Comments on: Hiding In Plain Sight: Using Medicare To Solve The ‘Public Option’ Conundrum http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/?utm_source=rss&utm_medium=rss&utm_campaign=hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum The Policy Journal of the Health Sphere Thu, 24 May 2012 07:58:29 +0000 hourly 1 By: fredericjones http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31931 fredericjones Mon, 14 Dec 2009 03:52:04 +0000 http://healthaffairs.org/blog/?p=2497#comment-31931 Diabetes Care and expanded Medicare coverage More than 44 million Americans will have diabetes within 25 years under current trends, and the annual cost of caring for them will triple to $336 billion in constant 2007 dollars, researchers said. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened healthcare system. Currently, some 24 million Americans are living with diabetes and this represents a great economic burden for the country and for government programs like Medicare. The average cost of treating diabetes in newly diagnosed people is substantially different from the costs of treating someone who has lived with diabetes for 20 or 30 or 40 years and is suffering from micro vascular or cardiovascular complications. For that population, evidence-based protocols are available that could assure best practices. Moreover, many of our free clinic patients are in the age group of 55 to 64 that is being considered for coverage under an expanded Medicare program. This would enable these patients to get a head start in preventing the costly complications of this disease. I am in my 26th year of serving the indigent in a free clinic setting. Along with a superb nurse practitioner, and 3 retired RNs, we hold regular metabolic clinics to manage insulin dependent diabetics, patients with resistant hypertension and dyslipidemia. We can treat the usual Type 2 diabetic with 3 generic drugs for $12 per month with excellent control of A1C, BP and lipids! In addition, evidence based guidelines allow most physicians to add insulin which needed in these same settings without referrals to the already short supply of diabetes specialists. Frederic G Jones, Sr. MD, FACP, FACC 140 The Pinnacle, Sapphire NC 28774 twitty@citcom.net Diabetes Care and expanded Medicare coverage

More than 44 million Americans will have diabetes within 25 years under current trends, and the annual cost of caring for them will triple to $336 billion in constant 2007 dollars, researchers said. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened healthcare system.

Currently, some 24 million Americans are living with diabetes and this represents a great economic burden for the country and for government programs like Medicare. The average cost of treating diabetes in newly diagnosed people is substantially different from the costs of treating someone who has lived with diabetes for 20 or 30 or 40 years and is suffering from micro vascular or cardiovascular complications.

For that population, evidence-based protocols are available that could assure best practices. Moreover, many of our free clinic patients are in the age group of 55 to 64 that is being considered for coverage under an expanded Medicare program. This would enable these patients to get a head start in preventing the costly complications of this disease.
I am in my 26th year of serving the indigent in a free clinic setting. Along with a superb nurse practitioner, and 3 retired RNs, we hold regular metabolic clinics to manage insulin dependent diabetics, patients with resistant hypertension and dyslipidemia.
We can treat the usual Type 2 diabetic with 3 generic drugs for $12 per month with excellent control of A1C, BP and lipids! In addition, evidence based guidelines allow most physicians to add insulin which needed in these same settings without referrals to the already short supply of diabetes specialists.

Frederic G Jones, Sr. MD, FACP, FACC
140 The Pinnacle, Sapphire NC 28774
twitty@citcom.net

]]> By: Big Government » Blog Archive » How the Media Has Failed America on Healthcare Reform–Part I http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31260 Big Government » Blog Archive » How the Media Has Failed America on Healthcare Reform–Part I Tue, 27 Oct 2009 19:41:13 +0000 http://healthaffairs.org/blog/?p=2497#comment-31260 [...] coverage on the health reform debate, including the public option. By way of example, this recent blog post by contributor Jeff Goldsmith directly acknowledges that the public option could lead to single [...] [...] coverage on the health reform debate, including the public option. By way of example, this recent blog post by contributor Jeff Goldsmith directly acknowledges that the public option could lead to single [...]

]]> By: ershaffer http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31247 ershaffer Sat, 24 Oct 2009 07:57:22 +0000 http://healthaffairs.org/blog/?p=2497#comment-31247 Cramdown? Voluntary enrollment in an insurance plan (even Medicare) is better than a universal program? Offering voluntary enrollment in Medicare to the 2nd sickest group in the US - people age 55-64 - would be more cost-efficient than offering a similar choice to all age groups? (The original Baucus proposal of Jan. 2009 would have automatically covered this age group in Medicare; it did not disappear due to opposition from "hard core" members of Congress, whatever that is supposed to insinuate.) Any health reform will strain the federal budget unless it is financed; CBO says the public option would reduce the deficit. Where is the well-informed analysis on this timely topic? Cramdown? Voluntary enrollment in an insurance plan (even Medicare) is better than a universal program? Offering voluntary enrollment in Medicare to the 2nd sickest group in the US – people age 55-64 – would be more cost-efficient than offering a similar choice to all age groups? (The original Baucus proposal of Jan. 2009 would have automatically covered this age group in Medicare; it did not disappear due to opposition from “hard core” members of Congress, whatever that is supposed to insinuate.) Any health reform will strain the federal budget unless it is financed; CBO says the public option would reduce the deficit. Where is the well-informed analysis on this timely topic?

