GOVERNMENT AND HEALTH CARE

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When Medicare and Medicaid were signed into law by President Johnson in 1965, it fundamentally changed healthcare in the United States forever. By 1972 when all disabled persons became eligible for coverage, private insurance had made practical adjustments and only the very wealthy among those eligible for the government programs could afford to opt out of them.

I believe that these government programs, for various reasons, provided incentive to stress the healthcare system and this is resulted in a good amount of the excessive increase in healthcare costs. But millions are now 'trapped' in the system and reversing the negatives has far reaching consequences.

Surely this at least gives pause for thought when we discuss putting all the rest of the healthcare system under government authority. The following should be a warning shot across the bow:

Medicare fees to doctors fall Tuesday
By JIM ABRAMS, Associated Press Writer
Mon Jun 30, 3:25 AM ET

WASHINGTON - One unpleasant task lawmakers will have over the July 4 recess is explaining to seniors why they didn't stop a 10 percent fee cut, going into effect Tuesday, for doctors who treat Medicare patients.

Physicians have been running ads hinting that patients may find doctors less willing to treat them.

In a particularly vitriolic exchange, Democrats and Republicans blamed each other for what Dr. Nancy H. Nielsen, president of the American Medical Association, said has put the country "at the brink of a Medicare meltdown."

"Seniors need continued access to the doctors they trust. It's urgent that Congress make that happen," the AMA said in ads taken out in Capitol Hill newspapers read by members of Congress and their aides.

One near-certainty was that lawmakers, not willing to face millions of angry seniors at the polls in November, will act quickly when they return to Washington the week of July 7 to reverse the fee cut and provide retroactive payments to doctors for losses they incur after July 1.

Just two years ago, after a cut had taken effect, Congress froze payments retroactively at the previous year's levels. In 2002 doctors had to live with a 5.4 percent cut.

The likelihood of retroactive relief didn't deter dire predictions last Thursday after the Senate fell just one vote short of the 60 needed to proceed to legislation that would have stopped the fee cut.

Doctors have complained for years that Medicare payments have failed to cover rising costs. "Many more physicians will reluctantly retire early or reduce clinical practice time. This hurts access to fragile senior populations," said Dr. Jack Lewin, chief executive officer of the American College of Cardiology.

Beginning Tuesday, payments will be cut for some 600,000 doctors who treat Medicare patients because of a formula that requires fee cuts when spending exceeds established goals. Almost every year, Congress finds a way to block the cuts.

This year majority Democrats homed in on cutting the Medicare Advantage program, which is an ideological issue for both parties. The Bush administration and Republicans like Medicare Advantage because it lets the elderly and disabled choose to get their health benefits through private insurers rather than through traditional Medicare. Democrats argued that government payments to the insurers are too generous.

The White House warned that President Bush would be urged to veto a bill that contained cuts to Medicare Advantage. "The bill would fundamentally change the private fee-for-service program and consequently reduce access, benefits and choices for many of the approximately 2.25 million beneficiaries" in such plans, the White House said in a statement.

That didn't stop the House last Tuesday from approving the legislation 355-59, well above the margin needed to override a veto. Every Democrat supported it, and Republicans, bucking their president, voted 129-59 for it.

In the Senate, however, most Republicans are not facing re-election this fall. They were more united in opposition Thursday in a 58-40 vote, two short of the 60 needed, that would have led to passing the bill. Actually, 59 senators present supported the bill ?-?- Senate Majority Leader Harry Reid, D-Nev., changed his vote to "no" in a procedural move allowing him to bring up the issue again.

Reid said Friday he will hold another vote after lawmakers return next week to give Republicans "another opportunity to reconsider their unfortunate decision to hurt patients and doctors."

Here is just one example with immediate ramifications for those affected:
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Re: GOVERNMENT AND HEALTH CARE

Foxfyre wrote:

I believe that these government programs, for various reasons, provided incentive to stress the healthcare system and this is resulted in a good amount of the excessive increase in healthcare costs.

You believe a lot of goofy bullshit--so what?

The two most significant reason for the rise of health care costs since 1970 have been new technology and the conversion of health care delivery into an area of corporate investment.

New technologies, such as gas chromatography, dramatically increased the amount of diagnostic information a doctor could accumulate in a short period of time, and to the extent that a physician were sufficiently well-educated, either in medical school or from continuing education, created a potential for much more effective health care.

