freeforall health policy and budget wonkery and the politics of where they meet

Obviously we health policy types have been wonking it out about premium support in Medicare given the selection of Rep. Ryan as Gov. Romney's running mate.

The short version is that hospice should be able to work under a private insurance option in Medicare that preserves the option of Seniors remaining in traditional Medicare, though there is a policy oddity regarding hospice and the current Medicare Advantage (MA) program that would have to be changed. Further, there are also some less obvious ways in which our lack of a straightforward long term care financing system will complicate hospice policy for the elderly going forward, especially if you coupled premium support with a block granting of Medicaid that was designed to reduce federal expenditures. This post is an overview, and I will revisit some of these topics in more detail.                READ MORE

This is the primary blog of Don Taylor, Associate Professor of Public Policy of Duke University that focuses on health policy, the federal budget and the politics of these key public policy issues. Mr. Taylor is the author of Balancing the Budget is a Progressive Priority published by Springer in April 2012. 

Our Health Policy Matters
A column focusing on federal, state and local health policy

A Medicare exchange in which private plans compete with a public option? A Medicaid program unshackled by federally determined program requirements and eligibility criteria?
Now that Governor Romney has chosen Rep. Paul Ryan as his running mate, these new visions of Medicare and Medicaid will become part of the health policy debate in every state.
They are both part of Vice-Presidential candidate Ryan's Prosperity proposal published earlier this year.

In his vision, Ryan attacks an "open-ended, blank-check" Medicare subsidy that in practical terms means a government that will pay providers what it costs to treat diseases even for the most expensive seniors.  In his own words...

Click HERE to read the entire blog post.

IN MY OPINION

Carol Gentry's great article titled "Medicaid expansion could save over 5,000 lives" was published in a recent Miami Herald "Other Views" section.  In the article she referred to a recent New England Journal article titled "Mortality and Access to Care among Adults after State Medicaid Expansions" which concludes that State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health. Carol Gentry correctly argues that "If Medicaid expansion prevents 2,840 deaths/year for every 500,000, then Florida's looking at 2,840 times 2, or about 5,680 a year. These are early deaths that are preventable. So when the debate begins about Medicaid expansion, remind those who control the state that they aren't just talking about money. They're talking about lives."   

She provided a factual contrast to Rick Scott's position whose "arguments" can be boiled down to a simple dogma:

We need to help people get the skills and education they need to get a job, and help the private sector succeed so they have jobs to offer. Then you'll have fewer people dependent on government programs because they'll be pulling themselves out of poverty and financial distress.

There is only one problem! Even higher education and more skills won't get you better paid jobs anymore and no more unions are available to fight for workers rights, benefits and fair pay!  Therefore, people need to work in two or three jobs to make ends meet which almost always is not enough to pay for expensive health insurance premiums.

Rick Scott's line of argument reminds me of the statements made by communist party officials I encountered many years ago when I spent some time in communist East Germany and had to endure the ideological communism babble. It's almost the same tune: we need more .... ism  to make people happy.

Well, extreme right and left do meet each other at the fringes of extreme "thinking." But as of today at least I know that our rights come from nature and God, not from government. I guess I have to do a bit more praying to get access to those rights fast because my health insurance premiums keep on rising.  

Dr. Wollschlaeger is a frequent contributor to FHIweekly and Specialty Focus. You can read more of his articles by visiting http://floridadocs.blogspot.com/.  

IN MY OPINION

As a licensed Israeli physician and Israeli citizen I am grateful that Governor Romney praised the achievements of the Israeli healthcare system. He was quoted at a fundraiser in Jerusalem, "…Our healthcare costs are completely out of control. Do you realize what healthcare spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on healthcare. And you're a pretty healthy nation."  Yes, Israelis are enjoying superb healthcare because Israel requires all residents to carry insurance (mandatory insurance coverage) and puts caps on parts of the healthcare system (rationing of healthcare services). Israel created a national government controlled healthcare system in 1995 with compulsory participation. The system is funded through payroll and tax revenue and the government provides all citizens with health insurance.

Health care coverage is administered by a small number of organizations, with funding from the government. People get to choose between four nonprofit plans, which have to accept all applicants including those with pre-existing conditions. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is funded for all citizens regardless of their financial means. There are no life-time caps and nobody can be dumped off the insurance plan. The plans also must provide a list of government-mandated benefits. In the U.S. certain political groups call such a system a "socialist model" and any country that embraces such model a "socialist society." In Israel we call it a human right and cherish the accomplishment of our democratic society. 

Thank you Governor Romney for supporting Israel's efforts to provide healthcare for all. I hope that Governor Romney will allow us to learn from Israel and to adopt their system.

Dr. Wollschlaeger is a frequent contributor to FHIweekly and Specialty Focus. You can read more of his articles by visiting http://floridadocs.blogspot.com/. 

Our Health Policy Matters         

A column focusing on federal, state and local health policy

The number of people diagnosed with Alzheimer's Disease or related dementia will grow from 5.2 million to at least 11 million over the next few decades.  The cost of caring for this many people will increase (in today's dollars) from $200 billion to $1.1 trillion. 
 
Click HERE to read the blog post.

Our Health Policy Matters         
A column focusing on federal, state and local health policy  

    In the next twenty years, more than 3 million people over the age of 65 will likely experience serious mental illness.  Are we prepared to treat them?

Click HERE to read the blog post.