Tuesday 17th of January 2017
RubinHealth Blog

Time for an Intervention on Medicare and Medicaid Costs PDF Print E-mail
Tuesday, 16 August 2011 18:23

The Bureau of Economic Analysis recently released data showing Medicare and Medicaid costs jumped 10% in the second quarter of this year. This puts the two healthcare entitlement programs on course to reach spending levels of almost $992 billion. Yes, that is almost $1 trillion. And guess what, it is not going to stop rising unless something is done soon.

The recent debt ceiling compromise in Washington did not touch or modify the programs but it does leave them open for restructuring in future negotiations. And as much as I love and value these entitlement programs, a massive restructuring is exactly what is needed. When Medicare was first enacted in 1965, approximately 19 million Americans enrolled. By the year 2030, an estimated 80 million Americans will be enrolled. The bad economy only adds to the burden as more and more Americans wind up in the Medicaid program. Medicare and Medicaid currently pay 57.5% of all provider bills for doctors and hospitals, and pharmaceuticals. That is up from 49.3% in 2005. Life expectancy when Medicare was created was 70. Today, it is 78. People are living longer and they are using more and more healthcare services. Each day, there are new and amazing discoveries, many of which will extend our life expectancy adding even more cost to an under financed system.

It would be a wonderful blessing if our country could fund all of our healthcare expenses indefinitely. But simply put, the math just does not add up. We must fix the funding of the program now so that we all benefit from it in the future; our children and grandchildren included. I believe there is a way if only we all listen and understand the facts on the ground.

Last Updated on Friday, 16 September 2011 20:39
NY Daily News editorial & my letter to the editor PDF Print E-mail
Thursday, 28 July 2011 13:26

From the Daily News:

You think the debt crisis is bad now? Wait until Obamacare takes its toll, By Andrea Tantaros

One of the main reasons for enacting Obamacare was to bring down health care costs - so said the President, then-House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid. But since its passage, the sweeping overhaul of one-sixth of our economy has done just the opposite. If you think the debt debate on Capitol Hill has revealed that this nation is on the road to fiscal ruin, just wait until health care reform really kicks in.

The Congressional Budget Office will tell you that we will save $143 billion between 2010 and 2019, but its assumptions were flawed from the start. Doing a close analysis of the budget office scoring, Kathryn Nix of the Heritage Foundation concludes that Obamacare "indisputably represents a massive new burden on current taxpayers and future generations."

Those costs are evident already. "Health care costs are expected to increase by 8.5% in 2012 - slightly up from this year's increase of 8%, according to the annual 'Behind the Numbers' report on medical costs recently released by [PricewaterhouseCoopers'] Health Research Institute," says the online publication Small Business Trends.

Part of that increase has to do with the fact that many of the nation's hospitals are buying up physician practices or consolidating with other hospitals to form conglomerates that are able to muscle insurers more than ever before for higher fees for service.
But the other factors that have contributed to the spike are the provisions in Obamacare that took effect immediately.

Insurers are now forced to cover patients despite any preexisting conditions. They are also required to provide preventive services and cover children as their parents' dependents up to the age of 26. The health care bill also scrapped annual and lifetime cap provisions, so if you get a rare form of cancer, you'll have unlimited coverage regardless of the cost. According to news website The Daily Caller, "the day Obamacare hit the books one year ago, 150 new regulations immediately went into effect. Since then, 125 more regulations have gone into effect."

All of this sounds wonderful, but someone has to pay. Every American who currently has health insurance in the U.S. will be forced to shell out higher premiums.

The danger to insurance companies, and thus to patients, is similar to what happened with Romneycare (a blueprint for Obamacare) in Massachusetts, where the new health mandates ruined the few efficiencies of managed care. Sicker (and, hence, costlier) patients sign up for coverage, which weighs down on the healthy population, whose premiums rise so drastically that they cannot afford coverage anymore. They figure, why pay expensive premiums when I can instead sign up for insurance when and if I do get sick and pay the penalty for not being covered (which is much less, anyway)?

It's just like car insurance: You need safe drivers paying their insurance to balance out the reckless drivers with shoddy driving records. Without just about all responsible drivers purchasing coverage, the system doesn't work.

That is why Obamacare is so poorly crafted. There is no incentive for healthy people to sign up. However, had the bill included a provision that opened up insurance markets over state lines, the competition among insurers for customers would have naturally kept costs in check.

In fact, if Obamacare isn't repealed, today's national debt will be far worse tomorrow because of exploding costs.

The National Federation of Independent Businesses released a report this week that revealed that "one in eight small businesses have had or expect to have their health insurance plans terminated since the passage of President Obama's health care reform," according to The Daily Caller. The findings echoed a report from consultants McKinsey & Co. last month that stated that 30% of employers will "definitely or probably" stop offering health insurance coverage to employees after 2014.

Think about it: If you own a business that has fewer than 50 employees, why would you continue to pay for their insurance when you can force them into the government exchanges? Not only does that mean you won't get to keep your doctor, as Democrats promised you would, it also means that Obamacare could drive us into fiscal ruin.

