Healthcare update

Wait! Paul Ryan has a point

Put this numbers game aside, however, and you still have the multitrillion-dollar point: In any other wealthy nation, a Ryan-sized voucher would more than suffice to ensure high-quality health care for seniors. In Singapore, it would be seen as offering an outrageous bonanza for the Medical Industrial Complex.
If you’re with me so far, the Democratic case on Medicare (as well as the GOP’s case last election) is therefore caught between two claims that can’t both be true: (1) we spend much more on health care than anybody else without better results; and (2) if we cut the growth of this spending to below the rate of GDP growth, we’d have to curtail Americans’ access and quality of care. No matter how often and how loud the interest groups, politicians and other forces of the status quo scream the latter, it cannot be true if the former is a fact.
And America’s health-care inefficiency is, in fact, a fact.
Ryan’s plan is thus a roundabout way of bringing us to the question of how we can best wring out the excess in American health care. The politics of any such effort are perilous not only because seniors are easily scared, but because every dollar of health care “waste” is somebody’s dollar of income.

Don’t Scorn Paul Ryan

Patients not taking medications cost $300B

The GOP 2012 Hopefuls Who Supported a Health Care Mandate

Why Medical School Should Be Free

Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.
Fixing our health care system will be impossible without a larger pool of competent primary care doctors who can make sure specialists work together in the treatment of their patients — not in isolation, as they often do today — and keep track of patients as they move among settings like private residences, hospitals and nursing homes. Moreover, our population is growing and aging; the American Academy of Family Physicians has estimated a shortfall of 40,000 primary care doctors by 2020. Given the years it takes to train a doctor, we need to start now.
Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care. It would also attract college graduates who are discouraged from going to medical school by the costly tuition.
We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.

Hospitals hunt substitutes as drug shortages rise

Can managed care help save Medicaid?

This week, California will begin to place all of its elderly and disabled Medicaid patients — the costliest, most illness-prone beneficiaries — into managed care programs under a waiver it received from the Obama administration in October. Although these long-term care patients make up only about a quarter of Medicaid patients nationwide, they’re responsible for two-thirds of the program’s expenditures. Certainly, the projected cost-savings of California’s plan are ambitious: The state budget calls for 10 percent savings through managed care over traditional fee-for-service, giving insurers a fixed lump sum for each Medicaid rather than directly paying doctors and other providers for individual services. Managed care proponents argue that these systemic changes — which include better care coordination, closer assessment of which services are necessary, and incentives for doctors to choose more cost-effective treatments — will save states money without sacrificing the quality of care.
Similarly desperate to rein in Medicaid costs, states including Tennessee, Rhode Island, Kentucky, New Jersey and Florida have also pushed to expand managed care to cut Medicaid costs. In recent months, for example, a handful of states have followed California’s lead by placing elderly and disabled Medicaid enrollees — known as “Seniors and People with Disabilities,” or SPDs — into mandatory managed care. In some respects, the move is simply the next step of the managed care expansion that began in the 1990s and has grown steadily since then. Over 70 percent of Medicaid beneficiaries nationwide are in some version of managed care, and the current fiscal crunch has accelerated its expansion.
But the California example is also telling of the concerns and questions surrounding the growth of managed care for Medicaid patients. In 2005, then-Gov. Arnold Schwarzenegger similarly proposed to make managed care mandatory for SPDs — a bill that was ultimately scuttled due to concerns that would compromise good patient care. Although some managed care companies have now spent decades covering Medicaid patients, they’ve mostly covered the program’s youngest and healthiest patients and have comparatively little experience overseeing elderly and disabled patients who require long-term care and have far greater medical demands.
The worry among consumer advocates is that HMOs and other managed care companies will end up cutting corners at the expense of a particularly vulnerable population. “The details matter a lot. SPDs have unique needs we don’t meet particularly well,” says Harold Pollack, chair of the University of Chicago’s Center for Health Administration Studies. What’s more, some have cast doubt on the projected savings that HMOs have touted: A 2005 study by the Robert Wood Johnson Foundation, for example, showed that an earlier expansion of managed care in California’s Medicaid actually increased costs to the state by as much as 17 percent without improving health outcomes.