Archive for the ‘#medicalcarereform’ Tag

A Possible Solution   Leave a comment

Freedom is an amazing thing because people who are free are able to think for themselves and come up with innovative solutions to the problems as those circumstances affect them.

The answer to America’s medical care crisis is not direction from Washington – which has already screwed up the best medical care system in the world. It is also not European-style universal care.

When I developed appendicitis while on a medical exchange in France several years ago, I dosed myself with antibiotics and painkillers and got on a plane to the United States. I risked a ruptured appendix over the Atlantic rather than use the medical care system operated by colleagues I respected. That should tell you something about my experience with European-style universal coverage. I was not putting my life in their hands and I still wouldn’t even though I am not running a fever at the moment.

So, what is the answer? Well, how about choice and innovation? How about putting doctors and the patients in the driver’s seat? How about taking the exact opposite approach from what broke the system in the first place?

Thinks about this. There are plenty of industries where businesses compete against one another without undue government regulation. Choices and innovation increase while prices and other barriers to access decrease. Why do we assume that a similar approach to reforming our medical care system wouldn’t also result in similar outcomes? No, it wouldn’t happen overnight, but it might well push the momentum in the right direction.

Obamacare’s rigid and centralized federal regulation of the nongroup market has failed. Premiums rose at unsustainable levels, choices dried up and enrollment in the individual policies continues to decline. Seven states were granted waivers from Obamacare mandates giving them the freedom to try new approaches. Significantly, states are achieving these favorable outcomes without the expenditure of additional federal funds. Instead, under their 1332 waivers, they re-purpose federal money that would have been paid directly to insurance companies in the form of premium subsidies, using it instead to directly pay medical bills for residents in poor health. These findings suggest that the most effective means of undoing the detrimental effect of Obamacare’s federal regime of subsidies, penalties, and regulations while ensuring that everyone can access private coverage is to provide states with the resources and flexibility to achieve that goal, rather than lashing them to a failing Washington-dominated system.

How do we do that? Well, Lela is down with just ending Obamacare tomorrow, but I’m more in favor of graduated measures like the Heath Care Choices Proposal. Under the proposal, current federal entitlement spending on Obamacare’s rigid structure of insurance subsidies and Medicaid expansion would be reprogrammed into state block grants, with broad flexibility for states to develop more consumer-centered approaches to meeting the needs of the poor and the sick, while keeping coverage affordable for other enrollees.

June 2018, a group of state and national think tanks, grassroots organizations, and health policy experts developed a proposal to enable and encourage state innovation. The Health Care Choices Proposal would reverse the Obamacare polarity. In place of rigid federal constraints from which waivers could provide limited relief, the proposal would rely on states to devise ways to assist the sick and needy, without pricing coverage out of the reach of healthy and middle-income families. The proposal would repeal Obamacare’s federal entitlements to premium assistance and Medicaid expansion and replace them with grants to states to stand up consumer-centered programs. Instead of asking Washington’s permission for some limited flexibility, states would use federal resources to finance approaches that best serve the needs of their residents.

The proposal would put in place some conditions for the grants. First, every individual who receives subsidies from the federal government (including Medicaid and Children’s Health Insurance Program), would be given new freedom to spend that money on the coverage arrangement of their choice— vastly expanding their options. States, additionally, would have to use a portion of their federal allotment to establish risk-mitigation programs. The proposal would also require states to spend a specified portion of their federal grants on subsidizing private, commercially available insurance coverage for people with low incomes. States could not use the money to expand Medicaid or consign low-income people to state-contracted managed care plans.

The proposal would release states from Obamacare requirements on essential health benefits, single-risk pools, medical loss ratio, and the 3:1 limit on age rating. Nullifying these mandates and providing states with new flexibility would reduce premiums, allow premiums to more accurately reflect medical risk, and, in combination with risk mitigation, assure that the sick get the coverage they need without saddling the healthy with unfairly high premiums.

Most important, the proposal would replace the Washington-knows-best approach to health policy with one that invests states with the policy initiative, something the section 1332 waiver process cannot accomplish. The block grant approach provides certainty for state (and federal) governments by putting spending on a budget that can’t be increased, as is the case today, if a state or insurer decides to spend more money. The block grant also gives states greater certainty in projecting the amount of federal funding that will be available to them over time. And it helps consumers because it gives new freedom to people to control their federal subsidy and direct it to their choice of a wide range of private coverage arrangements. Regardless of the approach a state chooses to implement, an individual can claim the value of the benefits and use it on the private coverage arrangement of their choice.

