OBAMA vs MCCAIN: Who will deliver quality, affordable healthcare for all?
With all the back-and-forth about health care in this year's presidential election, sometimes it can be hard to know what to think about the candidate's plans. Having a discussion with fellow medical students can be a great way to find out more about the plans and debate their relative merits.
The AMSA scorecard on the candidate's plans is a great place to start your discussion. Find it on the AMSA website at http://www.amsa.org/election/scorecard.cfm
Questions to consider as you think about each candidate's plan:
1) How does a private health insurance system work? What are the fundamental failings of such a system, and how might they be corrected with market incentives or industry regulation? What other models for health insurance exist, and would it be feasible to use these in America?
2) Is health care a right? Do Americans have to choose between equality, efficacy, and efficiency in our health care system, or is there a way to get all three? Do the plans of either candidates offer substantial progress towards achieving this goal?
3) Under McCain's Plan: What are the advantages to buying health insurance on an open market, across state lines? What are the disadvantages? How might this affect the system as a whole?
4) Under Obama's Plan: Will healthy individuals purchase health insurance without mandates, or will they "free-ride" the system until they get sick, knowing they will not be denied coverage due to a pre-existing condition? What are the advantages and disadvantages to requiring mandates?
5) What do the two plans have in common? Where are the areas of greatest disparity?
6) Imagine you are running for president. How would your own health care platform differ from that of Senators Obama or McCain? How might your opponent criticize your plan, and how would you frame your argument to defend your plan to the American people?
Don't forget to vote!
...and as always, here's to your health!
Tuesday, October 21, 2008
Monday, September 8, 2008
SEPTEMBER Topic: Health Savings Accounts
In elections all over the country, candidates are raving about Health Savings Accounts. But what are Health Savings Accounts, and are they really the silver bullet for American health care reform?
Questions to Ponder
1) In what ways is competition good for health care? In what ways is it bad?
2) Do Americans overuse health care? Is this overuse supply-driven (by doctors and hospitals) or demand driven (by patients)? Can this overuse be controlled by Health Savings Accounts?
3) In what ways do Health Savings Accounts affect the rest of the insurance market? What is the reason for the insurance function, and how can insurance markets fail?
4) What information do patients need in order to be rational, efficient consumers of health care services? What tools are available to help patients become better informed? What are the information problems and uncertainty intrinsic to health care?
Background and Resources
The Promise and Pitfalls of Health Savings Accounts
Wall Street Journal - To Your Health
NYT Op-Ed - The Health of a Nation
NYT Editorial - The Lopsided Bush Health Plan
RAND Health Insurance Study
AMSA Health Savings Accounts Primer
NEJM - Health Savings Accounts: The Ownership Society in Healthcare
Health Affairs - Medical Savings Accounts: Lessons from Singapore
In elections all over the country, candidates are raving about Health Savings Accounts. But what are Health Savings Accounts, and are they really the silver bullet for American health care reform?
Questions to Ponder
1) In what ways is competition good for health care? In what ways is it bad?
2) Do Americans overuse health care? Is this overuse supply-driven (by doctors and hospitals) or demand driven (by patients)? Can this overuse be controlled by Health Savings Accounts?
3) In what ways do Health Savings Accounts affect the rest of the insurance market? What is the reason for the insurance function, and how can insurance markets fail?
4) What information do patients need in order to be rational, efficient consumers of health care services? What tools are available to help patients become better informed? What are the information problems and uncertainty intrinsic to health care?
Background and Resources
The Promise and Pitfalls of Health Savings Accounts
Wall Street Journal - To Your Health
NYT Op-Ed - The Health of a Nation
NYT Editorial - The Lopsided Bush Health Plan
RAND Health Insurance Study
AMSA Health Savings Accounts Primer
NEJM - Health Savings Accounts: The Ownership Society in Healthcare
Health Affairs - Medical Savings Accounts: Lessons from Singapore
Tuesday, July 8, 2008
JULY Topic: Medicare Payment Cuts to Physicians
Just before the Fourth of July recess, the House passed a bill to prevent Medicare a pay cut of 10.6% by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1. But the Bush administration has delayed processing of new claims to give Congress time to come up with a compromise.
