rivalry - None.

Every single one of these means that costs would absolutely skyrocket. The end product would be one of two things: Reimbursement rates are too high, meaning the American people collectively end up paying more for health care than they are today, OR reimbursement rates are too low so all of the good doctors, nurses, and hospitals leave the insurance infrastructure all together and only serve those who can pay actual cash for their care.

 

[IrishLax]

Every single one of these means that costs would absolutely skyrocket. The end product would be one of two things: Reimbursement rates are too high, meaning the American people collectively end up paying more for health care than they are today, OR reimbursement rates are too low so all of the good doctors, nurses, and hospitals leave the insurance infrastructure all together and only serve those who can pay actual cash for their care.

Then why does Medicare currently work well for those covered? And why is Medicare cheaper with less overhead than all private insurance?

 

[wizards8507]

Harvard Business Review: Redefining Competition in Health Care

 

[wizards8507]

Then why does Medicare currently work well for those covered?

Medicare is popular with those who are covered, there's a difference.

And why is Medicare cheaper with less overhead than all private insurance?

Because all of the good doctors are opting out. Analogy time:

You're on a beer-subsidy plan. You go to the liquor store and your plan allows you to buy a six pack of Bud Light, Miller High Life, or Pabst Blue Ribbon. I pay for my own beer, so I go to the store and buy a six pack of Dogfish Head 60 Minute IPA because that's the one I really want. I pay $9.99, your beer-subsidy plan reimburses the store $5.99. You brag that your subsidized plan is 40%(!) cheaper than my private plan. Who is really better off?

 

[IrishLax]

Medicare is popular with those who are covered, there's a difference.

It has high satisfaction among consumers, and produces good results. What are you trying to equivocate here?

Because all of the good doctors are opting out.

That's not true -- the vast majority of doctors still accept medicare patients, and I think almost every single hospital does. Unless your contention that the 80%+ of doctors that take medicare patients all suck I have no clue what you're talking about... there's no evidence to back that up.

Yes, a significant portion of private practice doctors, etc. don't take medicare patients but that's for a lot of reasons.

 

[Legacy]

A few issues that must be addressed to achieve a cost-effective, consumer-friendly, easy to understand health care system are:

1. Cost control - premiums, deductibles, coverage, drugs
2. Spreading out the risk for insurers
3. An anti-competitive marketplace
4. Surprise hospital bills
5. Standardization of insurance regulations across state lines
6. Building in preventative care and appropriate triage
7. Standard value base pricing for different diagnosis groups
8. Affordability of insurance for smaller employer groups, individual's businesses or individuals.
9. Standard reimbursements (Medicaid pays much lower now)

Just a few. Expect growth of federal health care systems is expected to cost 6-7% a year with the result that in 15-16 years, the cost will have doubled from today's costs. What does that mean for the generation in 2035?

Do we support health care throughout a lifetime or does someone move from one insurance provider to another over their life span?

View the VA system as a single payer system with a higher percent of high risk patients "enrolling" each year. The federal government negotiates drug prices, determines coverage, and gets competitive bids.

 

[wizards8507]

It has high satisfaction among consumers, and produces good results. What are you trying to equivocate here?

Because they don't behave like consumers, that's the whole point. They're subsidized beneficiaries of an entitlement program, not rational consumers buying a product on its merits. "Produces good results" is a tough metric for Medicare because everyone over 65 is eligible so there's no control group of 65+ people without Medicare to compare them to. Also, as is obvious, elderly people are a unique subset of consumers when it comes to the healthcare market overall. A better comparison would be Medicaid, and yes I do have evidence to back of the fact that Medicaid does absolutely nothing to improve health outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071622/

That's not true -- the vast majority of doctors still accept medicare patients, and I think almost every single hospital does. Unless your contention that the 80%+ of doctors that take medicare patients all suck I have no clue what you're talking about... there's no evidence to back that up.

Yes, a significant portion of private practice doctors, etc. don't take medicare patients but that's for a lot of reasons.

Those statistics are extremely and deliberately misleading, so I don't blame you for being fooled by them. For example, the Mayo Clinic accepts Medicare for in-state patients from Arizona, Florida, and Minnesota only, but they are a "nonparticipating facility" for residents of any other state. They "count" in the statistics of doctors and clinics that accept Medicare, but that comes with a giant asterisk.

Mayo Clinic has chosen (by the board of governors) to be a nonparticipating facility, and thus does not accept assignment from Medicare for out-of-state residents at any of its campuses in Arizona, Florida or Minnesota.

