If you were old and frail and needed nursing care at home, who would help you to pay for it? As things now stand, probably no one.
Two-thirds of elderly Americans will need help with daily living at some point. Most would like to get it in their own home. But very few of them can afford the cost. Only one in ten Americans has long-term care insurance. Medicare only helps for a short time immediately after a hospitalization. And Medicaid only helps if you are extremely poor.
Wouldn’t it be nice if the frail elderly could get the help they need without becoming a burden to their families or taxpayers?
Imagine a health reform plan that has nothing to do with insurance. It adds no new regulations on insurance companies, no subsidies to help people purchase policies, and no individual mandate to force people to maintain coverage. And it does nothing to expand public programs, like Medicare and Medicaid.
Is such a plan possible? Could it do anything for the 50 million or so Americans who can’t get the care they need because they are uninsured?
The answer is that such a plan is not only possible but has already been implemented by the Obama administration. It takes the form of a major expansion of the National Health Service Corps, a program that sends doctors, nurses and other health care providers to underserved areas, where one-fifth of the population lives.
Think we have the best health care system in the world? Consider this: More people in the United States die from preventable causes than anywhere else in the industrialized world. That finding should give anyone pause.
As you’ve probably noticed, our health care system has some big problems. A report released this week by the nonprofit Commonwealth Fund, which included the finding on preventable deaths, shows exactly how big the problems are.
It is already well known that we spend far more on health care than anyplace else in the world. Yet despite that, lack of insurance keeps more of us from getting care than in any other developed country. (Emergency rooms must see everyone, but their services are limited to stabilizing emergency conditions.) And thousands die each year from medical errors.
The new report looked behind these failings with a scorecard that measured 42 indicators of quality, efficiency, equity, and overall health. We scored only 64 out of a possible 100.
Are death panels making a comeback? Last week, a federal board advised men against getting regular prostate cancer screening tests. Two years ago, the same body advised women against getting regular mammograms before age 50. That advice brought charges that the government was trying to save money by sacrificing lives.
The advisory board, known as the U.S. Preventive Services Task Force, is made up of 16 independent primary care providers with expertise in prevention. None of them are federal employees. They regularly review the latest medical evidence on disease prevention and recommend improvements.
The Task Force began work in 1984, and members since then have been appointed by presidents of both parties. Often, specialty societies adopt its advice in formulating standards of practice.
The Task Force’s work was largely uncontroversial until health reform debates started heating up in 2009. That’s when Sarah Palin and others linked the group to death panels. If they’re right, then we’ve had death panels for the last 27 years, starting with the administration of Ronald Reagan.
The mere possibility that health reform will reach the Supreme Court this year has generated widespread attention. But there is much more to health policy than “Obamacare”. Another major dispute is already on the justices’ agenda, and the case could prove just as important.
On the first day of the new term, the Court heard arguments in a case about Medicaid budget cuts. It may not sound like a glamorous issue, but the outcome could change the health care that all of us receive.
The case concerns an issue only a lawyer could love. Who can sue when a state cuts payments? Your first reaction may be, “who cares?”
Low-income beneficiaries whose health care is on the line certainly care. And so do many hospitals, doctors, clinics, labs, nursing homes, and other providers that treat those beneficiaries.
We’re paying more and getting less when it comes to health insurance. A survey by the Kaiser Family Foundation found that premiums for employer-sponsored coverage jumped by 9% for families and 8% for individuals this year. Last year, family premiums rose by only 3%, and over the past few years, increases have stayed below 5%. (Click here for the full report)
Our coverage is also shrinking. Many more workers have policies with deductibles of $1,000 or more. Co-pays are also going up. And workers at many companies must pay a higher share of the total premium.
This finding is somewhat surprising, since underlying health care costs rose at a slower pace than usual last year. A Standard & Poor’s survey found an increase of just under 6%, the lowest rate of growth in the past six years.
So, who’s to blame? Insurance companies are an obvious suspect. Some see them trying to pad their profits. Others charge they are rushing to raise premiums before more vigorous rate regulation kicks in under health reform.
If you’re over 65, there’s a good chance you find your Medicare coverage confusing. In a recent survey by the National Council on Aging, only half of seniors said that they understand how it works.
The survey found large gaps in knowledge about Medicare’s basic structure. Only 36% of seniors correctly identified the component that covers hospital care, and only 26% could name the component that pays physicians. (The answers are Part A and Part B respectively.) Two-thirds had no idea what Part C is for. (It lets you choose alternative coverage through a private managed care plan.)
Those approaching age 65 reported even more confusion about Medicare and displayed even less knowledge. Only 46% of those between the ages of 60 and 64 said they understand the program, and they were less likely than the seniors to correctly identify its components.
Much of the time, this confusion doesn’t really matter. Seniors get health care, and the government pays the bills. They don’t have to know the details of how the payments are made.
How soon do you want to know the results when your doctor orders blood work? In all but 13 states, you can get them straight from the lab. Unfortunately, Pennsylvania is not one of them – until now.
The Obama administration announced a proposed new rule to give patients everywhere in the country direct access to medical test findings. It will likely take effect in the next few months. (To see the text of the rule, click here.)
Right now, if you want to see your lab results in Pennsylvania, you have to ask the doctor who ordered them. That’s usually fine, if your doctor contacts you quickly. But sometimes, there can be delays.
What’s more, research shows that some test results never make it back to the doctor who ordered them. In some instances, doctors get the results but fail to communicate abnormal findings. In others, lab reports don’t make it to other doctors who are seeing the same patient.
You can’t blame Obamacare for this one. During the decade before it was enacted, health care costs rose so quickly in the United States that they wiped out most of the gains in income that workers received during that time. That’s the finding of a new report by researchers at the Rand Corporation.
We pay those higher costs in larger insurance premiums, greater out-of-pocket spending for items that insurance doesn’t cover, and more tax dollars devoted to health care. Between 1999 and 2009, these expenses left American workers with almost no extra money in their pockets despite earning higher wages.
Health care spending rose under both private insurance and public programs, like Medicare and Medicaid. That means we can’t place blame on either the market or on the government alone.
Why is American health care so expensive? A second recent study gives one answer. We pay our doctors a lot more than other countries do. In 2008, per capita spending for physician services in the United States was over four times the average for the rest of the developed world.
What will Obamacare do for those of us who get health insurance through our jobs? Could our employers decide to drop us? Could we be forced to search for a policy in one of the new exchanges?
The answer depends on who you ask.
McKinsey & Company, a global consulting firm, surveyed employers earlier this year. About 30% said they will definitely or probably stop covering their workers when the health reform law goes into effect in 2014. More than 60% plan a major change of some sort.
Those are scary numbers. But experts have severely criticized McKinsey’s methodology for asking only about current attitudes, not definite plans. And surveys by other consulting firms and research organizations have produced markedly different results.