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Roger Stark
MD, FACS
Healthcare

Liberals and conservatives agree the rapidly increasing cost of health care is unsustainable in the U.S. Last year the country spent $2.4 trillion, comprising 18 percent of our economy or gross domestic product. Although the rate of increase has tapered off slightly the past two years, the U.S. is still spending twice the rate of inflation for health care.

Who are the people using these health care dollars? Who are the most expensive patients?

The federal Agency for Healthcare Research and Quality (AHRQ) tracks health care expenditures and patient demographics. In 2008 and 2009, the last years of complete data, 10 percent of patients used 70 percent of all health care dollars. read more »

 

Major health care reform (Patient Protection and Affordable Care Act) became law two years ago. The legislation passed with only Democratic votes and totaled a massive 2,700 pages. The Medicare and Medicaid programs, by contrast, were enacted in 1965 with broad support from both parties and totaled only 137 pages. Although the 2010 PPACA will not be fully implemented until 2018, we know much more about it today than was apparent two years ago.

The American public continues to view the law unfavorably. The weekly Rasmussen poll consistently shows a firm majority of Americans, 52 to 60 percent, favor repeal. A recent poll by the Kaiser Foundation reveals 51 percent of the public views the law unfavorably. The CNN polling organization found that 59 percent of Americans oppose the law and only 39 percent support it. read more »

 

After completing four years of medical school and three to eight years of rigorous specialty training, your doctor will soon have to get a report card from the federal government. Oh, and his or her income will be determined by this report card, not by years of training or patient satisfaction. This new rating is mandated in the new federal health care law, the Affordable Care Act

Formally known as pay-for-performance, or P4P, the idea of grading doctors has been around for thirty years. It began in the 1980s with health maintenance organizations and then languished until a few years ago. The fundamental premise of mandatory grading is doctors are greedy and will order extra tests and procedures just to increase their incomes, even though there is ostensibly no patient benefit. read more »

 

The federal government recently announced it wants to spy on your doctor. The government planned to pay “mystery patients” to call doctors and find out whether they are willing to accept the prices set by Medicaid and Medicare.

The public was outraged, naturally, and within 72 hours government officials temporarily suspended the calls.

Federal officials sending fake patients to spy on doctors is not only unethical, it is one more disturbing indicator of why government price controls on health-care services don’t work. read more »

 

The Republicans in Congress recently released their ten-year budget proposal. The federal budget debate is essentially about how large government should be and how costly social welfare programs should be managed in the future. The Republicans would simplify the tax code and close tax loopholes. The president would like to raise taxes on the wealthy and ultimately on the middle class.

Federal government spending the past two years has been at 25 percent of the gross domestic product (GDP), which is well above the historic level of 18 percent since World War II. The Republican budget would drop spending back to below 20 percent of GDP, versus more than 23 percent of GDP for the president’s plan. read more »

 

The Patient Protection and Affordable Care Act (PPACA) became law one year ago and ultimately will impact one sixth of the United States’ economy. Never before has such comprehensive social legislation been passed by Congress with such a strictly partisan vote. Although full implementation will take at least eight years, we now have twelve months of experience with the new health care reform. How successful has it been?

President Obama promised the law would “bend the cost curve (of health care) down.” The original cost of the legislation was estimated at roughly $1 trillion, with one half of the funding to come from cuts to Medicare and the other half to come from new taxes. read more »

 

Major health care legislation became federal law last year. One half of the $1 trillion cost of the legislation will be spent on taxpayer-funded subsidies to purchase health insurance in new state health insurance exchanges. Eligibility for the subsidy will be based on an income of 133 to 400 percent of the federal poverty level. For a family of four, 400 percent of the poverty level is currently $88,000, which will increase to $96,000 by 2016. Obviously, under the new federal reform subsidies will go to upper middle class people as well as the poor. read more »

 

One of the most controversial issues during the debate over federal health care reform was the concept of government committees or agencies deciding who would receive health care and who wouldn’t. Those who opposed the President’s health care plan called these agencies “death panels” and worried the panels would allow people to die rather than provide costly treatments at government expense. The President’s supporters called this “fear mongering” and assured Americans the legislation would not establish government agencies to make life and death decisions for us. read more »

 

Liberals and conservatives agreed on one thing during the health care debate: the cost of health care in the United States is not sustainable. Last year we spent $2.2 trillion, or 17 percent of the United States’ gross domestic product (GDP), on health care. Without some type of reform that number will rise to an unrealistic 30 percent of GDP by 2030. From an economic standpoint, this could never happen.

We were assured by the Obama Administration over the past two years that federal health reform would bend the cost curve down and actually decrease the federal deficit. read more »

 
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