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Medicaid In A Squeeze

New reports peg Medicaid’s future as dismal and unsustainable, as states struggle for ways to pay for the rising costs of caring for their poorest residents. The Deloitte Center for Health Solutions study, “Medicaid Long-Term Care: The Ticking Time Bomb,” estimates Medicaid costs will nearly double as a percentage of state budgets by 2030, or perhaps nearly triple.

Meanwhile, the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured estimates Medicaid expansion will cost $464.7 billion by 2019. The federal government will cover $443.5 billion (95.4 percent) and the states will cover the remaining $21.2 billion. Minnesota won’t expand its Medicaid program until 2014 because of budget fears. Connecticut will. (The Fiscal Times, MedPage Today, Reuters, U.S. House Rep. John B. Larson)

U.S. Senators, meanwhile, are looking to phase out federal subsidies Medicaid as a way of pushing through stalled legislation — the same package that had included the “doc fix.” Speaking of that, Sen. Majority Leader Harry Reid said the Senate may soon turn its attention away from that toward other issues. (Wall Street Journal, The Hill, ABC News)

*This blog post was originally published at ACP Internist*

Physician Burnout: When Being A Doctor Makes You Sick

Do doctors take care of themselves? Sometimes patients may better follow the advice of physicians who aren’t obese and don’t smoke. That was a question asked in a post last year, entitled “When fat doctors talk to obese patients.”

According to studies, as reported in the Wall Street Journal, it’s a mixed bag:

Physicians as a group are leaner, fitter and live longer than average Americans. Male physicians keep their cholesterol and blood pressure lower. Women doctors are more likely to use hormone-replacement therapy than their patients. Doctors are also less likely to have their own primary care physician—and more apt to abuse prescription drugs.

Clearly there’s room for improvement. Read more »

*This blog post was originally published at KevinMD.com*

For Medicare Patients, “The Doctor Is Out”

In a last-minute shocker, the Senate voted Thursday against postponing a scheduled 21-percent cut in Medicare reimbursement to physicians and other healthcare providers. Sixty senators were needed to end filibuster debate and stop the cuts under Senate rules. Fifty six voted in favor, while 40 opposed. There was no Republican support. (And, of course, no support from Senator Lieberman, who is a Republican in disguise.)

Another consequence of the vote is that tens of thousands of Americans who have exhausted their jobless benefits would not be eligible for more. In addition, new taxes on wealthy investment managers would not be imposed, along with an increase in liability taxes on oil companies, leading Democrats to contend that Republicans were protecting Wall Street and the oil industry, according to the New York Times.

“We’re not going to give up,” said Senator Harry Reid, the Nevada Democrat and majority leader. “We know the American people only have us to depend on.” Read more »

*This blog post was originally published at EverythingHealth*

Congress Acts On Doc Fix: Music To Doctors’ Ears

Leading members of the Senate Finance Committee came to an agreement Thursday night on a six-month “doc fix,” paving the way for physicians to be reimbursed a little more for seeing Medicare patients instead of a lot less. (This is now separate from the rest of the legislative package it had been part of, which is still under debate.)

Sen. Majority Leader Harry Reid warned that without passage, there’d be “havoc in America.” But the American Medical Association (AMA) continued its attack on anything less than a permanent solution. The AMA compared it to fiddling while Rome burns. What tune are members of Congress playing?

A) Stayin’ Alive by the Bee Gees
B) Doctor, Doctor! by the Thompson Twins
C) Time to Get Ill by the Beastie Boys

(The Hill, Politico, American Medical Association)

*This blog post was originally published at ACP Internist*

No Go On A Doc Fix

The Senate has rejected the so-called “doc fix.” This means that doctors taking Medicare patients will now get 21 percent less pay for their work.

How’s that getting involved in politics working out for you guys? Not so good.

But there’s a larger issue here. Why do we keep trying to control healthcare costs by just mandating that less money be spent?

It’s failed for decades. But like a losing gambler convinced that if he just keeps doubling down he’ll finally come out ahead, people keep trying. For example, the New York Times reported on a study of the impact of pay cuts to doctors for Medicare patients with lung cancer. Read more »

*This blog post was originally published at See First Blog*

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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