Medicare/Universal health care

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Boomers gonna be a burden on health care system...

Study: Boomers to Flood Med System
Monday, Apr. 14, 2008 - Millions of baby boomers are about to enter a health care system for seniors that not only isn't ready for them, but may even discourage them from getting quality care.

"We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably," said John W. Rowe, professor of health policy and management at Columbia University. Rowe headed an Institute of Medicine committee that released a report Monday on the health care outlook for the 78 million baby boomers about to begin turning 65.

The report from the institute, an arm of the National Academy of Sciences, said:

•There aren't enough specialists in geriatric medicine.

•Insufficient training is available.

•The specialists that do exist are underpaid.

•Medicare fails to provide for team care that many elderly patients need.

The study said Medicare may even hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions and lack of coverage for preventive services or for health care providers' time spent collaborating with a patient's other providers. The American Medical Association responded that seniors' access to Medicare in coming years "is threatened by looming Medicare physician payment cuts."

"This July, the government will begin steep cuts in Medicare physician payments, and 60 percent of physicians say this cut will force them to limit the number of new Medicare patients they can treat," the AMA said in a statement. The report found there are about 7,100 doctors certified in geriatrics in the United States, one per every 2,500 older Americans. Turnover among nurse aides averages 71 percent annually, and up to 90 percent of home health aides leave their jobs within the first two years, the report said.

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Doctors keeping quiet about treatment options...

Treatments your doctor won't tell you about
Wed., June. 11, 2008 - Options for those with hip arthritis, uterine fibroids, depression and more

Breast cancer survivor Janice Collins gave silicone implants the benefit of the doubt not once, but twice: The first surgery resulted in an infection, the second in a lopsided breast. Only a chance meeting with another breast cancer survivor led her to investigate the DIEP flap, a reconstruction that would use her own abdominal tissue to build a breast that feels and looks natural. "Not even my own doctor had mentioned this procedure to me," says the 61-year-old probation administrator, who ultimately received a DIEP flap and couldn't be happier with it.

The technique is just one of several advantageous treatment options — for hip arthritis, uterine fibroids, depression, and other conditions — your doctor may not tell you about. The reasons are multiple: Your doctor may lack training in new, cutting-edge surgeries; it may be harder for him to obtain insurance coverage for a particular procedure; or he may simply be cautious about treatments that don't have decades of data backing them up. However, that doesn't mean you wouldn't want to be aware of all your choices — and have the chance to make the most educated decision about your health care. Here are four you should know more about.

Hip arthritis

The usual treatment: If you develop mild to moderate forms of osteoarthritis of the hip in your 40s, you're usually told to wait until you're 55 or 60 for a full or partial hip replacement, in which the entire neck and head of the thighbone (the femur) or just the head are replaced with metal parts. Though it may mean tolerating limited movement and chronic pain, there's a reason for waiting: Metal hips last up to 20 years, and in a recent British study, they lasted this long in only half of osteoarthritis patients under age 40.

More Treatments your doctor won't tell you about - Health care - MSNBC.com

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'Smart pill' creator wins big tech prize
12 Jun 2008, Harvard professor, Dr Robert Langer, has developed Star Trek-style 'smart pills', which allow life-saving drugs to be released into the body on demand.

The creator of a new generation of Star Trek-style 'smart pills', which allow life-saving drugs to be released into the body on demand and 'smart injections', which pass through the skin without needles, has been given the world's richest technology prize for leading a biomedical revolution that is helping millions around the globe. Dr Robert Langer, the Harvard professor who heads the world's largest biomedical engineering laboratory in the world at MIT, was awarded the Millennium Technology Prize here late on Wednesday.

The diminutive and downbeat doctor of chemical engineering, has often been described as a "pharmaceutical postman" for managing to deliver life-saving drugs to the right part of the body, in the right dose and at the right time. What that really means, he explained to TOI, within minutes of winning the 800,000-euro prize, is that "depending on how smart a pill is, you can target a disease in a controlled way". Langer, sometimes seen as 'the professor of the impossible', said he was now busy "using ultrasound to open the nano pores of the skin so that drugs can pass in non-invasively. It's like Star Trek but if you had the choice between being injected or not injected, you know which one you would choose".

The Techonology Prize falls just about 40,000 dollars short of the 10-million Swedish krona received by Nobel laureates and is seen to be the biggest award for innovation, having honoured the world wide web's creator Tim Berners-Lee at its inception in 2004. Langer said he "had always been excited by science from the age of nine and always wanted to help people". He said the Millennium Technology Prize, established as a private-public partnership between Finnish industry and the state and given every two years to recognise life-enhancing innovations, "is recognition that science can do good things".

