Medicare Meltdown Released!

  

 Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It

by Rosemary Gibson and Janardan Prasad Singh

• Seniors' entitlement to Medicare is not the problem.  The health care industry's entitlement to Medicare's money IS the problem.
• When Medicare was started in 1965, there were no health care companies on the Fortune 100 list.  Now there are 15.
• Identifies "The Seven Habits of a Highly Entitled Health Care Industry" and what they mean for you.
• Traces the nearly $600 billion a year that Medicare spends, where it goes, and who gets it.
• Gives a front row seat on the ties between Wall Street and Washington and how they are shaping Medicare's future.
• Shows how private equity firms and hedge funds are betting on Medicare and what it means for seniors.
• Explains why private equity firms are buying for-profit hospices -- and why so many for-profit hospices have come into the crosshairs of the US Department of Justice.
• Offers common sense fixes to keep Medicare sustainable that Wall Street and Washington don't want you to know.

 Medicare affects everyone. If you are a boomer, you are counting on Medicare to protect you from the cost of health care when you retire. If you have turned 65, you already depend on Medicare. If you are a Gen-X or Gen-Y, you are contributing to Medicare from your paycheck. Will Medicare continue to exist as we have known it? Will it be there when you need it? How much will it cost? As the future of Medicare is debated in Washington, Rosemary Gibson and Janardan Prasad Singh shine a light on a rarely-seen side of this storied program: the business of Medicare.Medicare is known as an entitlement for the nation’s seniors. It is also the largest entitlement-based program for any business sector in the US economy. Its beneficiaries include hospitals, doctors, drug companies, device manufacturers, Wall Street investment banks, private equity firms, hedge funds, and others that rely on the $600 billion that Medicare spends a year.

The ties that bind Wall Street and Washington in the healthcare industry are strong, and they will play an outsized role in determining Medicare’s future. Gibson and Singh reveal how the industry’s interests are often at odds with those of seniors and boomers.

While some politicians point to the culture of dependence of the public on Medicare, the authors suggest that policymakers turn their attention to the culture of dependence of the healthcare industry on Medicare, which is the predominant force pushing the program toward a fiscal cliff.

The amount of waste in the Medicare program is equivalent to the entire economy of New Zealand. For Medicare to be sustained, this culture of dependence -- and the habits it breeds, namely waste, excessive pricing, and overuse of unnecessary services -- should be the first priority for the chopping block. By parings back the excess, the authors argue, Medicare can be sustained for future generations. This is essential reading for anyone interested in how Medicare works, how it could work better, and where it will go if reforms are not made.

About the Authors:

Rosemary Gibson is a national authority on U.S. health care. At the Robert Wood Johnson Foundation, she designed and led national initiatives to improve health care quality and safety. She was vice president of the Economic and Social Research Institute and served as senior associate at the American Enterprise Institute. She is principal author of Wall of Silence, The Treatment Trap, and The Battle Over Health Care. She serves as an editor for the Archives of Internal Medicine series, Less is More.

Janardan Prasad Singh is an economist at the World Bank. He has been a member of the International Advisory Council for several prime ministers of India. He worked on economic policy at the American Enterprise Institute and on foreign policy at the United Nations. He has written extensively on health care, social policy, and economic development. He was a member of the Board of Contributors of the Wall Street Journal. He is co-author ofWall of Silence, The Treatment Trap, and The Battle Over Health Care.

Publisher:  Rowman and Littlefield Publishers (April 16, 2013)

Buy Medicare Meltdown on Amazon!   http://www.amazon.com/Medicare-Meltdown-Street-Washington-Ruining/dp/1442219793

Visit the Medicare Meltdown web site: www.medicaremeltdown.org

Scooting to Ruin (Interview with Rosemary Gibson on HuffPost Live)

"Scooting to Ruin" video from HuffPost Live, featuring Rosemary Gibson, author of Medicare Meltdown

Direct link >> http://live.huffingtonpost.com/r/segment/medicare-motorized-scooters/5154acbb2b8c2a10e8000147

"The Battle Over Health Care" on C-SPAN Book TV

Rosemary Gibson speaks on July 31 about her new book, The Battle Over Health Care, on C-SPAN Book TV

 

Rosemary Gibson examines the current health care debate and the provisions of the Patient Protection and Affordable Care Act. Ms. Gibson reports on the creation of the legislation, its recent passage, and the fiscal affect on insurance providers and the federal government. She showed slides during her presentation and responded to questions from members of the audience at Saint Peter's University Hospital in New Brunswick, New Jersey.

