Medicare

Can health reform heal our federal budget? Yes, but whatever passes now is just the beginning, and there will always be room for improvement.

That's our takeaway from an excellent event we tweeted this morning hosted by the US Budget Watch, a joint project between the Committee for a Responsible Federal Budget and The Pew Charitable Trusts.

There was a lot of ground covered by a panel of experts moderated by the Washington Post's Ceci Connolly and featuring New America's director of health policy Len Nichols. They tackled everything from raising Medicaid eligibility rates to fixing the Sustainable Growth Rate formula in a fiscally responsible way. But for now, we'll just give you the highlights of the discussion.

After all the sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts of horror stories about the resurrection, so to speak, of the "death panels." Maybe because all that fear-mongering was finally discredited. Maybe we are finally getting just a little bit smarter.

The inevitable focus on the politics of health reform, and the disproportionate amount of attention paid to the public plan, sometimes obscures the many ways that the House and the Senate health plans are ambitious. Not perfect. Ambitious. I've heard experts, people I like and respect, say the legislation does "nothing" to advance the cause of quality of end of life care in America. They are wrong. The House and Senate bill each contain measures that would advance that cause -- not fix it completely, far from it, but they will take us important steps in the right direction. It's too soon to know which of these measures - if any -- will survive a final melding of House and Senate legislation. But let's look at them here because, except for the end of life consults which got way too much of the wrong kind of attention, they haven't gotten adequate attention. In an accompanying guest post. Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, talks about what these changes can mean for his patients and their families.

Seniors are a primary target of the misleading rhetoric in the health reform debate. Though the harmful rumors have been proven false time and time again, seniors have had to worry about everything from "death panels" to Medicare cuts. Organizations like the AARP have stepped up to get the truth out to seniors -- health reform will protect Medicare, not diminish it. A recent report from the Center for Budget and Policy Priorities (CBPP), House Health Reform Bill Would Strengthen Medicare, came to the same conclusion. 

The CBPP reports that the House health reform bill would help all beneficiaries, and it highlights the provisions that will improve care for seniors:

Over at InsureBlog, Hank Stern takes exception to Len Nichols' thorough debunking of the recent report produced by PriceWaterhouseCoopers for AHIP.

Like the Latin title of Hank's post (Res Ipsa Loquitur...), most of his points speak for themselves.

If he wants to object to the idea that "Good policy research uses nationally and statistically representative data so that its conclusions reflect behavior of the actual population," that's his prerogative.

If he's ignorant of the IRS tax code that governs the non-partisan work of the Robert Wood Johnson Foundation and the Urban Institute, well, we guess that's fine, too.

But if he thinks there's no difference between the research produced by such independent institutions and stuff that's made to order for private interests, he should take a look at the work PriceWaterhouse did for the tobacco industry in the early 90s. An independent review of that study found "serious methodological problems and errors of omission." (h/t Media Matters) The same could be said of their latest work. AHIP got what it paid for and InsureBlog should be less credulous of the talking points it's buying.

About a year ago, Drew Altman, president and CEO of the Kaiser Family Foundation, wrote an essay about "delivery system" folks and "coverage" folks. When I saw Drew soon after that, interviewing him for an unrelated magazine piece,  I said I thought the overlap in that Venn diagram of coverage and delivery was both bigger than he described it, and expanding faster than he perceived it. I thought that as health reform became something that might really and truly happen the "coverage" camp had a growing appreciation of how delivery system reform, properly done, could improve quality of care while saving money needed to pay for that very same expansion of coverage. And the delivery system camp, at least the people I knew reasonably well, certainly thought it was high time that the United States did what every other developed country on the planet (and some of the not-so-well developed ones) has managed to do: make sure that everybody has decent affordable health coverage.

So it was a pleasant surprise to find Kaiser (which I think of as more on the coverage side) publishing a very useful, worth-reading paper on what we do and do not know about delivery system reform, at least with regard to Medicare.

A study in the Annals of Internal Medicine (Hat tip Kit Seelye) finds that people who are uninsured in their 50s and early 60s end up costing Medicare a lot more money when they hit 65. The extra cost is about $1,000 a year -- meaning that the savings would pay almost half the $197 billion it would cost to cover them in the first place.

