August News Hound

[policy doctor]

Medicare Part D premiums to increase an average 14 percent

By Larry Lipman
Austin Statesman
Monday, August 13, 2007, 05:23 PM

The average premium for Medicare Part D, which covers prescription drugs, will increase about $3 a month, or nearly 14 percent, starting Jan. 1, Medicare officials announced Monday. The average premium will increase from about $22 to $25 a month.

Trying to put the best face on the increase, however, Medicare officials noted that the average premium is still far lower than what Medicare and congressional officials estimated when the drug law was passed in 2003.

Medicare officials attribute the lower-than-predicted premiums to the impact of competition among drug plans.

"Competition and smart choices have been two important factors in holding down the cost of the Medicare drug benefit," said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services. "Medicare drug benefit bids continue to be well below projections because of slower than expected growth in prescription drug costs generally, in part because of increased generic usage, effective plan negotiation, and strong competition."

Medicare officials also note that most of the increase is due to technical factors in the way Medicare computes risk factors associated with the drug coverage.

Despite the increase, Medicare officials say 87 percent of beneficiaries enrolled in stand-alone drug plans will be able to find a plan with the same or even lower premiums than they now pay. The Part D program will have its third open enrollment period, in which beneficiaries can sign up for a different plan, from Nov. 15 to Dec. 31.

 

[policy doctor]

Hound//H.R.676

H.R. 676 would tax rich, give health care to all

Saul Friedman

Gray Matters
Newsday

August 4, 2007

The middle-aged fellow who takes care of my yard had a stroke some weeks ago, but he doesn't know how it affected him or whether another one may be coming.

That's because he hasn't had the $1,600 cash for the MRI he needs. He could not get health insurance, even if he could afford the huge premium, because he was not in the best of shape, and he can't get it now because of his pre-existing condition - the stroke. So he hopes for the best.

That is not an unusual story. I haven't yet seen "Sicko," but I don't need filmmaker Michael Moore to tell me (and most of us) that while American health care can be the best if you can get it, the health care distribution system is also the most backward, costly, unfair and inequitable in the civilized world.

The single most important reason: The multibillion dollar power of the private insurance industry stands in the way of genuine change.

The facts are well known, and unique to the United States. More than 43 million Americans, most with jobs, have no health insurance and no protection against illness or accident. More than nine million children are without health care coverage. People who are under 65 and have been laid off from jobs cannot get coverage unless they pay outrageous premiums.

Personal bankruptcies are increasing because of medical debt. And as Moore's documentary shows, the 250 million Americans with insurance can't count on coverage when they're really and expensively sick. Any of these facts would be considered outrageous almost anywhere else in the world.

Forget the silly and mostly inaccurate nitpicking about Moore's facts. We know from personal experience and from all we've read that his and our diagnosis of the American health care distribution system is correct. According to every poll, more than 70 percent of us know it needs to be fixed with a system that covers every American if they need it - whether it's for the flu, a broken bone or a long battle with cancer.

How do we do this? So far, most of the Democratic presidential candidates favor giving most of the role of providing health care to insurance companies in partnership with employers and the federal government. How much government would be involved remains an issue. (The Republican candidates would provide tax breaks to buy insurance with little or no government involvement.)

The most important reason the candidates involve insurance companies is the fear that their power, along with other financial interests of the medical-industrial complex, would kill any universal coverage that doesn't include a major role for the insurance industry.

But "Sicko" calls for an end to private health insurance (except for such services as cosmetic surgery) because, Moore says, insurance companies have an inherent conflict of interest. Their first obligation, under law, is to earn as much as possible for their shareholders. And that means they are obligated to spend as little as possible on health care, by limiting coverage to younger, healthy people or refusing as many claims as they can get away with, or restricting the services doctors and hospitals may provide. If your doctor can't spend time with you, there's an insurer in the room.

That's why Moore was able to find 25,000 people with tales of insurance denials, some of them fatal. And that's why Moore favors a publicly financed "single-payer" system, run by the government and with no role for the insurance companies.

But as my mail shows, there are misconceptions about what a "single-payer" system is. It is not the British model, in which health care providers work for the health service. That is not what advocates of single-payer system envision for the United States.

