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Honored Social Butterfly

Woops !! Lancet Study on M4A Doesn't Add Up. Take It ONLY with a Giant Grain of Salt.

Kaiser HealthNews 02/26/2020 - Sanders Embraces New Study That Lowers ‘Medicare For All’s’ Cost, But... 

 

from the link ~

 

. . . . other independent experts were skeptical of the Lancet study’s estimate — arguing it exaggerates potential savings, cherry-picks evidence and downplays some of the potential trade-offs.

 

“I don’t think this study, albeit in a prestigious, peer-reviewed journal, should be given any deference in the Medicare for All debate,” said Robert Berenson, a fellow at the Urban Institute who studies hospital pricing.

 

Savings?

Largely, the Lancet paper is more generous in its assumptions than other Medicare for All analysis, noted Jodi Liu, an economist at the Rand Corp., who studies single-payer plans. To the researchers’ credit, she said, they acknowledge that their findings are based on uncertain assumptions.

 

For instance, the researchers calculate $78.2 billion in savings from providing primary care to uninsured people — $70.4 billion from avoided hospitalizations and $7.8 from avoided emergency room visits. But previous evidence suggests that the logic is suspect at best. 

 

When states expanded Medicaid under the Affordable Care Act, providing new insurance to people who had previously lacked coverage, avoidable hospitalizations and emergency room visits didn’t disappear because people could suddenly use preventive care, noted Ellen Meara, a professor at the Harvard T.H. Chan School of Public Health. That evidence doesn’t appear anywhere in the Lancet paper.

 

“The notion that we’re going to get rid of all these avoidable visits — that’s not been borne out,” she said. 

 

The researchers also assume that a Medicare for All system would pay hospitals at a maximum of Medicare rates.

 

That’s tricky. In 2017, the nonpartisan Medicare Payment Advisory Commission estimated that, on average, a hospital has a -9.9% margin on a patient insured through Medicare. (Private pay helps make up that difference.) Some hospitals certainly would be able to swallow this cost. But others would struggle to stay afloat, said Adrianna McIntyre, a health policy researcher at Harvard University. 

 

Given the political influence hospitals, in particular, carry in Congress — where most members are sensitive to their concerns — passing a plan offering such a low payment rate would be politically challenging.

 

Beyond the lower payments, the researchers also suggest hospitals would spend less money on overhead, having to navigate only a single insurance plan. That change accounts for $219 billion in their estimated savings.

 

But again, that ignores some of the reality of how hospitals work. While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals.

 

“The assumptions are unrealistic,” said Gerard Anderson, a health economist at Johns Hopkins University in Baltimore. “You are never going to save that much money from the various providers.” 

 

The Cost-Sharing Question

Medicare for All would enroll all Americans in coverage far more generous than what most experience now — eliminating virtually all cost sharing associated with using health care. 

 

That’s a major change, researchers told us. Previous evidence suggests that such a shift would encourage consumers to use health care more than they currently do. 

 

The Lancet paper acknowledges that — but only partially. It allows that people who are uninsured or “underinsured” — that is, who have particularly high levels of cost sharing now — would use more medical care under Sanders’ system than they currently do. It factors that into the price tag. 

 

But its estimate does not account for people who already have decent or adequate insurance and who would still be moving to a richer benefit, and therefore be more likely to use their insurance. 

 

“It drastically underestimates the utilization increases we would expect to see under Medicare for All,” McIntyre said. “People have different views on whether the increased utilization is good or bad,” she added — it makes the program more expensive, but also means more people are getting treatment.

 

Other Estimates?

Context is helpful, too. Other estimates — namely, a projection by the Urban Institute — of Medicare for All have suggested it would increase federal health spending by about $34 trillion over 10 years. But the elimination of other health spending would make the overall change smaller. 

 

To implement the Sanders proposal, national health spending — public and private dollars, both — would increase by $7 trillion over a decade, Urban said. And Medicare for All would be bringing new services: more insurance for more people, and more generous coverage for those already covered.

 

Urban’s estimate of $7 trillion more in spending over 10 years is far removed from the study’s estimate of $450 billion less annually. And, experts said, relying on the latter figure isn’t a good idea.

 

 

“I think they need more work to prove” the savings, Meara said. “They’re not being complete, and by not being complete, they’re not being honest.”

 

It’s also worth noting that the study’s lead author was also an informal unpaid adviser to the Sanders staff in drafting its 2019 version of the Medicare for All bill, according to the paper’s disclosures section.

 

The ‘Lives Saved’

Experts agree that expanding access to health insurance would probably reduce early mortality. But the 68,000 figure is another example of cherry-picking, Meara said.

 

The figure is based on a 2009 paper. It doesn’t acknowledge a body of research that came afterward, including multiple studies that examined how expanding Medicaid affected mortality — and maybe offered less dramatic numbers.

