Health Affairs

On Day Three of arguments about the constitutionality of the Affordable Care Act, the Supreme Court turned its attention to the question of severability. Should the Court find that the ACA’s minimum coverage requirement is indeed a proper exercise of Congress’s right to regulate interstate commerce, today’s arguments were all for naught. However, if the... Read the rest of this entry »

What options does Congress have to insure the public if the Supreme Court rules unconstitutional the Affordable Care Act mandate that individuals purchase insurance?  Could Congress create a national public insurance program funded through a payroll tax? Well, yes.  It already does.  Medicare covers all Americans over 65, (also individuals with permanent disabilities or end-stage... Read the rest of this entry »

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines an approach for restructuring Medicare known as premium support. The concept means that the federal government would make a predetermined annual payment on behalf of each Medicare enrollee to the health plan of his or her choice–thus, “support” toward the... Read the rest of this entry »

Wisconsin Republican Paul Ryan is frequently hailed for his fiscal responsibility and political courage.   After all, the Congressman has now put forward not one but two budget plans that offer “a blueprint for safeguarding America from the perils of debt, doubt and decline” and take on sensitive issues like Medicare.   Ryan seems to have emerged... Read the rest of this entry »

For the second year in a row, Rep. Paul Ryan (R-Wis.) has advanced a comprehensive budget plan that would restructure Medicare and Medicaid, repeal the big-spending portions of the Affordable Care Act (ACA), and ultimately resolve the fiscal crisis facing this country.  Critics react that the Ryan plan would dismantle health care as we know... Read the rest of this entry »

Mission creep is the expansion of a project or mission beyond its original goals, often after initial successes. Mission creep is usually considered undesirable due to the dangerous path of each success breeding more ambitious attempts, only stopping when a final, often catastrophic, failure occurs. Health Information Technology (HIT or health IT) is one of... Read the rest of this entry »

On February 1, the American Medical Association’s Relative Value Scale Update Committee (RUC), Medicare’s primary advisor on physician payment, announced the addition of two seats: a permanent one for geriatrics and a rotating one for primary care. The American Geriatrics Society and the American College of Physicians praised the move as a step forward that... Read the rest of this entry »

How much health spending is sustainable? Charles Roehrig’s post addressing this question heads the list of most-read Health Affairs Blog posts for February. Next on the list is a post contrasting Medicare and commercial insurance by Diane Archer and Theodore Marmor. Also in the top ten are posts by Larry Wolf and Ashish Jha examining... Read the rest of this entry »

Medicare’s seven-year public reporting initiative for hospitals, Hospital Compare, had no impact on reducing death rates for two key health conditions and just a modest effect on a third. That’s the conclusion of a just-released study that raises questions about the initiative’s ability to improve the quality of care provided by the nation’s hospitals. The... Read the rest of this entry »

Editor’s note: For more on the Stage 2 proposed rules defining meaningful use of electronic health records, see Larry Wolf’s Health Affairs Blog post. Late in the day on February 23, 2012, the Centers for Medicare and Medicaid Services (CMS) released the preliminary rules for Stage 2 Meaningful Use.  For those not deep in the... Read the rest of this entry »

Editor’s note:  The ideas expressed in this post draw on the “IPAB Working Group,” a panel of health care experts supported by Pfizer and charged with identifying strategies the Independent Payment Advisory Board might use to lower Medicare spending. Though many of the ideas that follow stem from that meeting, the authors take sole responsibility... Read the rest of this entry »

Now that everyone in government is aggressively looking for cost savings, graduate medical education is again in the crosshairs. Just Google “Medicare and GME funding,” and you will see a number of educated (and uneducated) pundits opining on the pros and cons of the current system of financing. Medicare has recognized the costs of training... Read the rest of this entry »

As the debate over Medicare continues in connection to America’s fiscal problems, it is critical to understand how Medicare differs from commercial health insurance for working people.  There is a fundamental difference between these two types of health insurance plans, one social and one commercial. The basic difference between Medicare and commercial insurance is that... Read the rest of this entry »

Spurred by the nation’s federal deficit, unsustainable healthcare costs, and other economic challenges, America’s healthcare system must change from a fee-for-service to a fee-for-value system, challenging all industry participants to make healthcare more efficient, effective, accessible, and affordable. While patients, employers, and payers clearly benefit from lower costs, the fee-for-service system in place since Medicare’s... Read the rest of this entry »

Americans increasingly distrust what they perceive as poorly run and conflicted government. Yet rarely can we see far enough inside the federal apparatus to examine what works and what doesn’t, or to inspect how good and bad decisions come to pass. Comparing the behaviors of two influential federal advisory bodies provides valuable lessons about how... Read the rest of this entry »

In April 2012 a number of accountable care organizations (ACOs) will begin their contracts with the Centers for Medicare and Medicaid Services (CMS) under Medicare’s Shared Savings and Pioneer ACO programs. The latest health policy brief from Health Affairs and the Robert Wood Johnson Foundation provides an overview of ACOs, their origins, and the current... Read the rest of this entry »

In June of 2011, I flew to Washington, D.C. to say good-bye to my friend, Alvin.  I wanted to be there with him and his family during his peaceful passage from this life.  Unfortunately, his end was not peaceful.  It was a nightmare because he, like too many patients being transferred from one level of... Read the rest of this entry »

One of the priorities established in the Affordable Care Act is providing better, more efficient care to the “dual eligibles,” low-income seniors enrolled in both Medicare and Medicaid. AcademyHealth’s 2012 National Health Policy Conference (NHPC) will feature a panel on this topic, which is crucial to the nation’s goal of restraining health care cost growth... Read the rest of this entry »

An extraordinary slowing of the growth in use of health care goods and services contributed to a second year of slow health spending growth in 2010, federal analysts reported in the January issue of Health Affairs. Persistently high unemployment, a substantial loss of private health insurance coverage, lower median household income, and the burden of... Read the rest of this entry »

On November 8, 2011, the Centers for Medicare & Medicaid Services (CMS) solicited the public for feedback on Medicare’s controversial coverage with evidence development (CED) policy. Although CMS did not finalize the CED policy until 2006, the agency first applied the CED concept in 1995 through a national coverage determination (NCD) on lung volume reduction... Read the rest of this entry »