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A Suspicious Assertion - Health Care Rx Panelists

A Suspicious Assertion

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I am highly suspicious of any assertion that the government can achieve significant cost savings by scaling back the Medicare Advantage program without harming patients. There are only a handful of levers that will produce significant cost savings and all of them have negative consequences, either directly or indirectly, for patients:

· Cost savings can be effected by making patients pay more for their coverage, but that option makes the benefits more expensive for senior citizens.
· The government can choose to pay doctors and hospitals less. Any effort to pay less to doctors can backfire by causing some percentage of them to stop accepting Medicare Advantage patients. Those seniors who want to retain their physicians will find themselves unable to do so.
· The government can pay pharmaceutical companies and insurance plans less, but that simply shifts the burden to the remaining insurance plan policy holders, which means that seniors and others who are receiving insurance through a program other than Medicare Advantage will pay more.

There is no free lunch here. The ways to reduce the cost of Medicare Advantage for the government are to design health insurance plans to reward:

· Cost-effective care by doctors and other providers; and
· Patients who take better care of themselves to avoid illness and injury, to get screenings and immunizations and to follow their treatment plans when they have chronic diseases like diabetes and heart disease.

I am deeply concerned that our elected officials will not have the political will to redesign Medicare Advantage or Medicare to drive cost-saving behaviors. While they clearly have some level of understanding of the value of prevention, they tend not to connect the dots between health insurance plan design that drives prevention and the resulting cost savings.

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I believe that the quickest and surest way to a responsible health care bill which will benefit all citizens is to require all legislators to have the same coverages available to the average citizen. Because our federal legislators do not participate in the health legislation they are proposing for Joe Citizen they lack the incentive to construct cost effective plan. If our Sentor's and Congressmen were to face the same choices we will after the bill is past maybe they would stop listening to the special interest groups, insurance and pharmaceutical industries, and pass a bill we all could afford.

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Leveraging Health - Health Care Rx Panelists

Leveraging Health

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Life intervenes sometimes. I haven't had the chance to blog for the health-care reform panel in a month. However, during a layover en route from Washington, D.C., to Dartmouth (Hanover, N.H) to speak to Paul Gardent's class at the Tuck School of Business, I had the opportunity to again pick up laptop to commit my thoughts to... well, not to paper.

First, to play catch-up a bit. "How significant is the malpractice problem?" Very significant. The current situation certainly promotes defensive over-ordering of marginally indicated services. We need tort reform now!

"Taxing 'Cadillac' health plans: yes or no?" Yes. Taxing health-care benefits above a certain threshold should drive purchasers to find higher-value providers. For this to be successful, however, every plan must include a core set of high-value services (mostly preventive and catastrophic).

"Will cuts to Medicare Advantage hurt beneficiaries?" I honestly don't know.

And now, to the topic topmost in my mind this week: driving health-care value.

Sept 30 was an auspicious day for the Center for Health Value Innovation . I have the pleasure of serving on the Executive Board of Directors for this not-for-profit organization whose mission is to spread the message that innovations in health-care benefits design do, in fact, drive behavior change. Change which, in turn, drives down cost while enhancing health. Our merry little band of like-minded employers, payers, and providers launched the Center's first book, Leveraging Health, at the National Press Club in Washington, D.C. Authors include Cyndy Nayer, Jack Mahoney and Jan Berger. I had the pleasure of serving as emcee at the event. The book's a thin tome, and that's a good thing; an essential distillation of the major "levers" that move health-related behavior. It represents the stories of many of the founding members of the CHVI board. We learn a lot from each other and continue to innovate at our organizational homes. I bring up Leveraging Health at this time because I wish Congress would take our lessons to heart in crafting health-care reform legislation. Also to follow our lead in brevity.

Archimedes once said, "Give me a lever long enough and a fulcrum on which to place it, and I will move the world." This moment in American history is our fulcrum. However, I fear that as the days now grow shorter, so too, our lever to effect meaningful health-care reform shortens. This week began with news that the "public option" would appear to be dead (whew)! I hope that in Congress' haste to pass something, they do not lose sight of the true goal of health-care reform: aligning the incentives of all the actors in the health-care drama such that our ultimate outcome - a healthy U.S. population - emerges above the entrenched interests of those who would wish to see us remain mired in the sale of units of health-care delivery.

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Electronic medical records is the previous category.

Health costs is the next category.

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Savings at Seniors' Expense or Crucial Cost-Cutting? - Health Care Rx Panelists

Savings at Seniors' Expense or Crucial Cost-Cutting?

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If our seniors are worse off after reform than they are now, then we've failed. The health care overhaul must not inadvertently hurt those we're trying to help the most, among them retired Americans on fixed incomes who are particularly vulnerable to cost increases.

Cuts to Medicare Advantage are an area that seniors may feel jittery about. It's supplemental insurance that Medicare recipients can purchase to augment their coverage. The administration's claim that everyone gets to keep their doctor certainly wouldn't apply to all the Medicare Advantage subscribers who would lose coverage and providers if the cut goes through.

On the other hand, Medicare Advantage is privately run and has been seen by many in the reform conversation as a give-away to private insurers. According to their view, a trim to Medicare Advantage, an elective and supplemental insurance vehicle presumably favored by those seniors who can afford a little extra, will create $113 billion in savings that can be passed along to Americans throughout the health care spectrum.

We certainly don't want a system that overpays insurers without improving efficiency. At the same time, we need to make sure that important protections are included that limit cost sharing for certain Medicare Advantage services, like chemotherapy. To be fair, Sen. Max Baucus is working to refine this component to be less burdensome to seniors. No piece of legislation is perfect on arrival (or passage, for that matter) and my hat's off to him for trying to create solutions.

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Electronic medical records is the previous category.

Health costs is the next category.