 

“When they so clearly are cherry-picking, when they clearly have all the information on studies in front of them, it’s concerning,” Meara said. “It’s a situation where you’re going to overpromise and underdeliver.”

 

Our Ruling

Sanders said a recent study suggested Medicare for All would save $450 billion annually and save 68,000 lives.

 

That study does exist. And it cites some evidence. But many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. It cherry-picks data in calculating mortality effects.

 

This statement has some truth but ignores context that would create a dramatically different impression. We rate it Mostly False.

 

Honored Social Butterfly

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If for some reason the estimates come up short for covering everyone

with healthcare (no premiums, no co-payments, no deductibles, with dental, vision and hearing) they could add a penny sales tax on stock transactions. Problem solved.

 

 

Honored Social Butterfly


@gordyfl wrote:

If for some reason the estimates come up short for covering everyone

with healthcare (no premiums, no co-payments, no deductibles, with dental, vision and hearing) they could add a penny sales tax on stock transactions. Problem solved.

 

 


OH, yes, problem solved - until EVERYBODY starts using it to the hilt.

Until, everybody's records have to be put into electronic format for ease in access and follow-through.

Until, (private) hospitals decide they need more money or go out of business

Until (private) doctors and specialist decide that they need more money or decide to not participate in the (government) system.  Remember we already have many specialist that DO NOT participate in health plans now.

How are we gonna get enough primary care doctors, especially in barrien areas but not exclusively, to meet the demand without some pay enticements

Will the government begin to utilize some of the managed care cost saving techniques that private insurers use?  Like a referral from ones primary care doc (acting as a gatekeeper) to a specialist or are we gonna just self-refer?  Like step therapy?  Like quantity limits - medicines, amount of therapy of whatever sort.

Like "best practices"?

If we have NO copays, co-insurance - the sky is the limit in using the government provided coverage.

Who is gonna make the rules about off-label treatments?

How will the government decide who and where to place medical infrastructure like hospitals, labratories, therapy clinics, MRI / Radiology treatment centers, Oncology clinics, etc.?

Will we have a choice as to the hospital that we use - will we be encouraged to go to public hospitals?  Will we be encouraged to have ward rooms rather than private/semi-private rooms?

If we are gonna increase home care for the elderly or disabled, are we gonna pay for other physical structural changes to their home to make it feasible?  Like walkin baths or roll-in shower units.

I read an article last week on a proposal from California governor, Gavin Newsom - he wants homelessness to be added to the medical protochol so that issue could also be solved with healthcare coverage. 

Just like we saw in the last few years, government wanting to control opioid prescriptions for those who have chronic pain.  How has that worked out?  Government initially went overboard and now are back-tracking somewhat.

What about when science comes out with a firmly concluded recommendation, say on some preventive test saying that we are overtesting.  But some group or organization begin to yell loud to our politicians about the science? 

What if we go to negotiating drug prices - do you really think that every drug is gonna be included?

What if science brings in a new treatment for something but it cost a whole lot more than what is currently used.  Should we look at best outcomes or what it saves before we OK its use?  - lives or cost / lives and cost.

Then what do you do about trying to support the development of orphan drugs?  Or would we?

What criteria should we use to approve new drugs and other treatments?  Cost (negotiated price) ?  cost and outcome?  Comparitive cost/ outcome to older treatments?

 

We need to look to the system that have been set up in other industrialized countries and put in place some of their cost saving initiatives, their best practices, their negotiating measures and skills.  We can do some of those right now just to test out the waters.

Will American like it? 

 

 

 

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Honored Social Butterfly


@GailL1 wrote:

@gordyfl wrote:

If for some reason the estimates come up short for covering everyone

with healthcare (no premiums, no co-payments, no deductibles, with dental, vision and hearing) they could add a penny sales tax on stock transactions. Problem solved.

 

 


OH, yes, problem solved - until EVERYBODY starts using it to the hilt.

Until, everybody's records have to be put into electronic format for ease in access and follow-through.

Until, (private) hospitals decide they need more money or go out of business

Until (private) doctors and specialist decide that they need more money or decide to not participate in the (government) system.  Remember we already have many specialist that DO NOT participate in health plans now.

How are we gonna get enough primary care doctors, especially in barrien areas but not exclusively, to meet the demand without some pay enticements

Will the government begin to utilize some of the managed care cost saving techniques that private insurers use?  Like a referral from ones primary care doc (acting as a gatekeeper) to a specialist or are we gonna just self-refer?  Like step therapy?  Like quantity limits - medicines, amount of therapy of whatever sort.

Like "best practices"?

If we have NO copays, co-insurance - the sky is the limit in using the government provided coverage.

Who is gonna make the rules about off-label treatments?

How will the government decide who and where to place medical infrastructure like hospitals, labratories, therapy clinics, MRI / Radiology treatment centers, Oncology clinics, etc.?

