Winners and Losers: Assessing the Ramifications of Repealing Obamacare

 

Opposing ropes pulling on a doctor stethoscope as a symbol of the US healthcare systemAfter voting at least 60 times over the past six years to repeal the Affordable Care Act (ie, Obamacare) only to see their efforts stymied in the Senate, the Republican House is fairly foaming at the mouth at their golden opportunity to reach Nirvana now that they also control the Senate.

Indeed, the Senate passed a budget resolution on January 4 to begin the process, instructing the House to have a repeal bill ready by January 27. You can read how this might work in this excellent article in The New York Times.

There’s just one problem: Despite the six years they’ve spent trying to kill the ACA, the Republicans still have no replacement.

So here’s just a sneak peek at what might happen if they follow through on their threats.

10 Things We Will Lose if We Lose the Affordable Care Act Insurance for more than 20 million Americans. Guaranteed coverage without higher premiums for those with pre-existing conditions. This would affect the 52 million Americans, … Continue Reading

Labels:
ACA Affordable Care Act health insurance healthcare reform Medicare Obamacare

Why I Envy My Sister-in-Law (and Why You Should, Too)

Twenty-three years ago I married an amazing man who just happened to be Scottish. Real Scottish, as in, grew up in Glasgow and attended the university there. In the process, I gained a wonderful sister-in-law and, later, her husband (brother-in-law?).

She and her husband (and my mother-in-law, who is also pretty great!) live in picture-book-pretty idyllic Scottish towns complete with stone walls, sheep, cows, and salmon-filled streams for fly fishing. They also live in a country with nationalized healthcare, which, some would have us believe, is second only to nuclear war in terms of the horrific effects it would have if implemented here.

So when I was teaching a class on the US healthcare system this spring, I asked my sister-in-law for some insider information about the National Health System (or NHS as they fondly call it). Focus on your mother, I said, since she’s had some health problems in recent years. Here’s what she wrote me. . .

“Mum was taken to hospital around seven times in the space of two years. In total, she spent a few weeks in hospital. She didn’t pay anything, not for the ambulances, consultants, accommodation, … Continue Reading

Labels:
health insurance healthcare reform healthcare system; Medicare

Five Reasons Why Privatizing Medicare is a Bad Idea

We now interrupt our regularly scheduled programming to bring you a wonky blog post. 

So a few people out there are suggesting that we privatize Medicare and give out vouchers for recipients to purchase their own insurance on the open market. This is such a bad idea for so many reasons, and shows that some people simply don’t understand how Medicare works. Here are my top five. . .

1. Medicare is the closest thing we have to a single payer system. Medicare covers one in seven Americans, 97 percent of those 65 and older., or 49 million Americans. In 2030, the number of Americans covered is expected to nearly double, with one out of five Americans covered.

This huge cohort of individuals provides enormous opportunities to test  new reimbursement and quality initiatives with a large cohort. In fact, Medicare is leading the country in many of these initiatives, including accountable care organizations, pay-for-performance options, DRGs for hospital reimbursement (which reimburses based on diagnosis, not on how many aspirin you get), and financial penalties for hospitals if patients with pneumonia, heart failure, or heart attacks are readmitted within 30 days. Those penalties are expanded to vascular surgeries/procedures in 2015.

… Continue Reading

Labels:
Affordable Care Act health insurance healthcare reform mammograms Medicare vouchers

Messing with Success: Leave Medicare Alone!

I’m listening to the news at the tail end of a beautiful Friday afternoon and I am so angry I could spit. I just heard about the new budget plan passed by the House which calls for requiring Americans 65 and older to use “vouchers” to purchase private health insurance in 10 years and works to dismantle one of the most successful healthcare programs in the world — Medicare.

Yes, you heard me right, Medicare. Because the reality is that Medicare does a pretty decent job of covering core health care needs of a large component of American society and, because of its size, is the only health insurance program in the country that can literally change how medicine is practiced through its policies.

Yes, there is fraud and waste. But we are also getting better at reducing it. But to turn millions of older Americans loose onto the commercial health insurance market and expect it to translate into cost savings is one of the most ludicrous, ridiculous things I’ve heard in my more than 25 years of writing about health care in this country. Here are just a few reasons why:

1. Medicare beneficiaries already have the ability to … Continue Reading

Labels:
Medicare

Why are we so afraid of death?

My cousin’s mother-in-law is in her late 90s. She had horrible osteoporosis and can barely move. She has little cognitive function left. She requires nearly 24-hour care and no one would even attempt to say she has any quality of life left. She told her son years ago that she was “ready to go,” and had had enough.

And yet when I asked my cousin’s husband if his mother had any do-not-resuscitate orders, or had ever completed an advanced director  outlining her wishes of what kind of end-of-life care she wanted, he said no. His sister, he said, just wasn’t ready for that yet. So what, I asked, will you do when/if your mother gets pneumonia? Will you treat it with antibiotics? Will you put her on a respirator? If she is no longer able to eat, will you feed her through a tube?

He couldn’t answer. And he was clearly uncomfortable with the questions.

Therein lies the rub. These are conversations that this woman, her doctor and her family should have had years ago. Heck, I’m only 48 and yet my husband and I completed our durable powers of attorney and advanced directives outlining our end-of-life wishes years ago. … Continue Reading

Labels:
end-of-life care Medicare

Public Option, Medicare, What’s the Difference?

Warning: This is one of those “policy” posts, so if you’re looking for pithy freelance medical writing verbiage, come back tomorrow.

If you’re still with me, you know that the Senate begins debate today on the healthcare insurance reform bill (apparently we’re no longer calling it “healthcare reform” because there’s still so far to go in terms of reforming the overweight, out-of-control, drunken healthcare system we’ve created over the past 50 years).

One of the big sticking points to getting a bill passed in the Senate, pundits say, will be the so-called “public option.” This component provides a bare bones, government-sponsored health plan, subsidized as needed based on income, to compete with private health insurance plans. The plan would be delivered by private insurers paid by the federal government. In the Senate plan, states would be able to opt out of it if they wanted. Nonpartisan estimates from the Congressional Budget Office show that just 4 to 6 million Americans would go for it. Oh, and it would save billions over 10 years. Yet based on the reaction from most Republicans and some Democrats, you’d think it was a proposal to cut off every American’s right arm!

The main objection? … Continue Reading

Labels:
healthcare reform Medicare