Posted via email from danielmiessler.com | posterous

Posted via email from danielmiessler.com | posterous

• Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

• Insurers will be barred from excluding children for coverage because of pre-existing conditions.

• Young adults will be able to stay on their parents’ health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

• Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

• A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

• Medicare drug beneficiaries who fall into the “doughnut hole” coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

• A tax credit becomes available for some small businesses to help provide coverage for workers.

• A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011

• Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.

• Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

• A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.

• Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

• Employers are required to disclose the value of health benefits on employees’ W-2 tax forms.

• An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

• Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form “accountable care organizations” to improve quality and efficiency of care.

• An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.

• The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

• A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

• The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.

• The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.

• A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

• State health insurance exchanges for small businesses and individuals open.

• Most people will be required to obtain health insurance coverage or pay a fine if they don’t. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

• Health plans no longer can exclude people from coverage due to pre-existing conditions.

• Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren’t counted for the fine.

• Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

• Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

• An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions. (Reporting by Donna Smith; Editing by David Alexander and Eric Beech)

(thanks to this reuters article for the list)

Healthcare Solutions
By Dan Field, MD

1. Tort reform. Cap every state as has been done in California and Texas.
2. Medical justice panels. A jury by our peers. Medically trained arbitration panels to hear cases.
3. Eliminate doctors’ malpractice costs for patients who demand free care. If the government insists that ED docs see every patient (through EMTALA), they are de facto government employees for those patients and should receive government indemnification.
4. Limit advertising again. It was a bad move when they opened it up.
5. Research, publicize and reward best practices. The worst hospital at Kaiser today has a better record of sepsis prevention than the best Kaiser hospital two years ago. Some have had ZERO sepsis in two years. Sepsis costs $40,000 to $100,000 per patient and frequently adds to the nation’s iatrogenic death load. Replicate this through the major diseases and some of the $500 billion of savings we need to achieve becomes realizable.
6. Divest physicians of the benefit of profiting from ordering tests. A study shows a doctor who owns a scanner is seven times more likely to refer a patient for a scan.
7. Generics drugs for everybody, name brands for those who want to pay out of pocket (or from the HSAs).
8. Revamp medical reimbursement
9. Create a two-tiered medical system where everyone has catastrophic coverage and HSAs. Allow the rich and others to opt out for value-added service. This might be just enough incentive to keep some innovation moving forward. I seriously doubt most medication advances are necessary — seems to me they just add a molecule so they can extend the patent without any new, real benefit. First tier accepts all, including, pre-existing illness, with no rescission. Everyone pays same rate for basic tier, everyone gets a tax credit. Not sure how to deal with those that don’t work. Incentivize healthy behaviors — non-smokers with low cholesterol and great genetics are an attractive subgroup. Second tier insurance companies will compete for these stars with lower premiums. Veal calves with remotes and cancer sticks will be avoided like the plague and end up in the first tier or paying more.
10. Accept that disparities will continue but that they will be better and more morally acceptable disparities than before.
11. Allow true portability.
12. Give needles to addicts, along with access to treatment.
13. Strongly consider legalizing and decriminalizing drugs.
14. Realize that screening doesn’t save money for society.
15. People should have a right to unlimited end of life care … as long as they can pay for it.
16. All government officials must utilize the system they insist we follow, especially “the public option”.

Dan Field is a physician with The Permanente Medical Group.

We need a room full of 100 of these guys and some quality lawmakers who are willing to piss off the big corporations that donate to their campaigns. Get those two things together, and spend 3 months, and I think some excellent reform legislation would come of it.

Posted via web from danielmiessler.com | posterous

If Joe Lieberman or other senators came across John Brodniak writhing in pain on the sidewalk, they presumably would jump to help him and rush him to a hospital.

Someone tell me it makes sense for this to happen anywhere at any time, let alone in the United States in 2010.

Posted via web from danielmiessler.com | posterous

::

There’s a saying in atheism circles that aims to show Christian hypocrisy related to how they dismiss all the thousands of gods that have existed previously, yet fail to understand how atheists dismiss theirs:

I contend that we are both atheists. I just believe in one fewer god than you do. When you understand why you dismiss all the other possible gods, you will understand why I dismiss yours. – Stephen Roberts

Interestingly enough, the same concept applies to conservatives and healthcare. Here’s my modified version of this quote:

I contend that we both support public services. I just believe in supporting one more than you do. When you understand why you support public schools, a public fire department, and a public police force, you’ll then understand why I support public health care.

In other words, you’ll find that most conservatives are quite comfortable with calling a taxpayer-funded fire truck when their precious home is engulfed in flames. Similarly, if a conservative sees someone suspicious in his neighborhood he’ll probably not suffer any philosophical anguish while calling the taxpayer-funded police department.

Neither of these entities are for-profit. They are publicly funded and aren’t competing directly with private services. And it’s the same with public schools. Private services can compete with them if they so choose, and that’s fine, but you won’t find many conservatives arguing that the public versions of the services should go away.

Ultimately, conservatives need to answer a very simple question: what is the difference between someone’s home being on fire and someone’s child needing chemotherapy?

The answer is nothing–not in a modern society. So sure–debate all you want about implementation. Let’s hear plenty of conversation about efficiency and avoiding bureaucracy and such, but the concept itself of public healthcare should not be fought on principle. If one wants to have that conversation then it must also be had regarding all the other public services that are widely accepted as foundations of any first world society. ::