Will we have a choice as to the hospital that we use - will we be encouraged to go to public hospitals?  Will we be encouraged to have ward rooms rather than private/semi-private rooms?

If we are gonna increase home care for the elderly or disabled, are we gonna pay for other physical structural changes to their home to make it feasible?  Like walkin baths or roll-in shower units.

I read an article last week on a proposal from California governor, Gavin Newsom - he wants homelessness to be added to the medical protochol so that issue could also be solved with healthcare coverage. 

Just like we saw in the last few years, government wanting to control opioid prescriptions for those who have chronic pain.  How has that worked out?  Government initially went overboard and now are back-tracking somewhat.

What about when science comes out with a firmly concluded recommendation, say on some preventive test saying that we are overtesting.  But some group or organization begin to yell loud to our politicians about the science? 

What if we go to negotiating drug prices - do you really think that every drug is gonna be included?

What if science brings in a new treatment for something but it cost a whole lot more than what is currently used.  Should we look at best outcomes or what it saves before we OK its use?  - lives or cost / lives and cost.

Then what do you do about trying to support the development of orphan drugs?  Or would we?

What criteria should we use to approve new drugs and other treatments?  Cost (negotiated price) ?  cost and outcome?  Comparitive cost/ outcome to older treatments?

 

We need to look to the system that have been set up in other industrialized countries and put in place some of their cost saving initiatives, their best practices, their negotiating measures and skills.  We can do some of those right now just to test out the waters.

Will American like it? 

 

 

 


Nice long answer but totally useless until Trump is gone.

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Honored Social Butterfly

Two things about all the rightwing attacks on M4A:

1. Every other industrialized Nation has already done it.

2. Not a single Nation has been unable to pay for it.

 

 

What GOPerBopts leave out of their analysis is doing NOTHING will cost us $60TRILLION over the next decade and millions will STILL be uninsured and thousands will still go bankrupt, losing everything because their kid got sick.

 

Honored Social Butterfly


@Olderscout66 wrote:

Two things about all the rightwing attacks on M4A:

1. Every other industrialized Nation has already done it.

2. Not a single Nation has been unable to pay for it.

 

 

What GOPerBopts leave out of their analysis is doing NOTHING will cost us $60TRILLION over the next decade and millions will STILL be uninsured and thousands will still go bankrupt, losing everything because their kid got sick.

 


I don't think you are talking about "Medicare for All" which is a single payer system - you are speaking more about Universal Healthcare of which there are many varieties and should be our goal.  The problem is how to get to Universal Healthcare coverage.

 

There you go tlking about COST - we could use some of the tools which those other countries use and cut our cost too and with perhaps better outcomes.

 

14 countries are on a single-payer system, it doesn’t mean they all have the same financial or operational models. While all of them use taxes to pay for the model, some use a general tax whereas others use a directed tax with the money being collected going only to healthcare. How much is taxed, how often citizens are taxed, and how the healthcare tax is utilized differs in every country.

 

It ISN'T true that there is no cost to the consumer under a single-payer system. Only the United Kingdom and Cuba have zero costs to the consumer, but every other country still has out-of-pocket costs. The claim that private health insurers will no longer exist is also not true.

 

I believe that the UK's NHS is the only industrialized country that actually owns their own health care facilities and the providers are employed by the NHS system. 

 

You know as well as I that most countries have a hybrid system - part public and part private (non-profit or for-profit).  Private insurance can provide a bridge or it can provide a different system (think 2-tier system).  In some countries, private insurance is used so that a patient gets a private room in a hospital or gets bumped up to the front of the queue to get care.

 

Sometimes private insurance is used to cover benefits that are lacking in the public system like prescription drugs (Canada).  Or it could cover other providers that are outside the normal system like Psychotherapist or Psychologist who don't have a medical degree.

 

Again, concerning the cost - there has to be ways to control the cost.  But that isn't bad - it keep down on paying for stuff that does not work or stuff that does not work as well as something else.

 

 

 

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@GailL1 wrote:

@Olderscout66 wrote:

Two things about all the rightwing attacks on M4A:

1. Every other industrialized Nation has already done it.

2. Not a single Nation has been unable to pay for it.

 

 

What GOPerBopts leave out of their analysis is doing NOTHING will cost us $60TRILLION over the next decade and millions will STILL be uninsured and thousands will still go bankrupt, losing everything because their kid got sick.

 


I don't think you are talking about "Medicare for All" which is a single payer system - you are speaking more about Universal Healthcare of which there are many varieties and should be our goal.  The problem is how to get to Universal Healthcare coverage.

 

There you go tlking about COST - we could use some of the tools which those other countries use and cut our cost too and with perhaps better outcomes.

