Monday, September 24, 2012

Romney's plan to cover the uninsured: emergency room?

Mitt Romney’s specific plan for taking care of those without health insurance?
Scott Pelley to Mitt Romney on insuring the uninsured, 60 minutes, September 23, 2012
“SCOTT PELLEY: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?
MITT ROMNEY: Well, we do provide care for people who don’t have insurance, people — we — if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance and take them to the hospital and give them care. And different states have different ways of providing for that care”.
Romney should know better.  That’s why he invented the health care system in Massachusetts; it was a very expensive way to go.

The cost shift of expensive ER care to the Hospital goes , not to the State, but to the already insured and to the federal government’s programs for Medicare and Medicaid.  It is why we in the US pay 2 and a half times per person for health care than in other industrialized countries. The shift, the cost absorbed by the already insured ads up to $1000 per family per year , and also accounts to the shortening of the life of Medicare since it increases the general cost of health care,  the services of which are reflected in the costs of Medicare.    That is why the Simpson Bowles Debt Reduction Commission concluded that the cost of Medicare and Medicaid would be reduced if Obamacare was retained and the repealing Obamacare would add to the deficit and Obamacare would reduce it.

A person who treats the ER as their primary care physician does not get any  checkups, too, or preventative care..  For major illness, usually the patient arrives at the ER very sick and ends up having the most expensive care because of the   seriousness of their advanced condition…hospitalization, surgery and end of life treatment.  It is no wonder that the US has one of the worst death rates in the industrialized world.  Those who have insurance get good care; those who do not are more likely to die younger.  The result is a very bad average.  

We hear the GOP accusing Obamacare  taking $716 billion out of Medicare.  The inference is that the cuts go into thin air or benefits are reduced.  Wrong.  About $250 billion is ending the subsidy to private insurers for Medicare Advantage which, strangely enough, is continuing without the subsidy. The private insurers were being paid 17% more to administer Medicare than what the government could do itself….and it resulted in no advantage to senior care and the insurers got the only advantage.

From an article written by Sarah Kliff in the Washington Post, 8/14/22: “ By 2010, the average Medicare Advantage per-patient cost was 117 percent of regular fee-for-service. The Affordable Care Act gives those private plans a haircut and tethers reimbursement levels to the quality of care administered, and patient satisfaction.
The Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion.
The rest of the Affordable Care Act’s Medicare cuts are a lot smaller. Reductions to Medicare’s Disproportionate Share Payments — extra funds doled out the hospitals that see more uninsured patients — account for 5 percent in savings. Lower payments to home health providers make up another 8.8 percent. ….It’s worth noting that there’s one area these cuts don’t touch: Medicare benefits. The Affordable Care Act rolls back payment rates for hospitals and insurers. It does not, however, change the basket of benefits that patients have access to…”

That $716 in savings is reflected in Medicare’s future costs and improvements to the Medicare system.   The result: seniors will save on the average of $600  the a year since the  Medicare donut hole for prescription drugs will be covered by Obamacare, Medicare’s life is extended 8 years,  and the deficit problem will get some relief. Repealing Obamacare would eliminate all of these savings, reinstate the donut hole ,  eliminate the savings to the system, and continue providing the uninsured with very expensive health care.
(Sources for much of this can be found at the Kaiser Family Foundation web site and at; Much of this also is a repeat of my prior blog postings with sources documented then)

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