Healthcare Reform & Policy Today

Physician Employees: READ THE FINE PRINT!!!

2012-04-05T20:12:00.002-04:00

More and more physicians are chosing to be employees, but employers are demanding more and more from their employees.We "pay you, we own your brain and therefore own all your ideas." Read the article below - click on the link for the full story - and make certain you understand and read carefully before signing on the bottom line:

Physician Sues Massachusetts General Hospital Over Ownership Of His Inventions.

In a front-page story, the Boston Globe (4/4, A1, Weisman) reports, "For the past decade, Dr. Joseph A. Grocela has tinkered in the basement workshop of his Weston home, coming up with inventions that range from urological devices to a voice box that helps musicians harmonize and improves intonation for the tone deaf." Grocela is now "in a legal fight with the hospital where he practices, Massachusetts General Hospital, and its corporate parent, Partners HealthCare System Inc., over who owns the rights to those creations and others." Although "Grocela, a urological surgeon who also teaches at Harvard Medical School, acknowledges that every two years he signs a contract with Mass. General that gives the hospital system ownership rights to his inventions," he argues that the contract does not apply to what goes on in his own home, while he is not working.

U.S. Preventive Services Task Force Update - Opportunity for Public Comment

2011-02-22T12:54:00.000-05:00

Behavioral Counseling Interventions to Promote a Healthful Diet and Physical Activity

The U.S. Preventive Services Task Force (USPSTF) is inviting public comment on its draft recommendation statement on behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults. This draft recommendation is an update of the USPSTF 2002 recommendation on behavioral counseling in primary care to promote physical activity and a partial update of its 2003 recommendation on behavioral counseling in primary care to promote a healthy diet.( the part of the recommendation that dealt with counseling patients at risk of cardiovascular disease was not updated at this time. )

To provide comments, please go to http://www.uspreventiveservicestaskforce.org/tfcomment.htm. The opportunity to comment on this draft recommendations statement is available until March 22, 2011.

The U.S. Preventive Services Task Force is working to make its recommendations clearer and more useful. This is part of its ongoing effort to keep its work and methods clear to the public it serves. The USPSTF is a national, independent panel of medical experts that makes recommendations, based on scientific evidence, to primary care doctors and other health care providers about which clinical preventive services they should offer their patients.

Physician comment sought on proposed Joint Commission Primary Care Home Requirements

2011-02-21T11:09:00.000-05:00

The Joint Commission (TJC) is developing a Primary Care Home (PCH) designation as an optional add-on to its Ambulatory Care Accreditation Program. As part of this process, TJC has released for review Proposed Standards outlining requirements with which ambulatory care centers seeking PCH designation must comply.

A preliminary analysis suggests that the Proposed Standards are not entirely congruent with AMA policy on the patient-centered medical home as adopted by the AMA House of Delegates. In particular, the Proposed Standards do not appear to require that the PCH be led by a physician.

All physicians are encouraged to review the Proposed Standards and respond to TJC by completing a short survey on the TJC Web site. Physicians may also submit general comments to TJC via the Web site. The deadline to complete the survey or submit comments is March 14.

http://www.jointcommission.org/standards_information/field_reviews.aspx?StandardsFieldReviewId=4ebBa9OiwpyfXwx3k3wI39cTCPh7XyqNM%2fvSme1yjzg%3d

Following the Money, Doctors Ration Care

2011-01-10T20:45:00.001-05:00

New York Times
Business Day
Following the Money, Doctors Ration Care
By TYLER COWEN

Published: December 11, 2010

Doctors are already rationing health care and are likely to further discriminate based on whether a patient has private insurance, Medicare or Medicaid.

OMED: Local alliances vital for sucessful medical missions

2010-12-03T12:32:00.000-05:00

This article link comes from the DO Magazine online. Dr. Tooke-Rawlins spoke at the AOCOPM/AOA Annual Convention in October about the responsible way to plan for medical missions work abroad. The article demonstrates the need to understand the local and national health regulations & policies of the country(-ies) you may choose to "help" with your volunteer work.

