Jim Farmelant
On Wed, 19 Jan 2000 07:40:20 -0800 Marta Russell <ap888 at lafn.org> writes:
>
>
>Nathan Newman wrote:
>
>> There are serious issues for the disabled currently served by
>Medicaid that you
>> have raised, which are important and Consumers Union has highlighted
>for
>> concern. But for the non-poor disabled who don't qualify for
>Medicaid and the
>> non-disabled poor, Bradley's plan is a large step forward.
>
>Well the Medicare population could be described as the non poor
>disabled - it is
>non means tested and many seniors have saved money over a life time of
>earnings.
>Let me explain to you what has just happened to Medicare HMO
>enrollees. Several
>years ago govt decided to allow Medicare beneficiaries to buy into
>Medicare HMOs.
>It paid the HMO $400 per month which is more that the Bradley voucher.
> In 1998 the
>Medicare HMOs decided that the Medicare population of seniors and
>disabled was
>costlier, i.e., they weren't making profits off the $400 per month.
>
>This is because "cost containment,” the managed care mantra, has led
>to a payment
>paradigm shift. Hospitals and doctors no longer get paid for
>individual services
>rendered (fee-for-service), they get paid a flat fee as they would if
>medicine were
>socialized. However, unlike a socialization scenario, there are
>financial
>incentives for physicians and hospitals to keep costs low. As a
>consequence of
>market forces shifting the payment and delivery system from
>fee-for-service to
>managed care, those needing the most health care are no longer
>perceived as an
>asset (bringing more money in), they are seen as a liability (draining
>the
>profits).
>
>HMOs’ desire to sign up only those who would cost them the least to
>care for
>clashed with federal Medicare contracts because the government held
>the HMOs to
>enrolling ANY Medicare beneficiary wanting to subscribe. But
>gatekeeper physicians
>and administrators found other ways to get more costly subscribers
>out. Studies by
>the General Accounting Office(GAO), for example, show that one out of
>every 5
>Medicare HMOs had disenrollment rates above 20%. Further, the GAO
>found “the rates
>of early disenrollment from HMOs to fee for service were substantially
>higher among
>those with chronic conditions.” Why? The GAO (and other studies) found
>that most
>subscribers left HMOs due to “problems receiving medical treatment.”
>Medicare
>beneficiaries found it necessary to revert to fee for service for
>vital care. The
>upshot -- subscribers most needing services were forced out of HMOs
>by denial of
>care.
>
>But that was not enough for the Medicare HMOs. They contested
>government and the
>end, several large HMOs *abandoned* the Medicare population and did
>not renew their
>Medicare contracts. They dumped 400,000 Medicare beneficiaries in 22
>states off
>their plans.
>
>Nathan, you are assuming that what Bradley's plan says it can do, it
>can. But do
>you think any health care corporation will sit by and let their
>profits be eaten up
>by costly enrollees? They will not. Aside from all my other
>criticisms of the
>basis for Bradley's plan, I expect that if Bradley's plan is
>implemented that the
>private insurers will be at first greedy for any enrollees they can
>get, but soon
>they will start to calculate as the Medicare HMOs did and as they have
>from the
>beginning of time that disabled and chronically ill cost them more per
>capita and
>they will either trim back services, increase co-payments, insist that
>government
>pay more premium per head or do something very similar to what the
>Medicare HMOs
>described here did - or invent some new way to get out of providing
>care.
>
>Perhaps it will do what Ethix corporation did. Ethix Corp., an HMO,
>announced
>that they "welcomed broad coverage for assisted suicide in a medical
>economic
>system already burdened." Ethix Corp's embrace of such a new
>"treatment" should be
>seen as a harbinger. Vice President Barbara Coombs-Lee, was chief
>petitioner for
>the assisted suicide Measure which created Oregon's law legalizing
>physician
>assisted death. But media reports concerning Coombs-Lee failed to make
>much of her
>professional occupation within a health insurance group. She was
>portrayed as a
>passionate idealog who cared only for things like "patient autonomy,"
>an end to
>"intolerable pain," and offering "death with dignity" to those who
>wished to die on
>their own time-line. Coombs-Lee's role as a financially
>motivated health industry hatchet woman was carefully buried
>throughout the
>1994 campaign. A lethal dose in Oregon costs only $35 to $50; compare
>that to one
>day's stay in a hospital, about $1,000.
>
>The 9th Circuit (San Francisco) court's decision in support of
>physician assisted
>suicide specifically targeted the handicapped as "beneficiaries", and
>stated that
>it may be
>acceptable for "competent, terminally ill adults to take the economic
>welfare of
>their families and loved ones into consideration" when deciding
>whether to live or
>die, and it
>defended the use of assisted suicide to control medical costs.
>
>Sorry, you will never get me to support a bourgeios plan like
>Bradley's.
>
>Marta
>
>
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