Tag Archives: health care costs

Snapshot of state health spending yields some surprises

The Wall Street Journal and Louise Radnofsky did a nice package of interactive graphics and maps on state health spending. As Radnofsky noted, the high spenders are in the Northeast – but not only the Northeast. They are some rural states – but not all rural states. And Florida is up there.

It’s a fun and useful tool that gives you a snapshot of your state – and let you compare it with neighboring states or states with similar demographics.

But if you follow the work of the Dartmouth Atlas folks you’ll also know that spending doesn’t just vary by state – it varies by county, city – sometimes even neighborhood. Payment incentives is part – but only part – of the story. (They don’t explain why two hospitals in Manhattan may have such different utilization patterns, for instance). Local practice patterns, training, traditions, patient demographics all play a role.

Premium shock: The story isn’t as simple as it seems

You’ve seen lots of stories – and you may well have written some – about how much the cost of insurance is going to rise for younger people in the exchanges next year – the so-called “premium shock” or “price shock.”

This is a fair concern – but be careful that you handle it fairly. Continue reading

Boomers face delayed retirement, dwindling health coverage for retirees

For many baby boomers, retirement is a dream that’s slipping away.

Several publications have looked at this issue over the past few months, documenting the economic malaise that’s gripping boomers as they advance toward the age of 65 – once a retirement goalpost for many.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

The most recent story that caught my attention is by Diane Stafford of The Kansas City Star. She does a good job of telling readers what’s going on – people are delaying retirement and, increasingly, planning to work in retirement – and provides data that puts the trend in context:

“In 1991, just one in 10 workers told the Employee Benefit Research Institute that they planned to wait to retire until they were older than 65. By 2007, three in 10 said that.

“This year? More than four in 10.”

Blame it on an economic downturn that’s thrown older workers out of jobs earlier than they had expected, devastated nest eggs and diminished housing values. (Older adults’ homes are often their single most valuable asset and, when housing loses value, they have fewer resources to get them through their non-working years.) Continue reading

Potential stories about changes in health care delivery are abundant

Many of you probably saw the recent Sunday New York Times Magazine story about home- and community-based health care, called “What Can Mississippi Learn From Iran.” Basically, it describes a still rudimentary and not fully funded vision of creating “health homes” using community health workers to reach the medically underserved in the Mississippi Delta, particularly those with chronic diseases. The idea is based on a similar program in Iran.

So the points I raise below aren’t because I think the article was bad – as I said, I liked it. Rather it’s because I wanted to draw out a few points that will help you as health journalists read it a little more critically and then think a little harder about what’s going on in your own states or communities.There’s a lot I liked in this article by Suzy Hansen. The author is an American living in Turkey and she’s not a health care writer. She came to the subject – and to the Mississippi Delta – with fresh perspective. I liked her focus on chronic disease, disparities (black/white, rich/poor, rural/urban), prevention and wellness, the need for more and better primary care, the lack of care coordination and the rationale for more integrated delivery systems with primary care at its core. She did that well. Hansen also did include some context (I would have preferred a bit more) about some of the other delivery system changes unfolding through the Affordable Care Act, changes in the delivery of health care that my posts here often urge you to report on.

Hansen said in an interview that she first got intrigued about the Mississippi initiative after seeing an earlier report on it in 2010 AARP Bulletin. When I went back and read the 2010 article, and then re-read the Times piece several times I wasn’t really clear on how much the “health homes” had achieved in the two intervening years. I emailed her and she said, “It’s all moving slowly. They have implemented the HealthConnect program, they have trained community health workers, they have designed the health worker certificate program at Jackson State, and opened clinics in some of the schools. They are trying to demonstrate various aspects of the model in order to convince people to fund them.” But the to-do list is still long.

Given all the attention right now on changing health care to achieve precisely the goals that the Mississippi group is trying to achieve (wellness not sickness, better care coordination, fewer hospitalizations, reducing disparities, etc). I was left wondering what’s stuck here – why isn’t this program accomplishing more. (It might have to do with Mississippi and local politics and personalities – not purely “health.”) Continue reading

Find evidence that insurers can – or can’t – rein in health care costs

Here’s a question that reporters on the aging beat should look into as the debate over Medicare rages on:

Where’s the evidence that private insurers would be more successful than Medicare in holding down health care costs for aging Americans?

Nobel prize-winning economist Paul Krugman – a professor at Princeton University and a self-professed liberal – argues that it doesn’t exist. Private insurers have a worse record of keeping health care costs in check than Medicare, not a better one, he wrote this summer in The New York Times.

Take a look at the chart in Krugman’s piece comparing real cost (that means inflation-adjusted) per beneficiary for Medicare and private insurance. As Krugman observes, the sharp increase in Medicare costs is concerning – but the rise in costs for people covered by private insurance is even more so.

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“We don’t have a Medicare problem, we have a health care cost problem,” Krugman says.

Critics of Krugman’s piece made several points in the comments section. Costs are shifted routinely from public programs such as Medicare and Medicaid to private insurers, inflating these insurers’ expenses, they note. Private insurers are better at combating fraud and abuse by medical providers than is the government, they claim. And the track record for Medicare Advantage plans – which are run by private insurers and now serve about 25 percent of Medicare beneficiaries – shows that they work well, they observe.

That last point comes with a big caveat, however: Medicare Advantage plans have been getting surplus payments, over and above what they would get under traditional Medicare, for each member and these payments average about $1,000 per member per year. Also, they’ve been found to serve a healthier, less-expensive population of older adults. So, comparing the performance of Medicare Advantage plans and traditional Medicare can be a bit like comparing apples and oranges.

(The Obama administration has proposed eliminating these surplus payments, worth an estimated $156 billion, over the course of the next decade. For a look at the surplus payment issue, see this issue brief from the Commonwealth Fund.)

But I digress – let’s get back to the original question: What evidence exists that private insurance companies will be better at controlling health care costs for older Americans than Medicare? Continue reading