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If You Like Your Coverage, You Can't Keep It - Health Care Rx Panelists

If You Like Your Coverage, You Can't Keep It

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Medicare Advantage was created to give all seniors more private choices of higher quality and better benefits. Today it provides almost 11 million Americans coverage through private insurance plans--roughly 20 percent of all Medicare recipients. Recent data shows that seniors have better health outcomes under the plan. In fact, Medicare Advantage enrollees spent an average of 18 percent fewer days in the hospital than seniors in traditional Medicare; they had an average of 27 percent fewer visits to the emergency room; and, they experienced a 42 percent lower rate of hospital re-admissions.

The reform proposals currently being considered in Congress would gut the Medicare Advantage program risking the health and well-being of millions of seniors across the country. In the House, H.R. 3200 would cut Medicare Advantage by $172 billion, and in the Senate, the bill sponsored by Sen. Max Baucus would cut the program by $113 billion. These cuts are part of more than $400 billion in cuts advocated by the president and congressional Democrats. Despite the president saying "if you like your coverage, you can keep it," or the updated version, "if you like your coverage, you won't be forced to change it," millions of seniors who have Medicare Advantage plans would see their benefits slashed. This is not the "change" President Obama called for in November.

The president can do better. Rather than cutting Medicare, let's turn to cost-cutting measures that would truly transform our health system. Let's eliminate the fraud, waste and abuse that the Center for Health Transformation estimates would save our health system approximately $100 billion a year.

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In what media accounts are casting as a serious setback for President Barack Obama and lawmakers who back the "public option," the Senate Finance Committee Tuesday voted against including the provision in the bill. Reports also remark on GOP unity against the provision, which they compare to the Democratic split apparent in Tuesday's committee votes. Where I am a health insurance agent with www.benefitsmanager.net/SelectHealth.html . I find this frustrating somewhat. I don’t agree with the design of the “public option” where it works against a health system in place now and causes a financial burden on tax payers. But, I think we need one out there. I need the ability to get my clients a insurance policy that won’t decline them for pre-existing medical conditions. See Utah’s response to health care reform and health insurance reform. www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm.
Perhaps the feds should look at the only second state case attempt for reform as a model. What about TORT reform? That honestly impacts doctor insurance costs as well as health insurance premiums by 13% See study in prior link.

Newt Gingrich doesn’t like to deal with facts. The fact is Americans are already paying for universal health care, we just aren't getting it.

The former Speaker of the House fancies himself something of an economics expert, Ok, think back to your High School Economics class. What is the basic force in any capitalist economy? Supply and Demand right? So if we embrace Gingrich’s ideas of reform, Health Care will never be affordable for everyone. It's basic economics. When demand for any good or service is greater than the supply, what happens to the price? It goes up. Likewise when supply exceeds demand, the price of that same good or service will fall. Capitalism 101 right?

Under Newt’s dream of a purely market driven health care system you will have to accept a situation where prices will never fall but instead, keep going up forever. Demand for health care will ALWAYS far outpace the supply.

Newt Gingrich and his fellow 0pponents of a public option should be honest and call their approach what it really is. Economic Darwinism. Survival of the richest.

Newt Gingrich and his ilk, scream of health care rationing under a public plan when in fact, that is exactly what we have now. Rationing of care based on income. If you believe that is a good thing, fine. But be honest and call it what it is. As a nation we had far less public debate on whether or not to wage war to avenge the deaths of 3000 people on September 11th, than we are now having about a health care crisis where 84,000 people die every year as a direct result of health disparities in the United States.

If you oppose a public element to American Health Care you are saying that a certain number of Americans dying because they can't afford medical care is acceptable to you . Ok then, Newt Gingrich needs to be honest and answer one question for me;

How many American lives is Newt Gingrich willing to sacrifice to be ideologically comfortable?

For once in this debate, be honest. Give me a number.

Kill the messenger not the message. Rules for Radicals...
POSTED BY: CYNDIKUS | OCTOBER 3, 2009 6:51 PM
-----
May 1993

I do not remember this occurrence, I am extrapolating and juxtaposing from the facts at hand...

I am sitting at an airport lounge in Singapore with five more people. At length, the figurehead concludes his arguments, turns towards me and says "For the sake of the mission, you will have to take the trip, even if that means you may be hit and fall". I freeze and am not sure for how long. The figurehead plods on "What have you decided?". I can barely believe what I heard even as I am saying "I have taken quite a few punches and falls, one more shouldn't hurt that much".

I believe now is the time for Newt to sucker up some punches. He has taken quite a few in his career, surely one two more punches won't hurt him that much...

As retiree from my state I was at first on federal Medicare. No problems. Then I was pushed into a Medical Advantage program. Then that one was taken away and the state stuffed me into a different company and policy. Each time my care has gotten worse and more expensive. It is a foolish waste of funds for the Medicare system to be handed over to for profit insurance companies. I would like to see the Medicare Advantage program abolished! It has been a scam from day one. Seniors who think it is so good have been misled or have misunderstood what they are getting. There are least 4000 plus people in my state who don't want these programs either (the other retirees in my group) . When my friend and I go to get a flu shot she gets hers and leaves. I have to pay for mine or do without. That' s just one of the wonderful things my Medicare Advantage policy has done for me. If my friend and I need PT she gets hers through Medicare and I have to pay for mine. I don't have any choice of policy either. That's my Medicare Advantage program working for me. I don't complain for paying. It's just that why should my friend not pay and me have to pay and call that right. I myself am a proponent of a single payer system (or Medicare for all) as the only workable way to cover the most people fairly and honorably. We must try to setup some system to prevent private profiting on peoples illnesses and disabilities. Insurance companies are out of control.
I want people to have insurance. I know its value as I have been uninsurable from an illness at the age of 7 and, though I have been extremely healthy since then, the insurance companies don't care about that.
Unfortunately, if you see who is paying through contributions etc to the folks in the federal system which deals with these kind of problems, you will doubt that there is much hope for real reform and solutions. I recently saw a list of the salaries of some of the healthcare insurance execs and I was appalled.

"Waste, fraud and abuse."

If I only had a nickel for each time some pandering politician uttered those words...

Newt, give us a break.

Newt, you make me feel so sad!

