Each state should do the same in the cities having the most use of Medicare and Medicaid to get this EXPANDED AND IMPROVED MEDICARE FOR ALL on the road.....you cannot simply shout at state legislatures.
MARYLAND IS THE ONLY STATE SEEKING AN EXEMPTION FROM MEDICARE REGULATIONS AND BOASTS OF HAVING MORE HEALTH CARE WITHOUT HOSPITALIZATION----THAT IS CODE FOR CITIZENS ARE NOT ALLOWED ACCESS TO ORDINARY CARE WHICH IS WHY THERE IS A 20 YEAR LIFE SPAN DIFFERENCE IN BALTIMORE.....SAME AS THIRD WORLD NATIONS. THIS IS SUPPOSED TO BE A GOOD MODEL BECAUSE HOSPITAL PROFITS WERE SUSTAINED.
Maryland has used the model of excluding citizens from access to hospitalization they deserved for decades pretending that was bringing down hospital costs all while health industry fraud soared. That is why more and more health care happens in Maryland without hospitalization especially in Baltimore. Even Maryland Assembly pols admit that Medicaid funding is mostly not spend on health care.
Keep in mind it is Baltimore's pols that lead the way in complete deregulation from Medicare over a few decades just so citizens could be denied the level of care they were guaranteed by Federal Medicare.
'Today, more and more health care happens without hospitalization'.
This hurt mostly the working class and people made poor by long-term unemployment--ergo, the industrial workers in the city et al and that was a large crowd. Now, Baltimore pols have set the stage for city pensions to go down the drain with those citizens falling into Medicaid-level care. You see below as well this pressure to decrease spending as baby boomers hit making it a sure thing access is cut to slow spending.
If you wonder how these pols running as Democrats and serving as Hopkins' neo-conservatives stay in office -------over 600,000 Baltimore citizens do not vote. The ones that do do so to keep a job.
WE CAN REVERSE THIS EASY PEASY IF DEMOCRATIC VOTERS WOULD BECOME ENGAGED AND BE THE CANDIDATES IN ALL PRIMARIES AGAINST CLINTON NEO-LIBERALS.
Maryland’s Medicare waiver now front and center
May 4, 2012, 6:00am EDT
Ben Fischer Staff Reporter Washington Business Journal
Independent hospitals such as Doctors Community Hospital would have to negotiate on the… more
Maryland hospitals reluctantly swallowed a near freeze on rates May 2, but the state’s health care industry will now turn to an all-hands-on-deck attempt to save the unique system that allows strict government regulation of hospital rates in the first place.
The state’s authority comes from a 35-year-old exemption from standard Medicare rules, but the waiver comes with an important condition: Hospital costs must grow more slowly in Maryland than in the rest of the country, or the exemption goes away.
After meeting that standard by wide margins for decades, Maryland’s health care inflation has nearly caught up to national trends in the past year, putting the exemption in imminent danger. The .3 percent rate hike — comprised of a 1 percent cut to inpatient rates and a 2.59 percent boost to outpatient services — will delay Judgment Day, but Maryland officials agree the only long-term solution is to change what they call outdated rules for the exemption.
Stakes are high. Hospitals and politicians nearly universally defend the protection offered by public utility-style regulations, and many predict turmoil if they goes away.
“There would clearly be some market consolidation, and we’d probably have fewer hospitals,” said Michael Stitcher, director at the Berkeley Research Group in Baltimore, who advises hospitals on financial policy. “I think it would be a pretty tumultuous road for several years.”
Hospitals serving predominately poor patients, such as Prince George’s Hospital Center, would be further challenged to stay in the black. Independent facilities such as Doctors Community Hospital in Lanham would struggle to stay afloat without the clout to demand higher rates from insurers in direct negotiations. And lenders would factor new uncertainty into the cost of long-term debt, experts say.
The Health Services Cost Review Commission, which sets rates, has formed a work group that is “kicking around some of the major concepts” of reforming the exemption rules, said Executive Director Patrick Redmon. The commission hopes to present a white paper to the federal Centers for Medicare & Medicaid Services, which would ultimately approve the changes.
