What Does Medicare Actually Cover?

I say Bravo for this cogent piece by Henry Kotula laying out the key conceptual driver of exorbitant healthcare prices – inadequate assessment of value for dollars spent. I argue in this Fixing U.S. Healthcare blog that only a national single-payer system would have sufficient reach and clout to assess cost-benefit and then act – over against blowback from vested interests.

Here are some additional factoids:
1. The Oregon Health Plan of 1994 did use cost-benefit analysis to prioritize services. See my previous post: The Big Fix
2. The Affordable Care Act Section 6301 provides for “comparative clinical effectiveness research,” but then prohibits the Secretary from using evidence and findings from research to make a determination regarding Medicare coverage unless “through an iterative and transparent process which includes public comment and considers the effect on subpopulations” (which seems reasonable, and mirrors what was done in Oregon). Link: https://www.gao.gov/hcac/pcor_sec_6301.pdf
3. FDA’s current approach to technology assessment is potentially flawed and susceptible to gaming. See my posts: Even Research Statistics Are Rigged and It’s Not Just About Costly Drugs, It’s Testing Too
4. The U.K.’s National Institute for Health Research does technology assessment and uses results to provide “guidance” on coverage priorities. Link: https://www.nihr.ac.uk/explore-nihr/funding-programmes/health-technology-assessment.htm

Discussions such as this by Henry Kotula add texture to the current debate over healthcare reform. I hope Henry Kotula will keep them coming!  Enjoy this re-post!

HENRY KOTULA

What Does Medicare Actually Cover?

Image result for What Does Medicare Actually Cover?If it followed the path of traditional Medicare, it would end up paying for a lot of coverage that has little medical value.

In the first congressional hearing held on “Medicare for all” in April, Michael Burgess, a Republican congressman from Texas and a physician, called such a proposal “frightening” because it could limit the treatments available to patients.

The debate over Medicare for all has largely focused on access and taxpayer cost, but this raises a question that hasn’t gotten much attention: What treatments would it cover?

A good starting place for answers is to look at how traditional Medicare currently handles things. In one sense, there are some important elements that Medicare does not cover — and  arguably should. But a little digging into the rules governing treatments also reveals that Medicare allows a lot of low-value care — which…

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I’ve lived the difference between US and UK health care. Here’s what I learned

Henry Kotula’s first-person report on going back and forth between U.S.’s chaotic system and Britain’s single-payer is not only a compelling read, but also a credible glimpse into on-the-ground impact for an average patient of Medicare-for-all. Enjoy this re-post!

HENRY KOTULA

https://www.cnn.com/2019/08/07/opinions/single-payer-healthcare-beers/index.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive%2008-10-2019&utm_term=Healthcare%20Dive%20Weekender

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Earlier this year, I shattered my elbow in a freak fall, requiring surgery, plates and screws. While I am a US citizen, several years ago I married an Englishman and became a UK resident, entitled to coverage on the British National Health Service. My NHS surgeon was able to schedule me in for the three-hour surgery less than two weeks after my fall, and my physical therapist saw me weekly after the bone was healed to work on my flexion and extension. Both surgery and rehab were free at the point of use, and the only paperwork I completed was my pre-operative release forms.

Compare that to another freak accident I had while living in Boston in my 20s. I spilled a large cup of hot tea on myself, suffered second degree scald burns, and had to be taken to the hospital in an ambulance. In the pain and…

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The Problem of Diminishing Marginal Benefit in Healthcare

Why is it so bad for health spending to increase? After all, health care is good and noble. By the way, it also creates good-paying jobs. My answer, excerpted from Segment 6 of my Video Series, is that healthcare spending is good, of course, but only up to a point. Past a certain point it … Continue reading The Problem of Diminishing Marginal Benefit in Healthcare

Segment 3 – Healthcare Reform Successes & Failures

In Segment 2, we looked at the history of medical care in the U.S. until 1965, the year Congress enacted Medicare and Medicaid. In Segment 3 we will look at reform movements, starting with Medicare and Medicaid. We will look at why later reforms failed and where that leaves us now. By the early 1960s, … Continue reading Segment 3 – Healthcare Reform Successes & Failures