Indeed, the United States already has a couple of government-run, taxpayer-supported single-payer systems - Medicare, for persons over 65 and the disabled, and the Veterans Affairs health system, which provides doctors, hospitals, drugs and even long-term care for eligible veterans. Doctors and other medical personnel work for themselves. And both systems work remarkably well, despite this administration's efforts to undermine them.

You would think, then, that a single-payer system that expands Medicare to cover every American, and not just the old and disabled, would be logical and reasonable. But Rep. Dennis Kucinich of Ohio is the only Democratic candidate to endorse the idea.

In addition, while surveying the possibilities for universal health coverage, most of the press and even the authoritative Kaiser Family Foundation's new health care Web site, have failed to mention the only legislative proposal, endorsed by Kucinich and Moore, for a single-payer universal health plan: H.R. 676, the National Health Insurance Act, or "the Expanded and Improved Medicare for All Act."

But one of the most influential voices for seniors, Jane Bryant Quinn, has endorsed what she called, in Newsweek, "an excellent template for universal care right under our noses; good old American Medicare. When you think of reform, think 'Medicare for all.'"

That's the intent of H.R. 676, introduced in 2005 by Rep. John Conyers (D-Mich.), with nearly 80 co-sponsors. It would be financed by tax increases on the wealthiest Americans plus appropriations and premiums to guarantee free medically necessary health care, drugs, and long-term care to every American. But most of the cost would be offset by the end of private insurance costs. Like Medicare before HMOs were permitted, insurance companies would be prohibited from selling policies that duplicated the benefits provided under the act.

The cost would be much less than the $12 billion a month we're spending on Iraq because it would eliminate the need for employer contributions, Medicaid, the State Children's Health Insurance Program and other state programs.

Radical? Judge for yourself. Medicare for All, which could be phased in gradually and administered within states as Medicare is, has been endorsed by 15,000 doctors, even more nurses and 20 state labor federations. If you have access to a computer, visit the Web site of Physicians for a National Health Plan (pnhp.org) and see what it says about a single-payer plan. And read Conyers' bill by searching on your computer or at the library for H.R. 676.

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at [email protected].

 

[midwestbroker]

The democrats want government to have total and absolute control over our health care. Why do they think they can pull this off?

I see this like Iraq. 6 months ago they were crying "When I am president, the next morning the war will be over." Now they are saying it will take years to get out of Iraq.

Transpose that to health care - Now: Under my plan we all will have health care. 6 months from now: It will take years to get such a plan in place.

 

[insurance0707]

I saw the movie sicko. At the end of the movie a few people started clapping...then a few more....then the whole theatre...everyone was clapping. I was amazed. You don't see that too often, especially when it's a documentary. I thought to myself, thank goodness they don't know I"m an insurance agent, I'd probably be pummeled! Great movie though

 

[midwestbroker]

IMHO…

I think one of the main problems with America and the health care system today are the people who want it.

Yes, there are people out there who genuinely need health care and assistance from the government.

We should have some program for the people who need help, mostly for insurability out of their control. If you are uninsurable because of your own ignorance, then why should America bare the burden?

These people, who refuse to put down the fast foods, make financial adjustments (canceling cable, buying a cheaper car, etc) and not take responsibility for their actions are the ones who want it most, and I do not see why they have the right to infringe on my rights to a free market for my family’s health care.

We should have government health care, but it should be basic coverage. The government has the responsibility to give us basic needs, not comprehensive benefits.

 

[policy doctor]

GAO: Medicare's Health Plan Audits Are Toothless

By John Reichard, CQ HealthBeat Editor

Audits to assure that private health plans in the Medicare program are delivering all the benefits they are supposed to are too few and too tardy to be of much value, the Government Accountability Office has concluded. The Centers for Medicare and Medicaid Services should increase the frequency of those audits, speed them up to allow benefits to be provided as promised and pursue financial recovery from plans that provide too few benefits, the study found.

CMS is required each year to audit one-third of the bids filed by managed care plans to offer benefits to Medicare beneficiaries. Those filings state which benefits will be provided and estimate their cost. To the degree the bids fall below Medicare payment benchmarks, plans must provide more benefits or lower beneficiary costs for premiums or co-payments. If they exceed the benchmarks, the plan must charge plan beneficiaries higher premiums to recover the sums above the benchmark.

GAO said CMS generally agreed with its recommendations. Jeff Nelligan, a CMS spokesman, said the agency "welcomes constructive suggestions for improving the audit process and we are in the process of implementing some of the recommendations included in the GAO report."

