Posts tagged ‘Rationing’
We have to say, Forbes has it right! The co-pay for Medicare home health care proposed in the President’s budget is a big mistake. It will not save money, will harm people with chronic conditions, and will increase avoidable hospitalizations. It isn’t even a good tool for fighting fraud – if that is the goal.
Far from getting too much care, our experience is that thousands of people with multiple sclerosis, Parkinson’s disease, ALS, paralysis, and other long-term conditions, struggle to get the home care they DO need. A little bit of nursing and/or therapy, along with hands-on health aide services, often means the difference between staying home and requiring a hospital stay or nursing home placement. For most Medicare beneficiaries with chronic conditions, home health care is more humane, more effective and less expensive.
If fraud is the concern, fight it. Don’t add co-pays or other barriers for those who really do need home care and qualify for Medicare coverage.
Last week, the Congressional Budget Office released a new budget outlook with updated data on expected federal costs of programs including Medicare and Medicaid over the next ten years. According to the CBO, Medicare spending in 2012 grew by only 3% – the lowest rate of growth in over a decade, and a rate much lower than that of the private market. In fact, the Washington Post notes that “From the March 2010 baseline to the current baseline…[CBO] lowered estimates of federal spending for the two programs in 2020 by about $200 billion — by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program”.
The new baseline estimates indicate that Medicare is leading the way in controlling costs, and that Medicare has significantly contributed to lowering the nation’s deficit through innovative payment and delivery models as well as reductions in overpayments to private insurance plans under the Affordable Care Act.
CBO’s outlook illustrates that Medicare is not the problem, but rather the solution that policymakers should look to for addressing the real issue of overall health care costs affecting payers system-wide. While many look to slash Medicare and Medicaid in the name of deficit reduction through proposals like raising Medicare’s eligibility age or fragmenting the program through further means-testing, the CBO estimates reveal that such proposals are not rooted in fiscal policy. As the Post points out, “…$200 billion out of [Medicare and Medicaid] is nothing to sneeze at; that’s about double the revenue the government would generate by raising the Medicare eligibility age from 65 to 67.”
The Center for Medicare Advocacy has long maintained that if policymakers are really concerned about strengthening Medicare and reducing the deficit, cutting benefits is the wrong approach – and new polling shows that over 60% of Americans agree. In fact, 85% of Americans strongly favor one of the Center’s Solutions to reduce the deficit: Requiring drug companies to give the government a better deal on medications for people on Medicare. Whether Congress chooses instead to protect the windfall profits of pharmaceutical companies rather than protecting people living on less than $22,000 a year and rely on Medicare to maintain their health remains to be seen.
 Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2013 to 2023, available at http://cbo.gov/publication/43907.
 Washington Post, Wonkblog: Three Ways CBO Expects Health Spending to Change. Available at http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/05/three-ways-cbo-expects-health-spending-to-change/
 Center for Medicare Advocacy, Medicare Facts and Fiction: Costs and Spending Edition, available at http://www.medicareadvocacy.org/2013/01/10/medicare-facts-and-fiction-costs-and-spending-edition/
 Kaiser Family Foundation and Harvard School of Public Health: The Public’s Health Care Agenda for the 113th Congress, available at http://www.kff.org/kaiserpolls/8405.cfm.
According to researchers from the Urban Institute, writing in the New England Journal of Medicine, Medicare’s purported dire financial condition isn’t actually all that dire. Given the aging of our population, increases in enrollment have obviously contributed to spending growth. But, according to the Urban Institute, “in recent years “spending growth per enrollee slowed in Medicare and Medicaid, and per-enrollee growth rates in the next decade are projected to be very close to the expected growth in [Gross Domestic Product] per capita. These data do not support the need for major restructuring of either program.” (emphases added)
In short, contrary to repeated assertions, Medicare is not broke, going “bankrupt” or running out of funds,. Further, Medicare provisions in the Affordable Care Act (ACA) have improved Medicare’s economic outlook − extending the solvency of the Medicare Trust Fund by 8 years.
The real problem that needs to be addressed is rising overall health care costs. Overall healthcare expenditures per capita in the United States are higher than in any other country, and show no signs of slowing. Addressing US health system costs in general is the only real solution to the fiscal issues ahead. The Affordable Care Act addresses many of these pressing concerns. Let it work.
 Holahan, J., McMorrow, S. Medicare, Medicaid and the Deficit Debate. Washington DC: Urban Institute, April 2012. Published in the New England Journal of Medicine, August 2012.
 See, e.g., “Medicare is Not Bankrupt” by Paul N. Van de Water, Center on Budget and Policy Priorities (April 24, 2012), available at:http://www.cbpp.org/cms/index
 See, e.g., CMS Press Release: “Medicare Stable, But Requires Strengthening” (April 23, 2012), available at:http://www.cms.gov/apps/media/press/release.asp
 See, e.g. Kaiser family Foundation at http://www.kff.org/insurance/snapshot
The budget released on April 5th by the House of Representatives purports to benefit Main Street Americans.
Once again we’re hearing proposals to “reform” Medicare and to cut the federal deficit. These plans are not about reform or even dedicated to deficit reduction. They are about a long held desire to do away with Medicare, shifting costs to American families who are already struggling.
Newt Gingrich said in the 1990s that he might not be able to eliminate Medicare, but he could watch it wither on the vine. This time, the House of Representatives’ Republican budget actually does eliminate Medicare, replacing it with vouchers to purchase private insurance.
This proposal is reckless and extreme. As with Medicare Advantage and Medicare Part D, it will cost beneficiaries and taxpayers more than the traditional Medicare program. With a capped annual voucher to purchase insurance, Medicare beneficiaries will pay more out-of-pocket, get less coverage, and have less access to health care.
Sounds like rationing to us.