Watch video on C-SPAN Book TV

Watch Treatment Trap Video from 7/26/10

Take patients away from the overtreaters

Cross-posted from KevinMD: http://www.kevinmd.com/blog/2012/02/patients-overtreaters.html

A few months ago I was introduced to a gentleman who had been a corporate VP for employee benefits at a Fortune 100 company for many years. I was impressed with his knowledge of health care. He shared some of his experiences with company employees, who lived all over the country.

The company had a policy that when employees were informed they had a very serious medical condition, the company paid for a second opinion.

For example, when employees were told they needed a heart transplant, the company paid the cost for travel and a second opinion at the Mayo Clinic. Mayo found that 40% of the transplants that had been recommended to employees were not medically necessary or appropriate.

The VP saw cases in which transplants were recommended for people who were going to die soon from cancer whether the transplant was done or not.

Sometimes hospitals and surgeons were extremely aggressive in promoting transplants that could not possibly be beneficial to the patients. One hospital recommended a heart-lung transplant for a patient. When the patient visited Mayo for a second opinion, it was discovered that neither a heart nor a lung transplant was indicated for the patient. She left the hospital with no surgery.

Another employee was told he needed a heart transplant. When the VP called the surgeon at a well-known institution to tell him that his company will pay for a Mayo second opinion, the surgeon said the patient shouldn’t fly on a plane in his condition. In fact, the employee has just traveled on a plane to see the surgeon and was happy to go to Mayo for a second opinion. The second opinion revealed a small blockage that was successfully managed with a stent.

The VP said the team in his company that worked with Mayo had a wall of cards and notes from grateful employees. The employees who were spared massive surgeries called the VP’s team members and thanked them over and over again. The employees cried, the team cried, and so did the VP.

I’ve been working on overtreatment for a long time and have written about it in The Treatment Trap but this took my breath away.

The opportunity cost is profound when it comes to transplants. Medically unnecessary transplants take life away from those who could die without a new heart.

So far, the work to shine a light on overtreatment is compelling and includes:

* the “Top Five” list of good practices in primary care that lead to appropriate care, no more and no less, developed by the National Physicians Alliance, funded by the ABIM Foundation, and published in the Archives of Internal Medicine

* the ABIM Foundation’s Choosing Wisely campaign whose message is that wise choices are integral to medical professionalism

We need to get to the high hanging fruit where real and immediate harm is occurring.

As for the former benefits VP, his approach has been to take patients away from the overtreaters. I think Hippocrates would agree this is the right thing to do.

Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation. She is author of The Treatment Trap, Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans, and the forthcoming book, The Battle Over Health Care: What Obama’s Reform Means for America’s Future published by Rowman & Littlefield.

Why Republicans Can't Repeal Obama's Health Reform: Tea Party Take Note

Rosemary Gibson: Why Republicans Can't Repeal Obama's Health Reform: Tea Party Take Note, Huffington Post, 10/21/2011

As the congressional super committee looks for $1.5 trillion in deficit reduction, Republicans on the Senate Finance Committee urged repeal of President Obama's health care reform, The Hill reporter Sam Baker wrote this week. The truth is that Republicans are playing a two-sided game over repeal. Here's how.

You'll remember that in February of this year, House Majority Leader John Boehner led Republicans in the House of Representatives to vote for the repeal of the health care reform law even though the Senate didn't have the votes to do the same. It made for a good show of solidarity with the Tea Party that had swept Republicans into office in the 2010 mid-term election.

But wait a minute. Why would Republicans want to repeal health care reform? Sure, they don't want to see Obama succeed on his signature domestic issue. But their natural allies, big health care businesses -- drug companies, device manufacturers, health insurance companies -- gained a whopping 32 million new customers beginning in 2014 with the stroke of Obama's pen on March 23, 2010.

What businesses would ever get that many new prospective customers - with government subsidies to boot? Even better, each customer will spend, on average about $8,000 a year on health care. The medical-industrial complex will divide the lucrative spoils. This means that another 32 million people are at risk of having unnecessary cancer-causing CT scans, open heart surgeries and stents and drugs which I wrote about in The Treatment Trap.

Los Angeles Times reporter, Norm Levy, reports that conservative experts think that if the GOP wants to dismantle the law, they need to replace it with something else. They'll need a replacement, too, if the US Supreme Court declares the individual mandate unconstitutional.

Are Republicans having a moment of compassion for people without health insurance? Hardly. 
The truth is that Republicans face great peril if they succeed in repealing the reform law and denying the medical-industrial complex the hundreds of billions of dollars they expect in revenue from Obama's health care reform. Expect a big push back from an apoplectic industry.

Levy from the LA Times quotes Mary Grealy, president of the Healthcare Leadership Council, a coalition of executives of big health care industry companies, 'Wholesale repeal leaves you with nothing." That's right. Repeal of health care reform leaves the health care industry with nothing.

