Thursday, October 17, 2019

For-Profit Hospital Industry Leads Fight Against Medicare for All

For-Profit Hospital Industry Leads Fight Against Medicare for All: Tenet Healthcare, the nation’s third-largest investor-owned operator of hospitals, has donated nearly $630,000 to the Partnership for America’s Health Care Future.

Tuesday, October 15, 2019

Trump's Five Big Changes To 'Obamacare' : Shots - Health News : NPR

Trump's Five Big Changes To 'Obamacare' : Shots - Health News : NPR: Though polls show Affordable Care Act protections remain popular in the U.S., President Trump still threatens to drastically change the law if he can't repeal it. Here are five changes he's made.

Sunday, October 13, 2019

Government Watchdog Faults Trump Administration’s Approval of Medicaid Work Requirements

https://www.wsj.com/articles/government-watchdog-faults-trump-administrations-approval-of-medicaid-work-requirements-11570757426?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=77956879&_hsenc=p2ANqtz--wnCf40SN5rx0qrGlqwD8lPCe5Tp87419L5Alz3FA4r3347Z0TXGJ0YNH7EaxiuV7umbUyzu4XtJfxaJ-h9ULvI2GuFA&_hsmi=77956879
From Kip Sullivan: Early in October CMS announced that its main ACO program, the Medicare Shared Savings Program, saved $739 million in 2018 after accounting for bonuses paid out to some ACOs and collecting penalties from a few others. CMS released a similar press release a year ago announcing smaller savings in 2017 (after announcing losses between 2012-2016).

What CMS has never bothered to announce is (a) the savings constitute a tiny fraction of Medicare spending on the Medicare beneficiaries assigned to ACOs (without their knowledge) and (b) these savings are much smaller than the overhead costs of the ACOs (I'm not even counting CMS's overhead in running that complex program).

According to an article in Medpage, the savings in 2018 equaled a mere $73 per beneficiary. https://www.medpagetoday.com/publichealthpolicy/medicare/82544According to the Medicare Trustee's report, per beneficiary spending in 2018 was $13,665 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2019.pdf (Table V.D1p 185).

When we do the math, we discover the $73 per beneficiary savings in 2018 was half a percentage point of total Medicare spending on the 10 million beneficiaries assigned to ACOs in 2018.

According to MedPAC's staff, the average ACO has overhead of 2 percent of Medicare spending. (I suspect that's low.) Obviously, 2 percent is four times half a percent. ACOs, in short, are raising total spending.

The complete disinterest in administrative costs is par for the course for CMS and other managed care advocates. All the managed care schemes ever proposed -- from HMOs in the 1970s to "medical homes" in the 2000s to the Hospital Readmissions Reduction Program in the 2010s -- were proposed without any evidence on the administrative costs of these schemes. Managed care buffs suffer from terminal free-lunch syndrome.

Interestingly, Kaiser Health News yesterday summarized a Wall St J story about a GAO report saying Trump's wizards at HHS forgot to include administrative costs in their estimate of how much Medicaid would save if states added work requirements to their Medicaid programs. I have pasted in the blurb below. Notice the final bolded sentence.

Beats me why the GAO hasn't done this for all the managed care fads.

The Facts on Medicare Spending and Financing | The Henry J. Kaiser Family Foundation

The Facts on Medicare Spending and Financing | The Henry J. Kaiser Family Foundation: This issue brief examines the latest facts about Medicare spending and financing, including the most recent historical and projected Medicare spending data from the Centers for Medicare and Medicai…



From Kip Sullivan: "The Kaiser Family Foundation reports that Medicare overhead in 2018 was 1.3 percent of total program spending while the overhead of Medicare Advantage plans was 14 percent (scroll down to Figure 3 and look just under Figure 3). https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/


The 14 percent figure is lower than the 20 percent figure for private-sector insurance, in part because insurance companies don't have to pay for premium collection.


So, inquiring minds would like to know: How the hell do Medicare Advantage companies save money for Medicare with overhead like that?"

What's At Stake In The Current Court Challenge To Affordable Care Act? : Shots - Health News : NPR

What's At Stake In The Current Court Challenge To Affordable Care Act? : Shots - Health News : NPR: The health law again faces possible legal evisceration with a court ruling in Texas v. Azar anticipated this fall. Here's what it's about and what's stake.

Sunday, October 6, 2019


Wednesday, October 2, 2019


Tuesday, October 1, 2019

Healthcare Reformer Wendell Potter: The For-Profit 'System Is Unraveling' | Common Dreams Views

Healthcare Reformer Wendell Potter: The For-Profit 'System Is Unraveling' | Common Dreams Views: With the word “whistleblower” spinning through news cycle after news cycle these last few days, every headline about Trump, Giuliani and Ukraine is a powerful reminder that the whistleblower is a proud tradition in the United States, one that merits our support and protection. | By Michael Winship

Medicaid Expansion: Haves And Have-Nots On Two Sides Of State Border : Shots - Health News : NPR

Medicaid Expansion: Haves And Have-Nots On Two Sides Of State Border : Shots - Health News : NPR: On the Illinois side of the Mississippi river, many families struggling financially can get health care, thanks to Medicaid expansion. Meanwhile, their neighbors on the Missouri side don't qualify.