What's New

The latest "compromise" in the Senate debate on health care reform is the expansion of Medicare to anyone 55 - 64 years of age and the potential expansion of Medicaid to anyone who makes less than 150% of the federal poverty level (FPL). These measures would take the place of the "public option" passed in the House bill.

This is like something right out of Alice in Wonderland, where up is down and in is out.

Medicare is a public option, where everyone over the age of 64 is essentially required to join and where all participants are locked into a government run and controlled health care program. It is estimated that 3-5 million people would be eligible for the proposed Medicare buy-in. These new enrollees would be people without current health insurance and would be high utilizers of health care.

At present, Medicare has an unfunded liability of $89 trillion according to the CMS trustees. Adding millions more people to the program will not bend the cost curve of health care down unless significant rationing takes place. For the first three years there will be a buy-in for the 55 - 64 year olds to defray costs, yet after 2013 the federal government would simply wrap all participants into the standard Medicare plan.

Likewise, Medicaid is a government controlled health care program for the poor, where states share the cost with the federal government - in other words, tax payers from all over the country. Medicaid is also one of the largest budget items for virtually every state and is a main cause of the huge financial deficit states are facing.

Expanding Medicare and Medicaid is simply a bold move to place more of the American public in government controlled health insurance programs without calling it a "public option".

The Archives of Surgery recently a published a peer reviewed paper concluding that people without health insurance were more likely to die after major trauma than people with health insurance. The study looked at trauma deaths as recorded in the national trauma registry from 2002 through 2006 and included a total of almost 700,000 patients.

Overall mortality in the insured group was 4.7% with a breakdown of 3.3% for commercial insurance, 2.9% for managed care, 3.7% for Medicaid and as expected in the higher age range, 6.7% for Medicare. The uninsured had a 5.7% overall mortality rate.

The study was very well controlled for matching age, race, severity of trauma, and type of trauma (blunt vs penetrating). The authors concluded that having health insurance determines the likelihood of survival after major trauma.

The one glaring difference between the insured and uninsured groups was the incidence of penetrating injuries. The commercially insured and managed care groups had a 6% and 9% rate respectively with seniors in Medicare at 4%. The uninsured had a 24% rate. Most penetrating injuries are gun shot wounds and it can be argued that the chance of surviving a gun shot injury is much less than surviving blunt trauma which is usually in the form of an auto accident or a fall.

The implication of the paper is that providers treat patients in an emergency setting differently based on their insurance status. This is disingenuous and is absolutely insulting to the medical profession.

The Congressional Budget Office (CBO) scored the Senate Financial Committee health care reform bill this week. Never mind the fact the bill is only a summary and is not in legislative language, which made the CBO disclaim the cost of an actual final bill.

Total cost is reported at $829 billion with $81 billion in savings over the first ten years. Unfortunately, as published in a Micheal Cannon report for CATO, the cost would be closer to $2 trillion over the first ten years. So why the difference?

First, the CBO omitted $75 billion in new federal spending and $33 billion in unfunded mandates on state governments. Second, the nonpartisan CBO assumed Congress would allow the "sustainable growth rate" cuts in Medicare provider reimbursement starting in 2012. Congress has never let this happen. And finally, the CBO omitted the cost of the individual and employer mandates which represent 60% of the cost of Massachusetts' health care reform.

Therefore, to do the math: $829b + $75b + $33b = $937 billion (which is 40% of some number).

40% x N = $937 billion    N = $937 billion divided by 0.4 = $2.34 trillion.

So the Baucus bill is not budget neutral, let alone a deficit reducer. Instead, it is a colossal budget breaker that has the potential of bankrupting this country in just the first decade of application.