 

14 countries are on a single-payer system, it doesn’t mean they all have the same financial or operational models. While all of them use taxes to pay for the model, some use a general tax whereas others use a directed tax with the money being collected going only to healthcare. How much is taxed, how often citizens are taxed, and how the healthcare tax is utilized differs in every country.

 

It ISN'T true that there is no cost to the consumer under a single-payer system. Only the United Kingdom and Cuba have zero costs to the consumer, but every other country still has out-of-pocket costs. The claim that private health insurers will no longer exist is also not true.

 

I believe that the UK's NHS is the only industrialized country that actually owns their own health care facilities and the providers are employed by the NHS system. 

 

You know as well as I that most countries have a hybrid system - part public and part private (non-profit or for-profit).  Private insurance can provide a bridge or it can provide a different system (think 2-tier system).  In some countries, private insurance is used so that a patient gets a private room in a hospital or gets bumped up to the front of the queue to get care.

 

Sometimes private insurance is used to cover benefits that are lacking in the public system like prescription drugs (Canada).  Or it could cover other providers that are outside the normal system like Psychotherapist or Psychologist who don't have a medical degree.

 

Again, concerning the cost - there has to be ways to control the cost.  But that isn't bad - it keep down on paying for stuff that does not work or stuff that does not work as well as something else.

 

 

 


Universal Health Care is the same a Medicare for all. It means everyone can get medical treatment. We have had it for years now. What you seem to be talking about is cost and right now we do not have the cost of our total health care system. Once we get that we can then move to cut cost where we can, and come up with the best approach for outcomes Vs costs. The UK has private care available. Check with the Queen. In the US the VA, Armed Services, NIH all own their building etc, and everyone works for the Govt. Yes there are some small part contracted out. This is something that should be flushed out after Trump is gone. Do not forget the school crossing guard. Did that expense save money. Does building ramps   or supplying medical beds to people at home save money. I know of programs like that here in the USA and have been told it does. All this posting on something that will not be touched by any of it till Trump is gone period. Spend time helping improve the total system by fixing the main problem we currently have. Trump.

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Gail, you are correct about one thing...

within the last 3 years, and changing the cast of characters that trump has brought in, has not done one darn thing to improve healthcare, but has tried to make it worse!

Honored Social Butterfly


@williamb39198 wrote:

Gail, you are correct about one thing...

within the last 3 years, and changing the cast of characters that trump has brought in, has not done one darn thing to improve healthcare, but has tried to make it worse!


I don't see that much has changed.  And I don't think it will until we do decide how to contain some cost in the system and at the same time improve outcomes.

 

Socialism isn't Medicare, Social Security, Medicaid or Unemployment Insurance or even food stamps.  those are social insurance programs that are either covered by certain workers or by taxpayers in general to give a handup to those who may need it for a while.

 

But to take over the administration at the federal level of an entire industry like healthcare coverage is socialism because at that point, the government is making all the rules - what is covered, how it is covered, when it is covered, how much is paid for any given thing, if covered - because they would be responsible for building the system - negotiating all aspects of it - ALL providers, all medicine, all infrastructure, and hopefully establishing best practices and getting better outcomes. 

 

The reduction of covered people in the last few years has mostly been the result of those who DO NOT get a premium subsidy and their premiums have escalated to the point that it has become unaffordable for them.  These were the responsible people before the ACA who maintained their coverage because it was something they knew they had to have - I know, I was one because I was self-employed.

 

KFF 01/07/2020 - Tracking Section 1332 State Innovation Waivers 

 

New guidance and waiver concepts issued by the Trump administration in 2018 encourage states to use 1332 waiver authority to make broader changes to insurance coverage for their residents.

 

Several states have been approved for or have filed for a "reinsurance waiver" - simply put, these waivers establishes a state/federal fund that will cover the claims of people that have huge medical cost thus taking this higher amount off the books of the insurance companies once the claims get to the (whatever) level.  The states set their level in the waiver proposal.  This serves to keep down the premium cost and it is working.

 

CBPP - 04/13/2019 - Reinsurance Basics: Considerations as States Look to Reduce Private Market Premi... 

As of 04/13/2019, seven states have implemented 1332 reinsurance programs: Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin.

Since then more have either been approved and implemented or have filed for approval with HHS, including Colorado, Delaware, Montana, North Dakota, Rhode Island

 

 

If we would stop the HATE, we might find out that many of our Legislators and even some of our Administrative Heads have some very good ideas.

 

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Honored Social Butterfly

Once again the GOPers, lacking the faintest clue on how to improve things for We the People, trot out the absurd notion that M4A will "take over an entire Industry".

 

Give up the lie and admit adopting virtually the entire existing system AS IS and simply centeralizing and standardizing the paying of bills is a "take-over" is GOPerTripe of the highest order.

 

But the GOPerBase has been trained to never bother to think about issues and just repeat whatever Fox tells them is in full roar, and we'll continue to let thousands die from lack of care and thousands more to lose everything because their kid gets sick just to avoid the job of actually thinking.

