Consumer Power Report #468
In the wake of the U.S. Supreme Court’s decision to shield the Affordable Care Act (ACA) from legal precedence, the rule of law, and common sense in the landmark case King v. Burwell, the battle over the role of government in health care has now shifted away from the courts and back to the ballot box.
Democrats certainly have their work cut out for them. According to a July survey of likely voters by Rasmussen Reports, 53 percent of respondents say they have an “unfavorable” view of President Barack Obama’s signature health care law, with 37 percent indicating a “very unfavorable” position. Forty-two percent say they have a “favorable” view, but only a measly 20 percent of the 1,000 surveyed say they have a “very favorable” opinion of ACA.
The lukewarm opinion of the law isn’t a surprise to those who have studied ACA’s effect on the health care marketplace since its full implementation. Despite promises of greater access and affordability, Obamacare has done nothing but increase costs and limit health care freedom.
According to an analysis by HealthPocket, Inc., average premiums for men and women aged 23–63 increased substantially from 2013 to 2014, with young, healthy millennials having been hit the hardest. Men age 23 saw premiums rise by 78.2 percent and women age 23 saw increases topping 45 percent, compared to pre-Obamacare rates. Data released in 2015 indicate premium increases for millennials continued into 2015, and there are no signs costs will slow in the near future.
Cost increases have been coupled by a failure to provide care to 30 million people the Obama administration insisted did not have access to health care. A poll released by the American College of Emergency Physicians found three-quarters of emergency room (ER) doctors say ER visits on the rise, and an article in the Journal of the American Medical Association indicates the various programs established by the ACA have yet to have any effect at all on obesity-related diseases, perhaps the single greatest health care problem facing the nation.
In short, since ACA was forced on the American people, costs have gone up, access to primary care physicians has fallen, and the overall health of the nation remains relatively unchanged. Obamacare has clearly been a failure, and this damaging program’s supporters have already started looking for their next scapegoat.
In an article by Judy Lin titled “Road to health care bumpy for Latinos on Medi-Cal,” published by the Associated Press on Monday, a new strategy for advancing the necessity of further government control was revealed: demonizing doctors.
The article tells the story of Miriam Uribe, a 20-year-old college student who has been enrolled in Medi-Cal, California’s health insurance program for low-income people. Uribe says that despite actively seeking a primary care doctor for the past 10 months, she’s been unable to find a physician who will accept her as a new patient. Also cited in the article is Miriam Lagos, a 53-year-old who says she’s had to wait a year to see a specialist.
The article explains doctors say the reason so many in Medi-Cal and other Medicaid programs are being turned away is because reimbursement rates are too low, especially compared to the rates private insurers pay.
Lin reports, “Lawmakers have convened a special session to discuss increasing provider payments but there is no agreement on how to pay for them.”
Of course there isn’t. Cash-strapped states such as California can’t possibly compete with private insurers, and primary care doctors, who have to choose between patients who can actually pay for the full cost of the service provided and those who cannot. It doesn’t take an economist to explain why that’s not a difficult choice.
Some would see this as a significant design flaw of the Affordable Care Act, but that’s a big mistake. ACA was carefully crafted to achieve a specific goal, and no, that goal was never to provide as many people as possible with quality health care. If that was the aim, then simple, common-sense solutions such as allowing insurance companies to operate across state lines and creating programs that would increase the number of primary care doctors would have been included in Obamacare. The real foundation of ACA is the desire for increased government control over the lives of every American. Those who helped formulate the legislation have admitted the law was deliberately crafted and promoted to mislead people.
MIT economist Jonathan Gruber, one of the architects of ACA, made headlines in 2014 when videos of him surfaced calling the “lack of transparency” in Obamacare a “huge political advantage” and necessary due to the “stupidity of the American voter,” who Gruber suggested doesn’t know what’s best for him or her.
Further, Obama made it clear on numerous occasions the ultimate goal of health care reform is the creation of a single-payer health insurance system, one where government is the only insurance provider.
Once you put all the puzzle pieces in place – the provisions in ACA, the deception, and the goal of moving to a single-payer model – the picture becomes clear. ACA was designed to give the promise of health insurance to people who never had it, knowing all along the expansion of Medicaid would lead to millions of people being turned away by primary care doctors. This would predictably allow Democrats and those on the Left to pin the lack of quality care on doctors, many of whom belong to the dreaded “1 percent” the Occupy movement spent months ranting about.
The government promises health insurance it knows it cannot afford, the system falls flat on its face, and the only possible solution is to control costs, which means increasing taxes on the wealthy, cutting doctors’ salaries, and forcing physicians to make financially irresponsible decisions.
It’s the unholy trinity of the Democrats’ political strategy: create a new government program, blame rich people when it goes wrong, and then convince everyone to create more rules, regulations, and bureaucrats to take away the rights of others. It may be an old strategy, but you know what they say: “If it ain’t broke, don’t fix it.” Unless, of course, you’re talking about health care.
— Justin Haskins
IN THIS ISSUE:
When Christine Ryan’s ear was aching one recent afternoon, she didn’t head to the doctor’s office or emergency room; she went to her local CVS store in Cambridge.
Within 20 minutes, Ryan had been diagnosed with an ear infection and was picking up medicine and heading back to work. “This was the quickest visit I’ve ever had in my life,” the 24-year-old human resources professional said.
Consumers like Ryan increasingly are looking for faster and more convenient options to get basic medical care, and retailers like CVS are filling the gap with walk-in clinics and other services. That’s forcing traditional health care providers, from small doctors offices to big hospitals, to react.