 

[irishroo]

To be honest, I've always thought some version of "Medicare for all" is the way to go.

I haven't read any part of this bill yet, so I have no clue whether what is proposed is smart/effective legislation though.

That's the issue - nor do the people who proposed the bill, because it's not a complete bill. It's a wish list masquerading as a legitimate legislative option. Bernie supporters wonder why he wasn't taken seriously by the Democratic establishment? This is why, because he proposes utopian ideals with absolutely zero mention of how to actually achieve them.

 

[Legacy]

Because they don't behave like consumers, that's the whole point. They're subsidized beneficiaries of an entitlement program, not rational consumers buying a product on its merits. "Produces good results" is a tough metric for Medicare because everyone over 65 is eligible so there's no control group of 65+ people without Medicare to compare them to. Also, as is obvious, elderly people are a unique subset of consumers when it comes to the healthcare market overall. A better comparison would be Medicaid, and yes I do have evidence to back of the fact that Medicaid does absolutely nothing to improve health outcomes.

Primary Payer Status Affects Mortality for Major Surgical Operations


Those statistics are extremely and deliberately misleading, so I don't blame you for being fooled by them. For example, the Mayo Clinic accepts Medicare for in-state patients from Arizona, Florida, and Minnesota only, but they are a "nonparticipating facility" for residents of any other state. They "count" in the statistics of doctors and clinics that accept Medicare, but that comes with a giant asterisk.

IMO, the article may end up supporting a more standardized and spectrum of life system for health care, though that is beyond the scope of the article. Having parsed Americans into groups based on their insurance status, isn't it reasonable that those who can afford regular checkups, their drug costs, and incentives to seek care at the appropriate levels, i.e. the Employer-sponsored insurance group, would have better surgical outcomes?

The influence of socioeconomic factors and insurance status among United States patients has been a primary focus of many public health initiatives and current health care reform investigations. According to the US Census Bureau, from 2007 to 2008, the number of uninsured Americans increased from 45.7 to 46.3 million, the number of people covered by private insurance decreased from 202 to 201 million, and the number of people covered by government insurance increased from 83.0 to 87.4 million.1 The Medicaid and Uninsured patient populations have been shown to have worse medical outcomes compared with Privately Insured patients as a result of socioeconomic and patient-related factors.2,3 Further, disparities in disease treatment and resource utilization may occur as a function of insurance and primary payer status. With a rising elderly population and increased initiatives for government-sponsored health care, such trends provide an important platform from which to examine contemporary surgical outcomes as a function of primary payer status.

In the case of the Medicaid patients, their lower incomes would mean they forego expenses, cannot afford some meds for causative factors for coronary artery disease (hypertension, diabetes, high cholesterol, lack of exercise, healthy food choices, renal disease, obesity, smoking) and end up with longer hospital stays, more complications, and increased mortality? This group also delays seeking treatment until they need to go to the ER, especially if they reside in states that did not accept ACA.

Both Medicaid and Uninsured payer groups had the highest incidence of drug and alcohol abuse. In addition, Medicaid patients had the highest incidence of acquired immunodeficiency syndrome, depression, liver disease, neurologic disorders, and psychoses. Furthermore, Medicaid patients had the highest incidence of metastatic cancer, which likely reflects the combined influence of deficits in access to care, poor health maintenance, and delayed diagnosis resulting in the presentation of advanced disease stage within this population. Another possible explanation for the differences we observed among payer groups is the possibility of incomplete risk adjustment due to the presence of comorbidities that are either partially or unaccounted for in our analyses. Nevertheless, multivariable logistic regression identified Medicaid and Uninsured payer status as the highest significant independent predictors of in-hospital mortality after controlling for all patients, hospital- and operation-related variables.

Are you arguing that the payer status of Medicaid should resort to the Uninsured status, which had similarly poor results? Or is it more reasonable to provide a single payer system that covers an individual throughout their lifetime and stresses preventative measures, lowers costs, encourages healthy habits, and triages patients appropriately?

 

[MJ12666]

IMO, the article may end up supporting a more standardized and spectrum of life system for health care, though that is beyond the scope of the article. Having parsed Americans into groups based on their insurance status, isn't it reasonable that those who can afford regular checkups, their drug costs, and incentives to seek care at the appropriate levels, i.e. the Employer-sponsored insurance group, would have better surgical outcomes?