 

The Lancet study is highly accurate, it's the fear mongering number-jugglers from the GOP that will never "add up".

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@GailL1 wrote:

Kaiser HealthNews 02/26/2020 - Sanders Embraces New Study That Lowers ‘Medicare For All’s’ Cost, But... 

 

from the link ~

 

. . . . other independent experts were skeptical of the Lancet study’s estimate — arguing it exaggerates potential savings, cherry-picks evidence and downplays some of the potential trade-offs.

 

“I don’t think this study, albeit in a prestigious, peer-reviewed journal, should be given any deference in the Medicare for All debate,” said Robert Berenson, a fellow at the Urban Institute who studies hospital pricing.

 

Savings?

Largely, the Lancet paper is more generous in its assumptions than other Medicare for All analysis, noted Jodi Liu, an economist at the Rand Corp., who studies single-payer plans. To the researchers’ credit, she said, they acknowledge that their findings are based on uncertain assumptions.

 

For instance, the researchers calculate $78.2 billion in savings from providing primary care to uninsured people — $70.4 billion from avoided hospitalizations and $7.8 from avoided emergency room visits. But previous evidence suggests that the logic is suspect at best. 

 

When states expanded Medicaid under the Affordable Care Act, providing new insurance to people who had previously lacked coverage, avoidable hospitalizations and emergency room visits didn’t disappear because people could suddenly use preventive care, noted Ellen Meara, a professor at the Harvard T.H. Chan School of Public Health. That evidence doesn’t appear anywhere in the Lancet paper.

 

“The notion that we’re going to get rid of all these avoidable visits — that’s not been borne out,” she said. 

 

The researchers also assume that a Medicare for All system would pay hospitals at a maximum of Medicare rates.

 

That’s tricky. In 2017, the nonpartisan Medicare Payment Advisory Commission estimated that, on average, a hospital has a -9.9% margin on a patient insured through Medicare. (Private pay helps make up that difference.) Some hospitals certainly would be able to swallow this cost. But others would struggle to stay afloat, said Adrianna McIntyre, a health policy researcher at Harvard University. 

 

Given the political influence hospitals, in particular, carry in Congress — where most members are sensitive to their concerns — passing a plan offering such a low payment rate would be politically challenging.

 

Beyond the lower payments, the researchers also suggest hospitals would spend less money on overhead, having to navigate only a single insurance plan. That change accounts for $219 billion in their estimated savings.

 

But again, that ignores some of the reality of how hospitals work. While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals.

 

“The assumptions are unrealistic,” said Gerard Anderson, a health economist at Johns Hopkins University in Baltimore. “You are never going to save that much money from the various providers.” 

 

The Cost-Sharing Question

Medicare for All would enroll all Americans in coverage far more generous than what most experience now — eliminating virtually all cost sharing associated with using health care. 

 

That’s a major change, researchers told us. Previous evidence suggests that such a shift would encourage consumers to use health care more than they currently do. 

 

The Lancet paper acknowledges that — but only partially. It allows that people who are uninsured or “underinsured” — that is, who have particularly high levels of cost sharing now — would use more medical care under Sanders’ system than they currently do. It factors that into the price tag. 

 

But its estimate does not account for people who already have decent or adequate insurance and who would still be moving to a richer benefit, and therefore be more likely to use their insurance. 

 

“It drastically underestimates the utilization increases we would expect to see under Medicare for All,” McIntyre said. “People have different views on whether the increased utilization is good or bad,” she added — it makes the program more expensive, but also means more people are getting treatment.

 

Other Estimates?

Context is helpful, too. Other estimates — namely, a projection by the Urban Institute — of Medicare for All have suggested it would increase federal health spending by about $34 trillion over 10 years. But the elimination of other health spending would make the overall change smaller. 

 

To implement the Sanders proposal, national health spending — public and private dollars, both — would increase by $7 trillion over a decade, Urban said. And Medicare for All would be bringing new services: more insurance for more people, and more generous coverage for those already covered.

 

Urban’s estimate of $7 trillion more in spending over 10 years is far removed from the study’s estimate of $450 billion less annually. And, experts said, relying on the latter figure isn’t a good idea.

 

 

“I think they need more work to prove” the savings, Meara said. “They’re not being complete, and by not being complete, they’re not being honest.”

 

It’s also worth noting that the study’s lead author was also an informal unpaid adviser to the Sanders staff in drafting its 2019 version of the Medicare for All bill, according to the paper’s disclosures section.

 

The ‘Lives Saved’

Experts agree that expanding access to health insurance would probably reduce early mortality. But the 68,000 figure is another example of cherry-picking, Meara said.

 

The figure is based on a 2009 paper. It doesn’t acknowledge a body of research that came afterward, including multiple studies that examined how expanding Medicaid affected mortality — and maybe offered less dramatic numbers.