Hope for Quick Definative Diagnosis of Traumatic Brain Injuries

2010-11-08T19:53:00.000-05:00

In case you haven't seen this report in USA Today, it offers hopeful news for our service men/women as well as athletes and accident victims.

HHS Requests Comments on the National Health Care Quality Strategy & Plan

2010-10-01T12:06:00.000-04:00

The Department of Health and Human Services (HHS) is seeking public input in the development of a National Health Care Quality Strategy & Plan. The Patient Protection & Affordable Care Act (the Affordable Care Act) calls on HHS to establish a National Quality Strategy, including a comprehensive strategic plan and the identification of priorities to improve the delivery of health care services, patient health outcomes, and population health.

To provide feedback, HHS's requests that you provide comments on the webpage (link below). Alternatively, you may submit comments electronically to national_quality_strategy@hhs.gov . Written comments may also be submitted and should be addressed to the Agency for Healthcare Research and Quality, Attention: Nancy Wilson - Room 3216, 540 Gaither Road, Rockville, MD 20850 or faxed to the Agency for Healthcare Research and Quality, Attention: Nancy Wilson at (301) 427-1210.

All comments should be received no later than 5 p.m. on October 15, 2010.

Read the complete HHS report at: http://www.hhs.gov/news/reports/quality/nhcqsap.html .

Letter to the Nation's New Medical Students

2010-09-24T14:17:00.000-04:00

The Dean of Stanford University Medical School posted: "This week we were asked by Department of Health and Human Services Secretary Kathleen Sebelius and National Coordinator for Health Information Technology David Blumenthal, MD to distribute the letter that follows to first year medical students." Please click here and scroll down for the letter.

Understanding Insurance: Letter & Response to the April JAOA Article

2010-09-04T20:47:00.001-04:00

Dr. Fredericks began the discussion on the need for physicians to be taught the business of medicine in medical school, which led to my response and the subsequent survey in which I invite you to participate. Please click on the hotlink if you would like to learn more about the business of medicine or if you already have the necessary skills set and experience and are interested in teaching. Thank you -

Insurance Fraud Mushrooms

2010-08-13T05:30:00.012-04:00

As was predicted here in April, insurance fraud is now mushrooming, with new schemes popping up to scam the American consumer in 24 states. Section 1322 of the Patient Protection and Affordable Care Act mandated that states create co-ops. Under this legislation, private insurers or related entities in existence before July 16, 2009, cannot qualify as health insurance issuers in co-ops. The co-op provision in HR 3590 necessitates that a number of new nonprofit companies will pop up and apply for startup loans and grants from the federal government.

Who exactly will these new nonprofits be? After paying their premium dollars, will customers get the services they expect? Apparently not, according to a Reuters article published on Tuesday:

“The Federal Trade Commission said on Wednesday it is working with 24 states to crack down on sellers of medical discount plans that market them as health insurance that covers doctors, hospitals and other services. Such scams have increased in the wake of the health care reform law…, said David Vladeck, director of the FTC's Bureau of Consumer Protection…"The uncertainty about the benefits that will be available under the new federal insurance program and the fact that the budget doesn't kick in until 2014 is going to give scammers very fertile ground for this," Vladeck told reporters in a conference call. "They're going to try to capitalize on uncertainty."

…"Health discount plans are not insurance. They don't pay your medical bills," said Minnesota Attorney General Lori Swanson, who has filed three lawsuits. She added that continued job losses are fueling the scams since most Americans who have insurance get it through their employer. The companies targeted by the FTC and states are mostly privately owned. They include Health Care One, Consumer Health Benefits Association, and United States Benefits. So far, 54 lawsuits and other civil enforcement actions have been taken by the FTC and the states, officials said. New York's insurance superintendent, James Wrynn, said some of the discount plans do offer some limited payments for some healthcare expenses such as medical tests or short hospital stays, "but when you find out the extent of the coverage, there is for all intents and purposes, no coverage."

Expect even more fraud in the next few years. Given the state budget deficits most states are facing and ever deepening economic recession/depression, there will be even less resources available to combat it in the future.