What a blowhard you are Newt. What's amazing is that the so-called liberal media continually gives you a platform to run your trap. You have no credibility.

The Post is so afraid of being criticized for liberal bias that they permit liars and miscreants like Gingrich to print this nonsense in their paper. This isn't permitting equal access to varying points of view; this is aiding and abetting demagoguery. Enough. It's time to tell these fools to peddle it across town or on Fox News.

Gringrich is a right-wing extremist. Nothing that comes out of his mouth is true, or can be trusted. His "facts" concerning Medicare Advantage outcomes are cherry picked to support his view. Real Medicare studies have shown that there is no difference in outcome between standard Medicare and Medicare Advantage. What Gringrich is not telling us is that Medicare Advantage costs the taxpayers a lot more money and is one of the reasons that the Medicare fund is going in the red. The other reason is the unfunded prescription benefit passed by Bush's Republican cabal, the ones who more than doubled the national debt in less than 8 years, from less than 5 trillion to over 11 trillion. Gringrich is a liar and a fool. Gringrich was forced to resign from Congress because he has no ethics. Gringrich is hoping the public has no memory of his corrupt, foolish, divisive time in Congress. Gringrich is one of those facist right wingers that is dividing this country and tearing apart the fabric of our democracy with his demogogery.

Someone needs to stand up for the insurance companies. Here he is.....

Thank you, please post it- ihave sent this several news papers ans still nor waste.

Newt is just looking at the cost of care- can we afford-even drop of blood seen on the body is magnified and equivated with with death. Simple things should be simplified.Exaggeration become meaningless. I am a retired Cardiac surgeon, a drop of blood does not phase me- that was what was taught to me. We, as nation start using commonsense, instead of Gory picture behihd it. The war scenes, street fights are overly exaggerated by media as well as the people. Our health care costs have become the servent- diagnsotic tests are fine, but that is not the end point. I am sure millions of our citizens waste in trivia.But we become aggressive with law suits- who is paying for it, WE THE TAX PAYERS. The other fact is rich get better care than the poor, that is hogwash- there can be one medicine for that particular disease- after diagnostic tests- same conclusion. As a senior, but in the system, my malady is still there, and I have become sick and tired- altimately saying, let me deal with it. Unfortunately, in this age of GOOGLING, hardly any body check out the facts. Use commonsense- my mother in India took me to the hospital, torniquet, elevating the legs where the GASH was- my mother was more literate. First Aid- learn it by simple education- one need not be genius. Thinking back, I should have died bleeding- 1942.

This is also a great part of medical care- responsibility and commonsense

Goobers across the land need someone like Gingrich to reinforce their fear, loathing, paranoia, and cowardice -- and here he is ala the Washington Times (er...Post).

He pontificates, grandstands, and drools his shallow, divisive drivel over one part of a proposal while ignoring the fact that, by enforcing the elimination of Medicare fraud and waste by his pals, seniors -- as well as all US citizens -- will be much better off.

This adulterous, draft-dodging, hypocritical, racist wing-nut is responsible for so much back-stabbing, underhanded, behind-the-scenes special interest love-making and outright lies to the American people that it's amazing he hasn't been tried for treason.

Tip O'Neill was absolutely right -- Gingrich was an international embarrassment to the US Senate, and I thank God he is no longer allowed anywhere near the Capitol Building.

AND btw goobers -- I'm a moderate republican who once actually voted for this sniveling swine.

.

Kill the messenger not the message, rules for radicals MO. Instead of acknowledging what Gingrich says is true, that if you cut Medicare Advantage, those on Medicare will get less medicine, you go after the man you hate and attack his character. Keep drinking the Kool-aid. A bankrupt government can not give you everything you need. We are on our way to a devalued dollar that will be replaced for another currency, we are greatly in debt and we haven't put a dent in the forclosure problem which is essentially a bank default problem in the making and all you can think of is give me more stuff for free. You will soon be living in a third world country and the UN and Chavez are salivating with joy at this moment.

Kill the messenger not the message. Rules for Radicals....
What Gingrich is saying is completely true, yet instead of addressing the issue which is cuts in Medicare will hurt those on Medicare, you attack the man you hate.
Keep drinking the kool-aid if you think a bankrupt government can give you everything you need, you will learn how to survive as a third world country, which is exsctly what the UN and Chavis are hoping for. Cheers

Wonder if Mr. Gingrrich would accept a Medicare Advantage program where the providers MUST be non-profit since those on the current system are almost all fixed income members? If you don't have a system that is capable of increasing revenue, then why should the providers be allowed a yearly profit increase of one and a half percent? Non-profit provider cooperatives don't have international capital backers that must get an ROI like the current yearly 18 billion, so the Wall Street 'green shirts' wouldn't be interested. On the other hand, non-profit cooperatives as the only Medicare Advantage providers couldn't be nationalized, so the California 'red shirts' wouldn't be able to waste 20 billion a year. Does that mean the tax payers could keep an existing system going that reduces its cost by 3 billion a year because no one is able to skim off the top? What say, Mr. Gingrich, half a dozen programs at different age/income levels in which the objective is health care of that group instead of left/right/left skims?

Fellow Democrats,

Our mistake has been in wasting our time trying to reason with Republicans -- who have no heart, no brain, and no soul.

Republicans are at best a tapeworm on the body politic.

They're a disgrace to all warm blooded creatures.

Cold and calculating as the original Terminator they see other human beings as meat for their table, as lesser beings that exist only to serve them.

They can stick that where the sun never shines.

Its time to start using the DEMOCRATIC SUPERMAJORITY.

It has a nice ring to it, doesn't it, fellow Democrats.

We've already won.

We keep on forgetting that.

We don't need to spend a nanosecond bothering to try to convince the Republicans of anything.

They're not going to vote for what we want no matter what we do.

The time for bi-partisanship and making nice is over.

Its time to start using the DEMOCRATIC SUPERMAJORITY.

All we Democrats need to do is to vote as a block, just like the Republicans do, and we can get anything we want.