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Docs Bailing Out of Medicare, Medicaid...

Doctors Dumping Medicare and Medicaid
July 8, 2008 - Plummeting Reimbursement Rates Have Some Doctors Looking for a Way Out

For the past four years, Dr. Heather Tipsword has owned a family practice clinic that primarily treats Medicaid and Medicare patients in Oklahoma City. As many of her friends and family were looking forward to Fourth of July celebrations this past weekend, Tipsword was anxiously looking forward to another event altogether: Congress' meeting on the Monday after the holiday weekend to discuss some kind of fix to the scheduled 10.6 percent Medicare reimbursement cut.

To Tipsword, this round of Medicare reimbursement cuts, to become effective July 15, could make or break her family practice. (In many states, these cuts affect Medicaid too.) "I have struggled to build up my practice, but my outlook gets worse each year," Tipsword said. "The current round of Medicare cuts -- which will cut my repayments, which are miniscule right now -- as well as increasing malpractice insurance coverage, despite an A+ rating, makes it less feasible for me to continue practice."

However, the meeting yielded no short-term fix for the problem, and by the end of the session it was clear that the 10.6 percent cut would likely go through anyway. Now, Tipsword says she is working on an exit strategy from the program. At times, the bureaucratic demands of the job make her consider going even further. "Due to all the daily headaches of practice -- referrals, endless duplicate paperwork to prove medical necessity, phone calls, documentation, etc. -- I would honestly love to get out of medicine altogether," she said.

More ABC News: Doctors Dumping Medicare and Medicaid

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Doctors not gonna get short-changed...

Doctors, Patients At Ease After Senate Vote
Thursday, July 10, 2008 - Doctors and patients worried about pending cuts in Medicare treatments are resting easier tonight after the US Senate voted yesterday to eliminate reductions in Medicare reimbursments to doctors.

Physicians at the Missouri Heart Center have had to change the way they welcome patients. The potential Medicare cuts have put pressure on them to reconsider the number of Medicare patients they can see. "Right now in Columbia, it's difficult to find a primary care physician to see a new Medicare patient, cause they're limiting the number of those patients because the reimbursements is not enough to cover the cost," explained Medicare physician Dr. Jerry Kennett.

The Senate did pass a bill that would stop the cuts from going into effect July 15th, but at Columbia's Senior Center, there were some people that did express some concerns about the cuts. "There may be a time where the primary physician will say, Medicare doesn't pay me enough, so I'm going to collect from you, and then you can collect from Medicare whatever you can get," said Medicare patient Thelma Cester.

The Senate's bill to stop the cuts must still go through President Bush, who's said he opposes it. That could mean doctors and patients will have to get ready for cuts all over again. The American Medical Association reports 60 percent of physicians nationwide would limit the number of new Medicare patients if the cuts went through.

Source

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Gonna take a lotta taxes to make up the difference...

$36.3 Trillion Medicare Shortfall Can Be Fixed, Experts Say
Friday, July 11, 2008 – Experts on Capitol Hill on Wednesday discussed the future of Medicare and, in part, how to eliminate the $36.3 trillion budget shortfall projected over the next 75 years.

Len Nichols, director of health policy at the liberal New America Foundation, told Cybercast News Service that the chances of eliminating the entire debt are bleak, but not hopeless. “Fundamentally, all of us are about trying to bend that cost-curve. Now, are we going to get that debt to zero? Probably not,” he said. “But I don’t think it’s hopeless. I submit that doing things like linking payments to health outcomes is the only American way to bend that cost curve, and I think we can do it.”

In addition to explicit financial incentives for improved performance by health care providers, Nichols, who supports mandated universal health care, added that if Medicare starts providing good health care, Americans should be willing to pay a little more for the program. “As long as we are making people better off – and healthier – we may be able to pay more as we go forward,” he said.

But eliminating the Medicare debt should be possible by applying free-market principles to Medicare, according to John C. Goodman, president and CEO of the conservative National Center for Policy Analysis. Goodman told Cybercast News Service that if government-provided health care is opened to the free market, a resulting drop in prices for medical goods and services could translate into a monumental reduction – if not elimination – of the projected debt.

More CNSNews.com - $36.3 Trillion Medicare Shortfall Can Be Fixed, Experts Say

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Bush veto overidden...