As always - let the buyer beware!

Military fails on brain-test follow-ups

2010-06-16T12:07:00.000-04:00

Given our mini-seminar on Traumatic Brain Injury at our AOCOPM Spring Mid-Year meeting, I thought this article in Monday's USA Today might be of interest: Military fails on brain-test follow-ups

Understanding Insurance: Will a Public Option or Co-op Get US Where We Want?

2010-04-29T13:37:00.000-04:00

Today's commentary comes from an article I'd written for the Journal of the American Osteopathic Association and published today. Please click here.

Medicare SGR Update

2010-04-15T20:48:00.000-04:00

The Senate passed HR 4851, the Continuing Expansion Act of 2010, this evening preventing the scheduled Medicare cut until June 1, 2010. The bill was passed in the House before the Spring recess with an effective date through May 1, 2010. The Senate bill is being sent back to the House for approval to reconcile of the dates. It is expected to pass this week.

Opportunity Forfeited by National Physician Groups

2010-04-14T11:18:00.007-04:00

Today, the Senate is expected to vote on HR 4851, the Continuing Expansion Act of 2010. It will maintain Medicare payments on the level prior to the 21.3% cut which occurred April 1, 2010 because Congress has not yet permanently fixed the Medicare Sustainable Growth Rate (SGR) formula. Until now, CMS has been holding claims payments hoping for another Congressional fix; but the agency can only hold claims for 10 business days and must begin payments on April 15. If Congress approves this billl, it will kick the proverbial can down the road for another month, with another fix needed on May 1, 2010.

The question is why would our national physician organizations endorse a supposed comprehensive health reform plan that did not assure that physicians would be able to afford to continue to provide services to their patients? Did they not understand who their members are and that this is not a fiscally feasible business model for physicians? Why would such powerful organizations, with lawyers on staff, give up their leverage in bargaining for a permanent SGR fix for a politician's promise to take care of it at a later date? Did they all fail Negotiations 101?

At first, I too, believed that might have been the case, but that is perhaps too easy an answer. In hearing the coments of some of Democratic politicians (who eventually voted again the bill) regarding the arm twisting that went on behind the scenes, I heard one congressman say they were effectively told how lucky they were to even be invited to the table, otherwise they would have been the main course. Funny, I heard the same words from the leadership of one of our national physician organizations at the end of November. Coincidence?

Physicians representing national physician organizations may have been invited to the photo-ops, but at best, they were only give a crumb or two that fell on the floor with offers to study solutions to the malpractice problem. They were cleasrly not invited to the table to find solutions for healthcare delivery. Were they tricked into believing attendence was participation?

Given the Chicago-style politics in Washington today and the Chicago roots of our largest organizations, were they also strong armed? Did they willingly let the wool be pulled over their eyes? Was it Stockholm syndrome? Or perhaps the did fail Negotiations 101...

As Academia Slept...the Government Took Over

2010-03-31T19:20:00.002-04:00

The dearth of media coverage regarding the federal takeover of the federally funded student loan program (i.e. Sallie Mae) and the elimination of private lending via the Federal Family Education Loan (FFEL) program, is astounding. Americans were caught off-guard, when the political debate seemed to be about healthcare. After the fact, most assumed it was Washington padding the bill to make the healthcare numbers look more favorable.

With the government now the only lender to students, do you believe tuition increases will be permitted to continue unabated? "The National Association of Independent Colleges and Universities (NAICU), says...the average annual increase in tuition and fees has been 6 percent over the last 10 years... Do the math and you'll see that an average annual increase of 6% leads to an 80% rise in tuition costs over just one decade!" [Money and Markets and Federal Reserve Bank of St. Louis]

Our government is already in hoc up to its proverbial eyeballs to foreign debtors and in danger of losing its triple AAA credit rating. Why would it choose to take on more long-term debt, especially with student loan default rates reaching a nine year high of 6.5%? Defaults typically increase in tough economic times; consider the last recession, in 1989, when default rates reached 22%. Given that less foreign creditors are showing up at Treasury Department auctions, and the Federal Reserve is now monetizing the debt (buying unsold Treasuries at auction) - Why would the government choose to become the sole provider of funds for federal loans [Stafford and PLUS] at this time?