Private Advantage programs charge the government up to 19% more than what traditional Medicare pays for the same services. PLUS, they take can negotiate with suppliers where the law forbids traditional Medicare to do the same--and POCKET THE DIFFERENCE!

It's a license to print money for private insurers. If Newt is serious about finding Medicare fraud and abuse, he need not look any further.

I favor the Congress enacting a publicly-funded insurance plan with the insurance companies operating as non-profit cooperatives. Congress should nationalize the health insurance companies, in order to do this.

But it's not fair for the Congress to make cuts of this magnitude or enact a so-called "public option" - either of which would have the effect of putting private companies out of business at the hands of the Federal government. That's not even socialism, it's communism. Socialists pay for their programs by expropriating the companies and paying stockholders for their lost investment. That's what Hugo Chavez did, for the most part, in Venezuela. So, the American Congress by promoting this legislation is acting worse than Hugo Chavez.

For six long years the Republican party controlled both houses of congress, the presidency and had a friendly supreme court. They did absolutely nothing about health care. I find it difficult to see where they have any credibility on the matter.

Sorry to inject facts to this discussion. The windfall from MA is apparently real. Gingrich is likely a benefit of contributions. Why else would he be for a bloated federal program that wastefully spends taxpayer dollars?

http://voices.washingtonpost.com/ezra-klein/2009/09/is_medicare_advantage_worth_it.html

From what I hear and read, there is almost nobody that wants to continue this program. It was set up and gamed by insurers to maximize profits. They cherry-picked the healthiest seniors and collected big money. Nobody would want to keep it... except the insurers benefitting from it. I wonder if they have given any money to Newt's PAC?

"As opposed to the idiot who stated the plan is complicated on is mainly for the rich, I would state emphatically that it is quite the opposite."
========================
Well, I'm that "idiot"

"Rich" is a relative term.

When you have an income bordering around (slightly above, or below) poverty, these plans make NO sense.

If they do not cost more than the Part B premium, they offer NO additional service and certainly offer NO savings.

Most do not take the time to analyze their spending under both plans. I have done this, for myself and others, although it is complex.
The numbers don't LIE, only those making the PROFIT have the motive to deceive.

I am a Medicare recipient. I have studied these plans for myself and my neighbors.
Not one single plan LOWERS cost for seniors. Very few offer increased services. ALL cost extra money for taxpayers. Those that do offer increased services over standard medicare cost more than the value of the added service.

With any thought, it is clear this MUST be true. Whay?

They are skimming PROFIT from the system. Each $ of profit is one less $ for care.

It really is not difficult to understand.

IF these plans were non-profit, then they might be a good idea.

It is obvious from reading the above comments that those of you denigrating Medicare Advantage do not have the foggiest idea of what you are talking about. I have been enrolled in a Medicare Advantage plan for over 5 years and as far as I am concerned the plan works beautifully.

As opposed to the idiot who stated the plan is complicated on is mainly for the rich, I would state emphatically that it is quite the opposite. The cost to the insured is significantly less than under regular Medicare and the coverage is better. In my area the main beneficiaries are those at the lower end of the income scale. Eliminating or greatly reducing this plan will have a major effect on those who can least afford it.

We finally have a government program that works and now you want to take it away.

"If You Like Your Coverage, You Can't Keep It"

This is all too true. I lose my 2/3 COBRA subsidy in December and after that there is no way I can afford to pay $1050/month to keep that plan.

My wife and I both have pre-existing conditions that make us uninsurable. So far, our only income since I got laid off is from freelance work with no benefits. Between us we've applied for 300+ jobs, and so far we haven't gotten a nibble. Apparently there's no employer-paid health insurance in our immediate future.

So after we've both worked and paid taxes and plenty of health insurance premiums for nearly 40 years, Newt and the other licans want to cast us aside like used toilet paper?

Apparently so.

@Greg Neubeck, who wrote:

".....DON'T DISPARAGE THOSE OF US WHO ARE ALARMED AT THE INCIPIENT DAMAGE BEING WROUGHT ON OUR CONSTITUTIONAL REPUBLIC BY AN EXTREME LEFT-WING MARXIST RADICAL; and, belay the "racism" nonsense. Greg Neubeck"
===========================
You may not be a racist. There really is nothing racists in this comments.
You DO prove yourself to be a reactionary nut-job, with you silly language.
According to the Republicans, Roosevelt was a "Extreme Left-Wing Marxist Radical" as well.
Excuse us if we are not terribly impressed.

How many of you would bet that Lisa Tripp,
Assistant Professor of Law, Atlanta's John Marshall Law School, doesn't have a MEDICARE ADVANTAGE insurance plan; doesn't have a clue about how inadequate regular MEDICARE is in meeting all the health needs of seniors; and takes her talking points from AFL/CIO, SEIU, and HUFF. POST blogs?

Medicare "Advantage" was just another attempt by the RepubliCONs to Privatize Medicare.

Gengritch is intentionally misconstruing basic Cause and Effect. Only the healthiest and wealthiest Medicare recipients HAVE these "Advantage" plans. They are so complex to enter and understand, those with chronic health issues, or with limited resources, will stay away. Most offer NO services beyound Medicare, and cost tax-payers huge amounts of money.
They are just ANOTHER kick-back to the FOR-PROFIT industry.

Look, Gingrich is running for President. He should be buying column inch space to spread his folderol.

It's amazing to read that the same man who kept any enforcement language out of the medicare reform bill previously passed on his watch, would now call for removing the fraud and waste from medicaire. How do you do it if you have almost no enforcement powers. It is almost impossible to suspend or remove any provider or insurer from the system because of Newts own actions back then. Not to mention we would need to create another bureaucracy to investigate and more courts to prosecute. It probably is worth doing, just remember Newt has always preached against government interference in private insurers business and other government regulations.

I would point out that even if you could eliminate 90% of the waste, fraud, and abuse you would by his own numbers fall short as much as 100 billion.

Does this mean he opposes all reform or just opposes the idea of health coverage for all Americans. I believe it's the latter.