According to a Washington Post Op-Ed by Sen. Ron Johnson (R-Wis.) and former Congressional Budget Office Director Douglas Holtz-Eakin, "If half of the 180 million workers who enjoy employer-provided care wind up in the exchanges, the annual cost of Obamacare would increase by $400 billion by 2021. If the other half eventually follows suit, and all American employees wind up in the exchanges - which we believe is a goal of Obamacare - then the annual cost of the exchanges would increase by more than $800 billion."

That means that far too much of the private-sector health care balance sheet would be transferred over to taxpayers to foot the tab. Over 10 years, the costs would be in the trillions.

Wasn't the whole point of Obamacare to bring costs down - and not break the back of the federal budget?

That's why it must be repealed. The debt fight in Washington will be small potatoes today when you think about what it will be after health care reform goes into full effect. But by then, Obama will conveniently be out of office, and we'll be stuck with the bill.


To the Editor:

I am writing in response to the opinion piece written by Andrea Tantaros  on healthcare reform entitled “You think the debt crisis is bad now? Wait until Obamacare takes its toll.”  I have no problem with those who object to the many provisions included in the Patient Protection and Affordable Care Act (healthcare reform law) and I also agree it will end up being more expensive to implement than planned.  However, virtually every issue raised by Ms. Tantaros was faulty in its conclusion as to why healthcare reform will be more expensive than the Congressional Budget Office predicted.  I think it’s irresponsible to use incorrect facts when you are trying to make a point.  That is exactly what happened in this piece and let me explain why:

1.       It is true healthcare costs continue to rise at alarmingly high rates (8% predicted for 2012).  What is untrue is this growth is related to “Obamacare.”   Healthcare costs were rising well before healthcare reform was presented to the American public.  In fact, some of the very reasons behind the reform legislation originate with the concerns over the explosive growth in costs over the past decade.  Healthcare reform, while imperfect, is designed to bring those costs down.  It is true that hospital systems are buying medical practices and it is also true these organizations will use their newly found market clout to negotiate better reimbursement rates.  However, Medicare does not negotiate.  So these networks will not increase the federal burden on healthcare costs.  Secondly, the primary purpose of forming these hospital/physician networks is to better integrate care for the patient, and thereby, the healthcare system in general.  There is no question, when you better organize and manage a patient’s healthcare, you will save the healthcare system money by keeping people out of the hospital and lowering readmission rates.

2.       The healthcare reform provisions that have kicked in so far, such as requiring health insurers to cover dependent age children up to age 26, are estimated to increase the costs to the healthcare system by approximately 1%.  A fraction of the overall spending growth projected for 2012.  To suggest these few immediate provisions, intended provide instant relief for many and generate public support behind healthcare reform  are breaking the bank, is simply not true.  Neither is the claim that insurers are currently not allowed to deny applicants because they have preexisting medical conditions.  That provision does not start until 2014.

3.       I am truly dumfounded by Ms. Tantaros suggestion that only sick people  would sign up for healthcare insurance.  Perhaps the single most controversial component of the legislation requires all Americans to sign up for healthcare insurance.  Sick and healthy alike.  Everyone is in – plain and simple.  While unpopular to many, it is the underpinning of balancing the healthcare insurance markets. Without it, healthcare reform as written will fail.  However, as of today, the individual mandate is included, so Ms. Tantaros’ argument is not only irrelevant, but makes no sense. 

4.       Finally, and I could go on with more, it is still very unclear whether large group employers will stop providing healthcare insurance to their employees.  Healthcare insurance is a benefit that is not currently required to be offered today yet approximately 180 million Americans get their healthcare insurance this way.  It is true some employers will stop offering insurance and force employees into buying insurance on the state exchanges and the penalty the employer pays the government will be less than the cost for providing the insurance.  However, the impact and magnitude is still very unknown.  While this issue is complex and there is no data to accurately project the ultimate outcome, I think it is inappropriate to suggest employers will stop providing this benefit. Further, this has nothing to do with whether you would be able to see your existing physician. 

You may find this hard to believe, but I actually have concerns over the ultimate costs of healthcare reform on the government and society in general.  While there are new payment mechanisms in place to hopefully lower costs,  I do not believe the American public fully understands the real reasons behind the explosive growth in healthcare costs.  We are living longer and using more expensive healthcare every day.  Drugs, technology, multiple doctor visits, home care, etc.  One needs to look no further than the new late stage prostate cancer treatment drugs that prolong life for patients on average between 4-6 months at an estimated cost of $90,000.  While there may be no limit to the price we want to pay when we get sick and want to fight for survival, you cannot ignore the costs associated with these new treatments.  And since it is the insurance company or the government that pays the bill, we are not even aware of how much it costs.  Until we are all willing to accept the actual facts, the more we will let people like Ms. Tantaros distort the truth about why healthcare in this country is so expensive.

