Tagged: Commonwealth Fund

Myths and reality about Medicare and Medicaid

A pair of recent studies use evidence to challenge two widely held beliefs, namely that undocumented immigrants are draining the Medicare trust fund and Medicaid provides poor quality medical care.

In the first instance, a study conducted by investigators from Harvard Medical School and the City University of New York and published online in mid-June by the Journal of General Internal Medicine, found that undocumented immigrants pay more into the Medicare Hospital Insurance Trust Fund than they take out.

The second study, released June 25 and conducted by researchers at The Commonwealth Fund, found that in 2014, 95% of Medicaid patients who were covered all year had a regular doctor, and 55% said they received excellent or very good care.

“I think this underscores the need for evidence-based policymaking,” Sara Collins, PhD…a co-author of the organization’s study told MedPage Today. “It’s important that everyone look at the data that’s available.”

Between 2000 and 2011, unauthorized immigrants generated a substantial surplus for the Medicare Trust Fund — $35 billion, according to the Harvard study. That ranges to between $2.2 billion and $3.8 billion per year, or $316 per capita for that population, compared with $106 per capita for the rest of the American population…

On the Medicaid side of the equation, according to the Commonwealth Fund report…Medicaid patients ages 19-64 had similar experiences to people with private insurance and were in far better circumstances than those who lacked insurance altogether. Among the uninsured, the survey found, 77% of people reported having a regular doctor, with only 40% saying they received good care.

“There’s some conventional wisdom that Medicaid is not very good coverage, but this shows how well Medicaid does in enabling people to protect themselves,” Collins said. “It may be a surprise to many, but these figures do demonstrate that it’s certainly better to have Medicaid than to have no coverage at all.”…

Perhaps most telling, 19% of Medicaid beneficiaries reported having some kind of issue related to paying medical bills. About one-third of people with private insurance – and 47% of uninsured – reported the similar struggles.

Given the still-controversial Medicaid expansion called for by the Affordable Care Act, and the beating Medicaid coverage has taken in some quarters as a result, the survey findings call for a fresh look at what Medicaid really delivers, Collins said…

I hope you’re not surprised that evidence and data-driven analysis reveals a more positive outlook than conventional wisdom or conservative ideology. Now, let’s make it even better!

Expansion of Medicare to all citizens within a single-payer system reduces costs by cutting out the insurance industry slice of the pie. Congress isn’t likely to have the courage for that. But, the experience of Social Security – with operating costs about 80% cheaper than anything the insurance industry offers – proves the possibility.

The same holds true for Medicaid. And I may as well throw in my favorite criticism of the provisions as designed by Congress. There is no legitimate reason preventing taxpayers in general from enjoying the same fixed, government-negotiated rates for prescription drugs that are offered members of the armed services.

Health care is getting more affordable — see that on the local news, yet?

Every two years, the Commonwealth Fund surveys Americans on how difficult it is to afford medical care. The 2014 survey showed something new: for the first time in a decade, the number of Americans who say they can afford the health care they need went up.

The Commonwealth Fund fielded the survey during the second half of 2014, meaning they captured the people who signed up for Obamacare during the open enrollment period earlier in the year. And it showed, for the first time in the survey’s 10-year history, a decline in the number of Americans who reported having difficulty paying medical bills or who carried medical debt.

The Commonwealth Fund also looked at Americans who said they put off care because it was too expensive. And there, too, they saw a decline: 36 percent of Americans reported delaying care because of the price, an all-time low in the survey’s history.

This also coincided with an increase in the number of Americans who reported having health insurance, a finding that lines up with other national surveys on coverage.

In a way, it seems obvious that more people with health insurance would mean more Americans able to afford care. But that notion hasn’t always been taken for granted with Obamacare. Some of the plans sold on the new marketplaces have had especially narrow networks that limit coverage to a smaller set of doctors. These plans have also had particularly high deductibles, often over $2,000.

So it hasn’t been totally clear whether these plans would make it easier for Americans to afford coverage: would enrollees with a $2,000 deductible, for example, still find it too expensive to go to the doctor?

The Commonwealth Fund survey suggests that the answer is no: that the plans sold on the marketplace are making it easier for the people who buy them to see the doctor — which is one of the main points of having health insurance to begin with.

Makes sense to me. My Medicare Advantage has gone up a very small percentage; but, I’m entering the second year with a new provider – and all the insurance companies seem to play the same game of lowballing the first year.

The few other folks and family members I chatted with on the topic – admittedly a short sample – all agree with the article.

New Obamacare customers are happy

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We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases.

The survey, from the Commonwealth Fund, a research group, came to similar conclusions as other surveys about the expansion of health insurance. It found that about 15 percent of adults younger than 65 now lack health insurance, down from 20 percent before the Affordable Care Act rolled out in January.

What was more surprising is that people who got the new coverage were generally happy with the product. Overall, 73 percent of people who bought health plans and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with their new health insurance. Seventy-four percent of newly insured Republicans liked their plans. Even 77 percent of people who had insurance before — including members of the much-publicized group whose plans got canceled last year — were happy with their new coverage.

Larry Levitt, the senior vice president for special initiatives at the Kaiser Family Foundation, another research group that polls on the Affordable Care Act, said he wasn’t sure we’d see such high satisfaction so early

The Commonwealth poll appears to be the first national survey since the health-law passed to have gone beyond questions about insurance status and asked about satisfaction and usage.

Of course, since the article appears in the newest copout version of the NY TIMES, they meet the editorial requirement of stuffing the end of the article with beaucoup “what-ifs” just in case you might take a positive view – of a positive poll.

Perish the thought that changing times, a wee bit of change in politics as usual, might support even further movement in a population world-reknowned for ennui.

RTFA for more good news about legislation that benefits 99.9% of this nation.

U.S. comes in last of 19 countries in preventable death ranking

France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations…

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs…

“I wouldn’t say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don’t, I think that’s the main problem, isn’t it?” Ellen Nolte said in a telephone interview…

France did best — with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people…Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people…

After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.

The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings…

It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance,” Commonwealth Fund Senior Vice President Cathy Schoen said.

“The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference,” Schoen added in a statement.

Our politicians have been promising us universal healthcare all the way back to Harry Truman and the 1948 elections. He didn’t even introduce a healthcare bill after he was elected.

Now we have a halfass measure that provides some improvement and cost reductions. Cost reductions I’ve already experienced in Medicare. The halfass part comes from the original Republican individual mandate instead of a single payer program.

No matter. Republicans will be campaigning this Fall against the plan they originally introduced – and didn’t oppose until President Obama adopted it.

Democrats are afraid of a complete universal single payer program – afraid they might lose campaign contributions from insurance companies. Republicans share the paranoia and trump it with the number of their own breed in bed with pharmaceutical companies and healthcare chains.