Congress overrides veto of Medicare bill
15 July `08 WASHINGTON - President Bush had vetoed bill protecting doctors from Medicare rate cut

Congress on Tuesday rejected President Bush's veto of legislation protecting doctors from a 10.6 percent cut in their reimbursement rates when treating Medicare patients. The override vote in the House was a lopsided 383-41, easily meeting the two-thirds threshold needed to nullify the president's veto. About an hour later, the Senate voted to override, 70-26.

Bush has vetoed bills nine times, and Congress has had the muscle to override him only on a water projects bill and twice on farm legislation. The president said he supported rescinding the pay cut, but he objected to the way lawmakers would finance the plan, which would be largely by reducing spending on private health plans serving the elderly and disabled.

"I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said in a statement. "Yet taking choices away from seniors to pay physicians is wrong."

Lawmakers under pressure

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Drug Combo Fights Rheumatoid Arthritis
July 15, 2008 -- In the early stages of rheumatoid arthritis, taking the drugs Enbrel and methotrexate may make remission more likely than taking methotrexate alone, a new study shows.

The study, published in The Lancet, included 542 rheumatoid arthritis patients in Europe, Latin America, Asia, and Australia. For two years, all of the patients took methotrexate pills. Methotrexate has long been a cornerstone of rheumatoid arthritis treatment. The patients also got a weekly injection -- some got shots of the biologic drug Enbrel; others got a placebo shot.

So far, results are in for the first year of the study. During that time, half of the patients taking Enbrel and methotrexate had their rheumatoid arthritis go into remission, compared to 28% of those taking methotrexate alone. And rheumatoid arthritis at least didn't worsen on X-ray in 80% of the Enbrel-plus-methotrexate group, compared to 59% of those only taking methotrexate.

Side effects were similar in both groups, according to the researchers, who included Paul Emery, MD, a professor at the University of Leeds in England. Enbrel is marketed in the U.S. by the drug companies Amgen and Wyeth. Wyeth funded and designed the study, collected the data, and helped analyze the data, according to The Lancet.

An editorial published with the study points out that methotrexate injections might have been more effective than oral methotrexate. The long-term risks, benefits, and cost-effectiveness of Enbrel-plus-methotrexate treatment should also be studied, notes editorialist Joel Kremer, MD, of the Center for Rheumatology at Albany Medical College in Albany, N.Y.

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Health care costs goin' up...

More health care cost pain seen in 2009
Mon., Aug. 11, 2008 : 10 percent expected rise the smallest in 6 years, according to survey

Health care costs are expected to rise more than 10 percent into next year, according to a survey of insurers by Aon Consulting Worldwide. But that increase is the smallest Aon has seen in six years. Experts say it shows that efforts to tame costs, such as employee wellness or disease management programs, may be paying off. "There's a variety of tactics that employers have been employing over the last 3 to 6 years that has had an impact on the market," said study director Bill Sharon, an Aon Consulting senior vice president.

Aon Consulting surveyed about 70 health insurers around the country, including companies such as Aetna Inc. and Cigna Corp. It found that actuaries expect costs to rise an average of 10.6 percent during 12-month rating periods starting this year between April and September. That represents a slight drop from last year's forecast of 10.9 percent and a bigger fall from 2002, when health care costs were expected to rise by more than 16 percent.

But the percentage likely won't be what the average employee faces for a premium hike next year. It doesn't reflect insurance plan designs or changes an employer might make to benefits plans. "Pretty much every employer has to do something or is doing something in an effort to bring that number down," Sharon said. He said actual cost increases have wound up being three to four percentage points lower than preliminary estimates in the past couple of years. Still, he said Aon Consulting's survey gives employers a benchmark to use as they consider premium renewals.

More More health care cost pain seen in 2009 - Health care - MSNBC.com

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How we gonna pay for it?

Is the time right for universal health care?
November 22, 2008 | Barack Obama has one overriding task: he must restore the strength and confidence of the American economy, and the sooner the better. But keep your eye on health care.

When FDR came into office in March 1933 after an even longer and even more unnerving transition period than this one, he had one overriding task and he set about it with great energy and creativity. He proved that America could cope with the Great Depression, even though it took years and World War II to find great prosperity. But the real story of the New Deal was one signature program—Social Security. Passed in 1935 it reframed the crisis of the economy by focusing on the long-term security of the elderly. It has been America’s most successful and popular social program. And retirement security for the elderly helped keep the economy on an even keel through good times and bad.

