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A series on Medicare at 50

 

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President Johnson signs Medicare into law in 1965, with former President Harry Truman, 81, the first Medicare card holder, looking on.  Mr. Truman had long pushed for national health insurance.

As we approach the 50th anniversary of Medicare, MedPage Today starts a fascinating series looking at the achievements and problems — especially its spiraling costs — of the program.

Some of us at Cambridge Management Group well remember how the American Medical Association tried to stop the program from becoming law in the ’60s, asserting that it was “socialized medicine.”

It wasn’t but it did make many doctors and hospitals rich. Only in recent years have its reimbursements lagged physicians’ costs (and/or their financial expectations), leading to  major initiatives  aimed at bringing  its many wasteful aspects under control before it bankrupts America.

Meanwhile, even  many of the most ardent Tea Party conservatives like to talk about how evil would be cuts in Medicare benefits. But then, many Tea Party people are over or approaching Medicare age.

The original idea for Medicare goes back at least to Theodore Roosevelt in the sense of a national insurance plan. But Republican opposition has prevented a real universal, single-payer plan from being implemented.

Since the elderly vote in high numbers and because  age-related illnesses make it very difficult for most to get private insurance, they got what liberals  have wanted for the whole population. Politicians have generally worried more about old voters than, say, kids.

It will continue to be politically impossible to kill Medicare. Like Social Security, it’s too much a part of American life. But the flood of aging Baby Boomers and other factors ensure that it will continue to undergo change, some of them  wrenching.


Getting Medicaid repeaters out of the E.R.

 

The New York Times reports on experiments across America meant to better manage the impoverished, mentally ill and/or addicted people who drive up Medicaid and other public-health costs by frequenting hospital emergency rooms when they could be better and (often) more economically be treated elsewhere. Cambridge Management Group has been intensely working in this area of community health.

The Times reports that the Center for Healthcare Strategies  has documented such efforts in 26 states. “Some are run by private insurers and healthcare providers, while others are part of broader state overhaul efforts. The federal government is supporting some, too, through its $10 billion Innovation Center….”

“They raise a new question for the healthcare system: What is its role in tackling problems of poverty? And will addressing those problems save money?”

“We had this forehead-smacking realization that poverty has all of these expensive consequences in healthcare,” Ross Owen, a Hennepin County, Minn., health official, told The Times. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.”

”Now health systems around the nation are trying to buy the boots, metaphorically speaking. In Portland, Ore., health outreach workers help patients get driver’s licenses and give them essentials, such as bus tickets, blankets, calendars and adult diapers. In New York, medical teams are trained to handle eviction notices like medical emergencies. In Philadelphia, community health workers shop for groceries with diabetic patients.”

“The idea — to eliminate avoidable hospital use — went against years of economic habit. Hospitals make money by charging per visit and procedure, and fewer of both would dent revenues.”

So some jurisdictions, encouraged by Affordable Care Act incentives, have offered carrots.  Consider  Hennepin County {Minn.} Medical Center, which is paid a fixed amount per patient and gets  to keep the money even if patients  don’t show up, or use less medical care than was paid for.” Such pilot programs seek to care  for patients in places cheaper than hospitals — which is most places.


Will FQHC’s avoid the federal funding cliff?

 

Despite their many successes, the future of Community Health Centers is uncertain, warns the National Association of Community Health Centers (NACHC) because they face a federal funding cliff. Without action by Congress to address the funding shortfall, Community Health Centers face up to a 70-percent reduction in federal support on Oct. 1, 2015, the organization says.

So next Tuesday, March 17, the NACHC will release a policy report, Community Health Centers Past, Present and Future: Building on 50 Years of Success.

We at Cambridge Management Group, which has worked closely with Federally Qualified Health Centers, predict that Congress and the Obama administration will find a way of averting going off this cliff because of the  impact it would have on millions of patients, the increased traffic it would force on hospital emergency rooms and other woes.

Whatever that cliff, the chaos associated with a U.S. Supreme Court ruling against certain subsidies under the Affordable Care Act would also cause a lot of problems at FQHC’s.

 

 


Oregon’s secret to healthcare reform

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William A. Galston writes in a very important piece in today’s  Wall Street Journal that Oregon is so far succeeding with its 15 regional Coordinated Care Organizations  involving Medicaid patients “designed to break down the multiple ‘silos’ of health services and provide integrated, patient-centered  services with a focus on primary and preventive care.”

Oregon’s governor, John Kitzhaber, M.D., is leading the way in developing this national model of reform.

So far, the plan seems to be succeeding in saving money while improving healthcare delivery. If it goes on like this, says Mr. Galston, “the results would be revolutionary….for the country as a whole, implementation of the Oregon model could save Medicaid more than $900 billion over the next decade.”

Cambridge Management Group has been working  intensely in Oregon on coordinated-care community-health projects and is very pleased that Mr. Galston is touting what we at CMG also see as potentially revolutionary improvements.

He notes that the Center for American Progress suggests expansion of the Oregon model ”to cover all healthcare spending, public and private,” in the U.S.

 


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