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Archive for Saturday, August 18, 2012

Wait and see

August 18, 2012

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Now it is beginning to clear up.

Mitt Romney has been criticized for supporting the health care reform bill in Massachusetts that has been the prototype for the Affordable Care Act known as Obamacare. What might we learn from Romneycare as a predictor of what awaits us with Obamacare and perhaps gain a clue as to why Kansas Gov. Sam Brownback would return the $31.5 million grant to set up a health exchange plan in Kansas?

The Aug. 6 Wall Street Journal offers a view of what has happened in Massachusetts with Romneycare. Seventy-nine percent of the newly insured are on public programs, and health-related costs consumed 54 percent of the state budget in 2012, up from 24 percent in 2001. Over the same period, state spending in real terms jumped by 59 percent while education has fallen 15 percent, police and firemen by 11 percent and roads and bridges by 23 percent.

With K-12 funding now at 50 percent of the Kansas state budget and a state law that requires the budget to be balanced at year’s end, it is apparent that the Affordable Care Act will be anything but affordable. Brownback’s wait-and-see approach is more understandable.  

Comments

appleaday 2 years, 3 months ago

With almost 50 million people who are uninsured, the US still spends way more per capita ($7,100) than any other country. However, we have a higher infant mortality rate than almost all industrial nations, our life expectancy ranks 42nd in the world (Cuba is 37th), over 30% of our population is overweight or obese. Those of us with health care insurance have costs of the uninsured, underinsured, and those who use health care services at a higher rater (obese people with cardiovascular disease and diabetes with the accompanying renal and cardiovascular complications) passed on to them in increasingly higher premiums and out of pocket expenses. The uninsured seek health care only when they are very sick, meaning the costs of their care are always high since they tend to use emergency departments and hospitals rather than less expensive primary care. However we do this, we need to figure out how to get more people cared for at the primary care level with care that is preventive and focuses on health maintenance. Our current system is not "health" care, it is "sick" care.

Enlightenment 2 years, 3 months ago

appleday, it's actually up to approximately $8,300 per capita now and growing at twice the rate of GDP. Something needed to be done and the ACA is a start.

appleaday 2 years, 3 months ago

I couldn't agree more. I don't think the ACA goes far enough and neither do the many physicians and nurse practitioners I work with at Children's Mercy Hospital.

JackMcKee 2 years, 3 months ago

Well that explains why Romneycare is one of the most popular state programs in the country. I wonder how much less Mass wastes on ER care.

All Sam accomplished by dragging his feet was the loss of the ability for Kansas to determine its own fate.

Ken Lassman 2 years, 3 months ago

Seems to me that Obama and congress together did not have the political will (read: were afraid that their political campaigns would be defunded by the big players in health care) and so we ended up with an "Affordable Health Care" system that gave everyone better access to our health care system without significantly reforming the way insurance and health provider companies are able to line up at the money trough to continue to get an ever-increasing percentage of the GDP.

Republicans and Democrats are unwilling to work with each other to make further bipartisan reforms lest they have to admit that the other side has a good idea. Neither side by themselves has the political will to fundamentally change the health care structure in ways that don't either turn it into a political payola privatization plan that enriches the few at the expense of making a mediocre system even more mediocre, or a continued expansion plan that empties the public coffers ever more quickly.

Neither side seems capable of breaking out of their money-lined strategies. There is a real failure of imagination and leadership on both sides. Without true bipartisanship developing around a cluster of ideas that will meet the goal of both universal access AND affordable health care that doesn't consume the economy, the ship will sink on this issue alone, I'm afraid.

JackMcKee 2 years, 3 months ago

County, it wasn't too long ago to recall that Democrats and Obama wanted the vastly superior single payer system. It was the republicans that blocked s.p. so we ended up with the ACA compromise, which was a R idea in the first place. Now they act like its socialism incarnate. Republicans are the very definition of a dysfunctional political party.

It's no different than Sam Brownback cutting $4 billion from state revenues then acting like he has no idea why the state is broke.

rtwngr 2 years, 3 months ago

The state was broke before Gov. Brownback took office. Thank you to the legacy left by Dems and RINOs over the last 25 years. Some austerity is just what this state needs.

jafs 2 years, 3 months ago

Examples please, with actual facts?

KPERS is problematic, but it's due to the fact that the state has been failing to make their contributions to the system.

just_another_bozo_on_this_bus 2 years, 3 months ago

I'm guessing that a review of the program by someone other than the WSJ would reveal a different set of statistics.

jafs 2 years, 3 months ago

And, what's the truth of the matter?

From what I've heard, many people have better access, but it's also costing the state more than anticipated.

