Medicare

In Which We Learn That the Government's Innovative Health Policy Reforms Don't Always Work

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Today we learned that when the government tries to make America's health care system perform better, it doesn't work very well. It also tends to cost a lot of money. 

Let's start with a new Congressional Budget Office report on Medicare demonstration programs designed to improve both the quality and efficiency of health care delivery. CBO looked at the results of 34 different disease management and care coordination programs, but found that most did not reduce Medicare spending. "On average, the 34 programs had little or no effect on hospital admissions," the budget office explains. "In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered." 

The CBO also looked at four "value-based" payment reforms designed to reduce spending through bundled payments and quality bonuses. The results there were a little better; one of the four programs reduced spending on services related to heart bypass surgeries by about 10 percent. The other three, however, "appear to have resulted in little or no savings for Medicare."

The Congressional Budget Office isn't the only one with bad news for health wonks today. Kaiser Health News reports that in Alaska, the new high-risk pool set up under ObamaCare will end up costing about $10 million to cover just 50 people, or about $200,000 per person—far more than expected. Because ObamaCare's major insurance reforms don't kick in until 2014, the law created a network of state-based pre-existing condition insurance plans (PCIP) to help cover the difficult-to-insure.

Those programs were initially expected to be flooded with entrants and over budget as a result. But as I've noted before, it turns out that expectation was only half right: Enrollment is dramatically lower than expected. Many states, however, are still running far over budget. In California, high-risk pool claims came in three time higher than projected. New Hampshire only managed to enroll about 80 members by December of 2010, but simultaneously managed to spend almost twice the $650,000 in federal money that had been set aside to fund the program. Montana's program covers 296 people, but can't make the program work on the $16 million budget it was given. As in California, the per-member costs turned out to be far higher than expected. All told, nine states have requested additional funding to keep their programs propped up. 

Finally, Politico Pulse notes that hopes for a permanent fix to Medicare' physician fee schedule are being dashed against the rocks of legislative reality once again:

This isn't the way it's supposed to work. Many House lawmakers spent last year hoping to craft a long-term solution for Medicare's buggy SGR formula. What started out as a 10-year roadmap to repeal was shortened to a five-year blueprint with some caveats, and then finally pared down to a two-year patch. Now the bar could be considerably lower. 

Wait a minute: After decades of failed Medicare payment games meant to control spending, including years of failure to permanently fix the "doc fix," it turns out that this won't be the year that legislators and technocrats finally figure out how to make things work? 

Don't worry too much, though. Thanks to Medicare, Medicaid, and ObamaCare, those legislators and bureaucrats will have plenty of opportunity to keep trying. Eventually they'll get it right. Right? 

Read "Medicare Whac-a-Mole," my history of Medicare's many failed attempts to control costs through payment reform

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  1. <blockquote>”On average, the 34 programs had little or no effect on hospital admissions,” the budget office explains. “In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program, when the fees paid to the participating organizations were considered.” </blockquote>

    #1 How many programs?

    #2 “unchanged or increased relative to the spending that would have occurred in the absence of the program”  Is this Chinese for we didn’t include inflationary costs that will be across the board?

    #3 We already know that this program will improve the heath of poor and rich children alike; the long term gain of early intervention/disease prevention is not yet measurable 

    1. #1 How many programs?

      Umm, 34?

      #2 “unchanged or increased relative to the spending that would have occurred in the absence of the program” Is this Chinese for we didn’t include inflationary costs that will be across the board?

      No, its English for “We compared spending on the patients in the program and patients not in the program, and it was pretty much the same.”

      #3 We already know that this program will improve the heath of poor and rich children alike;

      We do?

      the long term gain of early intervention/disease prevention is not yet measurable

      Given that most of these pilot programs don’t have any kind of early intervention blah blah, what the fuck are you talking about?

      1. Forgot to point out:

        You realize that this is Medicare, which is old people, right? So why are you talking about programs that are alleged to improve the health of children?

        1. Are children with Progeria eligible for medicare?

          1. This is your favorite movie, isn’t it, you sick fuck.

            1. No it’s not… stop projecting!

              1. Are you implying I’m a Robin Williams fan?!? You’re the one that asked me if I wanted to do a sleepover at your place and watch Patch Adams and Bicentennial Man back to back!

                1. Wait, you were going to be back to back while you watched the movies? I heard spooning was better.

                2. Okay, every part of that sentence sounds like a euphemism.

                3. Admit it, his fake Boston accent from Good Will Hunting turns you on. Come to think of it, Robin Williams does look a bit bear-ish in that move. And you know who else is a bit bear-ish?

                  1. And you know who else is a bit bear-ish?

                    NutraSweet?

                    1. NutraSweet?

                      You make him call you “spaawwwt” and “chief” don’t you?

                4. No, I don’t like Robin Williams. You’ve either got me confused with someone else in your life, or, far more likely, you are confusing a dimly remembered dream with real life.

                  1. You were drunk and on ‘ludes, tarran. I told you you weren’t going to remember, but you kept slurring “yeth I will, I have a thotogrthic memory”.

            2. It is tough to decide which Robin Williams vehicle was the worst: Patch Adams, Jackob the Liar, or Jack.

              Got to go with Patch because of that courtroom scene at the end where the cancer stricken kids with severely compromised immune systems show up in their hospital gowns with big rubber clown noses.

              1. I want to watch Dead Poets Society again, because I just gotta see Wilson in that role, knowing what I now know, thanks to years of watching House.