And because Medicare pays a tad less than half of all health care spending for the elderly, the reduction in total medical spending (not just from Medicare but also out-of-pocket spending and from other insurers) after age 65 may be even greater.

A lot of the costs can be attributed to uncontrolled or poorly controlled diabetes and cardiovascular disease such as hypertension, heart attacks or stroke.The uninsured may also delay surgeries such as joint replacement until Medicare will pay for them."For adults with these chronic conditions," Dr. Michael McWilliams and his colleagues at Harvard Medical School and Harvard School of Public Health wrote," improvements in blood pressure, blood glucose, and cholesterol control associated with gaining coverage may substantially reduce subsequent annual health care costs."

The Republican stance on Medicare has Paul Krugman tearing his hair out. Or maybe he wants to tear their hair out. In a column titled "The Politics of Spite," he writes:

At this point, the guiding principle of one of our nation's two great political parties is spite pure and simple. If Republicans think something might be good for the president, they're against it -- whether or not it's good for America.

Now, it's understandable that many Republicans oppose Democratic plans to extend insurance coverage -- just as most Democrats opposed President Bush's attempt to convert Social Security into a sort of giant 401(k). The two parties do, after all, have different philosophies about the appropriate role of government.

But he argues that when Democrats opposed President Bush's plan to privatize Social Security, they did it in an ideologically consistent way. Not so the Republican assault on health reform. 

Security was tight as NPR's David Kestenbaum entered the inner sanctum. Six staffers hovered around him.

It wasn't the CIA. Or a secret air base. Or Fort Knox. Not even the Playboy mansion. It was the closely-guarded Medicare databank in Baltimore.

The databank is enormous, petabytes of data (a petabyte is a 1 with 15 zeros after it, Kestenbaum explains). The rows and rows of shelves, a half-million cassettes of computer data, so vast that a robot is required to navigate it. The library holds medical records of decades of Medicare patients. And their doctors. It could potentially tell us much about quality and performance and efficiency of just about every physician in the United States.

Except it's a secret. Some researchers and consumer advocacy groups have fought to open it up (not the patient records, but the doctor data). And doctors have fought to keep it closed.

Arnold Milstein, a physician and researcher who has advised the White House on health care economics, wants it open. Doctors don't even know how they stack up against their peers, against standards. The database could tell them.

Day three of the Senate Finance Committee mark up of the America's Healthy Future Act is underway. Highlights from the morning session include a definition of perspicacious from Senator Jon Kyl as well as Senator Chuck Grassley advising Senator Chuck Schumer to look into red yeast rice and omega-3 pills as an alternative to Lipitor.

As for amendments, progress is a slow, but steady, with Democrats and Republicans sticking close to party lines.

Republicans introduced several amendments relating to Medicare Advantage. Democrats want to lower government subsidies to these private plans and introduce competitive bidding to promote competition and choice while reducing costs. Republicans claim this will lead to a loss of benefits, especially in rural regions. Neither side seems willing to budge.

When Vice President Biden went home to Delaware a few weekends ago, the first thing his 92-year-old mother said to him was, "Joey, what about these death panels?"

"It's hokum," Biden said, "It's bunch of malarkey."

No one, no panel, is going to sit down and tell your doctor or you how to make these decisions, he explained. Health reform is about "giving you more power and your doctor more power" to make the decisions that are best for you.

If the Vice-President's own mother is hearing rumors about death panels, it's no wonder seniors, as a group, are among those most skeptical of health reform.

Helping to dispel these fears and sell the benefits of reform, the Vice President spoke Wednesday at a retirement community in Montgomery County, Maryland. Assisted by Secretary of Health and Human Services Kathleen Sebelius and White House Director of Health Reform Nancy-Ann DeParle, the Vice President laid out how reforms will protect and strengthen senior's Medicare.

Many of the key points from the discussion are outlined in a new report from the White House on Health Insurance Reform and Medicare. The report tackles questions seniors may have such as: