On the campaign trail recently, top GOP candidates have been rolling out the talking points with respect to the debate on healthcare policy and politics. That latter point is made quite clearly in the party’s stance on the “solvency”^[1] of the prescription drug benefit under Medicare Part D. Asked whether this rather costly program — arguably one of the most significantly costly from the George W. Bush administration’s passage of MMA in 2003 — should be yanked (as they feel so-called Obamacare should be), you’ll get a resounding “no” on that policy point.

Although the House GOP have led the deficit hawk brigade in response to President Obama’s recent comments on balancing the budget, the party as a whole has been relatively quiet on the Medicare overhaul issue, especially as it pertains to Part D — a program the party structured and passed under Bush eight years ago. It’s no secret politics is in play, especially when monies to support the benefit have to come from the government’s general coffers — competing for earmarks for other priorities, like education funding.

Republicans like to point out that throwing drug coverage under Medicare, in part, to the pharma marketplace has offset initial costs for supporting the program via competition. But, currently, the wide variety (amid the spate of new branded preps) of traditionally cheaper generics probably has to do more with keeping costs low — with respect to beneficiary affordability and the marginal profits on such non-branded offerings by Pharma.

Fast forward to 2011 and the popular Medicare provision is being utilized by over 60 percent of retirees (with the balance coming from former employers’ plans), and it looks safe for now. The big unknown is when the inevitable resurgence in pharma spending increases will occur over the next ten to fifteen years — and how Part D will fare within the reform mix. | LINK

1. There really is no dedicated tax toward funding the Medicare prescription drug benefit.

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A major provision in the healthcare reform law, the restrictions of formerly unregulated payments to private carriers in Medicare Advantage programs, seems to be taking hold without a hitch. Although somewhat early in the game — the new rules of MA reimbursements, ushered in during the first GWB administration in 2003 as part of the Medicare Modernization Act — have not brought fears of decreased access to market-based care, as Republicans had long argued. Instead, the opposite has happened.

Beginning in 2012, Medicare will begin lowering payment to Medicare Advantage providers to even the playing field between original Medicare and Advantage plans. But plans generally aren’t leaving because of healthcare reform, experts say. The Centers for Medicare & Medicaid Services is offering bonuses to plans that perform well, which should soften the cuts and keep good providers in the marketplace.

Beneficiaries still have ample choice of programs in many communities and are enrolling steadily.  Still, the jury is out on this reform work-in-progress. Leading insurance lobbies still predict an overall decline in MA plan participation by the mid ’10s, and the drop-dead date for much of reforms unfettered provisions (2014) will bring the first substantial signs of just how far the federal government’s reach in private penetration of FFS Medicare will affect premium levels (and, by extention, access to care) for millions of Boomers crossing that magic threshold for the first time. | LINK

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On Monday, Medicare (and Medicaid) turn 45. And to celebrate, the government will be touting its annual open enrollment. Well, okay, the feds will also be throwing in a plug for government’s role in health reform and what benefits are in store for those who were spring chickens when Medicare became law. Who better to message than the avuncular Andy Griffith?

Clearly targeted at those seniors who still think “death panels” are an essential creation of the Obama plan for reform, the ad — which begins airing in some markets today — will mostly focus on the benefits for seniors inherent in standalone or the program’s supplemental plans under reform. There will be no mention, however, of the major way the new reform law will maintain Medicare solvency well into the next couple of decades: trimming the fat from Medicare Advantage payouts from plans which originally saw benefit under the George W. Bush administration’s 2003 Medicare Modernization Act. | LINK

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Medicare Advantage flourished in the second George W Bush administration, creating new siphons of revenue for third parties in a rampantly robust healthcare marketplace. Although choices for plans presented to potential beneficiaries were touted as beneficial and desirable, confusion over eligibility and extent of coverage made participation mildly risky for seniors who felt traditional coverage was inadequate for certain services even Medigap plans couldn’t provide. Within the scope of the Obama reform law, MA plans will have to increase quality assurance parameters to remain viable.

Are the majority of MA beneficiaries getting that quality currently?

According to a recent survey commissioned by a public policy group, about one-quarter of beneficiaries were enrolled in plans that received either four- or five-star quality indicators. Metrics were very broad and covered everything from telephone customer service to follow up on beneficiary preventive medical services those plans explicitly underwrote. As payment to private insurers begins a new era tied to quality, numbers like these are sure to improve. | LINK

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The Cochrane Collaboration, an international body which evaluates published medical trials, has interesting insights into the nature of the results of compilations of study data in trials done all over the world. A brand new Cochrane review upholds the clinical suspicions which physicians and healthcare lobbyists know only too well: that studies with positive results are more likely to see the light of publication, reach publication sooner, saturate the media easier, and influence healthcare policy more effortlessly.

So-called negative studies (those which conclude results which may refute established medical dogma or anecdotal belief) were seriously hampered by what the researchers/evaluators termed as “publication bias”. Many involved in shaping healthcare delivery policy in this country know how important a trial with a positive result is as it applies to high powered Washington lobbying; this issue will become much more important as the Obama administration has pledged “transparency” (a word it uses front and center on its official White House blog, describing it as one of its innate characteristics) with respect to all policy matters.

Just as many have cried out that healthcare policy was over politicized and favored Pharma and Big Insurance in the Bush administration, time will tell if Barack Obama is pressured by those same critics to renounce policies which have their genesis in findings like those provided by Cochrane. | LINK

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Although his quest to “fix the healthcare system” currently has as much of a pie-in-the-sky altruism and idealism about it as — say, ending the Iraq War — there is much the future President Barack Obama can do on the issue of healthcare delivery immediately upon swearing in office in January. At the top of the list is revisiting the current President George W. Bush-led legislation involving the so-called “conscience rule”, which gives healthcare providers an out when faced with the possibility of performing procedures or prescribing medicines (notably, those treatments involving family planning) that might not square with their moral beliefs. Obama et al. promise to prioritize dismantling of this healthcare legislative piece, initially by allowing the Democratic controlled Congress to hamper its implementation. | LINK

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A healthcare imprimatur of sorts for the outgoing Bush Administration?  The current lame-duck president’s ‘Patients’ Right of Conscience’ regulation, which proposes that healthcare providers may withhold services based upon their moral beliefs, would probably do more to hurt patients than help — even those religious conservative patients who are the regulation’s intended targets.  Unsurprisingly, the major medical associations have swiftly come out against such proposed actions, citing patient safety — especially in emergency cases.

The definitions of “health care service program” and “health care service,” to which an individual can find a moral objection, are very broad and potentially impinge on a patient’s access to needed health care services. The preamble states that “health care service program” should be understood to include any activity related in any way to providing medicine, health care, or any other service related to health or wellness, and that “health care service” means any service so provided.

On the flip, orgs like the Christian Medical Assn. and the U.S. Council of Catholic Bishops come at this from the angle of reproductive rights.

…”The regulations reportedly under consideration at Health and Human Services apparently would simply protect the right for all healthcare professionals to make professional judgments based on moral convictions and ethical standards. Protecting this right also protects patients who choose their physicians based on life-affirming values.”

It’s quite a bold step for a legislative body, once again, to propose such regulatory stipulations, when providers (who are already well-regulated licensed professionals) have to accede to such obviously political ones. | LINK | ADDITIONAL LINK to HHS new rule proposal

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