              2. I don’t know if I can pick a winner out of that group, dude, and you also have to consider What Dreams May Come and The Birdcage (what a fucking insult to La cage aux folles that was). Amongst others. There are so many to choose from.

                1. It’s easier to pick movies he made that didn’t piss off the sane, as they are so few.

                  I walked out of Bicentennial Man. If the ghost of Asimov had told me to make those responsible pay, I’d have done it. Why no one can make one of his stories into a good movie is beyond me.

                  1. Williams started to go downhill sometime shortly after Jonathan Winters showed up on Mork and Mindy. Nanoo nanoo.

                    Asimov’s stories are dry and clinical and not well suited to the screen. Also, Hollywood is retarded, much like JW.

                    1. It depends on the story. Foundation, for instance, would be a little tough, with all of the expository and off-screen action. Not that it couldn’t be done well.

                      I do think stories like Caves of Steel could work. In fact, if someone could handle it, a miniseries of the original two books, followed by maybe a TV series of original stories set in the Cities could be pretty good.

                2. I just want to point out for the record, the man who is claiming he isn’t a Robin Williams fan is rattling off the names of his movies with specific comments as to why each movie sucks.

                  He’s watched all of them.

                  And he’s not a fan. Suuuure.

                  Epi, admit it, you’ve probably watched 3X the number of Robin Williams movies than anyone else here.

                  1. I’m not denying having watched a bunch of them, you boner. I watch Michael Bay movies sometimes too. Know they enemy, and all that. For instance, I talk to you, don’t it?

      2. Which 34 disease managements programs did they choose?  How many are there?  Was it a survey of 2%? CBO studies what is requested, who did so?  Who set the parameters?  

        Yes, I’m aware it is Medicare, and not Medicaid but the partisan approach is the same. 
        I refer to this study contradictory to the libertarian view.  

        1. Are you dense? They aren’t talking about disease management programs as such.

          They are talking about 34 Medicare pilot projects that were supposed to control costs in various ways, a few of which included some kind of disease management.

          1. Someone didn’t read the CBO report: I don’t think you are dense just another fucking lazy ass lawyer commenting on something he has no clue about

  2. onetime I played Operation and my tongue got stuck in the wishbone and it buzzed and my face danced until I fell asleep.

    1. That happened to me once, only it wasn’t a wishbone…

      (this would be funnier if there was an Andrew Dice Clay “OH!” sound effect there)

  3. Yes, a game containing bare electrical conduits. Ah, the 70s.

    1. Yes, what didn’t kill us made us stronger.

      1. Didn’t that thing run on 4 AA batteries or something? You can’t even feel 6V DC unless you’re using your tongue.

        1. Shows what you know. Back in the 70s, everything was nuclear powered.

          1. Yucca Mountain is full of old discarded Operation gameboards.

            1. Pussies. Radiation makes us strong.

              1. At the very least it’s even odds that you’ll get super-powers instead of cancer.

                Or perhaps a cancer-related super-power.

  4. ObamaCare will ensure black inner-city kids get aspirin. If it’s repealed by the Rethuglicants, grandma’ll be on the street. Same thing happens if we cut these damnable programs. RighT?

    1. “ObamaCare will ensure black inner-city kids get aspirin.”

      Yes, and that aspirin will cost tax payers $15 a tablet, but think of all the jobs it will create.

  5. This of course won’t deter the pinkos for calling for the complete socialization of healthcare since it’s obvious that the lack of success means we haven’t given government enough power and authority to fix the problem.

    1. I work with a guy that used to be an actuary at an insurance company. He believes, beyond a doubt, that the government is the only right group to run a health care system. His ultimate reason is that insurance companies are motivated solely by profit which makes them incapable of doing the right thing.

      1. He has a strange definition of “the right thing”.

        1. I guess he thinks the “right thing” is for insurance companies to pay out all claims, regardless of merit, until they go broke and can no longer provide health insurance…

        2. No doubt. We were in a team meeting when he started talking about it. All I could do was sit there with my mouth hanging open.

          1. If you had picked up a heavy object, said, “I’m sorry, but I have a fiduciary duty to our shareholders, policyholders, and beneficiaries; I have to do this” and hit him over the head repeatedly, legal would have totally backed you up.

  6. “Wait a minute: After decades of failed Medicare payment games meant to control spending, including years of failure to permanently fix the “doc fix,” it turns out that this won’t be the year that legislators and technocrats finally figure out how to make things work? “

    Has anyone seen my surprised face? I can’t seem to find it anywhere.

    1. Check between your cynicism and sunny disposition.

  7. Obviously, the people studying these “facts” and “data figures” just haven’t paid attention to all the wonderful, magical things this law accomplishes. Time for more press-releases!

    It would be awesome for a real-life journalist to sit down with Pelosi or Obama and lay out these numbers (among other findings) that show the PPCA is a huge money-suck that does little to improve care OR bring down costs. Could they stop lying for 3 whole seconds and just admit that it was a colossal fuckup?

  8. “In which we learn…”

    Who learned? We already knew better and the people who implemented will only try the same thing again but harder.

  9. Don’t you guys know that all that matters are your intentions and how you feel about yourself for having those intentions. All progressives know this, why don’t you?

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  11. In fact, under new health care reform your health insurance company will no longer be allowed to cancel your policy if you get sick, we should be doing this already! search online “Penny Medical” it is a good place to find insurance if you have illness like me.

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