But...but...but...I thought the free market was always better!?

For-profit nursing homes and hospitals on average provide an inferior quality of care compared with their nonprofit peers, according to an extensive review of studies published on Tuesday.



Authors writing in the journal Health Affairs found that a systematic analysis of 162 studies of nonprofit versus for-profit health care providers supports the concept that a facility's ownership status makes a difference in outcomes and in the cost of health care.

journal. [...]



In what they called the biggest review of the literature to date, authors reported that eight studies found nonprofit hospitals have lower mortality rates, versus one study finding for-profits have lower rates of death.



Nonprofit hospitals are also better at keeping costs down, the review found.

Meanwhile, free marketeers like Chuck Grassley have been musing over a legislative end to non-profit care centers. Unlike, say, megachurches, they apparently don't provide enough social benefit to justify their tax exempt status. Back to the study:

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Reading through the latest NBC News/WSJ poll this morning, something jumped out at me: by a margin of 35 points, respondents believe that the Democratic party would do a better job of dealing with health care than the Republican party. While it's certainly not news that Americans trust the Democrats on this issue, they haven't given them this kind of advantage since March of 1993, when the margin was 48 points. And we all know what happened in 1993.

Today, health care reform feels like more of a sleeper issue, playing second fiddle to other domestic issues like immigration and, of course, to foreign policy issues like the war in Iraq. It shows up in poll after poll as one of Americans' top concerns, and a simple glance at the cost trajectory of health insurance goes a long way towards explaining why. But it isn't just the cost increases alone, it's also that, as long as we have an employment-based health system, health care will be inextricably linked to the economy or, more precisely, to the way in which economic growth is distributed.

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There is already a long list of Republican corruption in using taxpayer money to promote their Part D disaster. But the latest story to break involves HHS Secretary Mike Leavitt using a private plane that was leased to the Centers for Disease Control and Prevention for emergencies to instead visit over 90 cities to promote Part D. Its estimated that this misuse of the plane has cost taxpayers more than $700,000 since January. To make matters even worse, the Atlanta Journal-Constitution has reported that Leavitt’s use of the plane meant it was unavailable during 2 actual emergencies. It seems that this administration will stop at nothing to sell and promote their prescription drug debacle. No amount of taxpayer money is too much for this administration to waste when there are elections to be won. This abuse of power is truly disgusting.

Earlier today a colleague at the Medicare Rights Center forwarded me a remarkable piece of data that left me astounded. We all know having private plans, rather than a benefit directly from Medicare, is needlessly costly and confusing. But few people know that the median time spent by seniors analyzing which plan is best for them is around 8 hours, according to a study (p.76) by the University of Chicago and Georgetown University. This means that signing up for what hopefully is the right plan is literally a 9-5 second job for many seniors and disabled.

What else does this mean? As the famous saying goes, time is money. With the average American wage being around $17 an hour (and assuming it would still take an hour to sign up for a direct benefit from Medicare), the confusing design of Part D is costing the average enrolled senior about $119 in Bush confusion taxes. Assuming at least 9 million seniors signed up for Part D, that means the confusion costs for all American seniors and disabled would be about 72 million hours lost, or about $1.1 billion! And this doesn’t even include the significant time spent by many seniors who analyzed the plans but then decided against enrolling.

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Michael Tanner writes:

There is no doubt that Americans spend more on health care than any other country. But why is that necessarily a bad thing? There is no “right” amount to spend on health care or anything else. The United States spends more on athletic shoes than any other country. No one speaks of the athletic shoes crisis.

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I highly recommend Daniel Gross's takedown of Greg Mankiw's prescriptions for what economically ails us. I'd add that in addition to endorsing the blue-state penalization plan that ends the deductibility of state and local taxes, it's worth noting that another idea from the President's tax commission, ending the deductibility of employer-based health insurance, is curiously absent from Mankiw's op-ed. Strange, a the rationale is precisely the same for both tax changes. Mankiw writes that "[u]nder current law, if one town enacts high local taxes to finance a municipal pool while a neighboring town does not, the first town gets a federal subsidy at the expense of the second. That outcome is neither efficient nor equitable." Meanwhile, under current law, if an employer purchases health insurance, he gets a federal subsidy at the expense of an individual purchasing health insurance. It's not clear why subsidizing employer-based health insurance at the expense of individuals is equitable or efficient, but it a) cuts against corporations and b) is politically popular in places Republicans need votes, so Mankiw doesn't mention it.

Following up on Jeff’s link about CMS honcho Leslie Norwalk’s invention of a survey that didn’t exist, it’s pretty damn obvious where her next job is. After all there’s one job above all in health care in DC which requires that the occupant be, as the British used to say, economical with the truth. Move over Karen—perhaps the AFL-CIO will take you back

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I’m really starting to get tired reporting on all of CMS’s lies. CMS’s newest lie, while not having the impact of deliberately lying about hundreds of billions of dollars in a cost estimate, is certainly incredible! A CMS official testified at a House Energy and Commerce Committee Health Subcommittee that nearly all of the Medicare prescription-drug plans are paying pharmacies in a timely matter, despite widespread reports from pharmacies to the contrary.