Core Concepts (will open in new window):
KaiserNetwork.org, 7/16.08
Congress Overrides Veto of Medicare Bill To Delay Physician Payment Cut
New York Times, 7/13/08
Long-Term Fix Is Elusive in Medicare Payments
Congress has blocked a cut in payments to doctors but has not solved the problem that caused the cut, experts say.
KaiserNetwork.org, 7/10/08
Senate Votes 69-30 To Approve Legislation That Would Halt Medicare Physician Payment Cut
New York Times, 7/7/08
Doctors Press Senate to Undo Medicare Cuts:
Ads by the American Medical Association blame Senate Republicans for a 10.6 percent cut in payments to doctors who care for older Americans.
New York Times, 7/5/08
The Senate Stalls on Medicare
A sensible new Medicare bill must pass so that Congress can wring subsidies from inefficient private Medicare plans.
KaiserNetwork.org, 7/8/08
Medicare Physician Pay Patch Bill Might Gain Enough Votes for Cloture in Senate, Baucus Says
Questions to Ponder
- How do you think physician payments should be set?
- Should Medicare Advantage programs exist? Why or why not?
- Why has no meaningful reform occurred regarding physician payments through Medicare?
- Are medical students at your school informed about Medicare payments? Do they think what happens with Medicare will impact their future careers?
Core Concepts (will open in new window):
KaiserNetwork.org, 7/16.08
Congress Overrides Veto of Medicare Bill To Delay Physician Payment Cut
New York Times, 7/13/08
Congress has blocked a cut in payments to doctors but has not solved the problem that caused the cut, experts say.
KaiserNetwork.org, 7/10/08
Senate Votes 69-30 To Approve Legislation That Would Halt Medicare Physician Payment Cut
New York Times, 7/7/08
Doctors Press Senate to Undo Medicare Cuts:
Ads by the American Medical Association blame Senate Republicans for a 10.6 percent cut in payments to doctors who care for older Americans.
New York Times, 7/5/08
The Senate Stalls on Medicare
A sensible new Medicare bill must pass so that Congress can wring subsidies from inefficient private Medicare plans.
KaiserNetwork.org, 7/8/08
Medicare Physician Pay Patch Bill Might Gain Enough Votes for Cloture in Senate, Baucus Says
Questions to Ponder
- How do you think physician payments should be set?
- Should Medicare Advantage programs exist? Why or why not?
- Why has no meaningful reform occurred regarding physician payments through Medicare?
- Are medical students at your school informed about Medicare payments? Do they think what happens with Medicare will impact their future careers?
Sunday, June 8, 2008
JUNE TOPIC: How is Massachusetts Mandated Insurance Working?
A study from the Commonwealth Fund that analyses mandated insurance in Massachusetts one year on.
An article from the Boston Globe about costs.
- Do you think mandated insurance is the most cost-effective insurance system?
- What do you think are the advantages and disadvantages of mandated insurance vs. Obama's plan vs. publicly funded insurance?
An article from the Boston Globe about costs.
- Do you think mandated insurance is the most cost-effective insurance system?
- What do you think are the advantages and disadvantages of mandated insurance vs. Obama's plan vs. publicly funded insurance?
Tuesday, May 13, 2008
Medicare Structure
The Original Medicare: Parts A and B
Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor's office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.
Part C: Medicare Advantage plans
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans.
Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare private health plan, Medicare pays the private health plan a set amount every month for each member. Members may have to pay a monthly premium in addition to the Medicare Part B premium and generally pay a fixed amount (a copayment of $20, for example) every time they see a doctor.
The private plans are required to offer a benefit package that is at least as good as Medicare’s, but they do not have to cover every benefit in the same way. Plans that pay less than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits. Private plans get a hefty subsidy from the government for each beneficiary they enroll, and use some of the excess payments they receive to offer supplemental benefits.
Part D: Prescription Drug Plans
Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all.
Out-of-pocket costs
Neither Part A nor Part B pays for all of a covered person's medical costs. The program contains premiums, deductibles and co-pays, which the covered individual must pay out-of-pocket. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.