In the case of the Medicaid patients, their lower incomes would mean they forego expenses, cannot afford some meds for causative factors for coronary artery disease (hypertension, diabetes, high cholesterol, lack of exercise, healthy food choices, renal disease, obesity, smoking) and end up with longer hospital stays, more complications, and increased mortality? This group also delays seeking treatment until they need to go to the ER, especially if they reside in states that did not accept ACA.



Are you arguing that the payer status of Medicaid should resort to the Uninsured status, which had similarly poor results? Or is it more reasonable to provide a single payer system that covers an individual throughout their lifetime and stresses preventative measures, lowers costs, encourages healthy habits, and triages patients appropriately?

It is also possible that the doctors who are willing to accept Medicaid patients are just not that good and provide a poorer level of service.

 

[Legacy]

Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA (Kaiser Family Foundation)

Before private insurance market rules in the Affordable Care Act (ACA) took effect in 2014, health insurance sold in the individual market in most states was medically underwritten.1 That means insurers evaluated the health status, health history, and other risk factors of applicants to determine whether and under what terms to issue coverage. To what extent people with pre-existing health conditions are protected is likely to be a central issue in the debate over repealing and replacing the ACA.

This brief reviews medical underwriting practices by private insurers in the individual health insurance market prior to 2014, and estimates how many American adults could face difficulty obtaining private individual market insurance if the ACA were repealed or amended and such practices resumed. We examine data from two large government surveys: The National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), both of which can be used to estimate rates of various health conditions (NHIS at the national level and BRFSS at the state level). We consulted field underwriting manuals used in the individual market prior to passage of the ACA as a reference for commonly declinable conditions.

Estimates of the Share of Adults with Pre-Existing Conditions
We estimate that 27% of adult Americans under the age of 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states. While a large share of this group has coverage through an employer or public coverage where they do not face medical underwriting, these estimates quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose this coverage. This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C). Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices. In a separate Kaiser Family Foundation poll, most people (53%) report that they or someone in their household has a pre-existing condition.

A larger share of nonelderly women (30%) than men (24%) have declinable preexisting conditions. We estimate that 22.8 million nonelderly men have a preexisting condition that would have left them uninsurable in the individual market pre-ACA, compared to 29.4 million women. Pregnancy explains part, but not all of the difference.

The rates of declinable pre-existing conditions vary from state to state. On the low end, in Colorado and Minnesota, at least 22% of non-elderly adults have conditions that would likely be declinable if they were to seek coverage in the individual market under pre-ACA underwriting practices. Rates are higher in other states – particularly in the South – such as Tennessee (32%), Arkansas (32%), Alabama (33%), Kentucky (33%), Mississippi (34%), and West Virginia (36%), where at least a third of the non-elderly population would have declinable conditions.

. (Tables of Stats for each state, Employment status of individuals, Declinable conditions, declinable meds, ineligible occupations, and adverse underwriting actions follows)

 

[SonofOahu]

To be honest, I've always thought some version of "Medicare for all" is the way to go.

I haven't read any part of this bill yet, so I have no clue whether what is proposed is smart/effective legislation though.

Even if I weren't against it on principled grounds, Single yayer fails the pragmatic test in every conceivable way. The Business 101 model to evaluate a marketplace is Porter's Five Forces Analysis. Single payer fails to hold up to scrutiny under every single criterion.

1. Threat of new entrants - There obviously isn't a threat of new entrance since insurance alternatives would be prohibited by law.

2. Threat of substitutes - Same.

3. Bargaining power of customers - None.

4. Bargaining power of suppliers - Infinite.

5. Industry rivalry - None.

Every single one of these means that costs would absolutely skyrocket. The end product would be one of two things: Reimbursement rates are too high, meaning the American people collectively end up paying more for health care than they are today, OR reimbursement rates are too low so all of the good doctors, nurses, and hospitals leave the insurance infrastructure all together and only serve those who can pay actual cash for their care.

I'm in healthcare, so I have worked through this issue for years. In my opinion, the answer to the single-payor question is Medicare-Advantage for all, not (original) Medicare for all. CMS oversees and regulates M-A plans, but the execution of the coverage is handled through private insurance companies.

M-A for all would allow the government to set the coverage terms for all parties, but would do so without completely destroying the healthcare-system. It would also allow for competition, rivalries, etc. Most important, it would provide an "escape hatch" in case the experiment fails -- it's much easier to shut down an M-A plan and shift the consumer to a private plan/Medicaid if the private-insurance companies are still in operation.

