Mar 26, 2010

Health Care Reform Timetable

Here's a good summary, from the Kaiser Family Foundation, of what will happen when, as health care reform ramps up over the next few years. See Health Care Reform Timetable.

Mar 20, 2010

Hypocritical congress manipulates CBO esimtates.

An old theory states that regulated industries ultimately "capture" the relgulators and are able to mold the rules to their own advantage. Too bad the theory always seems to work in practice. Now we're seeing it in the manipulation of the CBO scoring process by the "regulated" Congress. Keith Hennessey posted an example of how the House has crafted a Medicaid provision in the reconciliation bill that requires states to pay doctors the same as Medicare pays them, and HAVE THE FEDERAL GOVERNMENT PICK UP THE TAB, without being charged with a $52 billion ten-year cost that CBO estimated for that provision in the original House Bill. The reconciliation bill limits the years in which those increased fees would apply to only two --- 2013 and 2014 -- which brings the cost down to only $8 billion over ten years.

Of course, everyone knows that once those increases go into effect, Congress will never let the fees go back to the old rules. Look what's happened to the physician fee reductions passed in 1997 for Medicare. Each year Congress passes an over-ride, and the reductions are "delayed" for another year. That's what will happen here. So, the health reform bill will effectively federalize Medicaid and add it to the Medicare fee-for-service system (the system that "works so well"). State leaders will love it. Less payout for Medicaid. Doctors will like it, and more of them will participate in Medicaid, which is good for poor people, and by extension the rest of us. Let's face it, though...our deficit hole will just grow and grow and grow.

CBO has no choice but to score the bill this way. It has to assume the law will operate as it says in the bill it's scoring at the time, not as it will play out in reality. This manipulation of legislative language by Congress has improved over time, so at this point the "CBO score" is largely a political football, with the majority using it to hide major new cost-raising changes.

This is just one of dozens of little "surprises" lurking in the bill -- which I admit I still have not read in full and probably never will. What I'm learning is from newspapers and internet. Keith Hennessey's blog is a jewel . I may not agree with him on priorities, but he's an excellent analyst of policy and politics. And he's not lazy. He actually read the reconcilation bill.

Mar 17, 2010

"But, Medicare works so well for me..."

That quote comes from one of my most devoted readers, whose name will go unmentioned. In my never-ending effort to convince him/her that it only works well until it doesn't work, for example, when one cannot find an endocrinologist who will accept a new Medicare patient, I am attaching an interesting article about a new trend among cardiologists -- charging an annual access fee to Medicare patients. This appears to be legal if carefully crafted, and I for one applaud it, provided that I will be able to afford it when my own internist decides it's time to do that same. My doc is worth it, because he does old-style actual communicating-type medicine, and I'd gladly pay extra for those phone calls and email access, etc. But, please, not too much extra $$, buddy, okay? Here's the article from the KFF Website, "As Medicare Pay Shrinks, Some Doctors..."

Mar 13, 2010

Vitamin D prevents Influenza A in Children-randomized trial results

The results of a double blind randomized trial, just published in the American Journal of Clinical Nutrition, is the first definitive evidence that vitamin D3 supplementation actually reduces the incidence of influenza A viruses in children. (H1N1 is influenza A, as is H5N1.) Especially so in kids with asthma.
Check out the abstract in the AJCN website, "Vitamin D".

Mar 10, 2010

What the Senate health reform bill would do for women...but not for men

It's been a long time since I've posted on anything, especially on health reform, because I've been so conflicted. I want to see universal health coverage, and I want to see a regulated health exchange. To me, the Republicans' proposals are insipid because they ignore the realities of the individual insurance market. In short, insurance companies can't offer insurance to all with community rating in the individual and small business markets so long as health insurance is not mandatory, or at least difficult to escape without penalty. So, I want to see reform, and I care about it a lot for my family and friends.
But, those Democrats! Here's a perfect example of the problem. My own Senator Mikulski, ultra-liberal from Maryland, introduced with much emotion (and a speech laden with either stupid inaccuracies or outright lies -- I think the former) a bill that would cover annual preventive visits to doctors for all women for free. Here is Mikulski's own summary of her amendment. The Amendment passed with 61 votes and is part of the final Senate bill.
CBO estimated that it would add about a billion to costs over 10 years. But that's the cost of only about 5 years of actual coverage, since the law wouldn't go into effect until 4 years down the line.
What galls me is the over-reach of the liberals in both the Senate and House, not to mention the recent White House sweeteners, to mandate a rich set of benefits, when what people really need is to be covered when they are sick and scared.
What also galls me in particular about Mikulski is her discrimination against men. And I'm not even one.
I don't trust the Republicans when they say that they want to "just start over", but I can't trust the Democrats not to lard up a bill with new spending.
Bottom line: I hope it passes. Then I hope that the bill will be amended to take out all the stupid stuff, and add to taxes to pay for it. These hopes are also stupid, I know. That's why I haven't been blogging recently.