From the category archives: healthcare
While a flat line in the medical world is usually bad news...when it comes to health care costs in Medicare, this flat line is a good thing. We reported earlier on the latest Congressional Budget Office forecast for Medicare and why that news is being ignored by Washington’s well-financed anti-entitlement lobby and the fiscal hawks they support in Congress.
Today, the New York Times provides even more good news for Medicare and bad news for anti-Social Security and Medicare scolds:
“Medicare spending isn’t just lower than experts predicted a few years ago. On a per-person basis, Medicare spending is actually falling.
If the pattern continues, as the Congressional Budget Office forecasts, it will be a rarity in the Medicare program’s history. Spending per Medicare patient has almost always grown more rapidly than the economy as a whole, often by a wide margin.”
For years now, Wall Street funded fiscal hawk groups have been promising fiscal Armageddon unless Congress immediately cut benefits to middle-class seniors and their families. Contrary to that billionaire-financed bluster, the truth is there are clearly ways to see savings in Medicare through lower health care costs, not just by slashing benefits:
“The recent pattern reflects two main factors. One is that the baby boom generation is entering the program. In the long term, that’s a problem for Medicare’s finances because the number of people it must care for is going to surge. But in the short term, it skews the group enrolled in Medicare toward a younger, healthier population.
The second factor is more surprising and consequential. Over the last few years, Medicare patients have been using fewer expensive medical services, particularly hospital care and prescription drugs. The budget office is increasingly persuaded that such a pattern is going to last for a while.”
And there are even more proposals that could be enacted which don’t single out seniors for benefits cuts. How about allowing Medicare to negotiate for lower drug costs like the VA does for veterans? Or fully allow the proposed reductions in billions of dollars in federal overpayments to MA private insurance companies to be enacted, as proposed by the Affordable Care Act? This CBO report clearly proves there are ways to manage costs beyond the benefit-cutting or privatization schemes preferred by Congress’ self-proclaimed deficit hawks:
Joan McCarter at Daily Kos sums it up best this way:
“Here's what's particularly significant in this: "Reductions made in the last four years alone are responsible for 10-year savings of more than $715 billion, which dwarfs nearly every deficit-reduction measure currently under discussion." Take that, Paul Ryan.
Here's the thing. Medicare is going to be facing issues when the baby boom cohort gets older and sicker. But this trend in shrinking costs gives policymakers time to look at reforms that do not require benefit cuts, that don't require pain for Medicare patients. That means there's no reason for another Paul Ryan budget that slashes the safety net or for another catfood commission calling for raising the Medicare eligibility age or more cost-sharing by patients. Take note, Democrats, and stop with the deficit fetish already.”
In spite of years and years of doom-and-gloom predictions from conservatives that Obamacare will hurt Medicare, the facts just continue to tell another, very different story. Earlier in the month the annual Medicare Trustees report
showed how the ACA continues to extend the program’s solvency. Now, the Congressional Budget Office
has even more to say:
“You’re looking at the biggest story involving the federal budget and a crucial one for the future of the American economy. Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on Wednesday morning.
The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion. That sum is greater than the government is expected to spend that year on unemployment insurance, welfare and Amtrak — combined. It’s equal to about one-fifth of the expected Pentagon budget in 2019. Widely discussed policy changes, like raising the estate tax, would generate just a tiny fraction of the budget savings relative to the recent changes in Medicare’s spending estimates.”
Unfortunately, these fiscal facts will be ignored by those in Washington determined to cut Medicare benefits. Even though he’s on a nationwide book tour, Rep. Paul Ryan is doing everything possible to ignore talking about his plan which would turn Medicare into CouponCare while also repealing the ACA -- stealing years from Medicare’s solvency, eliminating free screenings for seniors, preserving massive subsidies for private insurers in Medicare Advantage and bringing back the costly prescription drug donut hole.
“How to Lie with Statistics” was a handy little guide that used to be required reading for journalism students and economics majors not so long ago. This book came to mind recently as we’ve followed the ongoing debate about the rate of doctors accepting or turning away Medicare patients. Columbia Journalism Review’s, Trudy Lieberman, tackled the issue:
“The (Wall Street) Journal had reported that last year, according to the Centers for Medicare and Medicaid Services, 9,539 physicians opted out of Medicare, up from 3,700 in 2009. It noted an American Academy of Family Physicians survey that found the proportion of family physicians accepting new Medicare patients was 81 percent last year, down from 83 percent in 2010. Furthermore, the Journal reported, reimbursement rates weren’t the only issue: some doctors were dropping out of the system because Medicare is too intrusive in their practices. Mary Jane Minkin, a gynecologist at the Yale School of Medicine, quit when she saw patients’ gynecological records displayed on electronic records which made them available to other providers they consulted. ‘There’s no reason the dermatologist has to know about my patients’ libido issues,’ she told the paper.