ThePilgrim 2 years, 3 months ago

Obamacare and Romneycare "work" because they throw hundreds of thousands onto State Medicaid. Obamacare only funds the increase in Medicaid for two years after it is fully implemented in 2014. And Ryan's budget cuts the financial funding of Medicaid in the future, to make an end-around on Obamacare, regardless whether they win/lose the election. With those facts taken into consideration, Obamacare will (further) bankrupt the State.

ThePilgrim 2 years, 3 months ago

But also be clear - most of the Obamacare policies on mandatory coverage and health insurance exchanges, were all Republican ideas and positions up to and through the 2008 election.

rtwngr 2 years, 3 months ago

To take ideas that were discussed then rejected and then make the leap to calling them policies is ridiculous. Furthermore the "ideas" you are referring to were more 90s under Clinton and not of this decade. The RINOs that came up with those kinds of "ideas" are no longer in office, either. They were retired by the Tea Party. Thank you very much.

Cant_have_it_both_ways 2 years, 3 months ago

No matter how you package it. There will always be people who don't want to or can't pay for their own health care. Seems to me, Obamacare or some program I come up with just moves the costs around, repackages it and continues to take from the producers and give to the non-producers under a different banner.

With out addressing some of the root problems like tort reform, nothing will get better. I am sure that dictating to the health care providers and facilities how much they are going to get paid per visit will do nothing but drive quality healthcare to the underground. Underground in this case is creating a pay to play system for the best Doctors and facilities.

Anyone knows that if you are getting a dollar now for your product or service, and the government comes in and tells you they want that product, but are only willing to give you .50 cents, you would, without hesitation look for different places to sell your product.

Under any type of directed health care system where costs are dictated or controlled, there is no way there can not be rationing. I would submit that if you are a producer, under the age of 55, and desire to not get the short end of the stick in your golden years, you should do everything you could distance yourself from any type of "One size fits all" healthcare plan, or any other scheme that smells like this. Rationing goes on now, just the medical experts do it, instead of some bureaucrat.

If you care to join me while I watch your mother die because the services she requires have been given to an illegal, or some younger person "Entitled" to the same procedure who could or is in the workforce and can be taxed, I'll give you my cell number.

The politicians do not care about you what so ever, we all know that. All they care about is creating a class of citizen, dependent upon them (The government) for survival, whether it comes in the form of free housing, food stamps, medical, dental, mental, transportation, cell phones or birth control. Producers are self sufficient, and self reliant and are quickly becoming the minority.

The non producers will always demand that those of us who produce, pay their way. We can not be everything to everybody, if we try there will not be anything for anyone.

It is your choice this fall. Especially you younger ones, if you want to start your working years further behind than you are now, by all means vote for some earmark politician who cares nothing about you. If you don't take a look at many of those running for office that are willing to stop the financial bleeding of this country as quick as possible, and start paying down the debt. We need to play from in front again, not from behind.

tomatogrower 2 years, 3 months ago

"Seems to me, Obamacare or some program I come up with just moves the costs around, repackages it and continues to take from the producers and give to the non-producers under a different banner."

I can't totally disagree with you on this, but there are a lot of hard working people out there who are getting the shaft. I don't have any sympathy for the deadbeats, but what about those who work really hard for a company who can more than afford to pay them better pay and/or for part of their insurance, but they don't. Please don't lump hard working people who want decent health care into moochers. And if you are anti worker's organization and you are anti government who is going to protect the workers? Many companies could care less about their employees. Got a kid dying of cancer? Don't take off work, and don't expect me to care. That is the attitude of business and many people now a days. It's all about me, me, me. I'll help you if I can get some good publicity, but otherwise forget it.

Ken Lassman 2 years, 3 months ago

Can't have it, Don't you realize that your description is a description of how the current health care system works? Those who don't have health care coverage go to the emergency room, and the costs are covered by those who do have insurance. Health care providers already have rates dictated to them by third party payors, whether it be Medicaid, Medicare or private health insurance. Instead of making things easier for health care providers, our current and future health care systems are getting so complex only fulltime paid staff can reliably get reimbursement, meaning that more and more doctors are affiliating with hospitals and large groups who can afford to deal with the insuror edifice that is so complicated that I think fraud can go undetected much of the time and independent health care providers don't have a chance getting reliable reimbursement from.

Could a single payor system administered by the government be awful? Sure. But could it be a vast improvement over the current out-of-control system? If we want it to be bad enough. Folks on all sides will have to take off their ideological blinders if we have any chance to make it happen, though.

Cant_have_it_both_ways 2 years, 3 months ago

The single payer system might be ok, if it was not administered by the government. Other than the military, the government does very little well. Frankly, I don't care to have some entry level bureaucrat in charge of what ever health care I or my family requires.

