Medicare

The latest version of Senate health care legislation (pdf available here) crafted by Majority Leader Harry Reid is making its rounds. There is a lot to review, but an initial read shows the bill is close to the legislation approved by the Senate Finance Committee in early October with a few notable changes: more generous subsidies, a higher threshold for the excise tax on insurers who offer high-cost plans, an increase in the Medicare payroll tax for Americans making over $250,000, and the addition of a long-term care insurance program for people with disabilities.

While this legislation also delays the implementation of insurance market reforms and subsidies (when compared to the Senate Finance legislation) there are a number of provisions that would start helping Americans immediately. In particular, the legislation:

The government paid $47 billion (that's billion with a B) in false or questionable Medicare claims last year, according to a new federal report obtained by the Associated Press.

In its Room for Debate section, The New York Times asks a group of health experts what one or two provisions could be added to health reform legislation to help contain health care costs going forward. Below is my contribution to the discussion. For more on the issue, you can read my colleague's post on the real versus the ideal options for slowing the growth of health care costs.

The Medicare payment reforms in both the House and the Senate bills will help to slow the growth of costs by rewarding value over volume, as will the proposed Medicare commission and the tax on insurers who offer high-cost health plans, which are in the Senate Finance Committee bill. And both House and Senate legislation also includes “innovation centers” which will allow us to test different payment models and health care processes.

Even with these steps, the reform bills could be strengthened. Specifically:

Can health reform heal our federal budget? Yes, but whatever passes now is just the beginning, and there will always be room for improvement.

After all the sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts of horror stories about the resurrection, so to speak, of the "death panels." Maybe because all that fear-mongering was finally discredited. Maybe we are finally getting just a little bit smarter.

The inevitable focus on the politics of health reform, and the disproportionate amount of attention paid to the public plan, sometimes obscures the many ways that the House and the Senate health plans are ambitious. Not perfect. Ambitious. I've heard experts, people I like and respect, say the legislation does "nothing" to advance the cause of quality of end of life care in America. They are wrong. The House and Senate bill each contain measures that would advance that cause -- not fix it completely, far from it, but they will take us important steps in the right direction. It's too soon to know which of these measures - if any -- will survive a final melding of House and Senate legislation. But let's look at them here because, except for the end of life consults which got way too much of the wrong kind of attention, they haven't gotten adequate attention. In an accompanying guest post. Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, talks about what these changes can mean for his patients and their families.

Seniors are a primary target of the misleading rhetoric in the health reform debate. Though the harmful rumors have been proven false time and time again, seniors have had to worry about everything from "death panels" to Medicare cuts.

Over at InsureBlog, Hank Stern takes exception to Len Nichols' thorough debunking of the recent report produced by PriceWaterhouseCoopers for AHIP.

Like the Latin title of Hank's post (Res Ipsa Loquitur...), most of his points speak for themselves.

If he wants to object to the idea that "Good policy research uses nationally and statistically representative data so that its conclusions reflect behavior of the actual population," that's his prerogative.

If he's ignorant of the IRS tax code that governs the non-partisan work of the Robert Wood Johnson Foundation and the Urban Institute, well, we guess that's fine, too.

But if he thinks there's no difference between the research produced by such independent institutions and stuff that's made to order for private interests, he should take a look at the work PriceWaterhouse did for the tobacco industry in the early 90s. An independent review of that study found "serious methodological problems and errors of omission." (h/t Media Matters) The same could be said of their latest work. AHIP got what it paid for and InsureBlog should be less credulous of the talking points it's buying.

About a year ago, Drew Altman, president and CEO of the Kaiser Family Foundation, wrote an essay about "delivery system" folks and "coverage" folks.

A study in the Annals of Internal Medicine (Hat tip Kit Seelye) finds that people who are uninsured in their 50s and early 60s end up costing Medicare a lot more money when they hit 65.

The Republican stance on Medicare has Paul Krugman tearing his hair out. Or maybe he wants to tear their hair out. In a column titled "The Politics of Spite," he writes: