Health Care Spending Spikes: Why?

Recent data from the Bureau of Economic Analysis (BEA) reveals that  during the last three months of 2013, spending on health care rose at an annual rate of 5.3%. The trend continued this year, with spending climbing 6.2% on a year-over-year basis in January and 6.7% in February. Now some of Obamacare’s fiercest critics are saying “I told you so.”

“We knew this was coming,” gloats Douglas Holtz-Eakin, John McCain’s former economic adviser. “The question now is whether we can hold spending down.” It’s worth recalling that Holtz-Eakin, who served as CBO director under George W. Bush, has been wrong in the past. When I debated him on the Lou Dobbs show in 2009 he insisted that the ACA would leave us with a “ton of debt.” In fact it has reduced the deficit. And in March of 2013 when testifying before the House Energy and Commerce Committee’s Subcommittee on Health Holtz-Eakin had the chutzpa to declare that “There is anecdotal evidence, of [Exchange] premiums nearing $100,000 in New York.”  This was, of course, utter nonsense.

Still, the surge in spending came as a surprise. Since December of 2007, after adjusting for inflation, health care outlays have been rising by only 2.6%  “The sudden jump has led some some commentators to declare an end to the era of slower health-cost increases, which has lasted for the past several years,” observes former CBO director Peter Orszag observes.  Yet, Orszag notes, “Medicare spending growth is still low, even through last month. Indeed, in the first half of this fiscal year, nominal Medicare spending was only 0.6 percent higher than in the corresponding period a year earlier.”

Why Have Outlays Risen for Those Under 65, But Not for Seniors?

BEA suggests that the jump during the first two months of this year reflects the fact that, thanks to the Affordable Care Act (ACA),  more Americans had comprehensive insurance that gave them access to a wide range of services.

Those who became insured in January and February are the folks who signed up at the very beginning of the enrollment period. No doubt many of them had been postponing needed care for a long time. As soon as they were covered, they began visiting doctors, scheduling elective surgeries, and filling prescriptions. Medicare patients, by contrast, had no reasons to seek more care at the beginning of 2014. Their insurance had not changed.

Going forward, won’t the fact that more Americans are insured mean that health care spending will continue to climb?  ”No”, says  Larry Levitt, a senior vice president at the Kaiser Family Foundation (KFF). This “will be a one-time bump in health spending.”
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Obama’s Proposals For Medicare — Do They Go Far Enough? Will They Become Law?

Not long ago, I wrote about the Center for American Progress’ (CAP’s) “Senior Protection Plan” —a report that aims to rein in Medicare “by $385 billion over ten years without harming beneficiaries.” In that post, I suggested that CAP’s proposals might well give us a preview of the “modest adjustments” that President Obama had said he would be willing to make to Medicare.  At the time, I highlighted three of CAP’s recommendations:

– increase premiums for the wealthiest 10% of Medicare beneficiaries (raising $25 billion);

– insist that drug-makers extend Medicaid rebates to low-income Medicare beneficiaries (saving $137.4 billion);

– prohibit “pay for delay” agreements that let “brand-name drug manufacturers pay generic drug manufacturers to keep generics off the market” (saving $5 billion).

Last week, in his State of the Union address, President Obama embraced the first two:  “Already, the Affordable Care Act is helping to slow the growth of health care costs,” he noted. “The reforms I’m proposing go even further. We’ll reduce taxpayer subsidies to prescription drug companies and ask more from the wealthiest seniors.”  (In time, I suspect that the administration also will call for a ban on those decidedly seamy “pay for delay” deals.)

“On Medicare,” he added, “I’m prepared to enact reforms that will achieve the same amount of health care savings by the beginning of the next decade as the reforms proposed by the bipartisan Simpson-Bowles commission.” The commission called for reducing Medicare spending by roughly $350 billion over 10 years–  a sum that is not far from CAP’s $385 billion target.

Are These “Adjustments” Too Modest ?

These may seem like small numbers. But keep in mind that this is on top of the $950 billion that the Affordable Care Act (ACA) saves by squeezing waste out of health care spending, while simultaneously raising new revenues. Of that $950 billion, some $350 billion comes in the form of Medicare savings achieved by:

–  Pruning over-payments to private sector Medicare Advantage insurers– $132 billion  

–  Containing Medicare inflation by shaving annual “updates” in  payments to hospitals and other large facilities by 1% a year for ten years, beginning in 2014– $196 billion

– Cutting disproportionate share hospital payments to hospitals that care for a disproportionate share of poor and uninsured patients over 10 years beginning in 2014 – $22 billion.

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Join the debate on “Reining in Medicare Costs without Hurting Seniors”

The January 26 post below (“How to Rein in Medicare costs without Hurting Seniors“) has drawn some 43 comments (including mine, as I responded to readers). I thought of turning a couple of my replies into posts, but then decided it might be more interesting for you to read them in the context of what other readers said.

I would love to see more readers participate in this thread. Comments are still open.

It’s a lively thread that takes on a number of third-rail issues: Does Medicare spend too much on pricey cancer drugs, end-of-life care and brand name hospitals?

 Should we try to spend less on end-of life care? Many say “Yes,” but Zeke Emanuel (a medical ethicist and oncologist who was part of the Obama team during the president’s first term), says “No.” I link to a column where he notes that “It is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. . . Wrong. Here are the real numbers: end-of-life care (not just for the elderly, but for all Americans) accounts for just 10% to 12% of  total health care spending. This figure has not changed significantly in decades.”

