CQ HEALTHBEAT NEWS
Aug. 11, 2009 – 5:31 p.m.
Obama Town Hall Meeting Spotlights Medicare Role in Overhaul
By Jane Norman, CQ HealthBeat Associate Editor
President Obama’s town hall meeting on health care in Portsmouth, N.H., on Tuesday failed to draw the heckling, shouting, and even effigy-hanging that have occurred at town hall meetings with members of Congress in other U.S. cities in recent days.
But Obama did purposefully focus attention on Medicare issues that are worrying seniors, who polls have found are the most skeptical about the president and congressional Democrats’ plans to overhaul the health care system. For example, a Gallup Poll released July 31 found that seniors are the least likely of all age groups to say that an overhaul will improve their situation.
Obama acknowledged that’s what the polls say, added that it’s “understandable” because seniors often require more health care, and put special emphasis on speaking directly to Medicare beneficiaries.
“Well, first of all, another myth that we’ve been hearing about is this notion that somehow we’re going to be cutting your Medicare benefits,” said Obama. “We are not. AARP would not be endorsing a bill if it was undermining Medicare, okay?”
The seniors’ group, however, issued a statement shortly after the presidential event to make it clear no endorsement has been issued.
“While the President was correct that AARP will not endorse a health care reform bill that would reduce Medicare benefits, indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate,” said Tom Nelson, AARP chief operating officer.
Obama perhaps most importantly confronted fears about “death panels,” which some Republicans have charged would make end-of-life decisions for ill seniors. The Web site Politifact rated as “pants on fire” a statement by former Alaska Gov. Sarah Palin on Facebook that the elderly “will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”
Said Obama: “It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready, on their own terms. It wasn’t forcing anybody to do anything. This is I guess where the rumor came from.”
A Republican, Sen. Johnny Isakson of Georgia, is a strong proponent of the provision, said Obama. He added: “And somehow it’s gotten spun into this idea of ‘death panels.’ I am not in favor of that. So just I want to — I want to clear the air here.”
The actual provision in the House version of the overhaul bill would authorize Medicare payments for an “advanced care planning consultation” between individuals and doctors, if a patient chose to schedule such an appointment. The session is supposed to include an explanation of directives including living wills, durable powers of attorney, and end-of-life services available such as hospice care and palliative care. Orders on how the patient wants life-sustaining treatment to be administered may be written during the consultation.
Obama said the underlying concern is that health care somehow will be rationed. “We do think that systems like Medicare are very inefficient right now, but it has nothing to do at the moment with issues of benefits,” he said. “The inefficiencies all come from things like paying $177 billion to insurance companies in subsidies for something called Medicare Advantage that is not competitively bid, so insurance companies basically get $177 billion of taxpayer money to provide services that Medicare already provides.”
However, the cutback in Medicare Advantage, which is administered through private health insurance plans and provides a big chunk of money to help finance the overhaul without running up the deficit, also likely would affect millions of seniors.
According to the Kaiser Family Foundation, 22 percent of those enrolled in Medicare in 2009 belong to a Medicare Advantage plan, and since 2003 the number of Medicare Advantage beneficiaries has almost doubled from 5.3 million in 2003 to the current 10.2 million, as of March. Enrollment rates tend to be higher in urban areas than in rural counties.
Kaiser says that Medicare Advantage plans provide basic Medicare benefits and are required to use rebates they receive by bidding below a benchmark to provide extra benefits like vision or hearing, or reduced cost-sharing or premiums. However, groups such as the Commonwealth Fund have argued that Medicare Advantage was supposed to save money for the program and has failed in that mission.
The Congressional Budget Office said in a 2007 report that while reducing the payment differential between Medicare Advantage and the fee-for-service program could result in substantial savings for the government, “it would also diminish the supplemental benefits and cash rebates the Medicare Advantage plans can offer to enrollees and lessen enrollment in those plans.”
Obama characterized the reductions as “subsidizing folks who don’t need it,” referring to insurers, and rejected the notion that changes to Medicare Advantage might affect the more than 10 million seniors who are currently beneficiaries.
“I just want to assure we’re not talking about cutting Medicare benefits. We are talking about making Medicare more efficient, eliminating the insurance subsidies, working with hospitals so that they are changing some of the reimbursement practices,” he told the audience in Portsmouth.