 

“When they so clearly are cherry-picking, when they clearly have all the information on studies in front of them, it’s concerning,” Meara said. “It’s a situation where you’re going to overpromise and underdeliver.”

 

Our Ruling

Sanders said a recent study suggested Medicare for All would save $450 billion annually and save 68,000 lives.

 

That study does exist. And it cites some evidence. But many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. It cherry-picks data in calculating mortality effects.

 

This statement has some truth but ignores context that would create a dramatically different impression. We rate it Mostly False.

 


Nice long article but it means nothing. First of all we have a type of Medicare for all. The ER section provides treatment whether you pay or not. Trump is destroying the entire system by what he is doing mostly by rule changes. The first step to improving health care is to get rid of Trump in Nov. and all should be working on that not spending a lot of time on meaningless articles which say or prove anything that will help in that effort.

Honored Social Butterfly


@john258 wrote:


Nice long article but it means nothing. First of all we have a type of Medicare for all. The ER section provides treatment whether you pay or not. Trump is destroying the entire system by what he is doing mostly by rule changes. The first step to improving health care is to get rid of Trump in Nov. and all should be working on that not spending a lot of time on meaningless articles which say or prove anything that will help in that effort.

Of course, it means something - we haven't spent (most recently) the last 10 years talking about our system - healthcare cost and health care coverage - for nothing - it is important.  That is way before the Trump Presidency.

 

You should get away from this premise of your about the depth and breadth of ER care.  It is for emergency care and is ONLY meant to stabilize a condition - not fix it or even treat it fully.

 

As history has shown us - just changing some of the characters does not necessarily change for the better our lives - in this case healthcare - the cost and the coverage.

 

 

 

 

Honored Social Butterfly


@GailL1 wrote:

@john258 wrote:


Nice long article but it means nothing. First of all we have a type of Medicare for all. The ER section provides treatment whether you pay or not. Trump is destroying the entire system by what he is doing mostly by rule changes. The first step to improving health care is to get rid of Trump in Nov. and all should be working on that not spending a lot of time on meaningless articles which say or prove anything that will help in that effort.

Of course, it means something - we haven't spent (most recently) the last 10 years talking about our system - healthcare cost and health care coverage - for nothing - it is important.  That is way before the Trump Presidency.

 

You should get away from this premise of your about the depth and breadth of ER care.  It is for emergency care and is ONLY meant to stabilize a condition - not fix it or even treat it fully.

 

As history has shown us - just changing some of the characters does not necessarily change for the better our lives - in this case healthcare - the cost and the coverage.

 

 

 

 


You should learn about ER Care before you comment. Yes it is for emergency and to stabilize. The last thing they say to you when you leave is see your Dr. right away for follow up. That is why it is the most costly, and poorest outcome of all parts of the system. There are many (over 50% I understand is some places) that have no Dr. to go to. When they become unstable they go back to the ER for more care. One study told us some 3 times per week. They are usually taken to the ER after Para Medic 911 call. This expense for the PM, and fire truck which is usually sent out to is in many different city or state budgets under fire dept. One city saved money by buying a smaller vehicle with less equipment, and did not send the fire truck. The city said it could tell the difference  on a repeat call over a first time call. (There is a study for you to go after.) The city also set up a program where it paired people up with a PC Dr. so they would not use the ER as their PC Dr.. The City said it worked and saved money. The cost of the Dr. program was in health care and the Saving in the Fire Dept. Budgets. This sort of things happens all the time and you need to learn the full cost of health care before you can make improvements that save money. If we had the full cost of our current version of medicare for all we might find even Bernie's version could cost the same or be cheaper. Your support article means nothing with Trump in Office as the health care system changes just about everyday, and for the worse. YOU WANT TO FIX HEALTH CARE? Cure the biggest problem first. TRUMP. Then anything is possible. Till then nothing is possible.

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@john258 wrote:

You should learn about ER Care before you comment. Yes it is for emergency and to stabilize.

The last thing they say to you when you leave is see your Dr. right away for follow up. That is why it is the most costly, and poorest outcome of all parts of the system.
There are many (over 50% I understand is some places) that have no Dr. to go to. When they become unstable they go back to the ER for more care. 

The city also set up a program where it paired people up with a PC Dr. so they would not use the ER as their PC Dr.. The City said it worked and saved money. The cost of the Dr. program was in health care and the Saving in the Fire Dept. Budgets. This sort of things happens all the time and you need to learn the full cost of health care before you can make improvements that save money.

If we had the full cost of our current version of medicare for all we might find even Bernie's version could cost the same or be cheaper.

I understand ER care as well as other healthcare - I have a MSN.

Yes, chronic ER care lacks continuity and is expensive; in fact it is little more that putting a bandaid on a really bad healthcare need. 