The report concluded that "CMS has not met the statutory requirement to audit the financial records of at least one-third of the participating Medicare Advantage organizations for contract years 2001-2005, nor has it done so yet for the 2006 contract year bid submissions." The percentage of managed care organizations audited ranged from 18.6 percent to 23.6 percent over the 2001-2005 period, and stood at 13.9 percent for 2006, when the number of plans participating in Medicare Advantage rose sharply.

In addition, "CMS does not plan to complete the financial reviews until almost three years after the bid submission date each contract year," GAO said. "This will affect its ability to address deficiencies in a timely manner."

While Medicare officials identified about $34 million in benefits offered by 32 managed care organizations in 2003 that beneficiaries could have received in added benefits, CMS told GAO it had no plans to pursue financial recoveries because the agency lacked authority to do so. Not so, according to GAO, which urged CMS to include provisions for the audits and for financial recoveries in contracts signed each year with managed care plans.

When CMS conducts too few audits or performs them too slowly, "the intended oversight is not achieved and opportunities to determine if organizations have reasonably estimated the costs to provide benefits too Medicare enrollees are lost," GAO said

In its response to the report, CMS said it would include contract language stating its intention to pursue financial recoveries or to seek legislative authority to do so if needed. It also pledged to make final a plan to meet the one-third audit requirement and to lay out a plan for how problems uncovered by audits will be addressed before the following year's bids are approved.

But CMS also noted that "the ability to obtain financial recoveries based on the bid audit is extremely complicated and can result in future payments by CMS rather than reimbursements by plans. Additionally, changes to the bids based on the bid audit can have an adverse affect" on Medicare beneficiaries, such as when the plan must reduce benefits to be consistent with the amount it bids, it said.


Source: CQ HealthBeat News

 

[policy doctor]

Testosterone pills: How safe for aging men?

By Megan Rauscher
Reuters

Tue Aug 14, 1:45 PM ET Testosterone supplements may make aging men feel and look better, but the results of a study conducted in rats suggest that it could lead to kidney damage and worsen high blood pressure (hypertension).

Testosterone levels gradually decrease with age in healthy men, a condition some doctors refer to as "andropause," which is analogous to menopause in women.

A growing number of healthy older American men take testosterone replacement therapy to improve their feelings of well being, sex drive, and muscle mass.

"Because chronic cardiovascular disease, like hypertension or kidney disease, is related to a sharp decrease in testosterone, a lot of doctors also prescribe testosterone to men who suffer from heart disease," Dr. Radu Iliescu, of University of Mississippi Medical Center, Jackson, noted in a telephone interview with Reuters Health.

However, "no well-controlled clinical studies have addressed the effects of testosterone on the cardiovascular system," Iliescu warned, "and our research actually showed that testosterone contributes to hypertension and end-stage renal disease in various rodent experimental models."

 

[policy doctor]

Testerone (pt 2)

Iliescu and colleagues found that testosterone supplements caused about a 2-fold increase in testosterone levels in the blood of male rats. They also found that blood pressure was significantly higher in testosterone-supplemented rats compared with normal "control" rats.

Castration did not alter blood pressure levels.

Compared with normal rats, testosterone-supplemented rats also had higher concentrations of protein in the urine, a sign of possible kidney trouble, whereas castration reduced protein in the urine.

These results were reported by Iliescu and co-researchers at a recent meeting of the American Physiological Society in Austin, Texas.

Supplementing testosterone or preventing the testosterone loss that occurs with age or chronic disease may actually worsen preexisting heart or kidney disease, the researchers conclude.

"We are trying to bring to the attention of the clinician of using care when prescribing testosterone supplements and to address cardiovascular risk," Iliescu told Reuters Health.

 

[policy doctor]

Buy your stocks in these companies

Your Weekly Medicare Consumer Advocacy Update

Extra Payments to Insurance Companies = Extra Profits

August 16, 2007

• Volume 7, Issue 32

Medicare private health plans should keep the extra payments they get from the government--so the argument goes--because they provide members with extra benefits. But while Congress debated cutting overpayments to Medicare private health plans, which average 12 percent more than what Original Medicare spends to care for patients, insurance company execs were laughing all the way to the bank.