States have shown they can take steps under Section 1332 to stabilize their markets without new federal money. It is utterly unnecessary to spend new federal money in the name of market stabilization.

Instead of providing new federal money or creating new federal programs, policymakers should revise the section 1332 waiver process. This would allow policymakers to make incremental progress toward the goal of transitioning from Obamacare’s Washington-centric approach to state-based health care reform. Obama Administration limits and statutory limits on the section 1332 process should be relaxed or removed during that transition. There already are a variety of proposals to do just that, including one from Senate HELP Committee Chairman Lamar Alexander. CMS should start by rescinding the December 2015 guidance, which imposes restrictions on state innovation that go beyond the already excessive statutory restrictions, creating burdens that are costly and time-consuming. In many cases, states have withdrawn their applications rather than see the process through to its conclusion. CMS should replace this process with a streamlined approach and develop model waivers organized around the principle of reducing premiums for private coverage in the broader non-group market, increasing choices for consumers. Such changes—while insufficient to the larger task of needed reform—would support states’ near-term efforts to address Obamacare’s damage to their broken private markets as part of a transition to the broader solution.

Posted January 4, 2019 by aurorawatcherak in Common sense

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Not A Solution   Leave a comment

So, the United States has a problem with a dysfunctional medical insurance system and a broken government-medical care system. So what is the solution. Well, it’s not becoming Canada.

The Frasier Institute recently undertook a research project to see how Canada’s medical care system stacks up to the rest of the world. When compared to 11 similar countries, including the United States, a recent study shows that whether it’s emergency room visits, same- or next-day appointments, seeing a specialist or getting elective surgery, Canada’s wait times are the worst.

In fact, in 2016, Canadians waited an average of five months for medically necessary specialist treatments. As a specialist working in a field where delay of treatment turns a manageable condition into a death sentence, that concerns me. Apparently it concerns Canadians as well because almost 60,000 of them visit the US and other countries for medical care each year.

Speaking of other countries, over in the United Kingdom, where they’ve had 70 years to figure out how to run a government-controlled health care system, over 80 percent of doctors say their workplaces are understaffed and the NHS reports a 45 percent higher hospital death rate than the US, which might explain why over 50,000 “non-urgent” surgeries were canceled in 2018 when their system was overwhelmed by flu season.

In Canada, apologists for the universal medical care system there (where private doctors are outlawed) claim the wait times remain a small price to pay for universal medicare care, but then why don’t we see similar issues in other countries with universal health care systems? Frasier’s research examined eleven other countries. While you could argue that the US doesn’t have a universal system (I wouldn’t argue that at this point), the other countries. Generally, they allow the private sector to provide core health-care insurance and services in which patients share in the cost of treatment and they fund hospitals based on activity. Canada funds most hospitals from a global budget.

You can look at the Netherlands, which was the top performer in the ability to see a doctor on the same or next day. Individuals are required a standard insurance package from private insurers in a regulated, but competitive market. A for-profit company is the market leader.

France has universally accessible hospital care delivered by public, not-for-profit and for-profit hospitals. In fact, about one-third of all French hospitals are operated on a for-profit basis.

Switzerland ensures universality in an environment of managed competition among insurance companies and medical-care providers. Cost sharing is a central feature. Individuals are expected to pay a deductible before insurance kicks in, and then there is a 10-20 percent insurance copayment, up to a annual maximum.

Germans use social/statutory or private insurance to a access public or private hospital care. Forty-two percent of hospitals are operated on a for-profit basis, but almost all hospitals are accessible by patients with the social/statutory coverage.

So, I believe there is a solution to the medical-care crisis in America, but I think other countries don’t have that solution.

Universal Medical Care Would Kill More Americans   Leave a comment

Tax reform ended the ACA’s tax penalty to support the individual mandate, thereby freeing many Americans to now negotiate with their insurance companies for more realistic medical insurance premiums. I know lots of people who will insist that means more people will die. I disagree.