 

We aren't just talking about people that have no access - we are also talking about people who purposely don't carry insurance because they think they are invinsible and then something really bad happens healthwise. 

 

For those who are homeless or poor, we have (public) clinics that provide services to them - continuing services and treatments - but here again it has not worked so well.

 

Even if we try something that sounds like it "should" work to save cost - many times it doesn't - but what do we do - we keep trying it in hopes for another outcome. 

 

KHN 01/24/2020 - Despite New Doubts, ‘Hotspotting’ Help For Heavy Health Care Users Marches On 

 

The Experiment: 

The “HOTSPOTTING” model was pioneered in Camden, New Jersey, in 2002 and inspired dozens of similar projects around the country, many financed by millions of dollars from the government and private foundations. The model focuses on people who face social barriers such as homelessness or drug addiction and use the hospital multiple times a year, typically for avoidable complications from chronic diseases. The participants work with doctors, social workers and nurses for individual help, seeking to prevent future hospital admission and extra expenses down the road.

 

A study in the New England Journal of Medicine published this month confirmed that repeat hospitalizations dropped for participants in the Camden program but the result was no better than the results from a group of patients who did not get the intensive care coordination.

 

A different study, released Wednesday, showed that a similar, multibillion-dollar experiment in California yielded even more discouraging preliminary results: Participants were hospitalized at more than double the rate of patients who were not enrolled in the program.

 

State and federal policymakers were attracted to the hotspotting model because they saw it as a possible solution for this intractable reality: Just 5% of patients account for half of all health spending.

 

The Hotspotting model is geared to patients who have the most emergency room and hospital visits because of unmet social needs such as hunger and housing.  Using nurses and social workers, the hospital pairs up these “super-utilizer” patients with community resources such as housing, transportation and meals as well as connecting them to primary care.

 

California also came up with a very similar Medicaid program - to increase intensive, comprehensive care management to high-needs, high-risk patients, including homeless people and those getting out of jail or prison. If approved by the state legislature, the infusion would also fund services designed to decrease reliance on expensive hospital visits and emergency service transportation.

 

The move would expand the state’s $3 billion, five-year Medicaid experiment called “Whole Person Care,” which began in 2016 and provides participants with social and medical services, such as substance abuse treatment and recuperative care after hospital stays. In most cases, California is creating services for participants in addition to connecting people to existing programs.

 

But a new report by researchers at the UCLA Center for Health Policy Research suggests that California’s experiment has resulted in more participant hospitalizations, despite offering comprehensive services.

 

The study found that, two years into the experiment, there was no significant change in emergency department visits for participants compared with a similar group of patients who were not part of the program.

 

. . . . The study confirmed there is a population of super utilizers that will not go away” just through these community efforts alone. He stressed local, state and federal policy changes are needed to fix social and legal challenges that influence patients’ health.

 

IOW, john258 - it is not just about how to medically treat these super utilizers of health care especially in the ER setting - IT IS ABOUT PROVIDING EVERYTHING TO THESE PEOPLE because they cannot do it themselves and evidently have no one else to help them - THAT, my friend, is the situation that will never leave us no matter what type of health care system we have.

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@GailL1 wrote:

@john258 wrote:

You should learn about ER Care before you comment. Yes it is for emergency and to stabilize.

The last thing they say to you when you leave is see your Dr. right away for follow up. That is why it is the most costly, and poorest outcome of all parts of the system.
There are many (over 50% I understand is some places) that have no Dr. to go to. When they become unstable they go back to the ER for more care. 

The city also set up a program where it paired people up with a PC Dr. so they would not use the ER as their PC Dr.. The City said it worked and saved money. The cost of the Dr. program was in health care and the Saving in the Fire Dept. Budgets. This sort of things happens all the time and you need to learn the full cost of health care before you can make improvements that save money.

If we had the full cost of our current version of medicare for all we might find even Bernie's version could cost the same or be cheaper.

I understand ER care as well as other healthcare - I have a MSN.

Yes, chronic ER care lacks continuity and is expensive; in fact it is little more that putting a bandaid on a really bad healthcare need. 

 

We aren't just talking about people that have no access - we are also talking about people who purposely don't carry insurance because they think they are invinsible and then something really bad happens healthwise. 

 

For those who are homeless or poor, we have (public) clinics that provide services to them - continuing services and treatments - but here again it has not worked so well.

 

Even if we try something that sounds like it "should" work to save cost - many times it doesn't - but what do we do - we keep trying it in hopes for another outcome. 

 

KHN 01/24/2020 - Despite New Doubts, ‘Hotspotting’ Help For Heavy Health Care Users Marches On 

 

The Experiment: 

The “HOTSPOTTING” model was pioneered in Camden, New Jersey, in 2002 and inspired dozens of similar projects around the country, many financed by millions of dollars from the government and private foundations. The model focuses on people who face social barriers such as homelessness or drug addiction and use the hospital multiple times a year, typically for avoidable complications from chronic diseases. The participants work with doctors, social workers and nurses for individual help, seeking to prevent future hospital admission and extra expenses down the road.