Reasonably interesting stuff. But also somewhat incomplete, as Diamond (Dan Diamond of California Healthline) writes: ‘What the Journal didn’t report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013. And other providers aren’t turning down Medicare, either. The number of nurse practitioners participating in the program has only gone up, Jan Towers of the American Academy of Nurse Practitioners told California Healthline.’
USA Today also reports, “More Doctors accepting Medicare patients”.
“The number of physicians accepting new Medicare patients rose by one-third between 2007 and 2011 and is now higher than the number of physicians accepting new private insurance patients, according to a Department of Health and Human Services report obtained by USA TODAY.
In 2007, about 925,000 doctors billed Medicare for their services. In 2011, that number had risen to 1.25 million, according to the report by the HHS Office of the Assistant Secretary for Planning and Evaluation.
‘I think the report comes at a time when people are asking questions about Medicare,’ said Jonathan Blum, principal deputy administrator for the Center for Medicare Services. ‘It provides a more complete picture of how physicians choose to participate in the Medicare system.’
“Ninety percent of office-based physicians accept new Medicare patients, a rate similar to those who take privately insured patients, researchers found. The rate of Medicare patients who say they can find a new doctor in a timely manner is similar to those who are privately insured, the report said.
Medpac found 28% of beneficiaries had a tough time finding a doctor who accepted Medicare last year, but Blum said that's also similar to privately insured rates. “
Threatening that doctors will leave Medicare is an annual rallying cry from physicians forced to fight against hugely unacceptable rate decreases mandated by a flawed formula that Congress simply must fix. For seniors, keeping their doctors is vitally important. It’s unfortunate that they’ve become the pawns in the battle to fix the physicians payment formula – something we agree must happen.
As President Obama continues his August push on the Affordable Care Act, Politico has an interesting look at the ACA compared to the passage of Medicare in 1965. There are a lot of similarities as the GOP fought hard against both:
President Barack Obama says he’s not worried that all the Obamacare fights will kill the law — because people fought the creation of Medicare and Social Security too, and now they’re more popular than ever.
Democrats have always wanted to believe Obamacare would follow the same pattern: Opponents tried to block passage of the new programs, but once they became law, the public saw the benefits and the opposition faded away.
But this time there’s a difference. Political opposition to Obamacare is still as strong as ever, more than three years after it was signed into law.
That means the administration’s task in launching the health care law — the biggest new social program since the creation of Medicare in 1965 — is harder than anything its predecessors had to face.
One problem with this analysis is that opposition isn’t as strong as ever. In fact, a GOP poll designed to give support to Republicans continuing to push for ACA repeal found the American people actually don’t support repeal:
“Americans — including 57 percent of independents in ten critical congressional districts — favor defunding Obamacare,” said Michael Needham, the CEO of Heritage Action. “House Republicans should be much more concerned with the fallout of failing to defund Obamacare than with the imaginary fallout of doing so.”
What Needham fails to mention, however, is that even this push poll that dramatically oversamples Republicans (more on that in a minute) finds respondents are more likely to say that the Affordable Care Act should be kept than scrapped — and that a plurality would blame Republicans if the government were to shut down.
Only 44.5 percent “oppose the health care law and think it should be repealed,” while 52 percent either support the law as is or have some concerns, but say they think implementation should move forward. And asked whom they would blame if “there was an impasse between president Obama and Congress on whether to continue to fund the health care law, and that impasse resulted in a partial government shutdown,” the top response (28 percent) was Republicans in Congress. The next option, Obama, got 21 percent of respondents.”
Seniors in Medicare have a lot at stake in this debate. Thanks to Obamacare, seniors will see an average savings of about $4,200 in their prescription drug costs over the next decade and the Part D coverage gap known as the “donut hole” will be closed. Seniors also receive free preventative visits and health screenings plus the Medicare trust fund has gained a decade of solvency.
These are real-life tangible benefits for millions of seniors they simply don’t want to lose. It’s no wonder the House GOP is feeling the wind dying down in their Obamacare propaganda campaign.