Prior to the event, former New Hampshire Gov. John H. Sununu correctly predicted the president would receive a “respectful” reception in Portsmouth, though Sununu said he understands the intensity of emotions that have surrounded the health care debate at other town halls around the country. People are upset because they feel there hasn’t been a “full debate” in Congress yet, he said. “This idea we have to pass something immediately is not the way to do it,” said Sununu, the chairman of the Republican Party of New Hampshire.
Comments
Misinformation & Correction : 1. Rationing & A long Line : With the help of upcoming IT system, the concern of a long waiting list probably doesn't matter. And now that docs are liable for patient's outcome, no intervention in the final decision is allowed other than 'recommendations' for best practices. In the government-run, single-payer Medicare program, enrollees choose their own doctors, receive care in a timely manner. Similarly, the public option can be viewed as extension of medicare, exactly speaking, an upgraded version of it. 2. Saving & low Quality : Most part of savings is made up of weeding out such wastes as so called "doughnut hole" , the unnecessary subsidies for insurers, the duplicate tests and unproven sham level of treatments, abuse, exorbitant costs by the tragic ER visits and so forth. As president Obama noted, the analogy of insulation, weatherization would be appropriate. With that in mind nearly two-thirds of the cost of reform will come from reallocating money, overall, the financial architecture is looking good. And let me stress : If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to prescribe the best medicine available earlier in the process, let alone skimming the wasteful, unnecessary, and risk-carrying procedures. 3. Take-over ; The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need. In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have BALANCING function to keep it in check in terms of INFLATION, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' . Under the circumstances the energy bill to determine human future and the other major issues are presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election. with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs changes and should join together to complete this reform , as promised, otherwise, the runaway premium only has itself to blame while new firms are filling the void with competitive deals. And It can be said that fair competition starts with a fair, sustainable market value. However, Job-based coverage (indirect payment) and a limitation code over transfer, mandate code, and ample capital, reduced ER costs, IT base to streamline the administrative processes and trim costs might be favorable to the private market. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services. 4. Tax rise : In the context the current health care wastes an estimated one-third – or about $700 billion – on unnecessary procedures, unnecessary visits to the doctor, overpriced pharmaceuticals, bloated insurance companies, and the most inefficient paper billing systems imaginable, health care reformers have often cited the system at Mayo Clinic as a model. In modernized society, the business lacking IT system is unthinkable just like pre-electricity period, nevertheless, the last thing to expect is happening now in the sector requiring the most accuracy in respect to dealing with human lives. Apparently the errors by no e-medical records have spawned the crushing lawsuits, and these costs have led to the unnecessary tests, treatments, even further, more profits so far. Thankfully, the pay for 'outcome' pack modeled after the system at Mayo Clinic is most likely to expedite the introduction of IT system, and the combined system is capable of shifting volume into quality in Medicare & Medicaid, thereby offsetting the 239 billions of estimated deficit, which is generated by $245 billions, the 10-year cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve' care, supposedly even a quarter of it might be enough to meet the goal of revenue-neutral. Moreover, in case this innovative idea applies to the public option, presumably it can lower the overall expense sharply, too. Please be 'sure' to visit http://www.nytimes.com/2009/08/13/opinion/13gawande.html?hp for credible evidence ! And in respect to preventative program, surprisingly enough, the system today is designed around treating patients once they become sick, following 'spillover' and 'levee breach' , as too high level of preventable chronic disease accounts for it. By contrast, all of the excellent health systems seem to have one feature in common, an expansive, systematic preventative program demanding immense investments. Some say the effect of preventative program is below zero compared with investments, or takes a long time even beyond next decade window, but if this program in the exemplary systems is disorganized, the odds are high that they will also face the same pressing need for reform in a few years. Like common sense, fire needs to prevent in advance or foil in early phase, and it would be the most cost-saving measure, in my mind. Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system. The rising mental stress & 'keep eating habit' , which are the epicenter of a number of different diseases, might be traced to this insecure system and exorbitant premiums. Once the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the the deep-seated apprehension and exorbitant premiums may bend the curve surprisingly. And reducing the tragic ER visits can lessen costs for the already insured, what's more, the balancing function of public option could mitigate fast-rising premiums. I guess If the cost of the reform is an issue Americans take seriously, then all of the 'free' nations in the world should withdraw the existing public policy. Instead, it might be the 'will' of reform to end disgrace. Here is the hope, while the runaway premium wound up in the collapse of middle class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, this time, clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' , in return, will help realize health care reform Thank You For Reading !
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