In 1965, Lyndon Johnson signed the second great pillar of American social policy and created the Medicare program. But the third pillar, universal health care, has languished. Democratic presidents from Harry Truman to Bill Clinton tried and failed to pull the sword from the stone. These three programs are really the heart and soul of the Democratic Party, to turn principles into reality or to defend them once created. Obama seems to be inclined to get to health care now and not later, although his timing is different than FDR. The economic crisis is so bad now that constraints on spending are likely to be suspended. Only a huge economic stimulus can help the economy now. If Obama can make the connection between the economy and health care, the momentum may become irresistible. I think the most powerful argument, though, is one he made on the campaign trail in talking about his mother’s final days, that she spent her time not coping with her situation but on the phone arguing with health insurance companies. This really hits close to home.

With the appointment of Tom Daeschle as Secretary of Health and Human Services, Obama has a long time advocate of health care reform. While Sen. Ted Kennedy’s support is to be expected, the entry of Sen. Max Baucus of Montana with a progressive health care plan shows that the politics of health care has expanded the electoral map in the same way that Obama’s campaign did. In fact, Hillary Clinton’s willingness to consider the position of Secretary of State may reflect that there are so many potential parents of a new health care system that her own pioneering efforts ih 1993 may not give her a seat at the head table when the new Senate convenes. Some Republicans are very worried --- not that Obama will be successful in dealing with the economic crisis—but rather that he will go farther and complete the Democratic grail of social programs. A similar fear led Congressional Republicans to block Clinton’s plan in 1993, a strategy that paid off handsomely in the 1994 congressional elections when they blamed Clinton for the failure of health care. But Obama’s victory was much more imposing than Clinton’s in 1992 ; and he also has the mistakes of the Clinton approach to study.

Finally, the Republican party is much weaker today than then. After Clinton won, conservatives could say that Bush, Sr. messed things up for conservatives by raising taxes. This year, the collapse of the Bush regime has been so total, and the Bush regime was so conservative that the Republicans are at a loss for direction. The logic for moving quickly on health care is also to act before the Republicans get themselves together again. And so we may be seeing history made again following an historic presidential election—perhaps the most significant change in American social policy since Medicare. The key to its success will be to remember that the best programs are simple and have a clear justification not just for the numbers crunchers but in terms of what is fair and who is deserving. That is one reason that FDR insisted that Social Security be a contributory program, a recognition of the work performed in one’s lifetime. I do not know what the equivalent values are in health care (maybe a mandate that everyone must have coverage) but we do know that it is important to find what they are.

Source

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Medicare Could Go Bust Sooner Than Expected...

Economy Likely to Move Up Medicare's Insolvency
WASHINGTON December 1, 2008 - Officials Estimate Struggling Economy to Speed up Medicare's Insolvency 1 to 3 Years

Federal health officials estimate that the struggling economy will speed up by one to three years the exhaustion of the Medicare trust fund covering hospital and nursing home care. Trustees for the Social Security and Medicare programs warned last March that the trust fund for Medicare Part A would become insolvent in 2019. But the chief actuary for Medicare said Monday the economy will likely generate less revenue through payroll taxes than the trustees had projected. Once the trust fund is exhausted, the federal government will continue to pay for hospital care and other services, but it initially would only have enough money coming in to cover 78 percent of estimated costs.

Trustees issue a once-a-year report on the financial conditions for Social Security and Medicare. In the fall, the trustees get an update that tells them what's happening versus what their latest projection indicated. In the latest update, Medicare's top actuary braced the trustees for a deterioration in Medicare's finances. "Right now, we know that we're in the start of the recession. We don't yet know how severe it might be," Richard Foster, chief actuary for the Centers for Medicare and Medicaid Services, said in an interview. "We did a very, very rough estimate suggesting that because of the recession, the exhaustion date might advance anywhere from one to three years."

That estimate would place the exhaustion of the Part A trust fund somewhere between 2016 and 2018. Foster said that higher unemployment as well as smaller wage increases are behind the projected drop in revenue for Medicare Part A. Services covered through the Part A trust fund include inpatient hospital care, nursing home care, hospice and home health. Health and Human Services Secretary Mike Leavitt, one of the trustees at Monday's meeting, said that Foster's update reinforced his concern that too many people view Medicare's finances as one that is in the distant future.

More ABC News: Economy Likely to Move Up Medicare's Insolvency