What your health bills will be under Medicare

Here is a page from the Medicare.gov Website that tells you what the various programs pay for, and how much they cost in premiums.  I liked it because it is succinct and easy to understand.

Quick access to ratings of nursing home quality

Over the years I've had plenty opportunities to observe nursing homes in action, not only for my parents' generation, but also for my own post-surgical rehab.  And, recently I've spent a good amount of time visiting an older friend who spent a lot of time in several nursing facilities in the Maryland suburbs.  This nursing home rating tool, made available through ProPublica, is an excellent summary source of information, and the information you can get by clicking on an individual home's profile dovetails with my own impressions of the various places I've recently seen.
So, I'm entering this post into my "citizen portals" label, recognizing that I (and you) may have plenty of reason to research information on potential nursing homes.  If a friend asks for advice, all you have to do is remember my blog's name:  www.theviewfrombethesda.blogspot.com  and they will be able to get to this applicaiton.

SCOTUS OPINION on Obamacare- Read it here!

Here is the C-span link to the Supreme Court opinion on the ACA.
Who would have thought that logic (i.e., a mandate that is enforced as a tax is a tax! and Medicaid is a voluntary program, that States can opt out of in pieces) would prevail?

Is this another switch in time that saved nine?  Or the opposite?  Only time will tell.  My relief tells me exactly where my own opinions lie.

What's the best outcome of SCOTUS on Obamacare?

Here we are, on the possible eve of the supreme court's decision on the constitutionality of the Affordable Care Act (ACA).  I've been grappling with what I want to see as the outcome, from the standpoint of what's good for the health care system, what's good for Obama's reelection, for the Democrats in Congress, and finally, for the crowd of  people who deeply believe that a single-payer health care system (a la Medicare) is best for the entire country.  To clarify, when I think about what's good for the health care system, I have in mind the ultimate effects on cost, quality and equality of access...those three competing objectives of public policies governing the delivery of health care.
What's good for Obama's re-election?  I believe the best thing for Obama politically speaking  is to have the whole bill nullified (except for the Medicare provisions, which nobody is talking about anyway).  That would wipe out the state-level exchanges, the insurance mandate (of course), and all the Medicaid provisions that expand access to Medicaid to all individuals and families with incomes less than 133% of the Federal poverty line (about $14K for individuals;  and $31K for a family of four).  I can't imagine how striking down the insurance mandate could leave in tact the ban on insurers discriminating on the basis of pre-existing conditions, or even the requirement to cover the under-26 crowd (even though some major insurers say they will keep that one.)
I think it would be good for voters to go back to square zero on health care.  It would take the fire out of the conservatives' righteously(?) indignant bellies over the mandate, while leaving the rest of the country to mull the alternatives.
What's good for the Democrats in Congress?  Re-election wise, see above.  Ideologically wise?  What ideology?  Dollars (theirs)  is what matters to them.
What's good for the Single-payer ideologues?  This is a no-brainer.  The mandate goes, the Medicaid provisions stay.  Most Americans do not realize that the Medicaid provisions, in addition to expanding eligibility, require Medicaid to pay for physician services at Medicare rates..  We hear a lot about how Medicare fees are low compared with private rates, but Medicaid fees are 30% lower than that!  And, to top it all off, the Federal government will pick up the entire tab for the health care costs of the new eligibles.  (Yes, yes, that's for 2 years, after which the Federal % drops to 90% and the Medicaid fee schedule rule drops, but who believes that the doctors won't have the clout to extend the fee schedule, just as they have managed to keep fees from plunging under Medicare's law by one-year extensions?)
Bottom line:  an extension of the Medicare-like single-payer system to a greater part of the population, and a gradual acclimation of the public to the idea that universal coverage can only come from a single-payer system.
What's good for the Health Care System?   At this point, I am rooting for a complete nullification, though  I am aware it's a long-shot.  That's because I don't believe in a single-payer system. So, what I mean is that if the mandate is going to be shot down, then I hope they shoot down Medicaid, too. That way, in having to start from scratch, perhaps Congress will put all the people into exchanges, which will treat the lower-income folks with the same respect they treat others. And, instead of  "exchanges," it should be "exchange."   I believe in a regulated market place (much like the Federal Employees Health care system) that offers competing plans meeting minimum coverage requirements.  The exchanges sounded like a good idea, but they are implemented at the state level, which doesn't allow much ability to pool risks, especially in smaller states.  (The state-level exchanges came from the Senate and its nefarious (Demorcatic) leadership, while the (Democratic) House bill had a national exchange system that would have guaranteed a large pool of enrollees.)
At this point, it would be worthwhile to go back to ground zero and let the nefarious Republican leadership deal with the consequences of its political intransigence and the public with another failure of our country to make access to health insurance (and therefore decent access to health care) a right.
What do you think?

