HSS has proposed moving back the change the ICD-10 system of medical coding for another year. It is a step in the right direction. Keep pushing the deadline back to never. Despite any advantages to the system over ICD-9, conversion will be extremely expensive–a waste of money when we are trying to find ways to reduce expenses.
Liberal Values Defending Liberty and Enlightened Thought
Blog Stuff
PolitiFact Has Problems Understanding Medicare
December 20, 2011 — Ron ChusidFor the past three years, PolitiFact has chosen health care statements as their lie of the year. Last year they chose the Republican lie that health care reform is a government takeover of health care. In 2009 the lie of the year was Sarah Palin’s claim about death panels. Perhaps they felt compelled to show that they are not biased towards either party by choosing a Democratic argument this year. The problem, as I discussed previously, is that the argument that the Republican-passed Medicare plan would destroy the Medicare program is actually true.
PolitiFact is nitpicking based upon the misleading fact that the GOP plan would replace the current Medicare program with something completely different. They point out:
With a few small tweaks to their attack lines, Democrats could have been factually correct, said Norman Ornstein, a resident scholar at the American Enterprise Institute, a conservative think tank. “I actually think there is no need to cut out the qualifiers and exaggerate,” he said.
Maybe it would be preferable if Democrats said the Republicans voted to destroy Medicare as we know it, or destroy the current Medicare program, for people under age 55. Leaving out such qualifiers hardly turns an accurate criticism into a lie. Steve Benen has a good analogy to explain this:
This is simply indefensible. Claims that are factually true shouldn’t be eligible for a Lie of the Year designation.
It’s unnerving that we have to explain this again, but since PolitiFact appears to be struggling with the relevant details, let’s set the record straight.
Medicare is a single-payer health care system offering guaranteed benefits to seniors. The House Republican budget plan intended to privatize the existing system and replace it with something very different — a voucher scheme. It would still be called “Medicare,” but it wouldn’t be Medicare.
It seems foolish to have to parse the meaning of the word “end,” but if there’s a program, and it’s replaced with a different program, proponents brought an end to the original program. That’s what the verb means.
I’ve been trying to think of the best analogy for this. How about this one: imagine someone owns a Ferrari. It’s expensive and drives beautifully, and the owner desperately wants to keep his car intact. Now imagine I took the car away, removed the metallic badge off the trunk that says “Ferrari,” I stuck it on a golf cart, and I handed the owner the keys.
“Where’s my Ferrari?” the owner would ask.
“It’s right here,” I’d respond. “This has four wheels, a steering wheel, and pedals, and it says ‘Ferrari’ right there on the back.”
By PolitiFact’s reasoning, I haven’t actually replaced the car — and if you disagree, you’re a pants-on-fire liar.
Part of the problem is that the fact checkers are journalists who attempt to determine the truth but cannot be experts on all matters. Health care law is complicated, and I have found similar lack of understanding on their part in the past (as in the discussion to this post). If PolitiFact had reviewed this and provided further background information they could have provided a useful service. Calling this a lie is simply a false interpretation.
PolitiFact claims that, “They ignored the fact that the Ryan plan would not affect people currently in Medicare — or even the people 55 to 65 who would join the program in the next 10 years.” First of all, destroying Medicare in ten years is still destroying Medicare. Secondly, while some may have ignored this fact, I have discussed this issue in the past (and I doubt I’m the only one). It is probable that those 55 and older will see changes if the plan were to pass as those under 55 are not likely to support continued funding for the Medicare program if they are never able to benefit from it. People over 55 have good reason to oppose the GOP proposal to maintain political support for funding the real Medicare program.
Their other objections are equally inane, such as arguing,
They used harsh terms such as “end” and “kill” when the program would still exist, although in a privatized system.
Eliminating a government-run single-payer system and replacing it with a privatized system with benefits which are not comparable to what seniors now receive is most certainly ending, and even killing, the current program regardless of whether the new program has the same name. In their discussion they even acknowledged that “seniors would have to pay more to get the benefits they receive today, according to an analysis completed earlier this year by the nonpartisan Congressional Budget Office (CBO).” Once again, a plan which is structured in a totally different manner and which provides lower benefits is not the same program as we have today.