With money tight in the public sector and credit tight in the private sector, wouldn't it make better sense to reform the interest subsidy and loan guarantee process to guarantee more loans for less money ( paying only on the unrecoverable amount of the defaulted loans), Rather than tie up money directly laying out the entire sum of the loan? After all, we do not have a sovereign wealth fund with money lying around to invest, as some countries do.

Given that all federal student loans will be subject to and administered by the Department of Education, which is funded at Congress' discretion, and given this Congress' track record for deal making - do you believe that these will continue to be distributed without favoritism to all those in need? As money gets tighter, will some states receive preferential treatment? Will the alma maters of certain politicians receive favoritism? Will certain degree programs receive preference? Where will osteopathic medical schools fall in this mix? Will physicians receive less favorable terms going forward if they are training in specialties or geographic areas which are not deemed shortage areas? What happens when the government decides to apply a Sustainable Growth Rate (SGR) formula to tuitions because there is not enough money to go around?

Given the current trends in Washington to "never let a crisis go to waste" - was this good economics, concern for students or control?

I invite your comments -

The Real Arithmetic of Health Reform

2010-03-23T11:30:00.004-04:00

Below are excerpts from a former director of the CBO who lays out the math in a NYTimes Op-Ed:

THE REAL ARITHMETIC OF HEALTH REFORM

"On Thursday, the Congressional Budget Office reported that the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but it would also lower federal deficits by $138 billion. In other words, a bill that would set up two new entitlement spending programs — health insurance subsidies and long-term health care benefits — would actually improve the nation’s bottom line. Could this really be true? [Not according to Douglas Holtz-Eakin, former director of the Congressional Budget Office (CBO) and president of the American Action Forum.]

How can the budget office give a green light to a bill that commits the federal government to spending nearly $1 trillion more over the next 10 years? The answer, unfortunately, is that the budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out.

In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges:

The health care reform legislation would raise, not lower, federal deficits by $562 billion," says Holtz-Eakin.

"...The bill front-loads revenues and backloads spending...(meaning) the taxes and fees it calls for are set to begin immediately, but its new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending."

"...To operate the new programs over the first 10 years, future Congresses would need to vote for $114 billion in additional annual spending, but this so-called discretionary spending is excluded from the CBO's tabulation."

"...In perhaps the most amazing bit of unrealistic accounting, the legislation proposes to trim $463 billion from Medicare spending and use it to finance insurance subsidies, but Medicare is already bleeding red ink and the health care bill has no reforms that would enable the program to operate more cheaply in the future..."

"The bottom line is that Congress would spend a lot more; steal funds from education, Social Security and long-term care to cover the gap; and promise that future Congresses will make up for it by taxing more and spending less," says Holtz-Eakin.

Excerpted from: Douglas Holtz-Eakin, "The Real Arithmetic of Health Care Reform," New York Times, March 20, 2010.
For full text of article: http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html

House Passes Sentate Health Bill

2010-03-22T23:00:00.025-04:00

Last evening the House passed the Senate's health bill, H.R. 3590, the Patient Protection and Affordable Care Act. Over 38 states are now stating they are in process and will file suit regarding the procedures and processes, as well as substance and constitutionality issues once the bill is signed into law. This law, along with H.R. 4872, the Health Care and Education Affordability Reconciliation Act which follows, will greatly expand Medicaid. Unlike Medicare, Medicaid requires states to chip in a percentage of the costs as well as administer the program. As mentioned in the January 4th posting, 43 states are facing financial deficits. Not every state was fortunate enough to get the nearly $600 million each in supplemental Medicaid deals to which Vermont and Massachusetts were privy, let alone the cornhusker kickback that Nebraska did which covered the state's required Medicaid contributions in perpetuity. (This provision for Nebraska will supposedly be eliminated in the yet to be passed by the Senate reconciliation bill.)