The business pages of many newspapers have reported that insurance company profits are rising thanks to the government's generosity.

Medicare Advantage program--which allows private plans to provide Medicare benefits--is a "bright spot" for UnitedHealthcare, a financial analyst told clients in July. The company's latest report showed that profits rose 22 percent due to government-sponsored health plans during the second quarter, according to the business wire service Bloomberg News.

UnitedHealth is the country's largest health insurer, but its rivals also reported rising profits during the second quarter of this year. Coventry Health Care profits rose 12 percent after its Medicare enrollment tripled. Aetna reported a 16 percent increase in profits, during the same time period.

Humana, another familiar name in the Medicare private health plan business, reported that profits more than doubled compared to a year ago, even surpassing the optimistic predictions of financial experts.

Every dollar that winds up as profit is a dollar that was not spent on health care. And it's worth pointing out that the companies' good news comes despite setbacks in other areas, like the increased costs of employer-sponsored health programs.

The Centers for Medicare & Medicaid Services (CMS), which is supposed to oversee the Medicare private plans, could be doing a better job tracking how private plans spend their government reimbursement. A July study by the Government Accountability Office (GAO), the investigative arm of Congress, found that Medicare private plans should have spent approximately $35 million on additional benefits, lower copayments or lower premiums in 2003, but they did not. In May, CMS informed GAO investigators that it does not have the legal authority to force the companies to refund the money.

GAO also found that CMS is lagging behind in complying with a requirement to audit a third of all plans every year: only 14 percent of plans were examined in 2006--a smaller proportion than in 2005--and less than half the required number.

At that rate, it will take CMS almost three years to complete its financial reviews of one-third of the plans. That's too long, the GAO concluded, to catch and fix problems.

But the news about the companies' healthy profits from their government contracts reveal what the audits may find some day--that the government is paying too much.

Legislation passed by the U.S. House of Representatives would eliminate extra payments to Medicare private health plans. The bill, called the Children's Health and Medicare Protection Act, would also increase premium subsidies for people with Medicare whose incomes are low and provide free preventive medical care. The legislation would also expand the State Children's Health Insurance Program (SCHIP) to cover more than six million children.

The U.S. Senate passed its version of the bill that extends children's health insurance, but it omits any mention of Medicare. The two bills must be reconciled into one and then voted on again before it goes to the president for his signature.

The prospect of losing the profitable Medicare payments worries insurance companies. Their insurance industry's trade association has bought TV ads and sponsored rallies to pressure Congress to maintain the extra payments.

The concern subsided momentarily when President George W. Bush promised earlier this month to veto any bill that cuts payments to insurance companies. That announcement alone had an immediate effect in the financial world: the president's support for future profits boosted the share prices of the country's five top insurance companies--by as much as 7 percent.

Medical Record

"Shares of Humana, Inc., the second-largest provider of U.S.-sponsored Medicare Advantage health plans, rose 7 percent today after President George W. Bush vowed to veto a bill that would trim government payments. ...Last week, after Humana said its second-quarter profits more than doubled because of higher earnings in its government programs, the company predicted it could weather reduced U.S. subsidies" Bloomberg News, August 2, 2007).

"CMS will not complete the proposed [2006] financial reviews until almost three years after the bids are submitted.... Such an extended cycle for conducting reviews of financial records to meet the one-third requirement will affect CMS's ability to address any identified deficiencies in MA organizations' and prescription drug plans' bid processes in a timely manner" U.S. Government Accountability Office, July 30, 2007).

"We need to reform our health care system by making private health insurance more affordable and available. We need to reduce our dependence on foreign oil by promoting alternative fuels. We need to confront the rising cost of entitlement programs like Medicare and Medicaid and Social Security. I look forward to working with Republicans and Democrats to come up with sensible solutions to solve these problems, so that we can say we solved the problems and not pass them on to future generations" (President George W. Bush, Washington, D.C., August 8, 2007).

"UnitedHealth Group Inc., the largest U.S. health insurance provider, revised up its second-quarter profit and 2007 earnings forecast after an increase in government payments for last year, sending the shares higher . . . The increased revenue came from the U.S. Medicare program for the elderly. Enrollment in employer-sponsored health plans has been eroding industrywide, and insurance providers are becoming more dependent on Medicare and other public programs for profits" Avram Goldstein, Bloomberg News, August 6, 2007).