He goes on to suggest that while we probably can’t make end-of-life “cheaper,” we can make it “better . . .  Here are four things the health care system should do to try to improve care for the dying, even if they won’t save money.”

A number of readers comment on what is driving Medicare spending. Is it “patient expectations,”  “doctors’ fear of litigation,”  “regulations that dictate nurse-staffing ratios,” “practice patterns that doctors learned long ago,” or is the biggest problem “promotional efforts by manufacturers?”

Other questions come up: Does anyone really have any idea how much Medicare will cost in 2022?  By then will Medicare have begun negotiating with drug-makers and device-makers for discounts on drugs (the way the VA does now, saving 40%)?  How far will Medicare go in using medical evidence to decide what to cover?

One doctor/reader points out that in his field Medicare has begun to refuse to pay for procedures when research shows that they are not effective. He and another reader agree that in this way Medicare can provide “political cover” for private sector insurers who will follow Medicare’s lead.

We also discuss the deficit, and whether we should be trying to address the deficit now — or wait until the recession ends and unemployment falls. Also, is the deficit already dissolving as CAP suggests? 

And is the deficit our biggest problem? On this question, you will find links to Paul Krugman, Peter Orszag (who analyzes the slow-down in health care spending over the past three years as a “structural change, not just the result of the recession) and Ezra Klein,

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The Nation is Divided, Not between Whites and Minorities, But between the Past and the Future

Women, minorities, and young people re-elected President Obama. 

Pundits have pointed out that the president won only 39 percent of the vote among whites—down from 43 percent four years ago. But exit polls reveal that among women, Obama enjoyed an 11 percent advantage. “Fifty-five percent of women chose Obama,” Blooomberg observes —and clearly, this group included many white women. Sixty percent of voters ages 18 to 24 favored Obama—again, many were white voters. Among Latinos, the fastest growing demographic in the U.S., Obama won with a 44-point advantage. Romney secured just 27 percent of the Hispanic vote, down from the 31 percent who voted for the Republican candidate four years ago. Ninety-three percent of  African-Americans voted for the president, along with 73% of Asians (who now make up 3% of the electorate.)  And in the rust belt, Obama appealed to enough of the Democratic Party’s old blue-collar base  (which is largely white) to carry that section of the country.

Romney captured just two groups:  Americans over 65 and white men.  Romney’s cohort is made up of the people who ran this country in the 1980s. In a word, his supporters represent the past. Obama won among the young people, Latinos and women who will shape this nation’s future. They will be our leaders.  We have reached an inflection point in our history.

                                             Women in the Senate

 When Massachusetts elected Elizabeth Warren this was the first time that the Commonwealth sent a woman to the Senate. Thanks to last night’s election a record number of women will be serving in the U.S. Senate. There are currently 17. While two are retiring, at least four more have won — Democrats Tammy Baldwin in Wisconsin, Warren in Massachusetts, Mazie Hirono in Hawaii, and Republican Deb Fischer in Nebraska.  Claire McCaskill of Missouri, once considered the party’s most vulnerable Senator, held off a challenge by her Republican challenger, U.S. Representative Todd Akin (one of two Republicans who learned that during an election it is never a good idea to talk about rape) 

This is not to say that, going forward white men will not also be in positions of power. But in the future, a more mosaic leadership will reflect a new majority.  As Ross Douthat observed in today’s New York Times: “conservatives must face reality: The age of Reagan is officially over, and the Obama majority is the only majority we have.  (It is worth noting that Douthat describes himself as a conservative, though less “starry-eyed” than George Will.) 

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Truth Squad: Is “Obamacare” Pushing Health Care Spending Higher? What Will Happen in 2014?

In last Tuesday’s debate Mitt Romney suggested that, under Obamacare, health insurance premiums have spiraled by $2,500 per family. Not true.  (Hat tip to Healthcarefinancenews.com.)

 First let’s get the number right: According to an annual survey of employer plans  by the Kaiser Family Foundation and Health Research & Educational Trust, since the Affordable Care Act (ACA) passed in 2010, the average annual premium for family coverage has risen by $1,975 not $2500.  $1975 is a hefty sum, but 20% less than Romney claimed.

More importantly, $1,975 represents the combined increase in contributions made by employers and employeeswith employers picking  up the lion’s share of the hike. “In reality, premiums paid by employees haven’t changed that much.Factcheck observes. In fact, when you look at the rise in how much employees contributed, “the federal health care law was responsible for a 1 percent to 3 percent increase because of more generous coverage requirements.” In other words, employees were paying a little more, but getting value for their dollars.

After telling a whopper about how much employee’s health care premiums have risen in the past, Romney went on to assert that if Obamacare is  “implemented fully, it’ll be another $2,500 on top” of that. His evidence?  None.

                                              The Media Spreads the Myths

Yet the media continues to swallow the notion that under “Obamacare” health care spending will levitate. A few days ago, the Washington Post’s Robert J. Samuelson wrote: “Almost every expert agrees that controlling health costs is the crux of curing chronic budget deficits. Health-care spending already exceeds a quarter of federal outlays. With Obamacare’s coverage of the uninsured starting in 2014 and retiring baby boomers flooding into Medicare, the share is headed toward a third.”

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