But such technologies don't come cheap, and this was especially so 40 years ago when they were developed and began to be put in use. Hospitals and clinics--which at that time were almost all locally-owned and the majority owned by physician associations--had to undertake significant capital expansion. This was more the case in that initially, such technologies were far more expensive in real dollars than they are today, when the proliferation of technology actually drives down the cost. New equipment was amortized over relatively brief periods of time--ten years was common--and the cost of the equipment was built into the costs of tests which doctors ordered.

But when a piece of amortized equipment was paid off, the cost of tests ordered was not reduced to reflect the fact that the tests were no longer so costly for the providing facility. Whether the costs of health care are paid by insurance corporations or the government, the standard method of determining and paying costs are fee schedules. So if the hospital or clinic's cost for a blood gases test had declined, they are still going to charge and be paid the original fee. When inflationary pressures lead to the need to re-negotiate fee schedules, the easiest thing to do is for the parties to negotiate an across-the-board increase. You can be that hospital or clinic administrators are not going to insurance corporations or government bureaucracies to say: "Hey, we paid off our eqipment, so we're going to reduce the costs of those tests by 30%." They surely don't say that to anyone unfortunate enough to be obliged to pay the cost of their medical treatment out of their own pockets.

The habit of increasing costs of health care delivery to the patient without a realistic relationship to the cost of health care delivery to providers was simply too tempting to health care industry administrators, since the bulk of their customers were the patients, but insurance corporations or the government.

Which lead to the other cause for the dramatic rise in health care costs in the United States, which the "corporatization" of health care delivery facilities--hospitals and clinics. It did not take those who look for lucrative investment opportunities long to spot the goose which was laying the golden eggs, and large capital base investors moved in quickly to snap up local hospitals and clinics to form larger and larger health care provider corporations. Insurers and the government don't care whose name is on the check they sign, and the fee schedules assured that even a poorly run facility was profitable, and profits could be increased by keep costs down--costs such as ancillary staff (the people who clean up after the "professionals" are often the first to go), with predictable results: too few nurses and nurses aides, longer wait times, critical neglect of patients, and the rise of hospital and clinic spawned new infectious agents such as c. difficile.

When corporate boards make the ultimate decisions for health care provider facilities, their view is toward the bottom line--to make the most money for the shareholder. It is certainly not in their interests to lower cost merely because the levels of the fee schedules cannot be justified based on the cost of delivering service.

I'm sure conservatives don't like to hear it, and want to blame government. But the high cost of health care in the United States is most definitely a product of how the industry pays its bills and charges its customers, and the take over of health care systems in the United States by large corporations who have only their own bottom line in mind.

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"But the high cost of health care in the United States is most definitely a product of how the industry pays its bills and charges its customers"

IT is the CHARGE for some of these services that seems a bit outrageous.

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woiyo wrote:

"But the high cost of health care in the United States is most definitely a product of how the industry pays its bills and charges its customers"

IT is the CHARGE for some of these services that seems a bit outrageous.

As any of us who have been in business know, any individual charge is relative to the overall cost of doing business. Therefore that $10/aspirin is related to the cost of the physical facility, furniture, supplies, storage, utilities, staff salaries, and the doctor who okayed it none of which show up on the statement of charges. If the facility/staff/doctor is required to charge below cost for a Medicare or Medicade patient, that loss has to be made up somewhere else which means shifting the costs to other patients - or - ordering a gazillion tests and procedures that are probably unnecessary but make money for the facility/provider - or sooner or later services will be denied or simply unavailable to such patients altogether.

The last time I worked for a hospital was in the 1970's, and then the cost of a single tube for the X-ray machine was around $10,000 and you only got so many x-rays out of that tube. So the cost of that tube affects the cost of the x-ray along with all those other factors mentioned. A radiologist requires more education than many other medical specialties and therefore merits higher pay than many other hospital physicians.

Back when we all simply paid for a doctor's visit for Johnny's sore throat and the antibiotic or eardrops prescribed just as we expect to pay to fix the flat tire or new spark plugs for our car, the costs were affordable. We got an itemized bill and could question any wierd or excessive charges on it. Even if we see a fully itemized bill now, we have little recourse (or reason) to challenge costs that we aren't paying directly out of our own pocket.

I remain unconvinced that government is as capable of running medicine as efficiently and effectively or economically as can be done by the private sector.

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