Part C and D plans may or may not charge premiums, at the programs' discretion. Part C plans may also choose to rebate a portion of the Part B premium to the member.
Payment for Services
Medicare contracts with regional insurance companies who process over one billion fee-for-service claims per year. In 2003, Medicare accounted for almost 13% of the entire federal budget. Based on the CMS projections, 33 cents of every dollar spent on health care in the U.S. is paid by Medicare and Medicaid (including State funding). Looked at from three different perspectives, 61 cents of every dollar spent on nursing homes, 47 cents of every dollar received by U.S. hospitals, and 27 cents of every dollar spent on physician services is funded by Medicare or Medicaid.
For institutional care such as hospital and nursing home care, Medicare uses prospective payment systems. A prospective payment system is one in which the health care institution receives a set amount of money for each episode of care provided to a patient, regardless of the actual amount of care used. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the kind of diagnosis made at the hospital. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for the hospital. However, if the patient uses more care, then the hospital has to cover its own losses. This results in the issue of "upcoding," when a physician makes a more severe diagnosis to hedge against accidental costs.
Payment for physician services under Medicare has evolved since the program was created in 1965. Initially, Medicare compensated physicians based on the physician's charges, and allowed physicians to bill Medicare beneficiaries the amount in excess of Medicare's reimbursement. In 1975, annual increases in physician fees were limited by the Medicare Economic Index (MEI). The MEI was designed to measure changes in costs of physician's time and operating expenses, adjusted for changes in physician productivity. From 1984 to 1991, the yearly change in fees was determined by legislation. This was done because physician fees were rising faster than projected.
Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor's office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.
Part C: Medicare Advantage plans
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans.
Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare private health plan, Medicare pays the private health plan a set amount every month for each member. Members may have to pay a monthly premium in addition to the Medicare Part B premium and generally pay a fixed amount (a copayment of $20, for example) every time they see a doctor.
The private plans are required to offer a benefit package that is at least as good as Medicare’s, but they do not have to cover every benefit in the same way. Plans that pay less than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits. Private plans get a hefty subsidy from the government for each beneficiary they enroll, and use some of the excess payments they receive to offer supplemental benefits.
Part D: Prescription Drug Plans
Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all.
Out-of-pocket costs
Neither Part A nor Part B pays for all of a covered person's medical costs. The program contains premiums, deductibles and co-pays, which the covered individual must pay out-of-pocket. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.
Part C and D plans may or may not charge premiums, at the programs' discretion. Part C plans may also choose to rebate a portion of the Part B premium to the member.
Payment for Services
Medicare contracts with regional insurance companies who process over one billion fee-for-service claims per year. In 2003, Medicare accounted for almost 13% of the entire federal budget. Based on the CMS projections, 33 cents of every dollar spent on health care in the U.S. is paid by Medicare and Medicaid (including State funding). Looked at from three different perspectives, 61 cents of every dollar spent on nursing homes, 47 cents of every dollar received by U.S. hospitals, and 27 cents of every dollar spent on physician services is funded by Medicare or Medicaid.
For institutional care such as hospital and nursing home care, Medicare uses prospective payment systems. A prospective payment system is one in which the health care institution receives a set amount of money for each episode of care provided to a patient, regardless of the actual amount of care used. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the kind of diagnosis made at the hospital. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for the hospital. However, if the patient uses more care, then the hospital has to cover its own losses. This results in the issue of "upcoding," when a physician makes a more severe diagnosis to hedge against accidental costs.
Payment for physician services under Medicare has evolved since the program was created in 1965. Initially, Medicare compensated physicians based on the physician's charges, and allowed physicians to bill Medicare beneficiaries the amount in excess of Medicare's reimbursement. In 1975, annual increases in physician fees were limited by the Medicare Economic Index (MEI). The MEI was designed to measure changes in costs of physician's time and operating expenses, adjusted for changes in physician productivity. From 1984 to 1991, the yearly change in fees was determined by legislation. This was done because physician fees were rising faster than projected.
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