There’s not much time for what will surely be a complicated process, both technically and politically, said Carmela Coyle, president of the Maryland Hospital Association. She believes the issue needs to be solved by November, in time for next year’s rates to be set. “There’s still quite a bit of work to be done,” she said.
The “waiver modification effort” is set on addressing two major flaws that have developed in the federal exemption rules, as defenders see it: The rules reflect the 1970s-era hospital industry, in which most care involved overnight admissions and cost-containment strategies built around cutting days off of stays.
Today, more and more health care happens without hospitalization. As lower-cost cases migrate to the outpatient side of the ledger, it drives up the per-case cost on the inpatient side, hurting Maryland in the “waiver test.”
Maryland has also assessed hospitals a fee to generate more federal matching funds in the Medicaid program. And those fees contribute to higher inflation, as defined in the rules. The state has included various reform efforts, such as not paying hospitals for re-admitting patients for the same condition, in the rates.
The ultimate solution would have to satisfy Maryland regulators, the hospital industry writ large and the mega-players Johns Hopkins Medicine and the University of Maryland Medical System, influential insurance companies such as CareFirst BlueCross BlueShield and the federal government.
CareFirst, which unsuccessfully argued for a cut to outpatient rates too, will work with hospitals, the commission and other stakeholders in doing “everything possible to preserve the waiver,” the insurer said in a corporate statement distributed by spokesman Scott Graham.
“CareFirst believes it is imperative that Maryland retain its unique hospital all-payer system,” the statement reads. “It brings more than $1 billion in additional federal (Medicare and Medicaid) funding to the state, which we cannot afford to lose.”
Politically, the stars could be aligned for proponents of the system, observers say: For the moment, Maryland has influential politicians on its side, namely Sen. Barbara Mikulski, the Democrat who wrote the waiver into federal law in 1980. Also, the Obama administration will likely be amenable to saving a system that enables many of his reform initiatives.
“The hospitals will have to believe the reforms make sense from their perspective,” Stitcher said. But he added: “I think there’s a good chance the waiver can be redesigned and modernized.”
Rate regulation is a nearly dead concept elsewhere in the country. About 30 other states regulated hospital rates to one degree or another at one point, but now Maryland is alone. Throw in the possibility of the Supreme Court overturning the 2010 federal health care overhaul law and the possibility of a new Republican administration taking over Medicare in January, and it’s an open question whether the new rules would win federal approval.
“Part of this depends on the federal government’s time frame,” Redmon said. “We’ve been in informal discussions back and forth, but there’s no formal process at this point.”
So far I have explained how Baltimore City would develop a public health system to compete with Maryland's very private one and given many examples of how to fund this. One thing that makes a domestic economy work is local businesses hiring locally and earning enough money to consume locally to fuel the economy. Baltimore has none of that and it is deliberate-----Baltimore City Hall and Maryland Assembly passed laws that create the environment for high poverty and unemployment because they want it that way.....well, Baltimore Development and Johns Hopkins wants it that way.
One of the first things a REAL progressive liberal would have done a few decades ago when Baltimore's industrial base left would be to subsidize just as Baltimore subsidizes global corporations now, local factories and manufacturing. One example would be manufacturing all of the generic drugs that our citizens and surrounding areas will use in the course of a year. We must get people used to buying local and spending just a little more as we move away from a global economy. Building a domestic economy does not exclude global markets-----it simply makes local markets dominate and that is what will make Baltimore a healthy stable economy with most people employed.
Now, call me crazy but it seems a city government could be that business gearing up for manufacturing generic drugs. Now, remember, Trans Pacific Trade Pact seeks to make it harder to produce generics in nations tied to this treaty so we are going to start now to fight this.
Drug Patents and Generic Pharmaceutical Drugs
When a pharmaceutical company first develops a new drug to be used for a disease condition, it is initially sold under a brand name by which the clinicians can prescribe the drug for use by patients. The drug is covered under patent protection, which means that only the pharmaceutical company that holds the patent is allowed to manufacture, market the drug and eventually make profit from it.
In most cases, the drug patent is awarded for around twenty years in the United States. The lifetime of the patent varies between countries and also between drugs. Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years.
