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From the monthly archives: April 2009

We are pleased to present below all posts archived in 'April 2009'. If you still can't find what you are looking for, try using the search box.

Medicare Overhaul Proposed

It's not surprising that quality control and improving payment processes for Medicare were among the first items tackled by the Senate Finance Committee in their newly unveiled health care reform strategy, entitled "Description of Policy Options."   Chairman Max Baucus told reporters: 
"Almost all health providers agree that the we are taking the right approach...The concerns are implementation."
 The recommendations detailed in the committee's report are designed to hold doctors and hospitals more accountable, slow the growth of Medicare, and improve chronic care for seniors in the program.  The New York Times summarizes the proposals this way: 
  • Medicare would increase payments to doctors who regularly exceed "national benchmarks" for the quality of care. Doctors who did not meet federal standards would be subject to financial penalties.
  •  Medicare would pay bonuses to hospitals that provide superior care for heart attacks, heart failure, pneumonia and selected other conditions. The cost would be offset by cutting Medicare payments to other hospitals. 
  • Doctors could receive extra payments if they hired nurses to manage follow-up care for Medicare patients who were discharged from the hospital after being treated for chronic conditions like diabetes, asthma, depression and coronary artery disease. 
  • The government would set national standards for the appropriate use of CAT scans, magnetic resonance and other diagnostic imaging techniques. Medicare would cut payments to doctors who drive up costs by overuse of imaging services. 
  • In addition, Medicare would make a single "bundled payment" for all the services provided to a hospital patient. The bundle would include payments for any nursing home care or home health services that a person received after leaving the hospital, an idea that made some providers uneasy. 
Senators Baucus and Grassley believe improving the delivery of health care in the Medicare program will help drive the broader effort to overhaul our entire healthcare system. We here at the National Committee applaud these efforts but hope it won't stop there.  Congress should also reinvest at least some of the savings found in Medicare back into the program.

The Medicare = Health care Equation

There is a multitude of factors in the national health care reform equation but one thing is clear, the skyrocketing cost of health care is hurting all Americans, young and old alike.  That's why it's critical that Congress treats Medicare as more than just a cash-cow to pay for system-wide health care reforms.  Some of the savings proposed by the Obama administration should be reinvested to improve care for the nation's 45 million Medicare beneficiaries.  We can't reform health care while ignoring the nation's largest health care provider. We've written a letter to President Obama and Congress suggesting 3 key Medicare priorities: 
On behalf of the National Committee's millions of members and supporters, we propose three priority areas we believe must be addressed.  First, we urge you to eliminate the billions of dollars in subsidies that are being paid to private insurance plans under Medicare Advantage.  Currently, our nation is spending over $1,000 more per individual for those enrolled in Medicare Advantage plans than it would cost to cover those same individuals under traditional Medicare.  There is simply no justification for the wasteful overpayment of private plans participating in the Medicare program.  Second, we urge Congress to enact sorely-needed reforms to the Medicare prescription drug benefit.  Priority improvements in Part D include:  providing seniors the choice of a Medicare-operated prescription drug plan, providing Medicare the authority to negotiate lower drug prices, eliminating the doughnut hole (which does not exist in any private sector health insurance system), and improving assistance to low-income seniors.  We believe these changes will both improve seniors' health and lower costs over the long term.  Finally, as you consider changes in coverage for those under age 65, we urge you to consider parallel improvements in the Medicare program for those aged 65 and older.  For example, most private health insurance plans include a limit on annual out-of-pocket costs for beneficiaries.  We believe a similar cap in Medicare would address some of the issues seniors on fixed, limited incomes face with the unpredictability of annual health care expenditures.
You can see the full letter posted here on the National Committee's website.

Medicare Should Lead Health care Reform

That's the suggestion made by Senate Finance Committee Chairman Max Baucus and echoed by panelists at the first of the committee's health care roundtable meetings.  The Associated Press and Maggie Mahar provide the best reviews of this first Senate session, which focused on reimbursement and delivery reform.  Baucus told attendees: 
"Medicare is the big driver here" and "How to scale it up" will be one of the key questions, he said, but "Medicare will be a big part of that solution."  
His written statement also said: 
"The U.S. health system scores 65 out of 100 on indicators of health outcomes, quality, access, equity, and efficiency. And we know from previous research that adults receive recommended care only about half of the time. [And these are adults who have access to care.] We have the opportunity to modernize our outdated payment systems. Those payment systems encourage the delivery of more care, rather than better care."
The National Committee applauds the Senate's efforts to ensure Medicare is more than just the piggy bank used to pay for system wide health care reform.  Eliminating wasteful industry subsidies to private insurers in Medicare Advantage makes good sense but some of that money must also be reinvested back into improvements for Medicare to:
  • lower drug prices through government negotiation
  • close the prescription drug doughnut hole
  • limit seniors' out-of-pocket costs
Medicare's actuaries predict over one-half of the average senior's Social Security benefit check will be consumed by Medicare out-of-pocket costs by 2025. Containing health care costs is an important goal of national health care reform and we believe seniors in Medicare have a large stake in that ongoing debate.