Herman Cain Appears To Mistakenly Believe Medicare Is A State-Run Program
November 9, 2011 — Ron ChusidTime after time when hearing Republican proposals to fix problems I find reason to question whether the Republican has any knowledge of that program or issue under discussion.This was the case again during Herman Cain’s health policy speech last week when it sure looked like Cain does not realize that Medicare is a federal as opposed to a state-run program. (An alternative, and less likely, interpretation is that he thinks Medicare should be transferred to the states). Here is a partial transcript:
The way that I am going to help all of us convince the American public that we’ve got to restructure Medicare and not just change the benefits and retirement age is to paint a real clear picture of the disaster path that we’re on. That’s #1.
Secondly, back to one of my guiding principles, talk to the states, talk to the doctors and find out what can we do first to reduce the Medicare bureaucracy that’s imposed on doctors and health care providers and hospitals. I believe, based upon listening to doctors, that there’s a lot that can be done.
Much of the over-regulatory burden that’s imposed by Medicare is driven by the fact that the bureaucrats don’t trust states and hospitals. I do. I would rather error on the side of trusting the states and maybe five of them won’t get it right, but that the other 45 are going to get it right and we all will benefit.
The standard Republican line of reducing regulation has some truth to it, but it is also simplistic–especially as Republicans overestimate the regulatory cost of Democratic regulations as opposed to the comparable cost of Republican-passed regulations. Simplifying regulations would be helpful and save some money, but this would be trivial compared to the overall problems in health care. These savings would not make up for the increased costs due to an aging population and new, more expensive medical technology. Solving all problems in Medicare would not resolve the even more serious problem in the private insurance market, which Republicans refuse to address. Of course to even begin offering solutions, Cain needs to understand the basics of how Medicare is run–such as that it is a federal and not a state program.
American Medical Practices Have Substantial Costs Dealing With Insurance Companies Compared To Canadian Practices
October 28, 2011 — Ron ChusidA report in Health Affairs shows how the high cost of dealing with American insurance companies and other third party payers greatly increases the overhead costs of American physicians compared to doctors in Ontario. Following is the abstract:
Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently.
Conservatives often use the cost of malpractice insurance to explain the higher health care costs in this country, but the cost of malpractice insurance is t rival compared to the cost of health care billing. Comparisons of physician reimbursement in this country to that in other countries must need to take into the account the need for American physicians to have at least one full time employee, and often more to handle tasks such as obtaining HMO authorizations. In an American medical practice the biller is often the highest paid employee, greatly adding to overhead costs. While large practices might gain from economies of scale, they also have a larger number of insurance claims to deal with which requires multiple employees. The addition of drug coverage for Medicare patients which is provided by multiple companies with different formularies also adds tremendously to office overhead due to time spent obtaining authorization for prescriptions.
AMA Report Shows Continued Lack Of Competition In Insurance Market
October 28, 2011 — Ron ChusidA report released by the American Medical Association shows, as also has been demonstrated in the past, that there is a lack of competition in health insurance in four out of five markets. The report “is intended to help regulators, lawmakers, researchers and policymakers identify markets where mergers among health insurers may cause competitive harm to patients, physicians and employers.” Among their findings:
- A significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the AMA. These markets rated “highly concentrated,” based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission*.
- In about half of metropolitan markets, at least one health insurer had a commercial market share of 50 percent or more.
- In 24 of the 48 states reported in the new AMA study, the two largest health insurers had a combined commercial market share of 70 percent or more.
- The 10 states with the least competitive commercial health insurance markets, are: 1. Alabama, 2. Alaska, 3. Delaware, 4. Michigan, 5. Hawaii, 6. District of Columbia, 7. Nebraska, 8. North Carolina, 9. Indiana and 10. Maine.
Administrative Costs For US Doctors Four Times Higher Than In Canada
August 4, 2011 — Ron ChusidConservatives frequently blame costs associated with malpractice (including defensive medicine) for the growing cost of medical care in this country. While these are real costs which should have been addressed in the Affordable Care Act, there are two other costs to physicians which impact practice the cost of providing medical care more than the cost of malpractice insurance. One is costs due to unreimbursed services involving patients without health care insurance. This problem should become minimal once we approach universal coverage but another problem will persist–the cost of dealing with multiple payers.
Health Affairs compared the overhead of physicians in the United States with those in Ontario where there is a single-payer system:
We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year.
This cost added cost for dealing with multiple payers is over six times the cost of my malpractice premiums. While we should take advantages of saving money from malpractice reform, there are other changes in our health care system which could save far more. Higher expenses such as these administrative costs also show why trying to cut reimbursement for medical care to that of other countries is not possible.
