Tell Me Again How Centralized Healthcare Administration Is Going to Save Money??

Apologists for national health care or federally-directed-centrally controlled health care, which I believe we’re headed for, say that by curing “fraud and abuse” we can actually insure 31 million more people for less money.  Yeah, Obama said that.

This, of course, ignores the fact that Medicare and Medicaid have had 50 years to cure “fraud and abuse” — and haven’t done it.

It also ignores the fact that the OTHER way they’re covering the costs is by stiffing the elderly and putting them to death when some bureaucrat determines that they’re no longer “economically useful.”  I overstate, but not by much.

But I’m less worried about fraud and abuse than I am about bureaucratic stupidity.  MONUMENTAL bureaucratic stupidity.  Like that shown in this report:

Medicaid unnecessarily spent $271 million on brand-name drugs when much cheaper generic versions were readily available, according to a report from the American Enterprise Institute.

The Institute identified 20 brand-name drugs that Medicaid paid for, calling the outlay on those pharmaceuticals “wasteful spending.”

Medicaid’s utilization rate of generic drugs is only around 64 percent, about 10 percent lower than for the general population, an analysis by the Generic Pharmaceutical Association (GPhA) found.

Every 2 percent increase in the substitution of generic drugs for brand-name medications reduces Medicaid drug spending by about $1 billion, the GPhA reported.

The potential for savings on drugs is enormous. For the decade 2000 through 2009, the use of generic prescription drugs in place of brand-name products saved the nation’s healthcare system more than $824 billion.

Last year alone, the use of FDA-approved generics saved $139 billion — a 15 percent increase over the prior year — or about $382 million every day.

The increase is largely due to several widely prescribed drugs coming off patent and being replaced by generic versions, including the antidepressants Zoloft and Zocor.

For Medicaid, achieving savings on drugs is increasingly important, The Wall Street Journal observed, because “participation in the federal-state program as well as state children’s health programs will expend” by anywhere from 16 million to 23 million, according to varying estimates.

Call Me Scrooge

Call me inconsiderate, but this most recent development in health care ‘cost control’ strikes me as wrong: paying people to take their medications.

Here’s the rationale.  A story in the NY Times (it pains me even to mention that blot on journalism’s reputation for balanced reporting) points out that 33-50% of prescriptions aren’t taken correctly, either discontinued too soon or taken sporadically.  25% are never even filled, by one estimate.

That misuse leads to $100 Billion in annual medical bills (about half the amount Medicare loses to fraud every year).  So Aetna and some other carriers and researchers have a novel idea: Pay some amount to people unlikely to comply so as to improve compliance.  Mostly token amounts (in one case $10 a month seemed to work as well as well as a larger amounts), the payments seem to improve compliance.

What’s wrong with this picture?  I take my beta blockers every day.  Because I don’t want a heart attack, stroke, or other complication.  And I pay money to get the medication.  So now some irresponsible idiot is going to be PAID MONEY to take the medications he should take anyway?

I don’t care how much it lowers medical costs — it’s WRONG, and it simply underscores the perversity of our society today.  Don’t take your meds?  Then TS, Baby.  Screw yourself if your that dumb.

Medicare Cuts Under Health Care “Reform”

The Senate has gagged insurers from telling their OWN customers the truth about the Medicare portion of Health Reform.  Humana and others were letting insureds know that cuts proposed under reform ($123B over ten years in the Senate bill and $175B in the House) would result in seniors having their health care benefits cut.

Apparently the Senate — not believing in free speech for all — stopped them from communicating with their insureds about  the bill and opened an investigation into Humana.  However, the AARP, a liberal lobbying group despite masquerading as representing seniors’ interests, was allowed to continue to promote the plan.

But the NY Times, inadvertently let the truth slip out in an editorial.  On one line the Times said that cuts would be “modest” and on THE VERY NEXT LINE they said that “The value of an enrollee’s added benefits would shrink by more than half from current levels but would not disappear; they would still be worth about $500 a year in 2019″

The worst part about this is that Medicare Advantage plans do what Congress says they want done — cut health care costs.  I recent study said the following in the introduction (here’s the link to the entire study).  I’ve added emphasis in some places because this is pretty dramatic:

“The Agency for Healthcare Research and Quality (AHRQ) has compiled statewide datasets on hospital admissions in California and Nevada that allow direct, risk-adjusted comparisons of utilization rates among enrollees in Medicare Advantage (MA) plans and in Medicare’s traditional fee-for-service (FFS) program.

“Based on the AHRQ data for these states in 2006, risk-adjusted rates of inpatient days per patient were 30 percent lower for MA enrollees than for FFS enrollees in California, and 23 percent lower in Nevada.

“Same-quarter re-admission rates for the same DRG (Medicare’s “diagnosis-related group” codes for each type of hospitalization) were 15 percent lower among MA patients in California and 33 percent lower among MA patients in Nevada.

Based on classifications for 13 potentially avoidable admissions defined by AHRQ – ranging from dehydration to urinary tract infection to uncontrolled diabetes – risk-adjusted MA patients had a 6 percent lower rate of avoidable admissions than FFS enrollees in both California and Nevada. These comparisons were adjusted for health status using the Medicare risk score process for age, sex, and 70 Hierarchical Condition Categories (HCCs) for serious diagnoses that are used as a basis for Medicare risk adjustment.

“The AHRQ data also allow comparisons of MA vs. FFS results across regions within California and Nevada. For example, reductions in risk-adjusted re-admission rates among MA enrollees were highest in the Central region (-34 percent) and North San Joaquin region (-27 percent) compared with FFS enrollees, but were much smaller or near-zero in other regions, such as the West Bay (-6 percent) and Orange County (+1 percent). Re-admission rates were reduced among MA enrollees by about the same amounts compared with FFS in Nevada’s Las Vegas
referral area (-32 percent) and Reno referral area (-34 percent).”

Health Care “Reform” via MedPAC

Ever hear of MedPAC?  Neither had I.

It stands for Medicare Payments Advisory Commission.  It’s composed of a bunch of health care experts who know all there is to know about medical treatments and which should be used and how much each is worth, yada, yada, yada.

They churn out this voluminous report every year detailing what ought to be paid for (by Medicare) and at what rate.  But it has to go through Congress where our elected dudes/dudettes (who are mostly lawyers and don’t know squat about health care administration) can slice, dice, chop and mutilate the recommendations until nothing substantive is changed.

So President Obama is suggesting that MedPAC would be set up as an “independent board” and they’d set the Medicare payment rates.  No Congressional input because by the time any suggested changes make it through the sausage grinder of Congress, nothing substantive ever happens.

So far, so good.  But here’s where it gets tricky.