To back up their assertions, CMS cited a survey they claimed they conducted finding that up to 18 of the top 20 prescription-drug plans (which account for more than 90% the drug coverage for Part D beneficiaries) pay pharmacy claims in 15 days or less. But low and behold, we now find out that no such survey was ever conducted. It really blows my mind how CMS can consistently lie to Congress and the American public and keep getting away with it.

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Interesting article in today's Times substantiating all the bellyaching over medical paperwork. Insurers, it turns out, don't like to pay claims. Better yet, sometimes they don't. The reasons range from denials of responsibility to calculated tardiness to lame protestations that they lost, or didn't receive, the papers, which were sent by certified mail. Estimates have the cost of following up on these arguments comprising about 20% of administrative costs at doctor's offices. Guess who ends up paying the difference?

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Savor this, because it's a rare moment of total agreement between me and The Weekly Standard, but our organ donation system is totally fucked up. It's just stupid, it's deadly. The medical community has adopted a bizarre stance of non-interference in the organ line. Here's the scenario: you have kidney failure, dialysis twice a week. Dialysis is soul-crushing stuff; hours hooked up to a machine as it cleanses your blood of poisons your kidneys aren't discarding. It's tough on your heart, bad for your life expectancy, rough on your spirit. None of your friends or family provide a kidney match, but a newspaper reporter hears of your plight and writes an article. A stranger comes forward -- she's compatible, and willing to give up the kidney. And then you get a call: the hospital won't do the transplant, it's official policy to refuse those attempting to subvert the waiting list.

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Secretary of Health and Human Services, Mike Leavitt, recently was quoted praising the Part D enrollment process, which ended last week, as a “remarkable American moment . . . sort of a de Tocqueville moment.” Well it seems that the administration has finally found the perfect analogy for the Part D disaster.

One of Alexis de Tocqueville’s famous observations is that it is easier for the world to accept a simple lie than a complex truth. This administration seems to be banking on this by trying to repeat over and over that Part D is a success despite the overwhelming evidence contradicting this.

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I’ve been looking at how Part D is affecting the Latino community and the results are scandalous. The full report was released earlier this week and its clear Latinos are suffering disproportionately from the poor design of Part D.

First there are the financial costs. Because Part D doesn’t have a guaranteed benefit directly from Medicare with negotiated prices, Latino beneficiaries and taxpayers are paying $59.3 billion dollars in excess costs over the next decade. The poor design of Part D in forcing seniors to choose among competing (and more expensive) private plans is also the chief source of confusion.

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I approve of government programs done well. Michael Cannon doesn’t approve of them done much at all. We both disapprove of them being done expensively and then having so-called Conservatives in power lie bold face about their costs and enrollment rates. Yup, I’m sending you over to the Cato Institute blog. That might be a first for TPM Cafe, but it’s a great explanation of what’s wrong with Part D.

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Folks interested in the TNR-DLC-blog wars should check out Ed Kilgore's rundown of where the DLC concurs with and where it dissents from the list of policies Atrios thinks the blogosphere basically supports. Mostly, things stack up as you'd expect, with the DLC and the blogosphere concurring on near everything. The divisions, however, are surprising.

Where Atrios thinks bloggers agree that Medicare should run the Medicare drug program, Kilgore dissents that the DLC "opposed the current plan, but [we] think the problem is cost and complexity, not the basic idea of offering choice and competition, a la the federal employees' plan." Of course, cost and complexity are absolutely intrinsic to the primacy of private insurers (and I'm sorry to see Kilgore buying into the GOP spin that terms privatization "cost and competition."). So far as I know, none seriously dissent from the belief that Medicare pays more than the VA, Canada, Britain, France, or any other socialized system because it's barred from using its market power to negotiate. The current king of the free market, Wal-Mart, dominates on cost and crushes the competition by throwing their weight around, and it's schizophrenic to value the free market but bar Medicare from adapting the tactics most successful within market rules.

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Yesterday, hundreds of activists protested outside of HHS Secretary Mike Leavitt’s House demanding that the May 15^th deadline be extended. Leavitt has insisted upon keeping the administration’s deadline, while millions of seniors will soon be getting hit with lifetime penalties and the inability to sign up for Part D until 2007.

Meanwhile, several public interest groups called for a corruption investigation into the prescription drug law. A new report released by the Campaign for America’s future highlights how former Rep. Billy Tauzin, R-La helped shape the bill for PhRMA, rather than for the seniors he represented. I’m sure negotiating with PhRMA to become their top, and one of DC’s highest paid, lobbyists had nothing to do with him insisting on provisions that forbid Medicare from negotiating prices. Wink, wink.