Last Thursday, Arizona's new budget signed by the governor dropped coverage for childless adults and the child health insurance program (CHIP) instate, leaving 357,000 Arizonans without coverage. The governor stated the "budget is a vivid reflection of how the fiscal crisis affecting state governments is cutting deeply into healthcare."

Politicians may choose to ignore the will of the people and pass legislation, but ultimately someone must pay for it. Given the present economic crisis, tax revenues are falling for both state and federal governments. It seems Washington has forgotten the fiscal realities of those outside of the Beltway. If the checks and balances built into our Constitution do not cause this legislation to be rethought, the financial realities will.

CBO Report Released Today on Cost of ObamaCare is Incomplete

2010-03-18T16:00:00.000-04:00

The CBO Report is out on ObamaCare [H.R. 4872, the Reconciliation Act of 2010 combined with H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as passed by the Senate], stating that it will cost $940 billion over 10 years. Whether this forecast is realistic is for another day’s discussion. Never mind that it uses 10 years of premiums to pay for 6 years of claims.

What is not included is “the doctor fix” for Medicare, which is estimated to be $247 billion. This means that the present health bill is NOT budget neutral, but ADDS to the deficit.

Last evening on Special Report, Bret Baier interviewed the President [transcript]:

“BAIER: And you call this deficit neutral, but you also set aside the doctor fix, more than $200 billion. People look at this and say, how can it be deficit neutral?

OBAMA: But the — as you well know, the doctors problem, as you mentioned, the "doctors fix," is one that has been there for years now. That wasn't of our making, and that has nothing to do with my health care bill. If I was not proposing a health care bill, right — let's assume that I had never proposed health care.

BAIER: But you wanted to change Washington, Mr. President. And now you're doing it the same way.

OBAMA: Bret, let me finish my — my answers here. Now, if suddenly, you've got, over the last decade, a problem that's been built up. And the suggestion is somehow that, because that's not fixed within this bill, that that's a reason to vote against the bill, that doesn't make any sense. That's a problem that I inherited. That was a problem that should have been solved a long time ago. It's a problem that needs to be solved, but it's not created by my bill. And I don't think you would dispute that.”

This bill was to be a comprehensive bill. We were told it could not be done piecemeal. We had to have one bill. Suddenly, paying doctors for their services is somehow irrelevant to providing care for our elderly citizens.

Ignoring the facts, failing address the real access to care issues and failing to add up ALL the costs of in one bill because it isn’t convenient seems more than a little disingenuous, doesn’t it?

Pandemic Influenza: Guidance from the CDC for Primary Care Offices

2010-02-14T17:11:00.000-05:00

The CDC published this helpful planning tool this past week, outlining things you may wish to consider in your office's operational planning. See the hotlink below:

Abbreviated Pandemic Influenza Plan: Template for Primary Care Provider Offices

Haitian Earthquake Relief

2010-01-15T11:08:00.008-05:00

The U.S. government, USAID, and the Departments of State and Defense are working closely together to take appropriate action. Due to the extensive damage, the country is unable to accommodate all the volunteers interested in helping at this time. The U.S. government has asked that all people and agencies interested in responding to the disaster wait until some on-the-ground organization can be accomplished.

However, for those interested in helping immediately, you can donate to the international fund of the Red Cross. Contribute online to the Red Cross, or donate $10 to be charged to your cell phone bill by texting HAITI to 90999. CNN has put together a list of organizaitons already operating in country. Since this list is not comprehensive, I would add two additional organizations already there - Operation Blessing and the UN High Commissioner for Refugees; I have personally worked with these groups - they are good people doing exceptionally good work.