That's not an option for Republicans who have conspired with the big-moneyed health care interests whose bottom lines depend on the blind generosity of the American taxpayer.

Health care is still so lucrative now that private equity firms are jumping on the bandwagon and pouring money into health care with the expectation of profits in the next couple of years. See my earlier blog post:They want to get in, grab the money, and go before health reform's Independent Payment Advisory Board (IPAB) kicks in beginning in 2015. Maybe.

Republicans and the industry are targeting the IPAB and anything that gets in the way of them taking a larger share of America's income. The board acts like a circuit-breaker if Medicare spending shoots up too much in a given year. It's the only part of the health care reform that has a meaningful chance of making Medicare sustainable as the boomers reach their 80s and 90s.

Of course, the medical-industrial complex doesn't care about that. It claims that the board will allow government bureaucrats to get in between you and your doctor. Here's the truth.

Drug and device companies want to get in between you and your doctor so they can market every drug and device known to humankind right on your IPad and IPhone. This gives new meaning to direct-to-consumer advertising. People will succumb to all kinds of gimmicks -- treatments, tests and surgeries that can cause more harm than good.

Whatever happens, Wall Street-driven health care will find its way into your wallet.

Rosemary Gibson is the author of The Treatment Trap: How the Overuse of Unnecessary Medical Care is Wrecking Your Health 


Read article on Huffington Post

Medicare Unveils New Online Patient Safety Ratings for Hospitals

Medicare Unveils New Online Patient Safety Ratings for Hospitals - California Healthline (10/18/2011)

"...Medicare officials last week began publishing patient safety ratings for hospitals across the U.S. on CMS' Hospital Compare website, Kaiser Health News/MSNBC reports.

The data evaluate hospitals based on rates of surgical complications, infections, medical errors and potentially avoidable deaths. The website compares hospitals' ratings with national averages for medical complications and hospital-acquired conditions.

The ratings are part of an initiative mandated by the federal health reform law in which hospitals with the lowest quality ratings will receive lower Medicare reimbursements.

Patient Safety Advocates Commend Ratings
Patient safety advocates have praised the ratings.

Rosemary Gibson -- the editor of a series of articles on overtreatment in the Archives of Internal Medicine -- said, "This is pulling the curtain back on preventable health care harm to older Americans." She added, "These are really good things to know."

Read rest of article

Attention Wall Street Protestors: Wall Street is Messing With Your Health by Rosemary Gibson Cross-Posted from Huffington Post, 10/7/11

Have cancer? Don't worry, Kohlberg and Company bought 16 outpatient cancer centers this year.

Live in Massachusetts and need to go to the hospital? No sweat, Cerberus Capital bought six Catholic hospitals that the Archdiocese of Boston had to sell in a fire sale.

Have a loved one who needs home health care? Check out the four largest publicly traded home health care companies that are in the crosshairs of the US Senate Finance Commitee for overtreating patients just to make a buck - Amedisys, LHC group, Gentiva, and Almost Family. If you think overtreatment doesn't matter, read The Treatment Trap for tips on how to avoid medical care that can cause you more harm than good.

Live in Detroit? Did you know that the Blackstone Group controls Vanguard Health Systems which bought the Detroit Medical Care System?

Have a loved one who is dying? No need to fear. They can get care from hospices owned by a private investment firm, Cressey and Company.

If Wall Street messed with your wealth, imagine how it is messing with your health.

Investor-owned, for-profit health care is determining the medical treatment you get.

It wants you and everyone else to be a patient every day and forever. In return, the investors run to the bank after billing you, your insurance, and Medicare.

In fact, you need to worry less about government bureaucrats getting in between you and your doctor, and more about Wall Street interests determining the treatment you get. Perish the thought.

The financial industry nearly brought the country to its knees. No worry there either. For-profit health care will replace them if they ache too much for too long.

Its tentacles reach into the homes all across America, on Maple Streets, Sycamore Avenues, and Grand Boulevards.

Their ideal patient is taking ten drugs that cost thousands of dollars a month; has repeat back surgeries that cost $80,000 each; and has cancer and goes to the doctor three times a week.

Wall Street needs you, me, and everyone to be sick so they can report ever-escalating stock prices and earnings per share. Don't have the money?

Charge it on your credit card. As for the federal government, no worry their either. It will just keep borrowing 40 cents for every dollar it spends. Thank you, China.

As for health reform, well, health insurance used to be about giving people access to providers. Now, it's about giving private equity firms access to people.

Rosemary Gibson is the author of The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do To Prevent It.