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Last week, the General Accounting Office (GAO) released the results of their probe on CMS’s 1-800-Medicare Part D help line. The results are a stunning reaffirmation of how needlessly complicated the Bush Part D disaster is and why the deadline needs to be extended while the program is reformed.

The GAO found that the government’s 7,500 paid Part D experts were wrong one third of the time! But it gets even worse. On one of the main reason seniors would call for help, to find out which plan is cheapest for them, the experts answered wrong a whopping 41% of the time. How can we expect seniors to pick the right plan when CMS’s paid experts are giving the wrong advice nearly half of the time?

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It’s incredible how a couple of bullshit surveys, dishonestly conducted have changed the rhetoric a little on Part D. Now there’s a very odd article about Part D in The LA Times, which has been speaking truth to one power (Kaiser Permanente) all last week. Apparently it’s all going swimmingly well.

By the May 15 deadline, federal officials expect to have more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called. That would include at least 7 million who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year or more. That's a considerable achievement for a government that has not tried to roll out such an ambitious entitlement program since the days of Lyndon B. Johnson. It's especially so for President Bush, who is no fan of big government.

And read on because it quotes lots of dinisterested parties like everyone's favorite lobbyist and truth-teller Karen Ignagni, and the flack from the AEI, before it gets to the real triumph of Medicare Part D. It’s cheap, much cheaper than we were told!

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After my Uninsured primer earlier this week, I had a few requests to compile a profile on those with insurance. This is also my last day blogging, so I figured a round up of my favorite health policy issue is appropriate.

Insurance has seen substantial changes and shifts in the last five years, and these are due to the explosive growth of health spending. As costs rise ever further, employees are hurting. The pain is dual -- due to delayed treatment for illness or lost coverage for various procedures, as well as a hole in the pocketbook that's become meteor-sized.

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As Kate points out, Association Health Plans, the vehicles through which small businesses would purportedly band together to obtain cheaper health insurance if only those pesky insurance regulators would get out of the way, are a bit of a Trojan horse. And if AHPs won’t solve the very real problems that small businesses face in finding affordable health insurance for their employees, why are small business associations like the National Federation of Independent Businesses (NFIB) and the Chamber of Commerce pulling out all the stops to pass this legislation?

An article that appeared in the Wall Street Journal a few years back fills us in on the supporters of this perennial legislation:

The National Federation of Independent Business has sold Republicans on a conservative answer to expanding health coverage: a new kind of insurance policy that trade associations could offer members…What they don't emphasize is the significant benefits this could provide the NFIB, a major Republican Party benefactor. If the Bush administration and congressional leaders push association health plans into law, the NFIB could reap more than $100 million of annual revenue by selling policies, according to one estimate.

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Republicans have acquired an attachment to the word “modernization”.  Especially when it comes to health care legislation.  And like most of their deceptively but cleverly named bills (Healthy Forests Initiative, anyone?), modernization has been assigned a new meaning.

In the reality-based health wonk community, modernization evokes images of electronic health records and eprescribing systems.  But for the Republican party, “modernization” is now synonymous with “corporate handout”. 

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It's Cover the Uninsured Week, sponsored by the Robertwood Johnson Foundation, the health advocacy behemoth. They've set up a fairly good website replete with the standard facts, figures, and photos of a guy with an eyebrow piercing (the pierced need health care too!)

I've been thinking deeply about health care for quite awhile. More than that, I've been talking to people about health care for quite awhile. Again and again in these conversations, people assert a handful of truths about the uninsured that couldn't possibly be true together: the uninsured are all lazy and poor, the uninsured can afford health care but they don't want to pay for it (which sure works well with that poor meme), the uninsured get health care for free whenever they need it, and because of this, they really aren't a problem serious enough to seriously address.

Now, because you're all trapsing about TPM Cafe, I know you would never peddle these lies to me should I run into you at a bar or a bar-b-que. But in honor of Cover the Uninsured week, because you can never stress this stuff enough, I've made a nifty bullet point guide about the uninsured. So you can funnel your inner health wonk when those less informed go on their usual health care diatribes.

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Looks like someone's been reading Drug Bill Debacle.

As I suggested a few weeks ago, a new bill sponsored by Sens. Max Baucus (D-MT), ranking member on the Senate Finance Committee, and Blanche Lincoln (D-AR) proposes six plan options as a way to reduce confusion and simplify the Medicare drug benefit. The bill also forbids insurers from altering their list of covered medications during the year. This provision addresses the inequality of current law that allows insurers to change their formularies as often as they wish while seniors can only change plans once a year.

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One of the right’s favorite arguments against health care reform is that private insurance is inherently more efficient than public programs like Medicare.

It works as propaganda because it’s consistent with the public’s deeply held skepticism of government. But it’s just not true. And this week Wall Street gave us yet more proof of that.

It happened yesterday after Aetna, one of the nation’s largest insurers, released its first-quarter earnings report. Earnings were up more than 3 percent – the kind of news that, one might suppose, Wall Street would greet with glee. Not so. Shares actually plummeted...

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