At Atrius Health, a large medical group, more doctors are leaving their doors open until 8 p.m. Tufts Medical Center is taking online appointments for its emergency room. Several hospital networks are building walk-in clinics for urgent care. Doctors have started seeing patients through video chats. And apps are being built that will let consumers make appointments and view medical information from their phones, the way consumers already access so many other services.
“This represents a huge paradigm shift in health care,” said Normand E. Deschene, chief executive of Wellforce, the parent company of Tufts Medical Center and Lowell General Hospital. “The systems that are going to succeed are those that are going to embrace it because this is what the consumers want. Most industries follow what their consumers want. Health care should be no different.”
It was nice while it lasted, but it’s over and may not return for many years, if ever. The “it” is the slowdown in national health spending.
From 2008 to 2013, health spending grew roughly 4 percent a year, which was less than half the 9 percent average of the three decades before the Great Recession. Because the 4 percent rate matched the economy’s overall growth, health spending stabilized at 17.4 percent of gross domestic product (GDP). There was some hope that an era of sizable increases was over.
Forget it. Government actuaries from the Centers for Medicare and Medicaid Services (CMS) last week reported that health spending in 2014 rose 5.5 percent to $3.1 trillion. Worse, spending is projected to increase 5.8 percent annually between now and 2024. That’s faster than the economy’s expected growth, so health costs would rise to 19.6 percent of GDP by 2024. The gain in GDP share (from 17.4 percent to 19.6 percent) may seem small. Not so. It’s worth almost $400 billion a year. (All these dollar and GDP figures are unadjusted for inflation.)
So it’s back to the future. Health spending will silently shape the nation’s priorities. It will squeeze take-home pay, as employers devote more of their compensation to insurance and high deductibles raise workers’ out-of-pocket expenses. Government will spend more on Medicare (government insurance for the aged) and Medicaid (insurance for the poor). Other programs will compete for a smaller pot – or taxes will rise. The only good news, assuming the actuaries’ projections come true, is that spending has slowed from its pre-recession trajectory.
Rebecca Behrendt assumed it was a scam.
Landmark Health called late last year, offering to send medical practitioners regularly to the 82-year-old Schenectady resident’s home to help her keep small issues from mushrooming into medical crises that put her in the hospital. It would cost her nothing, the caller said. Behrendt’s insurance company was picking up the tab.
That sounded fishy to Behrendt. She had never heard of Landmark and hadn’t had a house call from a doctor since her children were small nearly six decades ago. She reached out to her health insurer, Latham-based Blue Shield of Northeastern New York. Yes, they said, this is real.
Now she depends on the new Care at Home program, which is designed for Medicare beneficiaries with at least six chronic conditions that put them at high risk for hospitalizations.
The program is the latest entry in an emerging trend toward helping patients manage serious conditions and avoid high-cost hospital or emergency room treatments. St. Peter’s Health Partners started its Home Visiting Physicians Program two years ago, to get doctors to patients who had trouble getting to a medical office. Ellis Medicine has established several initiatives to manage chronic conditions for patients at risk for hospitalization, including for Schenectady residents with asthma and another, called Transitions, for patients who are leaving the hospital and may need expert help to avoid a quick return.
Though they sound like a throwback to Norman Rockwell-era medicine, the impetus for these programs is saving money. It turns out that personal, at-home service may also be well-received by patients and result in improved care. More services earlier on – when treatments are simpler, more effective and less expensive – brings down health costs.
In an effort to reduce AIDS deaths and prevent new infections, Minnesota’s largest health care providers are rewriting the rules on who should get screened for HIV.
Instead of limiting testing to high-risk groups such as gay and bisexual men or intravenous drug users, the new rules call for everyone aged 18 through 64 to get tested at least once.
HealthPartners and the Mayo Clinic have already begun testing a broader group of patients, and other clinic groups are expected to join in coming months, after several influential blue-ribbon medical panels recommended new guidelines. …
Nationally, more than 1.2 million Americans are HIV-positive, including an estimated 168,000 who do not know that they are infected, according to the Centers for Disease Control and Prevention in Atlanta.
About 320 new infections are discovered in Minnesota every year, and about one-third, on average, are found in “late testers” – those who develop AIDS within one year of the HIV diagnosis. …
Under the Affordable Care Act, the HIV test is considered an essential preventive service, on par with mammograms, immunizations and colon cancer screening, which means that most health insurers must pay for it.
The U.S. Centers for Disease Control recommended universal HIV screening in 2006, but the goal received a boost in 2013 after the U.S. Preventive Services Task Force, a federal panel of prevention experts, urged the same. …
If HIV screening becomes mainstream, it will mark the biggest use of the test since it was first developed more than 30 years ago.
Medicare is still treading financial water.
The latest report on the program’s trust fund says it will become insolvent in 2030, the same projection as was issued last year. The conclusion by Medicare’s trustees means that if nothing changes, the trust fund will be able to meet all its financial obligations for another 15 years.
The report, released Wednesday, shows that per-beneficiary costs rose by 2.3 percent in 2014, the largest increase in three years. The increase was driven by a 10.9 percent spike in the cost of Part D drug coverage, which the trustees attributed primarily to the expense of breakthrough treatments for hepatitis C.
Medicare costs have grown at historically low levels in recent years – 0.3 percent in 2012 and 0.1 percent in 2013. The slowdown in spending rates has resulted in a significant extension for when the trust fund will begin failing to meet its obligations. Since 2010, when the Affordable Care Act was passed, the insolvency date has been extended by 13 years.
That has provoked heated debate over cause and effect. It remains an open question how much of the slowdown in costs can be attributed to the Great Recession and how much to Obamacare. Most health care experts come down somewhere in the middle.
SOURCE: Paul Demko, Politico