Suicidal GOP

Now really, what are they up to with recent ambushes of seniors? AARP, Medicare, Medicaid, Social Security. As Digby says, is the GOP demonstrating suicidal tendencies?

The End of Medicaid?

From Howard Gleckman's recent post at Home Care Association of Florida:

These proposals won’t become law any time soon. But they are evidence that Medicaid could be on the fiscal chopping block. In that environment, it makes sense to get the program out of the long-term care business. And a way to do that would be to replace it with a broad-based insurance system. The Community Living Assistance Services and Support Act, which was created by the health overhaul, will create a voluntary national long-term care insurance program. Program participants would begin contributing in 2012, but wouldn’t b eligible for benefits for at least five years. But there are real doubts about whether CLASS insurance will attract enough middle-class buyers to reduce the burden on Medicaid. If it can’t, Congress should begin to think about what insurance design can, and do so before the Medicaid safety net for long-term care is in tatters.

Expanding Hospice Care to Include Concurrent Care.

New guidelines, adopted in March, will expand Medicare and Medicaid and to cover hospice services that include "concurrent care." Both Christian Sinclair and Diane E. Meier are quoted in the article. From Amed News:

The law also calls on the Health and Human Services secretary to conduct a three-year, budget-neutral demonstration project of concurrent care for Medicare patients at 15 hospice-care sites.

The use of hospice and palliative care has grown steadily in recent years. Nearly 1.5 million patients received hospice care in 2008, up 36% from 2004, according to the National Hospice and Palliative Care Organization, which represents 80% of the country's hospices. Yet physicians offering this alternative to patients often receive hostile responses from patients and families who view it as the final step through death's door.

The median length of stay in hospice is less than three weeks.

"There are people who, when talking about hospice, they'll say, 'Don't say that word in front of my loved one,' " said Christian Sinclair, MD, associate medical director of Kansas City Hospice & Palliative Care in Missouri. "We get such a visceral reaction to changing toward a palliative care goal."

Choosing hospice care can be especially scary for patients on Medicare, said Diane E. Meier, MD, director of the nonprofit Center to Advance Palliative Care. Some private health plans cover concurrent care, but for Medicare patients -- and, until recently, children covered by Medicaid -- choosing hospice has meant giving up aggressive treatment efforts.

"The Medicare hospice benefit is the jewel in the crown of Medicare in that it's truly interdisciplinary care," said Dr. Meier, director of the Hertzberg Palliative Care Institute at New York's Mount Sinai Medical Center. "But in order to get this wonderful benefit that is hospice, you must, on the flip side, sign a form giving up the right to regular Medicare. People feel, quite rightly, that it's like signing a death certificate."

The benefit this change offers patients, families and carers at the end of life is increased time in hospice programs, greater assistance to those facing end of life planning and decision-making, and more flexibility in where they are treated.

"You go from one phase to the next phase with something to hold on to as you make that transition," Schumacher said. "Many people say, 'I wish I'd come to hospice sooner.' "

Getting patients into hospice earlier gives them access to expert advice to help decide whether curative efforts are worth pursuing further, Schumacher said. "We believe involving hospice sooner will help people forgo nonproductive treatment."

The new law also calls on Health and Human Services to conduct a pilot program to test the efficacy of the changes:

The law also calls on the Health and Human Services secretary to conduct a three-year, budget-neutral demonstration project of concurrent care for Medicare patients at 15 hospice-care sites.

The demonstration project will test whether paying for concurrent care helps patients and saves Medicare money. Then the HHS secretary will recommend to Congress whether to change the hospice-care payment policy. A Centers for Medicare & Medicaid Services innovation center created in the health reform law also may be able to act on the recommendations. Hospice care cost Medicare $11.2 billion in 2008, according to the Medicare Payment Advisory Commission.

Some of the greatest benefactors of this change may be ill children:

In the meantime, children with terminal illnesses and their families should benefit from Medicaid's coverage of concurrent care efforts, Dr. Sinclair said.

"In pediatrics, the prognosis for patients can be a lot harder to define," he said. "Having a concurrent care model is helpful, because those families need a lot of help, especially from psychosocial and the other resources that hospice can provide."

Not a Dime of My Tax Dollars for That Brand Name Drug!

Dr. Scott Gottlieb has rallied the "America has the best health care in the world" crowd with his pro-doctor, pro-medical industry op-ed in today's WSJ.

Let me just say up front that it's hard to find something good in this health care bill already without making up poorly-framed arguments that those poor doctors and suffering medical corporations are going to have to, you know, adjust their practices. Had the industry better regulated itself over the past few decades, we wouldn't be where we are now. In a predicament where health care coverage is tapping the country's economy and still not reaching the majority of citizens effectively.

Of course the Wall Street Journal has a particular clientele, one that belongs to a class of society pampered by employer-paid stellar health care coverage. To claim that our system is currently working is to ignore the 45,000 deaths a year from inadequate health care access, or the 50 million Americans who have no health care at the moment. But this demographic never saw health care as a right, only as a commodity. If those poor bastards in a Texas had studies harder, pulled themselves up by their boot straps, they'd have decent jobs and decent health care coverage. In other words, not having health care is shameful and indicative of laziness. So goes the privileged reasoning.