M-A for all would probably allow the private-insurance companies to operate "Cadillac" plans for those who want something better than the base-plan. I don't have numbers to back my assertions; these are just theoretical concepts based on what I know of the current payor/provider/patient dynamics.

Wizards, here's some friendly advice for you: The next time you think about using Porter 5-Fs to present your argument in the way you did, don't. You would not be received very well in the boardrooms that I have been in. Don't get me wrong, Porter's construct is obviously solid. The problem is healthcare is complex (who knew!) and you present as an overconfident, new-grad douche when you try that stuff.

 

[SonofOahu]

Then why does Medicare currently work well for those covered? And why is Medicare cheaper with less overhead than all private insurance?

For many services, Medicare reimburses the providers at a lower rate than a private insurance plan, because they control a larger number of lives. (Medicare has greater pricing leverage.) Also, Medicare has a robust and aggressive auditing arm that can recoup inappropriate payments. (You might see terms like MAC audit or RAC audit.) Essentially, Medicare will outsource this auditing function to "bounty hunters" who are paid a percentage of the take-backs they gather.

Medicare is popular with those who are covered, there's a difference.


Because all of the good doctors are opting out.

Yes, but no. Less good docs leads to higher overall cost, because patients become train-wrecks needing more acute services. You're right that MDs are opting out, but that has little to do with Medicare costs being less than other insurances.

Because they don't behave like consumers, that's the whole point. They're subsidized beneficiaries of an entitlement program, not rational consumers buying a product on its merits. "Produces good results" is a tough metric for Medicare because everyone over 65 is eligible so there's no control group of 65+ people without Medicare to compare them to. Also, as is obvious, elderly people are a unique subset of consumers when it comes to the healthcare market overall. A better comparison would be Medicaid, and yes I do have evidence to back of the fact that Medicaid does absolutely nothing to improve health outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071622/


Those statistics are extremely and deliberately misleading, so I don't blame you for being fooled by them. For example, the Mayo Clinic accepts Medicare for in-state patients from Arizona, Florida, and Minnesota only, but they are a "nonparticipating facility" for residents of any other state. They "count" in the statistics of doctors and clinics that accept Medicare, but that comes with a giant asterisk.

Medicare versus Medicaid is like an apples to oranges comparison. You're looking at vastly different patient populations. Also, all statistics are misleading for a number of reasons. For one thing, not everyone is captured in the data. Also, the providers "clean up" their results... at least they should be. No one reports their data without auditing and fixing things.

 

[Legacy]

The Facts on Medicare Spending and Financing
July 18, 2017 . Kaiser Family Foundation

TRENDS IN TOTAL AND PER CAPITA MEDICARE SPENDING
Recent years have seen a notable reduction in the growth of Medicare spending compared to prior decades, both overall and per beneficiary.

Average annual growth in Medicare spending per beneficiary was just 1.3 percent between 2010 and 2016, down from 7.4 percent between 2000 and 2010.The Medicare provisions of the ACA have played an important role in strengthening Medicare’s financial status for the future, while offsetting some of the cost of the coverage expansions of the ACA and also providing some additional benefits to people with Medicare. Savings were achieved in part by reducing payments to providers, such as hospitals and skilled nursing facilities. Medicare provider payment changes in the ACA were adopted in conjunction with the ACA’s insurance coverage expansions, with the expectation that additional revenue from newly-insured Americans would offset lower revenue from Medicare payments. In addition, Medicare savings were achieved through lower payments to Medicare Advantage plans.

Slower growth in Medicare spending in recent years can be attributed in part to policy changes adopted as part of the Affordable Care Act (ACA) and the Budget Control Act of 2011 (BCA). The ACA included reductions in Medicare payments to plans and providers, increased revenues, and introduced delivery system reforms that aimed to improve efficiency and quality of patient care and reduce costs, including accountable care organizations (ACOs), medical homes, bundled payments, and value-based purchasing initiatives. The BCA lowered Medicare spending through sequestration that reduced payments to providers and plans by 2 percent beginning in 2013. Medicare spending trends in recent years have also been affected by changes in prescription drug spending and hospital inpatient readmissions, a sharp decline in home health spending, and recoveries from program integrity efforts. In addition, although Medicare enrollment has been growing around 3 percent annually with the aging of the baby boom generation, the influx of younger, healthier beneficiaries has contributed to slower spending growth.