A Great Guide to the Supreme Court's Upcoming Review of the Health Reform Law

The Supreme Court seems to be taking this seriously, admitting (???) that they need help in understanding the issues by scheduling 6 hours of argument (compared with usual 1 hour).  A great article in the New England Journal of Medicine, available without a subscription, lays out the issues and the timeline.  It's written for doctors, so it's actually readable for us all, since so many docs don't seem to understand anything about insurance markets and cost control (my editorial comment, of course).  Update as of Mar 15, another article in NEJM.  Clearly, the profession cares about this

Gingrich says CBO must go.

Why I'm taking Gingrich seriously, knowing what I know about him from my CBO days, is a mystery to me. I guess it's just that I worry about who the Prez might be if not Obama.  So, here he is at his most Gingrich, espousing the death of CBO BECAUSE OF ITS HEALTH WORK!  Neat!  Thanks to the CBO alumni group for alerting me to this.  Link to Stan Collander's article is here: http://capitalgainsandgames.com/blog/stan-collender/2416/newt-gingrich-wants-kill-cbo

Everything you ever wanted to know about molds on foods

Here is a CDC summary of the dangers of eating moldy foods -- even a little pinprick's worth. 
And who said our taxpayer dollars don't produce anything useful?

A vivid example of the dangers of Fracking

Is there any such thing as "adequate" regulation of an environmental hazard?  My friend with an insider's knowledge of FDA says no, and she peppers me with stories about how politics have made the job of reviewers difficult.  (Her experience dates back to the Bush years, so I calm myself by thinking that all of this has changed since the new leadership at the FDA has arrived.  (Some of those higher ups are holdovers, however, so why should I think they've changed their spots?) 
Well... this post is about hydraulic fracking, the environmental issue du jour for Pennsylvania, New York and Maryland.  Here is an article about some of the health problems that westerners in the path of fracking have experienced, brought to you by ProPublica, that innovative on-line source of investigative journalism.
Of course, I sit here with my new hip, wondering whether it's one of those metal-on-metal things that are failing at a rate of about 29% so far (based on British data...we Americans don't have registries, being ostriches as we are).  So, maybe FDA is more important than the future of the planet. 

Another great Health Reform Timeline online

From Kaiser Family Foundation...this one is a year-by-year breakdown of each provision, some more important than others.  See KFF Timeline.

Federal Employees Health Plan 2011 Premiums

The US Gov't OPM announced the new rates for 2011 for the FEHB plans. Here is the chart showing 2011 premiums for national plans. For HMOs and other plans available in your area, click on FEHB site page.

For those of you who hate federal workers, you can see what the premium subsidy is for federal employees and retirees. Before you explode and bloviate, however, remember that salary + benefits = total compensation, and in general total federal compensation is not out of line with the private sector. In my view, federal employees are generally more risk averse than private sector workers, or more dedicated to public service, or lucky to have found a safe federal job and aware they couldn't command the same salary in a more competitive system. (Or some combination thereof.) We're no angels, but we aren't total ripoff artists, either.

Great summary of the Health Reform Act

The Kaiser Family Foundation has published a very readable Summary of the Health Reform Act in plain English, except for pesky abbreviations such as FPL (=federal poverty level). Some, possibly critical, details have been left out. For example, if you are going to be eligible for Medicaid, due to low income on your IRS tax form, will the State be able to place you in their managed care program, or will you have to go fee-for-service Medicaid? This is important, because at present most doctors don't accept Medicaid and you'll have trouble finding a provider. Little unimportant details like that.
Otherwise, it's a great place to start.

Why Vitamin D recommendations are so low.

Here's a great article in the Financial Times about the politics of Vitamin D recommendations. With this issue, there are no bad guys, only policy makers and scientists with different mind-sets about what constitutes good evidence.

State-level hospital infection rate comparison available

Not every state requires hospitals to report their rate of infections, but of those that do, I would choose to live in Washington State or Vermont, and not Maryland! Check the CDC report: First State-Specific Healthcare-Associated Infections Report (scroll down to page 10).

Schedule for changes in the Medicare Part D benefit

If you want to know how your (or your loved-one's) Medicare Part D benefit will change over the next 10 years as a result of the health reform legislation, see this excellent and short summary from KFF: Key Changes to the Medicare Part D Coverage Gap. What the summary sheet doesn't tell you is what the changes mean for Part D premiums and government spending ... (up up up, of course). Still, if the benefit is out there for everyone else, we'd be stupid not to take our share, right?

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.

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.

"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..."

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.

Wellness Discounts in Health Reform a real problem

Having already admitted that I cannot read the 4000+ total pages of legislative language in the two final bills (House and Senate) without giving up all other aspects of my life, I'm depending on secondary sources to uncover aspects of one or the other bill that are problematical. Here is what Kaiser Family Foundation says about one provision that sounds discriminatory against those with "lifestyle" issues. This affects people with employer based health insurance. Read KFF News on Wellness Program.

A good link to comparison of House & Senate Health Reform bills

Here's a good Q&A analysis of differences between the House and Senate bills as passed. Easy To read, from Kaiser Family Foundation.