Health Insurers prefer Astroturf over real Grassroots lobbying

For years, the health insurance industry, led by AHIP, has tried to foment a senior revolt to head off any attempts in Washington to trim back billions in outrageous industry Medicare Advantage subsidies provided by the Bush administration.  AHIP created its own "grassroots" group,  "The Coalition for Medicare Choice" offering free lunches and door prizes at "community meetings" designed to convince seniors that Congress wants to "take away your Medicare".   Now it appears this Astroturf lobbying campaign has reached a new low...sending letters to the editor from seniors without their knowledge.  The New Bedford Eagle-Tribune in Massachusetts reports on three fake letters it received: 
"Some of those seniors are unaware that they have sent any such letters to newspapers. Some of them hadn't even heard of Medicare Advantage. ‘I did not write a letter to the editor. It's not from me,' said Gloria Gosselin, 75, of Lawrence.  Gosselin's name was on one of three strikingly similar letters touting the Medicare Advantage program that were sent to The Eagle-Tribune. Writers of letters to the editor are routinely contacted by newspapers to make sure letters are legitimate. In this case, they weren't. All three of the purported authors of the letters said they had no idea their names were being used to advocate for the health insurance program. The letters were, in fact, composed and sent by the Boston office of a national political consulting firm attempting to create the appearance of a ‘grass-roots' movement for Medicare Advantage."
A quick Google search shows a number of similar letters did make it to print in papers nationwide, large and small.  How many are real?  Who knows.  But when you look at the history of Medicare Advantage's creation, its marketing abuses, rising premiums and out of pocket costs, this Astroturf campaign can't be too surprising from an industry pulling out all the stops to preserve it's profitable government subsidies.  The Obama administration is right to go after these outrageous industry overpayments which will cost Medicare$150 billion over ten years, shave almost two years from Medicare's solvency, and force all beneficiaries (not just those enrolled in MA plans) to pay $36 per year in higher premiums.  These subsidies should be repealed and the savings reinvested in traditional Medicare to improve coverage for 44 million Americans.  That's a true grassroots effort that seniors have supported and will continue to support without free meals, fake letters and Astroturf campaigns.


House Republicans, led by Congressman Paul Ryan, released their budget proposal yesterday...yes, on April Fool's day. Unfortunately, this plan was not offered in jest.  And it's potential affects on America's seniors and their families is no joke.  
  • The GOP plan would cut Social Security. 

This proposal would means test Social Security, turning a social insurance program into a welfare program. Conservatives have long believed that changing Social Security's core mission is the only way to erode public support for a program which serves all Americans well, regardless of their income. Incredibly, according to the Wall Street Journal,  the Obama Administration says it "would have to take a close look at the GOP proposal on Social Security".

"Social Security reform, largely ignored since President George W. Bush's ill-starred initiative in 2005, could be resurfacing soon. On a conference call with reporters Wednesday where he generally blasted Republican budget proposals, a top Obama budget official said the administration would have to take a close look at the GOP proposal on Social Security, and hinted that the White House would have more to say on the issue soon."

  •  The GOP plan would privatize Medicare.
 Their plan continues the privatization begun with the passage of the disastrous Medicare Modernization Act during the Bush administration. The goal is the dismantle Medicare piece by piece and turn it over to private insurers. The Wonk Room has a detailed description of this proposal saying:

 "Over time, this proposal would turn Medicare into a voucher system in which seniors would get a check from the government and would be told to go buy private insurance. In the absence of federal cost controls (which are part of the Democratic but not the Republican program), health costs would skyrocket and the voucher amount would quickly fall far behind the cost of insurance. Obviously, seniors who couldn't afford to pay more out-of-pocket would become under-insured and insurance companies would make out like bandits. "

  • The GOP plan would rescind the recently-enacted economic stimulus package, except the unemployment provisions.
  • The GOP plan would provide approximately $4 trillion in tax cuts to the rich by extending George Bush's 2001 and 2003 tax cuts. It creates a new tax sytem that also benefits higher earners while also suspending the capital gains tax for 2009 and 2010. This proposal would also cut the corporate income tax rate from 35 to 25 percent.
  • The GOP plan would freeze discretionary spending for 5 years.
We loved Matt Yglesias' description of what such a draconian measure proposed during a recession is akin to:
"Basically, you can imagine a school that today is serving a certain number of children and has a certain budget. Well, over the course of five years the population will grow and the number of kids in that school will also increase. But the school won't get any additional money. Instead, because there's inflation, the school will actually be getting less money even as it needs to teach more children. And so on across the board for federal programs. If you think that there's literally nothing in the entire federal budget that's useful, this may strike you as an appealing idea. Otherwise, April fools!"

In spite of all the clarion calls for tougher budgeting and deficit reduction here's the real April Fool's joke...even if these draconian proposals targeting social programs and the middle class were passed, the Republican plan would still leave annual deficits of about $500 billion, not much lower than the Democratic plans.

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