More people receiving medical care means fewer preventable deaths. If universal healthcare, such as single-payer, leads to less death, then it is obviously the superior moral choice. Politicians like Bernie Sanders will go a step further and claim that Republican legislation, in fact, kills people by reducing government-sponsored coverage.

I am so far not a supporter of the on-vacation GOP healthcare plan because I don’t think it goes far enough. So when Rick, my cousin who is a world-renown doctor in his field, sent me some ideas for a health care article, I was excited to see that he’s not really for the latest-in-series GOP plan either.

What if there were evidence to suggest that more people would die under a universal medical care scheme than under the current US system? What if, by the left’s standards, the American medical care system is less of a killer than the average European one?

There is no accurate, undebatable estimate for how many people in the US died for lack of medical insurance. Consider the best estimates of how many people die in the US due to a lack of medical care. So, for the sake of argument, we’re going to accept the oft-cited (by the progressives) figure of approximately 45,000 fewer people would die in the US every year if all Americans had decent medical care.

Flip the question.

How many people in other countries die due to deficiencies in the medical care systems? And how many Americans would die if we had treatment outcomes similar to those other countries?

study by the Fraser Institute titled The Effect of Wait Times on Mortality in Canada estimated that “increases in wait times for medically necessary care in Canada between 1993 and 2009 may have resulted in between 25,456 and 63,090 (let’s just say about 44,273) additional deaths among females.” The US has about 9 times as many people, so adjusting for the difference in populations, that middle value inflates to an estimated 400,000 additional deaths among females over a 16-year period. This translates to an estimated 25,000 additional female deaths each year if the American system were to suffer from increased mortality similar to that experienced in Canada due to increases in wait times. Rick did not comment on a system that disproportionately harms women, but I will note that doesn’t sound very progressive.

Image result for image of doctors in hospital corridorLet’s look at interventional outcomes. According to the CDC, stroke is the cause of more than 130,000 deaths annually in the United States. However, the US has significantly lower rates of 30-day stroke-induced mortality than every other OECD country (except Japan and Korea). OECD data suggest that the age- and sex-adjusted mortality rates within Europe would translate to tens of thousands of additional deaths in the US.

Just for example – if America had the 30-day stroke-mortality rate of the UK, we could expect about an additional 38,000 deaths a year. For Canada, that number would be around 43,500. That only accounts for mortality within a month of having a stroke, which in turn accounts for only 10% of stroke-related deaths.

This is further reflected in overall stroke-mortality statistics: for every 1,000 strokes that occur annually in the US, approximately 170 stroke-related deaths occur. The UK has 250 stroke related deaths per 1,000 strokes and Canada has 280 stroke-related deaths per 1,000 strokes. Considering that Americans suffer approximately 795,000 strokes each year, the discrepancy in stroke-related mortality is humongous.

Similarly, cancer-survival rates are considerably higher in the US than in other countries. Check out this data cited by the CDC, which comes from the authoritative CONCORD study on international cancer-survival rates. The US dominates every other country in survival rates for the most deadly forms of cancer.

Recognizing that the US is a much larger country than the UK, if we weight the CDC-quoted survival rates for different forms of cancer in accordance with their contribution to overall cancer mortality, there would be about 72,000 additional deaths annually in the United States if our survival rates were comparable to the UK’s. There would similarly be about 21,000, 23,000, and 31,000 additional deaths per year with Canadian, French, and German survival rates.

Lives are saved by the many types of superior medical outcomes that are often unique to the US. This is not to mention the innumerable lives saved each year around the world due to medical innovations that are made possible through vibrant US markets.

Rick would be the first to admit: our medical system is far from optimal. Among other things, soaring medical care costs need to be controlled, while insuring against medical calamity ought to be much more affordable. Still Sanders and Company’s policy demands display completely ignorant of the massive deficiencies that are characteristic of universal medical care systems. They’ll sing songs all day about the 45,000 lives taken every year by greedy insurance executives and their cronies on Capitol Hill, yet remain completely ignorant of the fact that the European systems they fetishize are less humane by their own standards.

If we’re going to call Paul Ryan a killer for attempting to curtail Medicaid spending, then we logically have to apply that epithet to all politicians who advocate for European systems, because those systems have outcomes that would result in tens of thousands of additional deaths in the US every year.

Posted December 22, 2017 by aurorawatcherak in Common sense

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