After all as a former congressman he receives a full service insurance plan cost free for the rest of his life.

the despicable gingrich, run out of town in disgrace after hamstringing the nation's government with his reactionary view of america. has re-emerged from his self imposed exile to champion the healthcare industry. mr gingrich regularly recieves money , support and an anxious forum to float his version of capitalist healthcare run for profit & the benefit of the investment class in america.he has no credentials to substantiate his positions. he is just a recognizable face & voice hired by a client to advertise their position by whatever means necessary to win. its no mystery why the healthcare industry embraced mr. gingrich, the only question is why did the post?

Medicare Advantage - Disadvantage to Taxpayers

Medicare Advantage puts the insurance industry between doctors and patients and that costs taxpayers too much. According to the Center on Budget and Policy Priorities, taxpayers spend an average of more than $1,100 for each beneficiary enrolled in a Medicare Advantage plan over traditional Medicare. Over the last four years taxpayers have put $44 billion in over-payments in the pockets of the health insurance industry. Some of that they have spent on services to insureds. But half ($22 billion) is profit, marketing and overhead. Can we afford this? Of course not. Gingrich has some good ideas on health reform (computerization of medical records among them), so why is Gingrich supporting such a fiscally irresponsible plan? I don't know, but it may have something to do with the fact that Gingrich's Center for Health Transformation is heavily funded by the health insurance industry. One more thing - be sure to check the source of his "data" about how good Medicare Advantage is - it all comes from, surprise surprise, the health insurance industry! We can't afford Medicare (Dis)Advantage.

Lisa Tripp
Assistant Professor of Law
Atlanta's John Marshall Law School

the despicable gingrich, run out of town in disgrace after hamstringing the nation's government with his reactionary view of america. has re-emerged from his self imposed exile to champion the healthcare industry. mr gingrich regularly recieves money , support and an anxious forum to float his version of capitalist healthcare run for profit & the benefit of the investment class in america.he has no credentials to substantiate his positions. he is just a recognizable face & voice hired by a client to advertise their position by whatever means necessary to win. its no mystery why the healthcare industry embraced mr. gingrich, the only question is why did the post?

The president can do better. Rather than cutting Medicare, let's turn to cost-cutting measures that would truly transform our health system.
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Listen Newt, I was unemployed for extended period of time during which I was forced to do short term part time consulting jobs etc.

I understand the pain and suffering of people who go through such duress.

So stop your bu_lll-shii_ttt.

Much as I respect you and your kind, right now I am willing to give away anything just to wipe that shii_tty smirk off of your shi_ttty face for good.

You and your likes are nothing but garr_bbage-eating, shi_ttt spee_wwing rottt_en bas_tarrds wormms in a se_wwage hole. Do you get it?

Let President Obama do his work.

The president can do better. Rather than cutting Medicare, let's turn to cost-cutting measures that would truly transform our health system.
-------

Why even give a voice to this newest witch hunt? The Post might as well give
Limbaugh and Trent Lott a comlumn or two.
Consternation and dismay is trying to be created in the minds of the elderly?
An all new low has been reached.

Spreading propaganda , the witch hunt is on again by the Newt.
I agree with the above posts as to why- even give the newt opinions a voice at all. To create consternation and anguish in the elderly?
The Post may as well give Rush Limbaugh or
Trent Lott a column.

When I read the title, I thought Newt was going to discuss a contrarian viewpoint to what President Obama refers to when he mentions these lines: ‘If you like your coverage, you can keep it’ – the EMPLOYER OFFERED COVERAGE, uttered always in that context. But no, it wasn’t about that argument at all. He does the same thing some of the people on right do – take something small somewhere that can be made questionable, and use it to paint the whole legislation unworthy because of that (‘the death panel’ example). He fully intended to commit fraud on our sensibilities again. So to begin with, he is doing something - committing a fraud – something he suggests as a cure-all.

Think of this way. When a possible passage of any legislation is say 55/45 and you are able to affect even a few legislatures by riling up some people using these fraudulent arguments, you may become responsible for the problems posters like ‘jazzfan1’ above do and will face. This of course is what you are trying to do speaking from the lined-up pockets of the insurance companies and other healthcare providers. Are they contributing to one of your various campaigns for ‘this or that’ that you have called me to contribute about? Doesn’t your conscience ever bother you? Even just a little? Sorry but I wonder if God keeps a special place reserved for the likes of you.

Dear Newt,

by denying millions of uninsured Americans comprehensive health care the Republicans, i.e. you, condemn them to a life of illness and an early death. New, you are sitting on a death panel!

Sorry - I don't hear good things about Medicare Advantage....

Insurance companies exist to make a profit.

That means they're checking every claim twice with the intent to reject it.

beware.

People would be willing to support a massive government run health care if they could only trust government -- but we can't. Fix Medicare and Medicaid (which is suppose to be for those who cannot afford the insurance), find the fraud (just don't tell us you're going to do it -- just do it first) and then we'll go from there.

With regards Obama's fiscal policies: "IF" Obama is successful in implementing his Socialized Health Care Reform -and- his commercially destructive Cap and Tax legislation, this Nation WILL EXPERIENCE a double-dip recession; and, IN ALL PROBABILITY an economic relapse far worse. Obama is the most dangerous demagogue EVER to surface on the American political scene. FOR THOSE OF YOU WHO ELECT TO PARTAKE OF THE OBAMA KOOL-AID, THAT'S MOST CERTAINLY YOUR PREROGATIVE; BUT, DON'T DISPARAGE THOSE OF US WHO ARE ALARMED AT THE INCIPIENT DAMAGE BEING WROUGHT ON OUR CONSTITUTIONAL REPUBLIC BY AN EXTREME LEFT-WING MARXIST RADICAL; and, belay the "racism" nonsense. Greg Neubeck

The difficulty with Mr Gingrich's argument is that Medicare Advantage, while a great idea turned out to be nothing but a boon for insurers. One only has to read the Medicare Annual Bulletin to see how many companies are enriching themselves. The proposal is only to make insurers bid for the business rather than receive a guaranteed overpayment.
This nation is cursed by unswerving loyalties to ideology rather than intelligent results. Let's do what is right for our nation and forget conservative vs liberals all the day.