Andrew Rubin

Host, Healthcare Connect on Sirius/XM Doctor Radio


Last Updated on Tuesday, 16 August 2011 18:26
Medicare Cuts: Give Them A Chance PDF Print E-mail
Saturday, 02 July 2011 23:41

This week Senators Joe Lieberman (I-Conn.) and Tom Coburn (R-Ok.) introduced a proposal to eliminate $600 billion from the Medicare system. They should have been applauded, commended and celebrated around the country. Instead, democrats swiftly rejected their proposal. No questions asked. They were portrayed by liberals as attacking the benefits of seniors and of being out of touch with main stream America. I would argue they may be the most "in touch" members of the Senate. Sadly Americans will not have the opportunity to hear how this proposal could actually maintain Medicare as a viable program for seniors and disabled while addressing its long term funding crisis.

To me, a believer in the healthcare reform legislation, these attacks were unfair, misguided, and quite frankly, downright ridiculous. There is no question the Medicare program is in financial trouble. Whether you are a republican, democrat, or independent, no one can argue the Medicare program has sufficient funds to pay for all the expected benefits for future generations of Americans who will rely on this entitlement program.

While there is nothing simple when it comes to healthcare, Senators Lieberman and Coburn have some rational (and admittedly controversial) ideas for saving the Medicare program including:

1) Raising the Medicare eligibility age to 67 from the current 65;
2) Increasing the premiums for wealthy seniors for their Part B premiums (the doctor portion of the program),
3) Implementing real and meaningful steps to reduce fraud and waste and simplify how healthcare is administered.

This country can no longer afford politics as usual; particularly when it comes to saving Medicare, and the country, from financial ruin. When Medicare was created back in 1965, Americans did not live as long and we did not spend as much on our healthcare as a percentage of gross domestic product. Simply put, healthcare costs were much lower and less significant to our overall economy as they are today. So the idea that we can leave the existing program intact, without making meaningful and structural changes is a flawed argument. While there are certainly many ideas and programs to fix Medicare, I believe it is going to require a full blown overhaul. The creators of Medicare did not intend for the program to bankrupt the country or run out of money in 20 years from now.

The Patient Protection and Affordable Care Act was a meaningful, and in my belief, good start in addressing some of our country's biggest challenges: providing healthcare access to all Americans. However, while there are many initiatives included in the legislation to meet this goal, I believe the law does not adequately provide the mechanisms to save enough money to keep the program viable. The funding issues facing Medicare are as significant now as they were when the act became law in March 2010. As I was a year ago when the law was passed, I am concerned over its long term financial viability.

During the debate over healthcare reform, I was very clear that the legislation being discussed and debated at the time had many flaws. I was also clear in my belief that while the bill was not perfect, it was a very bold and good first step in reforming our healthcare system. Some at that time called me liberal even though I have always been independent. Nor does it make me a conservative because I believe Senators Coburn and Lieberman have a reasonable proposal. It makes me, and others, practical.

If we are going to be able to solve the enormous challenges facing our country, we are going to have to find a way to move past partisan bickering and be open to new ideas. There are some very important issues to consider:

1) The current Medicare program is not sustainable in its current form. We know this because both parties and the Congressional Budget office agree that at some point in near future, if we do not restructure the program, Medicare will run out of money.
2) There is no one good answer to solve this problem. And since there are so many problems and an even greater number of solutions, we are all going to have to accept compromise. Liberals and conservatives, along with independent politicians are going to have to stop the nonsense and sit together to work something out.
3) The rhetoric is wasting valuable time which our country can ill afford.

The current proposal requires compromise and sacrifice from everyone and it will not be easy. We must be willing to try. If for no other reason, Medicare will run out of money and changes will be rushed and forced on all of us. Careful planning will go by the wayside. It's always better to plan ahead and make changes/fix mistakes along the way, particularly when it comes to something as complex as fixing Medicare. Give Senators Lieberman and Coburn a chance to be heard. Ultimately, America may say no to their idea and that is democracy at work. But to silence potentially good ideas without meaningful debate and discussion is a national shame. Further, it prolongs the impression that nothing can be done in Washington. It puts all of us, who will someday rely on the Medicare system, at risk of losing a national safety net that is too important to go away.

Last Updated on Thursday, 28 July 2011 13:37
My response to Paul Ryan's Medicare proposal PDF Print E-mail
Thursday, 26 May 2011 15:24

How Consumer Choice Can Save Health Care

Last Updated on Tuesday, 05 July 2011 13:09
Question and Answer PDF Print E-mail
Thursday, 19 May 2011 20:45

Question:  If Medicare is the secondary insurer will they reimburse for the copay? And what about any other out of pocket expenses I incurred?

Answer: Sometimes yes and sometimes no.  Medicare will compare what the primary insurer paid versus the Medicare approved amounts. Medicare will then pay any additional costs up to the Medicare-approved amounts, including a co-pay.  However, if your primary insurer paid more than the Medicare allowed amount, you will have to pay the costs of services (co-pay and co-insurance) above those that Medicare would have paid.

Last Updated on Thursday, 26 May 2011 15:39
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