On S-Chip ... and Medicare Advantage ... and Physician Reimbursements ...

Finally back from vacation, and almost caught up at work.

Dominating my work life these days is S-Chip, both the House and the Senate versions. I gotta say, the House version bugs me. It just seems so utterly unrealistic. The bill does so much ... from a major expansion of S-Chip, to a 45-cent tobacco tax, to major revisions in Medicare (i.e. physician reimbursement levels, nursing home and inpatient rehabilitation reimbursements ... and let's not forget everyone's favorite -- Medicare Advantage).

Reimbursed on average 12% higher than traditional Medicare, and sometimes as high as 19% more, Medicare Advantage is House Dems' favorite source of S-Chip funding to meet their own pay/go guidelines. And no wonder why, the latest CBO scoring finds equalizing the payments will save $50.4 billion over five years and $157.1 billion over the next decade. Dems argue that there's no reason these plans should get more, just because they're private. It's a big Republican scheme to make insurance companies richer, they say.

Republicans, along with AHIP, HATE the idea of equalizing the reimbursement rates. Some reasons they give why the rates shouldn't be equalized:

1. The lower reimbursement rates will make the plans unprofitable and cause the insurance companies to drop them, which could hurt seniors in rural areas, who have limited options to begin with.
2. If companies drop the MA plans, minorities will be adversely affected because they enroll in higher numbers in the private plans. (This is a contentious assertion. Rep. Pete Stark, and other supporters of an equalization, say this is simply not true -- that minorities are equally enrolled in both the traditional plans and private plans.)
3. Reducing the reimbursement will cause physicians to stop accepting patients enrolled in the plans, which would obviously be bad for everyone.

So who to believe?

MedPAC, which advises Medicare, issued recommendations (PDF) in June saying that MA rates should be equalized. It writes that

MedPAC has a long history of supporting private plans in the Medicare program. The Commission believes that Medicare beneficiaries should be able to choose between the [traditional] Medicare program and the alternative delivery systems that private plans can provide. Private plans may have greater flexibility in developing innovative approaches to care, and these plans can more readily use tools such as negotiated prices, provider networks, care coordination and other health care management techniques to improve the efficiency and quality of health care services.

However, the recommendations continue:

The Commission believes that payment policy in the MA program should be built on a foundation of financial neutrality between payments in the traditional ... program and payments to private plans. Financial neutrality means that the Medicare program should pay the same amount, adjusting for the risk status of each beneficiary, regardless of which Medicare option a beneficiary chooses.

I'm going with MedPAC. I think overall reimbursement rates are too low and the access to care for Medicare beneficiaries is a problem, but I don't think continuing to give private plans more money is the solution. I'm all about an overhaul of the reimbursement system.

So go ahead and equalize 'em, Stark, you've been waiting for this moment all session. (Now if only you could get enough support in the Senate to actually make it happen...).

More on S-Chip in the days to come.

Moore vs. Gupta, Round 2

As promised, here's the Larry King Live segment:



I gotta say, I really thought that Moore would rip Gupta to shreds, but Gupta makes some valid points AND comes off as much more sane than Moore. CNN really should have better fact-checkers, considering they are supposed to be a reputable news source (although I really lost respect for CNN several years ago when they posted a story about Barbie and Ken breaking up). $251 vs. $25 is a huge difference, and someone should have caught that on their end.

This is why Michael Moore seriously annoys me

Chill out, Michael.



While I think Moore is an absolutely ridiculous interviewer, he has a right to be angry, Gupta's criticisms of his movie are not accurate or fair (see Moore's website, which includes links to his citations). Gupta should have known better than to fuck with someone as angry as Michael Moore. His movie might have been incredibly one-sided, but not many people have challenged the truthfulness of any of his statements.

I hear that Gupta and Moore are going to battle it out on Larry King Live tonight. Unfortunately, I don't really have television, but I'm hoping it'll be on YouTube tomorrow and I can respond then.

As usual, women get screwed

As a women's studies minor in school, I did a lot of reading about how women are forced to succeed within a society built by men. A lot this concept has to do with the workforce: in order to get ahead, you have to put in a lot of hours and spend a lot of years, etc., which forces women to either choose not to have a family, or to not get ahead.

Of course, I am always really happy to read an article about how some companies have implemented a policy (such as telecommuting, flexible hours, daycare onsite, etc.) that provide all employees (not just women -- the policies also benefit men) greater flexibility that allows them to avoid being forced to choose between having a family and succeeding in a career.

So it really bugs me to see shit like the (slow) rise in popularity of high-deductible health plans . According to an article on Thursday in Dow Jones (I can't link), several studies show that women get fucked in out-of-pocket costs under HDHPs. It's not only bad enough women have to be pregnant, most likely be the primary caregiver once the kid is born, while working, now women also might have to pay more to be pregnant.

HDHPs are not women-friendly health plans. They are, as usual, a way for businesses to save money while leaving women behind.

The Commonwealth Fund in April released an issue brief written by Judy Waxman, vice president for health at the National Women's Law Center, and Elizabeth M. Patchias, a health policy analyst at NWLC. It writes,

Women are more likely than men to need health care throughout their lifetimes. Women’s reproductive health needs require them to get regular check-ups, whether or not they have children, and women of all ages are more likely than men -- 60 percent versus 44 percent -- to take prescription medications on a regular basis .... For younger women, this difference is even greater; women ages 19 to 29 use prescription drugs at almost three times the rate of men in that age group. Further, women are more likely than men to have a chronic condition requiring ongoing treatment (38% vs. 30%). Finally, certain mental health problems, including anxiety and depression, affect twice as many women as men.

It concludes,

Given these factors, policy proposals that provide comprehensive benefits at affordable cost would help more women obtain meaningful coverage. Conversely, reforms that result in higher out-of-pocket expenses and limited benefits will not significantly improve the health and financial security of women.

Exactly, ladies.

Sicko is Right.

I saw Sicko right after work on Friday (lest anyone ruin it for me before I saw it), and I left with a couple of impressions:

1. I must move to France ASAP.
2. The British have a really great sense of humor.
3. I didn't hate it as much as I thought I would.

It's just, I don't think I single-payer system is the right option for the U.S. Perhaps Moore's right, perhaps it works so well in France because the French government fears its residents. But if I've learned one thing in the last 7 years of the Bush administration, it's that the U.S. government has absolutely no fear of its citizens. We are the government's apathetic pawns. I do not trust the government to run my health care, and I certainly do not trust the government to contract out my health care. And to be honest, I'm kind of surprised Moore does.

Here's a great AP article on some contentious points of the movie.