Medicare advantage has become a marvelous government subsidy of the wealthy: First, the insurance companies, Second, many of the well off Americans who can afford to buy extra coverage at better prices than the poor can.

At what point will the GOP quit trying to gut reform? People are dying every day because they didn't have coverage and didn't get treatment in time. That Republicans continue to play politics with the lives of the neediest among us is to their everlasting shame.

I cant understand why they keep running commentary from discredited hacks like Newt , Kristol, Gerson. No wonder this paper is going under. What , cant find Nixon to write something you like?

So why can't the insurance companies use some of their bloated profits to continue this option? Oh, I see, they can't possibly compete in the revered "free market" arena without subsidies from the government. Does Gingrich actually ever think before he babbles? I thought his whole movement existed on the caveman slogan of "free market good, government bad." So what's wrong with cutting some of the waste he so decries, starting with this massive welfare program for big insurers?

Adult newts have lizard-like bodies and may be either fully aquatic, living permanently in the water, or semi-aquatic, living terrestrially but returning to the water each year to breed.

I don't like my coverage. Thanks for asking.

Republicans fought a tough battle to prevent Medicare from existing in the first place, claiming that it represented "Socialism" and would ruin the country. They pilloried it over the last four decades. Suddenly they've changed their spots, claiming to be defenders of the "right" to a Medicare program that they spent generations attacking.

Newt Gingrich has a slick presentation of a fraudulent message. Medicare Advantage is a government subsidy for private insurance programs. It is a taxpayer-funded welfare program for those that don't really need it. Gingrich and his fellow Republicans hated welfare when it helped those who needed help, but they love a government subsidy when it helps wealthier individuals and--let's admit the truth--when it helps the companies that are funding Gingrich's money-making operations.

I don't like my coverage. Thanks for asking.

Republicans fought a tough battle to prevent Medicare from existing in the first place, claiming that it represented "Socialism" and would ruin the country. They have pilloried it over the last four decades. Suddenly changed their spots, claiming to be defenders of the "right" to a Medicare program that they spent generations attacking.

Newt Gingrich has a slick presentation of a fraudulent message. "Medicare Advantage" is a government subsidy for private insurance programs. It is a taxpayer-funded welfare program for those that don't really need it. Gingrich and his fellow Republicans hated welfare when it helped those who needed help, but they love a government subsidy when it helps wealthier individuals and--let's admit the truth--when it helps the companies that are funding Gingrich's money-making operations.


Eliminate fraud, waste and abuse immediately. Send the Ginch away, far away.
oldswede

Why is this man getting a column in the Washington Post - or anywhere? He's irrelevant, except to the health care organizations that join his for-profit "Center for Health Transformation": "A Charter Member membership is "Open to any organization that pays the annual Charter membership fee" and entitles the member to, among other things, "Quarterly planning sessions for Charter members only"; "Invitation to Charter Member only retreats, summits and special events"; "Invitation to participate on the CHT Advisory Board Invitation for five (5) attendees at all CHT member meetings"; "Invitations to serve on panels"; and "Access to Newt Gingrich on your company’s strategy."

AstraZeneca
BlueCross BlueShield Association
Booz Allen Hamilton
Cancer Treatment Centers of America
DaimlerChrysler
Ford Motor Company
Gallup Organization
GE Healthcare
General Motors Corporation
GlaxoSmithKline
Healthways
MedImpact
Novo Nordisk
Sanford
SHPS
Siemens
Sutter Health
UnitedHealth Group
ValueOptions"

http://www.sourcewatch.org/index.php?title=Center_for_Health_Transformation

Judging by the type of clients he serves, it would seem that the best advice Mr. Gingrich offers is how to turn sick folks into cash cows. Is there a charlatan in the house?

But Newt, the thing is I DON'T like my coverage. I'm self-employed, and in fact I can't get coverage at any price from private insurers because of a pre-existing condition, even though I've been completely healthy for almost 20 years.

So all you conservative blowhards are ruining my chances to get decent, basic health care. Thanks.

What is it with you guys? Why are you so set against this? All your arguments are so flimsy or hypothetical as to be essentially non-existant. The only conclusion I can reach is that, once again, you're trying to score cheap political points. Well, this time you're doing it with my well-being, and I'm damn pissed off about it.

Health care reform is one thing. Reducing the cost of health care is another. At least the cost of medicine? Stop those prime time pharmaceutical company commercials. Aired nationwide their cost must be in the billions of dollars, which of course is added to the prescription cost. They advise us to "check with your doctor," or "ask your doctor," or "get a simple blood test" to determine whether the side effects will be fatal. They don't seem to know that to check with your doctor requires a co-pay, that a simple blood test requires co-pays to both the doctor--who must authorize it--and to the lab to draw and analyze the blood. If these drugs are so great why can't they simply tell the doctors about them and let them--not the patients--decide whether they are appropriate?

And consider these pictures. A few months ago, a three-day hospital stay resulted in a bill of more than $60,000. My insurer (Kaiser Permanente) settled it for about $7,000. A more recent bill of more than $20,000 (for less than a one-day stay) was settled by Kaiser for about $3,000. Now, which of those four figures are correct?

Cute headline, but it applies to the current employer-provided private system prevalent across the country. Coverage keeps going down, premiums keep going up, and then the employer drops the insurance plan entirely or the insurer cuts YOUR coverage entirely, or you change jobs and lose your coverage entirely. Great system, for insurers.

Mr. Speaker - definition please.
The man working in his garden two days ago who now comes in with low back pain & demands a lumbar MRI? Is that waste or abuse?
The mother whose child was "up all night" & today demands the pediatrician prescribe an antibiotic, is that waste or abuse?
The executive insulted by the offer of a first tier, low-cost generic, because "everyone knows they aren't as good as 'trade-name' drugs" - waste/abuse?
Expensive, though. And not always good medicine. Would the withholding of the above because of no "evidence base" constitute "rationing"?

I cannot understand why Gingrich is still on the political scene. He is a has been. He needs to get some help.

I'm all for cutting waste and fraud. I'm also all for giving everyone the option to get insurance from the government.

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Seniors Would Save Far More Than They Lose - Health Care Rx Panelists

Seniors Would Save Far More Than They Lose

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Like Ezra, I am impressed by health-care economist Austin Frakt's analysis of Medicare Advantage (MA) . I wrote about it here . A quick summary: "under Obama's plan a small fraction of Medicare beneficiaries will lose their MA benefits and/or face higher costs. However, the potential savings are enormous and research shows that the benefit cuts needed to achieve them will not be terribly missed."

At the same time, Mark Kelley tells us that his patients love their Medicare Advantage HMO plans, and that before giving up on MA, the government should look at plans "on a case-by-case basis, examining the performance of every contractor."

Kelley is right: there are individual insurers out there providing value for tax-payer dollar. But these are insurers who offer the Medicare HMOs that he is talking about. These HMOs do a much better job of managing costs than Medicare Private Fee-For-Service plans (PFFS).

The average PFFS plan receives $114 more per member per month than traditional Medicare would spend on the same senior. Meanwhile, it delivers "extra" benefits worth $35 a month. And who is paying the $114 tip? Medicare Advantage is financed by traditional Medicare.

Thus the 78 percent of Medicare beneficiaries who have stuck with traditional Medicare are funding the bonus for PFFs. Not only that, they're spending $3 for $1 of extra benefits going to someone else. This hardly seems fair.

Why are PFFS so expensive? They are not designed to rein in spending. Quite the opposite, "fee for service" encourages over treatment: the more a provider does, the more he is paid. Let me be clear: very, very few doctors recommend tests and treatments that they know their patients don't need. But there are so many gray areas in medicine, and this is where fee-for-service does create an incentive to "do more."

By contrast, the Medicare HMOs that Kelley is talking about receive a fixed annual payment for every beneficiary. It's up to them to figure out how to use that money to keep their patients healthy. If they fail, the cost of patient care may exceed the yearly payment.

These HMOs "bid" for patients, telling Medicare how much they think they will need to care for the average patient for a year. The 2009 Medicare Payment Advisory Commission (MedPAC) report explains that this year, the average HMO is offering to provide patient care for 2 cents less than it would cost traditional Medicare. So for every dollar spent, the average beneficiary in a Medicare HMO receives an extra 2 cents worth of benefits. The quality of the HMOs varies widely; the more established HMOs typically offer the best value, MedPAC observes.

This suggests that some private insurers have found ways to enrich the benefit package by being more efficient. This stands as persuasive evidence that private insurers do not need corporate welfare. They can provide comprehensive care without spending more than traditional Medicare. The best HMOs have figured out how to do this and Kelley is not the only witness who reports that patients are satisfied with the results. I have heard from patients and doctors in the Northwest where Medicare Advantage is working well. Often, the insurers are non-profits.

But don't some expensive Medicare Advantage programs provide freebies that seniors like, such as eyeglasses frames and gym memberships? Yes, they do. But there is no reason that the 78 percent of seniors who have stayed with traditional Medicare should be footing the bill for the 22 percent in Medicare Advantage--especially when they are paying three times what the benefits are worth. Nor is there medical evidence that most of these extras improve health.

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Good Deal or Rip-Off? - Health Care Rx Panelists

Good Deal or Rip-Off?

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Medicare Advantage is a good concept: the government offers an HMO option instead of the disjointed fee-for-service of traditional Medicare. The insurance company receives a fixed annual payment for every beneficiary. Medicare Advantage eliminates billing hassles, keeps patients in organized systems of care and emphasizes quality and access. My patients love it, particularly since they are accustomed to HMO insurance.

Now, the sticky part. Congress provided incentives for the insurance industry to participate in this program. Since then, most insurance companies have gained financially from this program. Some argue that this has been related to good management while others contend that some insurers have ripped off the government.

The facts should speak for themselves: did patients get access to cost effective and appropriate care? Was quality improved? Are the patients highly satisfied? If the answers are all favorable, then the "profits" were well deserved--and the public got its money's worth, at a negotiated, fixed price. This is what "bending the medical inflation curve" all is about.

On the other hand, if none of these goals were achieved, the taxpayer got a raw deal. Therefore the government has every right to reset its price and its expectations. However, this needs to be managed on a case-by-case basis, by examining the performance of every contractor.

Americans are used to this. We shop for good deals in large retailers like Wal-Mart and Costco and worry little about their profits. For Medicare Advantage, the federal government must be our prudent shopper--and manage this program by business fundamentals rather than sweeping legislation.

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A Wasteful Program - Health Care Rx Panelists

A Wasteful Program

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The argument over Medicare Advantage is pretty simple: The program, which allows private providers to compete for Medicare patients, was supposed to cost as much or less than traditional Medicare. It actually costs 114 percent of what Medicare costs. Democrats want to eliminate those overpayments and force private insurers to live within Medicare's budget, given that they're taking Medicare's money. Republicans say that will cut benefits for retirees, which is something they're suddenly very concerned about.

On some level, Republicans are right: The reform will change some benefits for a small minority of Medicare's beneficiaries. But will it change it by very much? Austin Frakt, a health economist at Boston University, has studied whether the Advantage program is spending its windfall on patients or not-patients (profits, advertising, administration, and so forth). The answer? Not-patients, mainly.

Payment to MA plans has gone way up since 2003. Did the payment increase largely benefit beneficiaries or not? This is a current political and policy debate, about which much has been written in the media (both traditional and blogospheric). It turns out the answer is known and quantifiable. My work (with Steve Pizer and Roger Feldman) shows that for each additional dollar spent by the federal government (taxpayers) on the program since 2003, just $0.14 of it can be attributed to additional value (consumer surplus) to beneficiaries (see also: findings brief).