While monetary donations are preferred, commodity contributions and volunteer support can also be of value. If you would like to volunteer your medical skills as a physician, you can register your skills and experience at the Center for International Disaster Information's registration page. "Volunteer Opportunities for Disaster Relief are Extremely Limited. Volunteers without prior disaster relief experience are generally not selected for relief assignments. Candidates with the greatest chance of being selected have fluency in the language of the disaster-stricken area, prior disaster relief experience, and expertise in technical fields such as medicine, communications logistics, water/sanitation engineering. In many cases, these professionals are already available in-country. Most agencies will require at least ten years of experience, as well as several years of experience working overseas. It is not unusual to request that volunteers make a commitment to spend at least three months working on a particular disaster. Most offers of another body to drive trucks, set up tents, and feed children are not accepted. Keep in mind that once a relief agency accepts a volunteer, they are responsible for the volunteer's well-being - i.e., food, shelter, health and security. Resources are strained during a disaster, and another person without the necessary technical skills and experience can often be a considerable burden to an ongoing relief effort."

The CIDI website gives these guidelines for those who wish to help:

"Monetary Contributions to Established Relief Agencies are Always the Most Useful Response to Disasters

Financial contributions allow professional relief organizations to purchase exactly what is most urgently needed by disaster victims and to pay for the transportation necessary to distribute those supplies. Unlike in-kind donations, cash donations entail no transportation cost. In addition, cash donations allow relief supplies to be purchased at locations as near to the disaster site as possible. Supplies, particularly food, can almost always be purchased locally - even in famine situations. This approach has the triple advantage of stimulating local economies (providing employment, generating cash flow), ensuring that supplies arrive as quickly as possible and reducing transport and storage costs. Cash contributions to established legitimate relief agencies are always considerably more beneficial than the donation of commodities.

Confirm There is a Need for All Items Being Collected

Do not make assumptions about the needs of disaster victims. Exactly what is needed can be confirmed by checking with an established relief organization that has personnel working on-site. Do not send what is not needed; unneeded commodities compete with priority relief items for transportation and storage. Organizations that receive in-kind relief donations can help this process by clearly communicating what items are required (in what size, type, etc.) as well as clearly stating what items or services are NOT needed. Please remember, certain foods, particularly in famine situations, can make victims ill. In most cases, donations of canned goods are not appropriate. The collection of bottled water is highly inefficient. It is important to have an accurate analysis of need before determining response.

Deliver Items Only to Organizations having Local Distribution Capacity

Distributing relief supplies requires personnel and financial resources within the affected country. To efficiently distribute relief commodities, staff, warehouses, trucks and communications equipment are required. It is not enough to gather supplies and send them to an affected region; a sound partnership with a reliable local agency having transport and management capacity is mandatory.

Donate Only to Organizations having the Ability to Transport Collected Items to the Affected Region

Immediately after a disaster, many local organizations will spontaneously begin collecting miscellaneous items for use in disaster relief. However, at the time that these collections are begun, agency officials will not have thought about to whom, or how, the items will be sent. It is not unusual for community and civic groups to have collected several thousands of pounds of relief supplies only to find that they do not know whom to send the supplies to and that they do not have viable transportation options for shipping the goods. At this juncture, it is often advisable for those collecting the goods to auction them off locally, converting commodities into cash to be applied to the relief effort.

Never Assume the U.S. Government or any Relief Agency Will Transport Unsolicited Relief Items Free of Charge

It is important to make arrangements for the transportation before collecting any kind of material donations. Never assume that the government or any relief agency will transport donations free of charge (or even for a fee). In the majority of cases, the collecting agency will be responsible for paying commercial rates for the transportation and warehousing of items gathered."

{Heavily adapted from AOA email concerning the Haitian situation.}

States AGs revolt as House and Senate Bills expand Medicaid

2010-01-04T11:00:00.007-05:00

Expect more states to join the 13 AGs who threatened to sue if either health bill is enacted by Congress claiming certain Senators and Representatives were given sweetheart deals to get them passed.

Forty-three states are facing financial deficits given the down turn in the economy. According to a CNN report December 10, "As states attempt to get their budgets in line for the new fiscal year, ...budget constraints are causing 25 states to reduce services to their residences. So far 17 states have already made cuts or are considering cuts to programs that affect low-income children's and family's access to health insurance and health care services." In the last House vote of 2009, it passed the "Jobs for Main Street Act" by a 217-212 vote along party lines, which provided states with some funding mostly for current operations, including $53 Billion for extending benefits/health insurance subsidies for the unemployed and $23 Billion for Medicaid.