 

A study in the New England Journal of Medicine published this month confirmed that repeat hospitalizations dropped for participants in the Camden program but the result was no better than the results from a group of patients who did not get the intensive care coordination.

 

A different study, released Wednesday, showed that a similar, multibillion-dollar experiment in California yielded even more discouraging preliminary results: Participants were hospitalized at more than double the rate of patients who were not enrolled in the program.

 

State and federal policymakers were attracted to the hotspotting model because they saw it as a possible solution for this intractable reality: Just 5% of patients account for half of all health spending.

 

The Hotspotting model is geared to patients who have the most emergency room and hospital visits because of unmet social needs such as hunger and housing.  Using nurses and social workers, the hospital pairs up these “super-utilizer” patients with community resources such as housing, transportation and meals as well as connecting them to primary care.

 

California also came up with a very similar Medicaid program - to increase intensive, comprehensive care management to high-needs, high-risk patients, including homeless people and those getting out of jail or prison. If approved by the state legislature, the infusion would also fund services designed to decrease reliance on expensive hospital visits and emergency service transportation.

 

The move would expand the state’s $3 billion, five-year Medicaid experiment called “Whole Person Care,” which began in 2016 and provides participants with social and medical services, such as substance abuse treatment and recuperative care after hospital stays. In most cases, California is creating services for participants in addition to connecting people to existing programs.

 

But a new report by researchers at the UCLA Center for Health Policy Research suggests that California’s experiment has resulted in more participant hospitalizations, despite offering comprehensive services.

 

The study found that, two years into the experiment, there was no significant change in emergency department visits for participants compared with a similar group of patients who were not part of the program.

 

. . . . The study confirmed there is a population of super utilizers that will not go away” just through these community efforts alone. He stressed local, state and federal policy changes are needed to fix social and legal challenges that influence patients’ health.

 

IOW, john258 - it is not just about how to medically treat these super utilizers of health care especially in the ER setting - IT IS ABOUT PROVIDING EVERYTHING TO THESE PEOPLE because they cannot do it themselves and evidently have no one else to help them - THAT, my friend, is the situation that will never leave us no matter what type of health care system we have.


Well then it nice to see you agree with me that we have a form of Medicare for all in this country and have had it for years. The ACA was the first attempt to address the the problem of people who do not purchase health insurance. If I recall you were against the ACA when it was first brought forwarded. The ACA was the first step in forcing the people you speak of to purchase Insurance as we need everyone covered to get the lowest rates. The ACA was doing its job as the number of people in that class was falling. You paid a fine if you did not purchase insurance. Now who killed that part. TRUMP. With that part dead the pre Ex will return and do not talk about reinsurance., as the reinsurance pools you have spoken of in the past of are fake insurance since they need public money to work. Medicaid was the vehicle for the people who could not afford insurance and all states were required to expand their programs. The far right Reb. opposed that and Reb. controlled States refused. The Gov. of your State told the press: Let them die in the streets. Who supports them now: TRUMP. What has not been done is getting total cost of our entire health care system. That means cost tha tare in all sorts of different headings like Fire Dept. Once you have that amount you can then compare what effect changes have. Yes there will be a lot of trial approaches some fail some do not. Under TRUMP they all fail so the first step is get rid of Trump and the rest can be solved. Here is one. All Hospitals are non profit. No Hospital holding Cos. period. Insurances Carriers are just that. They can not own hospitals, drug admin programs, or any medical provider. Here is my Carrier record on me for 2019. Delayed new heart approach for 14 days, Stopped drug to end serious back attack, then approved it with out talking to my Dr. which forced me into the ER. Used new co they purchased to handle drugs as of 1/1. Did not tell anybody using the system how to use the new system so all records were gone 1/1 and people left with nothing. Finally were forced to move records to new co so I got the needed drugs, but billed 2 times, and they set up wrong phone number in their system so when you called  you went to the old supplier. How much do you think they added in costs to the health care system, and sadly this happens all over. Insurance Co took over hospital chain in my state some years ago. It took them about 3 years to take the chain into bankruptcy then sold it, and new owners who new hospital business have it back to where it was. These happen due to poor business oversight by Govt., and now with Trump no oversight. By the way Trump was for what Bernie wants to do for years, and told all there would be health care for all. Trump is the main problem we have today and nothing will be done till he is out as President. All your studies are worthless until there is a workable system, and KHN is no help as it breaks and skirts the rules just like the others. KHN has gotten to big and acts like the VA in some cases. Now attack the big problem TRUMP then the others can be handled. Less articles, and more action to end the Trump mess now.

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