What do we make of the other $0.86? That goes to the insurance companies but doesn't come out "the other end" in the form of value to beneficiaries. In part it is accounted for by the costs of the additional benefits and in part it is captured as additional insurer profit.

So, do higher MA payments produce little value to beneficiaries, as Obama claims, or are the benefits they fund important to maintain, as Republicans would have us believe? The balance of the evidence is on Obama's side. In fact, it is a landslide: for each dollar spent, 14% of the value reaches beneficiaries and 86% of it goes elsewhere (profit or cost).

"Cuts to MA should be a no brainer," he concludes. This is a case, incidentally, where Republicans have lined up in favor of a wasteful government program, where their rhetoric relies on the inviolability of current and future Medicare benefits, and where they are opposing a reform that will improve the deficit over time. It almost makes you miss the purity of the Gingrich crew.

Entry originally published here.

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Improvements For Everyone Else - Health Care Rx Panelists

Improvements For Everyone Else

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When the predecessor to Medicare Advantage was established, there were two key arguments made for it: first, that it would move Medicare to a system of care coordination, thereby improving health care for seniors and people with disabilities. Second, it would create efficiencies in a manner that would reduce program costs. Today, neither of these attributes are the hallmark of Medicare Advantage.

Too many Medicare Advantage plans provide little or no coordination. Indeed, the fastest-growing component of Medicare Advantage -- private fee-for-service -- simply takes the old fee-for-service system in traditional Medicare and transplants it to the private health plans at a much higher cost.

It is by now well-established that Medicare Advantage is considerably more costly than providing coverage through the traditional Medicare program. According to the Medicare Payment Advisory Commission, those costs are approximately 14 percent greater than what the costs would be if Medicare Advantage enrollees were in traditional Medicare. Among the private fee-for-service plans, those costs are approximately 19 percent higher.

When Congress realigns costs so that Medicare Advantage payments are close to the costs of traditional Medicare, there may be some loss of benefits for the 1 of 5 people currently in Medicare Advantage. However, for the 4 of 5 Medicare beneficiaries who are not in Medicare Advantage, improvements will be readily apparent. By reducing the over-payments to Medicare Advantage, premiums can be reduced and the life of the Medicare Trust Fund can be lengthened. At the same time, America's taxpayers will no longer bear the burden of unjustifiable windfall payments to private health plans.

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Go After Fraud - Health Care Rx Panelists

Go After Fraud

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Why cut back on Medicare Advantage alone when there are so many other ways to find fraud? When clinics, usually the larger ones who can hide in largely populated areas, can double bill, bill for deceased individuals or charge for unnecessary tests or tests that were not even performed; that's fraud. When doctors in small towns take advantage of the elderly, when clinics bill for patients who were never seen or when a patient who needs to be seen cannot be; that's immoral.

When a senior citizen or a disabled individual qualifies for Medicare it's hardly taking advantage of the system. In order to qualify, they had to earn the privilege, pay into it for a number of years and rely upon it, usually, as a last resort. A Medicare Advantage program would not be my choice but my mother-in-law is in one now and my late mother belonged to such a program. They have both been happy with the care they received. I find it hard to believe that cutting $113 billion from those particular programs are the whole answer.

If they are billing in a criminal manner, if patients are being neglected, abused or not treated in any program, clinic or hospital, then the government who is supposed to be overseeing medicare should do a better job. This whole health-care reform subject has been hijacked by headline seekers and poorly informed politicians who haven't a clue as to what to do. Everyone is running around trying to put out their fire of choice without gaining knowledge of the facts. Of course, many elderly would be hurt if $113 billion was cut from this particular form of medicare application. How could they not be? Why are we allowing ourselves to be distracted from the basics of administering an honest and fair program? Is the task so overwhelming that we have to give up? Isn't the consideration of a public option just laziness? Do we really want the same government who has allowed Medicare to become so entangled to be turned loose on the rest of us?

Let's stop dealing in sound bytes and attention seeking devices and just take care of the patients. Go after fraud. Go after abuse. Go after those who ill use the funds for the elderly and disabled. Does anyone in Washington know what they're doing in this whole health-care reform issue? I think not and until they do, leave my life, my mother-in-law's life and the lives of seniors alone.

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No True Harm - Health Care Rx Panelists

No True Harm

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I am certain that there are some beneficiaries who will see any cut in government support (and, thus, the expected reduction in benefits or access; notwithstanding that much of the savings may just come out of the economic profit) as true harm. Knowing however, that the existing fee-for-service Medicare is there to greet them, I am confident that the greater good will still be served.

The history of managed care in the Medicare population has been a lengthy one with lots of ups and downs. Both Democrats and Republicans have embraced it, at one point or another, as a means of 1) holding down health care costs, 2) better integrating care for our nation's elderly and disabled, 3) offering expanded services in exchange for a more limited choice of providers (and therefore better negotiation over reimbursement rates), and/or 4) the ideological goal of moving the system toward capitated subsidies or vouchers. The most recent iteration, "Medicare Advantage" has been explicitly supported with additional subsidies (above and beyond the expected cost of the benefits and the "load factor"), in an effort to gain sufficient traction in all areas of the country: no one would expect a health plan to move into a region without the promise of profit; and the long history of government involvement in this sector meant a greater degree of skepticism (and, thus, a greater demand for a profitable opportunity) before entering and developing the necessary infrastructure. But, that has long since arrived and grown: with nearly 22 percent (10.2 million) now enrolled, varying across states with a low of 1 percent in Alaska to 42 percent penetration in Oregon.

If one believes, on ideological grounds, that Medicare Advantage is part of the solution to what ails our Medicare program, then continuing the pattern of subsidies (at least in the lower penetration states) may make sense. If, on the other hand, one believes that the gross overpayment is too high a price to pay for an experiment with uncertain results, we must cease or curtail.

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About this Archive

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market competition is the previous category.

Pharmaceutical Companies is the next category.

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