Just two months ago, the Obama White House vowed
it wouldn’t be sucked into debt ceiling negotiations with Republicans again. “Thank goodness” we all said, since that debacle ultimately led us to the ongoing budget mess and sequester
which continues to hurt American families
“Gene Sperling, director of the National Economic Council, told reporters that the president "simply is not going to negotiate on the debt limit." The Hill
Hmmm....Guess what? The White House has been meeting behind closed doors with Republicans ever since then doing exactly that...negotiating with Republicans about which middle-class benefits will be cut in order to head off another GOP led hostage taking over the debt ceiling. Clearly, past is prologue.
Here’s what the National Journal reports today:
“At least a dozen Republican senators are regularly meeting with President Obama’s top aides in an attempt to plot a way forward on the looming fiscal challenges facing leaders this fall, senators involved in the meetings tell National Journal.
The meetings, which began after Obama hosted GOP senators for dinner earlier this year, are the first sign that Democrats and Republicans are in talks to strike a deal that would reduce the deficit and reform entitlements and taxes.
Republicans plan to use the debate over raising the debt limit to force Democrats to cut spending—a negotiation Obama has said he won’t engage in. But these meetings demonstrate that the president is in fact engaging Republicans in a broader discussion about debt and spending.
An administration official said White House aides have made clear to Republicans that the president’s offer from December—including $600 billion in new tax revenue for $400 billion in Medicare and other health care cuts—still stands.
Republicans are open to $600 billion in revenue, Burr said, but want to see it come from a mix of entitlement and tax reform. And the GOP opposes Obama’s $400 billion in Medicare cuts, arguing they want more structural reforms.”
Just in case you’ve forgotten, those “structural reforms” actually end traditional Medicare and put seniors at the mercy of private insurance companies, dramatically increasing their health care costs and limiting their choice of doctors. What Republicans want is passage of the Ryan/GOP budget, which is nothing more than “CouponCare” which gives seniors a coupon to go buy their health coverage from private insurance companies. The American people don’t support “CouponCare” yet the Republicans in the House have introduced this plan three times and clearly hope President Obama will give them what the Senate will not.
And then there’s President Obama’s plan for Social Security and Medicare, which isn’t to be applauded either. He proposes cutting Social Security benefits for current and future retirees, veterans and the disabled plus raising taxes on the middle class through the Chained CPI.
“Cutting benefits by adopting the chained CPI would cut the COLA by 3% for workers retired for ten years and 6% for workers retired for twenty years. This cut targets both current and future retirees. Three years after enactment, this translates to a benefit cut of $130 per year in Social Security benefits for a typical 65 year-old. The cumulative cut for that individual would be $4,631 or more than three months of benefits by age 75. While supporters claim the chained CPI is more accurate; you have to ask yourself, if this chained CPI really is more accurate, then why the need to offer an incremental benefit “bump” to some beneficiaries? The answer is simple. The chained CPI does not accurately measure these groups’ expenses; in fact, it makes most of the same errors as the current formula and adds a few. Adoption of this new formula is really about cutting benefits and raising taxes on average Americans to reduce the deficit.” Max Richtman, NCPSSM President/CEO
In a letter to the White House Max also told the President:
"The 'chained CPI' is not a 'technical tweak,' and no amount of rationalization can make it so. In reality, the chained CPI is a benefit cut for the oldest and most vulnerable Americans who would be least able to afford it. To offer to trade it away outside the context of a comprehensive Social Security solvency proposal ignores the fact that Social Security does not even belong in this debate because it does not contribute to the deficit. Cutting Social Security benefits to reduce the deficit is unacceptable to the vast majority of Americans across all ages and political affiliation."
On Medicare, President Obama also supports even further means-testing which will ultimately hit middle-class families, not just “wealthy seniors.”
“Proposals to expand Medicare means testing include increasing income-related premiums under Medicare Parts B and D until 25 percent of beneficiaries are subject to higher premiums. A study from the Kaiser Family Foundation found that this would affect individuals with incomes equivalent to $47,000 for an individual and $94,000 for a couple if fully implemented in 2014 – meaning it would reach many middle-income Americans.”
So, everything old is new again. President Obama is negotiating with the GOP all over again and middle-class benefit cuts are the only thing we know for sure is on the table. You have to wonder, where are Congressional Democrats?!
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