Given that Medicaid is a program jointly funded by federal and state governments and administered by the states, it is easy to see why states are financially unable to expand benefits programs. It seems Congress is out of touch with the reality of the severity of the economic crisis and continuing politics as usual, in these are anything but usual times. Unlike the federal government states cannot just print money. Despite claims to the contrary by our politicians, neither bill seriously does anything to bend the proverbial cost curve downward. However, as mentioned before in this blog, both do an extensive amount of cost-shifting.

No one wants to see anyone without healthcare, but it's time we take the politics and politicians out of it. The reason why became clear in talking with a friend who is an Indiana State Representative. He said, "So much of what we do with regard to legistlation is in response to some horrific hardship case we hear about. We feel compelled to right a wrong, and so we pass legistlation. But we don't take the time to look circumspectly at the issue to understand the potential unintended
consequences of what we pass."

It seems Congress is using the same rationale my friend described. Poorly, reasoned laws are worse than none at all. Let's be financially responsible and fair to all our citizens. Perhaps the States can succeed in getting Congress to appreciate we need to be writing good bills rather than paying people off to pass any bill.

A Very Happy, Healthy & Blessed New Year to Everyone!

2010-01-01T11:30:00.002-05:00

Social Safety Nets with Growing Holes

2010-01-01T10:35:00.002-05:00

After much hoopla, Congress finally began its Christmas vacation last week.

House or Senate plan, public or private, it really doesn't matter - what the politicians seem to have forgotten is that any plan must be underwritten correctly and with the appropriate safeguards or it won't be solvent. For some reason, beneficiaries tend to get upset there is no money to pay claims.

The CBO takes a snapshot in time approach to financial analysis. This static accounting approach does not account for the way human beings react in the real world, a fact they readily admit with multiple disclaimer footnotes in all their reports. Rather, what is needed is an underwriting analysis of the proposals. Underwriters try to predict the future given past behavior, human nature, changing market conditions and nature of the risk pool. The fact that accountants rather than underwriters are determining the feasibility of our social welfare programs may explain why Medicare, Medicaid and Social Security are projected to have a combined deficit of well over $100 Trillion into the future.

Underwriting isn't sexy enough for the politicians, which is no doubt why they ignore it entirely. Underwriting is risk assessment, and sometimes risk management; the very words convey dullness and boredom. No, it's much more exciting for Democrats to accuse Republicans of wanting you to die, and die quickly, and for Republicans to say that Democrats want to kill Granny. But where does this leave the American people? Don't we deserve better?

A Very Merry Christmas to You & Your Family!

2009-12-25T07:22:00.001-05:00

Senator Reid makes the Doctors Pay for Medicare under Senate Bill 3590

2009-12-24T07:13:00.001-05:00

The politicians are claiming that Senator Reid's bill will save the country money according to the latest CBO report. Physicians were scheduled to have a 21% pay cut caring for Medicare patients as of January 1, 2010. However, under Section 3101, this bill provides for .5% increase for physicians in 2010 but assumes no further increases or change to the Medicare Sustainable Growth Rate formula which is used to compute physician payment rates. It is known to be a flawed formula requiring an act of Congress to "fix" each year. Politicians have always provided some nominal increase in physician payments, even if it has not kept pace with inflation. According to the Alliance of Specialty Medicine, "If the SGR formula is not fixed, physicians will receive negative updates of approximately five percent each year from 2006 until 2013 and rates will not return to their 2002 level until well after 2013. In other words, physicians will receive less reimbursement in 2013 than they did in 2002 for the exact same procedure, regardless of inflation and increases in practice costs." This unrealistically assumes doctors will bear the cost burden for the Medicare population. More likely physicians will have to stop Medicare participation (stop caring for Medicare patients) under these conditions. It seems disingenuous to claim "savings," when not all the costs have been realistically accounted for in this bill. This bill will surely go over the CBO estimates if real world historical political behavior of annual "fixes" are assumed as opposed to the static assumptions of the CBO.