What Are the Implications of Repealing the Affordable Care Act for Medicare Spending and Beneficiaries?
(Dec 13, 2016) KFF
(Exceprt)

This brief explores the implications for Medicare and beneficiaries of repealing Medicare provisions in the ACA. The Congressional Budget Office (CBO) has estimated that full repeal of the ACA would increase Medicare spending by $802 billion from 2016 to 2025.1 Full repeal would increase spending primarily by restoring higher payments to health care providers and Medicare Advantage plans. The increase in Medicare spending would likely lead to higher Medicare premiums, deductibles, and cost sharing for beneficiaries, and accelerate the insolvency of the Medicare Part A trust fund. Policymakers will confront decisions about the Medicare provisions in the ACA in their efforts to repeal and replace the law.

Discussion
The Medicare provisions of the ACA have played an important role in strengthening Medicare’s financial status for the future, while offsetting some of the cost of the coverage expansions of the ACA and also providing some additional benefits to people with Medicare. Savings were achieved in part by reducing payments to providers, such as hospitals and skilled nursing facilities. Medicare provider payment changes in the ACA were adopted in conjunction with the ACA’s insurance coverage expansions, with the expectation that additional revenue from newly-insured Americans would offset lower revenue from Medicare payments. In addition, Medicare savings were achieved through lower payments to Medicare Advantage plans.

 

[Rogue219]

Graham-Cassidy healthcare bill has Alaska Purchase for Lisa Murkowski - Business Insider

Alaska's prize in the Graham Cassidy tax cut for the wealthy is they get to keep the ACA, more or less, so Murkowski votes yes.

I give Republicans credit. They are completely out of fucks to give and don't care who knows it.

 

[Legacy]

Graham-Cassidy healthcare bill has Alaska Purchase for Lisa Murkowski - Business Insider

Alaska's prize in the Graham Cassidy tax cut for the wealthy is they get to keep the ACA, more or less, so Murkowski votes yes.

I give Republicans credit. They are completely out of fucks to give and don't care who knows it.

Quote from linked article:

...his healthcare proposal would award each state almost precisely $4,400 in federal subsidy for each "eligible beneficiary" — except Alaska, which would receive $6,500, or 48% more than everybody else.

Hmm. Do we know anybody from Alaska?

Making things odder: Neither VerBruggen nor I could locate the provision in the bill that seemed to authorize this Alaska Purchase.

So I asked a staffer in Cassidy's office and was told the office would be revising the projections. The spreadsheet came down off the senator's website after I inquired about it.

Who posted that damn spreadsheet so that the public could see the results of the bill's secret provisions especially since we're voting before a CBO score which would look closely at these items?

It's really great that everyone has to figure these extremely consequential matters out on the fly because Republicans in Congress want to overhaul healthcare on the back of an envelope.

Colorado Gov. John Hickenlooper, other governors oppose Graham-Cassidy health care plan

Dear Majority Leader McConnell and Minority Leader Schumer:
As you continue to consider changes to the American health care system, we ask you not to
consider the Graham-Cassidy-Heller-Johnson amendment and renew support for bipartisan
efforts to make health care more available and affordable for all Americans. Only open,
bipartisan approaches can achieve true, lasting reforms.

Chairman Lamar Alexander and Ranking Member Patty Murray have held bipartisan hearings in
the Senate’s Health, Education, Labor and Pensions (HELP) Committee, and have negotiated in
good faith to stabilize the individual market. At the committee’s recent hearing with Governors,
there was broad bipartisan agreement about many of the initial steps that need to be taken to
make individual health insurance more stable and affordable. We are hopeful that the HELP
committee, through an open process, can develop bipartisan legislation and we believe their
efforts deserve support.

We ask you to support bipartisan efforts to bring stability and affordability to our insurance
markets. Legislation should receive consideration under regular order, including hearings in
health committees and input from the appropriate health-related parties. Improvements to our
health insurance markets should control costs, stabilize the market, and positively impact
coverage and care of millions of Americans, including many who are dealing with mental illness,
chronic health problems, and drug addiction.

We look forward to continuing to work with you to improve the American health care system.
Sincerely,

John Hickenlooper
Governor
State of Colorado

John Kasich
Governor
State of Ohio

Bill Walker
Governor
State of Alaska

Steve Bullock
Governor
State of Montana

 

[Legacy]

What’s in the new GOP health care bill, in one (simple) chart