On a smaller scale, what would you think if the City of Lawrence was the single payer for our citizens healthcare? They can't even manage their own bank accounts.

hedshrinker 2 years, 3 months ago

If you have private health insurance (which yr employer will determine what brand and the general type of benefits) some entry level bureaucrat is NOW frequently in charge of what kind of healthcare you get (not the gov't either); you and yr healthcare provider are NOT running the show; the ins co bureaucrat can refuse to pay for the Rx yr MD (or ARNP or PA) prescribed, can deny hospitalization/surgery/procedures, etc.But it totally depends on which ins co you have and it varies fr one ins co to another....as someone mentioned earlier, most providers must now have multiple dedicated staff who ONLY deal with the variations and pecadillos of an endless # of different ins cos. At least with m'care, there's one universal set of rules and one administrative network, not hundreds of different cos with their own rules. Providers and their patients are caught in the middle with ins cos running the show. And don't get me started on the COMPLETELY erroneous red herring of "producers vs.non-producers". OK, I;m started anyway; here goes! MILLIONS of hard-working Americans now have poor-paying jobs without insurance benefits who can't pay for any kind of routine and preventive healthcare....their ONLY option is to wait for a catastrophe, get hauled to the ER and then declare bankruptcy. What kind of a country tolerates this. ????? It's a complete outrage. I have worked in the healthcare industry since the 1970's, have had both the luxury of employer provided Cadillac level ins and unfortunately for many yrs now, none at all until M'care so I have seen this from both sides.I agree the President should have just gone for the single payer system, the Repubs couldn't have demonized him more than they have already anyway.

tomatogrower 2 years, 3 months ago

I thought some of the numbers seemed a bit high in this letter. This is what I found after doing a bit of research. I'm not sure where the letter writer got his figures. Health care is a big chunk of their budget, but why inflate the numbers to make your point? It just makes people not listen to you or believe anything you say.

http://sunshinereview.org/index.php/Massachusetts_state_budget Healthcare

Under the budget as passed, health care spending for FY2013 will be $15.14 billion and will account for 43 percent of the overall state budget, according to a Massachusetts Budget and Policy Center analysis. One in five Massachusetts residents will have their health care largely covered through the budget. The budget includes a $546 million increase in spending on Medicaid and health care reform[9]

The budget assumes savings of about $700 million in health care costs through changes to payment and delivery models used by MassHealth, the state's version of Medicaid

Ken Lassman 2 years, 3 months ago

Did you run across any stats about what single payor systems would save in terms of what our health care savings might be for a baseline set of care for everyone? Seems like there ought to be a way to provide this kind of care for everyone, with the option for supplemental care for those who choose to spend the extra amount, kind of like social security plus retirement pensions/401K systems work.

tomatogrower 2 years, 3 months ago

I think it's the medical providers who need to be audited and regulated. My daughter had an out patient surgery performed recently. On her itemized bill just for writing a prescription for her pain pills she was charged $200. Those pens must cost a fortune. The same surgery, years ago when it was an inpatient procedure cost about 80% less. Now there has been inflation, and it's nice that they have equipment that makes the recovery more rapid, but give me a break. Where is the money really going? Not to the nurses, they don't get paid nearly enough for the crud they have to put up with. And there aren't that many suits brought against doctors and hospitals. I don't mind someone making a living from the health care system, but who is getting filthy rich from something that everyone needs. Utilities that are essentially monopolies of our energy needs are regulated, so they won't screw their customers. Maybe health care needs the same safeguards.

hedshrinker 2 years, 3 months ago

It's NOT the providers who are lining their pockets, it's the insurance cos. Providers are told by ins they must write off much of their fees...the money goes to some ins co exec for his yacht, or the pencil-pusher who denied the claim gets a bonus. Many healthcare providers are barely hanging on with massively reduced reimbursement structures and paying ever increasing fees for admin staff to deal with all the ins bureaucracy.

tomatogrower 2 years, 3 months ago

By the way, the doctor who wrote this letter has made a lot of money, a lot of money. I remember a friend of mine dropping him as a doctor, because he also pushes his religion on patients. Fortunately there are a lot of religious people in Ottawa, and not too many doctors, so he still has many patients. Enough to live more than well.

JackMcKee 2 years, 3 months ago

I'd find a new new doctor. I don't go to a Priest for medical advice and I don't go to a M.D. for religious advice.

I don't see anything wrong with making a good living, however.

msezdsit 2 years, 3 months ago

Well if we were to believe the LTE,(come on just pretend for a moment) with all this carnage Romney inflicted on Massachusetts, why on earth would we want him to be president. Add to that, during his watch, Massachusetts was 47th in job creation. The guy's a train wreck.

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