Gottlieb makes the following claims in his piece:

While the AMA supports health care reform (and it's a dogged piece of legislation that has little to do with reform and all to do with appeasing the medical industry), various surgeon and specialty associations oppose it. That's because they will be hard pressed to pursue their specialties with the same abandon if they hope to accept Medicare payments. The legislation reigns in specialists - a group that has ballooned over the past few decades simply because the AMA has encouraged licensing of such specialists and because that's where the money is.

He protests the new powers given to Medicare and Medicaid to select cheaper services for patients, refusing to pay for name-brand drugs and treatments when generic will do. Of course the medical industry is up in arms over this. The overhead on name-brand services is what has made the industry such a rich and powerful loggerhead in medicine. Basic economics shows that Medicare and Medicaid can't afford - and shouldn't pay for - such overpriced services when cheaper ones are available.

Gottlieb argues that those who want to sue Medicare for not covering less expensive services will be discouraged from suing for them. To this I say: If you want a specialty services, pay for it. As women are being forced to do with the "specialty" service of abortion. For women the law of no coverage is simply religious discrimination but once mention that making economic decisions regarding other coverage is unfair and you get a gaggle of "free-market" conservatives claiming that Medicare has too much power. Let the patient pay for their extraordinary care if they think it will better help them. This isn't rationing. This is practicality in buying as far as I am concerned.

Gottlieb also criticizes what he calls incentives for independent specialists to merge or consolidate with other practitioners in order to keep costs down in delivery. This too is a practical concern. Independent specialists cost more, their overhead is not shared with other practitioners and therefor must come from somewhere. Until now that has been from Medicare and Medicaid or high-end insurance companies willing to pay more when the employer or patient pays more. If we want to cover all citizens and apply government regulation to government plans to reign in costs, we have to address the excesses. But if I were an independent specialist, I would be squealing too. My fat run is coming to an end.

Most of the cost-saving programs Gottlieb is criticizing are really demonstration programs, trials by Medicare to see what works. Instead of addressing the excessive costs of health care today, he is focusing on the wrong audience, the doctors, privileging their position - as all associations are of course apt to do - above that of the patient. But that's because Gottlieb is opposed to treating medicine as a right, affordable and accessible. Instead he wishes it to remain a commodity that has led to overspending.

He writes:

Regulation of medicine has always been a local endeavor, and it's mostly the province of medical journals and professional medical societies to set clinical standards. This is for good reason. Medical practice evolves more quickly than even the underlying technologies that doctors use. This is especially true in surgery, where advances flow from experimentation by good doctors to try different surgical approaches.

Sorry, but industry self-regulation is not regulation. As the medical industry has proven over the past decades, the great percentage of killers in the US have gone unaddressed by the big money innovators. Equipment and drug manufacturers have both pressured the public into pursuing boutique illnesses while heart disease and cancers have proven to go unchecked. That advancing innovation comes from small-time, independent surgeons is a fallacy. Innovation now, as Gottlieb calls it, is large corporations finding niches that will make them quick money.

The rallying cry worked for abortion has been "Not my tax dollars!"; how about using it to curtail excessive drug company profits and "innovations" in medicine that only address boutique treatments? When we start seeing advancements that change lives for those suffering the primary killers, preventative medicine that reduces costs and increase quality of life, and more affordable prices for all Americans, we can then discuss the excessive ways of the medical industry as innovative.

Gottlieb, a fellow at the notoriously conservative Free Enterprise Institute is approaching medicine from the medical industry's position. We've unsuccessfully tried that for decades. It's time we approach medicine from the standpoint of the patient.

Oh Nos! Medicaid Expanded to Cover 14 Mill Uninsured.

Today's Heritage Foundation newsletter, The Morning Bell (You should subscribe! It's a hoot!) reports that, "Obamacare Is Not Reform. It's Just Medicaid on Steroids."

Among the arguments the HF poses to the health care reform plan to insure via Medicaid $14 million currently uninsured Americans:

*"shoving" Americans into the program hides costs because Medicaid is partially paid by states (I wonder how much states currently pay for emergency medical care of the uninsured at hospitals?)

*participating doctors and hospitals receive 20 to 25% less pay from Medicaid than from other insured patients (duh. it's a cost containment issue. Medicaid expands competition for other medical industry soakers.)

*Medicaid recipients will exacerbate the existing access issue patients already have with willing doctors (uh huh, those doctors who wish to make that 20 to 25% more)

Their claim that the health care reform bill (termed Obamacare by opponents) is solely comprised of this initiative to expand Medicaid is silly. But even if they were right, those 14 million newly eligible Americans might not have a problem with it.

Maybe The Heritage Foundation is speaking for Big Pharma, Insurance Cons and other medical industry sponges??

McCaughey and Weiner Scrap on Morning Meeting.

Don't miss this video boxing between it's-gonna-kill-the-elderly Betsey McCaughey and New York Senator Anthony Weiner about health care reform:

via dailykos. And you can find Ben Smith's coverage at politico.