]]> By: brucequinn http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31243 brucequinn Sat, 24 Oct 2009 00:46:22 +0000 http://healthaffairs.org/blog/?p=2497#comment-31243 Having worked as a regional Medicare medical director for several years, I see many advantages to this plan, and it has indeed circulated for some years. The crisis facing a self-employed 55 year old in getting insurance is awful. That said, there would be some concern about merely "enrolling at actuarial cost." If a lot of people with $50,000 expenses enrolled at $5000 age-average cost, it would be a train wreck pretty fast. The gap between Medicare payments and private insurance is not enormous for many services. Most of us with private insurance see physician office visit bills for $200 that our insurance settles for $70 insurance, $20 copay, all the time. The net payment from Medicare is only a moderate percentage in variance to the private insurance rate, at least for many physician services and when compared to large insurance companies. Goldsmith's proposal to piggyback on Medicare avoids the touted possibility of a "small" stand-alone public plan, which would have relatively high administrative costs, networking and contracting difficulties, a lot of adverse risk exposure, and little market power, as Victor Fuchs and others have convincingly pointed out. Having worked as a regional Medicare medical director for several years, I see many advantages to this plan, and it has indeed circulated for some years. The crisis facing a self-employed 55 year old in getting insurance is awful. That said, there would be some concern about merely “enrolling at actuarial cost.” If a lot of people with $50,000 expenses enrolled at $5000 age-average cost, it would be a train wreck pretty fast.

The gap between Medicare payments and private insurance is not enormous for many services. Most of us with private insurance see physician office visit bills for $200 that our insurance settles for $70 insurance, $20 copay, all the time. The net payment from Medicare is only a moderate percentage in variance to the private insurance rate, at least for many physician services and when compared to large insurance companies.
Goldsmith’s proposal to piggyback on Medicare avoids the touted possibility of a “small” stand-alone public plan, which would have relatively high administrative costs, networking and contracting difficulties, a lot of adverse risk exposure, and little market power, as Victor Fuchs and others have convincingly pointed out.

]]> By: karoli http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31217 karoli Tue, 20 Oct 2009 20:28:19 +0000 http://healthaffairs.org/blog/?p=2497#comment-31217 I have long argued that this is the most obvious solution to the problem, and not simply because it brings in the ones who are uninsurable. Anyone over age 50 who isn't making six figures knows exactly how expensive private health insurance has become. I am a healthy, fit 51-year old with no chronic illness who sees the doctor once every couple of years when bronchitis strikes and lingers. I would gladly buy into Medicare for the peace of mind it would bring, as would my spouse, who is 56. If healthy people are buying in, positive cash flow could be generated to help with those who aren't. We have a 20-year old son who was just diagnosed with ulcerative colitis and diabetes. Under current laws, he is now uninsurable. HIs diabetes is genetic -- he's not overweight nor sedentary, and when he gains the weight back from his bout of ulcerative colitis, he'll likely be able to manage his diabetes with diet and exercise and one small insulin injection per day. If he were permitted to buy into Medicare along with others like him, he'd be able to continue his dream of being a self-employed (and quite good) musician. I have long argued that this is the most obvious solution to the problem, and not simply because it brings in the ones who are uninsurable. Anyone over age 50 who isn’t making six figures knows exactly how expensive private health insurance has become. I am a healthy, fit 51-year old with no chronic illness who sees the doctor once every couple of years when bronchitis strikes and lingers. I would gladly buy into Medicare for the peace of mind it would bring, as would my spouse, who is 56. If healthy people are buying in, positive cash flow could be generated to help with those who aren’t. We have a 20-year old son who was just diagnosed with ulcerative colitis and diabetes. Under current laws, he is now uninsurable. HIs diabetes is genetic — he’s not overweight nor sedentary, and when he gains the weight back from his bout of ulcerative colitis, he’ll likely be able to manage his diabetes with diet and exercise and one small insulin injection per day. If he were permitted to buy into Medicare along with others like him, he’d be able to continue his dream of being a self-employed (and quite good) musician.

]]> By: Dr. M.Z.Younis http://healthaffairs.org/blog/2009/10/20/hiding-in-plain-sight-using-medicare-to-solve-the-public-option-conundrum/comment-page-1/#comment-31216 Dr. M.Z.Younis Tue, 20 Oct 2009 19:16:57 +0000 http://healthaffairs.org/blog/?p=2497#comment-31216 Such proposal and even the other proposals of Health Insurance Reform (which called health care or universal care) are a step forward. However the problem is that all theses proposal and plans are "Tenuous". and have the chance to fail during the current administration. The health care system in US is unique and we have the ability to move to the British system by expanding on the VA health care system or the single payer system by adopting Medicare for ALL. Such proposal and even the other proposals of Health Insurance Reform (which called health care or universal care) are a step forward.
However the problem is that all theses proposal and plans are “Tenuous”. and have the chance to fail during the current administration.
The health care system in US is unique and we have the ability to move to the British system by expanding on the VA health care system or the single payer system by adopting Medicare for ALL.

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