Once the patent has expired, the drug can be manufactured and sold by other companies. At this point, the drug is referred to as a generic drug. According to guidelines in most countries, including those from the US FDA, generic drugs have to be identical to the branded drug in terms of efficacy, safety, usage, route of drug administration, pharmacokinetics and pharmacodynamics.
Therefore, a drug can be manufactured as a generic drug when the following apply:
- Its patent has expired
- The company that would manufacture the generic drug certifies that the patents held on the drug are either unenforceable, are invalid or would not be infringed upon
- There has never been any patents on the drug before
- In countries where the drug has no patent protection
The company holding the initial patent may, however, renew the patent by forming a new version of the drug that is significantly changed compared to the original compound. However, this may require new clinical trials and re-application of the patent. Furthermore, the new compound may have to compete with the original generic molecule on the market, unless the drug regulators find faults and remove the original from the market altogether.
Now, Clinton neo-liberals have all of use busy with 'innovations' and 'startups' because all of that creates new business ideas and products that global corporations can then buy cheap----THEY ARE USING CITIZENS TO CHEAPEN PRODUCT DEVELOPMENT FOR GLOBAL CORPORATIONS. All of Maryland's economic funds go to this huge corporate subsidy.
Imagine if instead of robotics and other advanced STEM projects our schools would simply design ordinary medical products----not too fancy because we do not want to be sued for injury---that we could then patent and produce right in a community factory and have our public hospitals, clinics, home care, and outpatient care purchase. This could go to things from bandages to walking canes.
The point is this-----Clinton neo-liberals and neo-cons deliberately have focused all economic development to global markets and corporate subsidy while doing nothing to build a local economy.
THAT IS THE DIFFERENCE BETWEEN A REAL PROGRESSIVE LABOR AND JUSTICE LIBERAL AND A CLINTON NEO-LIBERAL PHONY DEMOCRAT
All of this is easy peasy and all we need to do is GET RID OF ALL MARYLAND POLS ----THEY ARE NEO-LIBERALS AND NEO-CONS.
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This is what I call an example of profiteering. MRI machines have been around for decades. When they were first brought to hospitals the costs for the machines were high and hospitals worked the costs for these expensive medical equipment into the charges per patient. Well, those machines have been long paid for and what once compensated for cost is now simply profit. It is the fact that Clinton neo-liberalism removed the Democratic Party from public interest to corporate profit that allowed hospitals to continue to charge too much for services. With the new code word 'innovation' in medicine----the goal is to place this on steroids. Never allowing patented drugs to sunset for example to generics is the goal of reformulation going on in BioTech labs connected to universities.
One thing about a Federal stimulus meant simply to pay for these university research facilities and all that is in them----ALL THE EQUIPMENT IS PAID FOR AND SHOULD NOT BE FIGURED INTO HEALTH COST.
Simply auditing Medicare and Medicaid for these kinds of things will stop profiteering. Our pols could have found all of these billing gimmicks easily and ignored them as health industry looted our Medicare and Medicaid Trusts.
Why an MRI costs $1,080 in America and $280 in France
By Ezra Klein March 3, 2012 Follow @ezraklein New York Times
There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.
That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.
There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”
As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.
“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”
On Friday, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.
Prices don’t explain all of the difference between America and other countries. But they do explain a big chunk of it. The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it.
“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.
In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.
Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.” In certain cases, the customer is passed out, or otherwise incapable of making decisions about her care, and the decisions are made by providers whose mandate is, correctly, to save lives rather than money.
In other cases, there is more time for loved ones to consider costs, but little emotional space to do so — no one wants to think there was something more they could have done to save their parent or child. It is not like buying a television, where you can easily comparison shop and walk out of the store, and even forgo the purchase if it’s too expensive. And imagine what you would pay for a television if the salesmen at Best Buy knew that you couldn’t leave without making a purchase.
“In my view, health is a business in the United States in quite a different way than it is elsewhere,” says Tom Sackville, who served in Margaret Thatcher’s government and now directs the IFHP. “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.”
The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.
The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers.
This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.”
But many researchers are skeptical that this is an effective way to fund medical innovation. “We pay twice as much for brand-name drugs as most other industrialized countries,” Anderson says. “But the drug companies spend only 12 percent of their revenues on innovation. So yes, some of that money goes to innovation, but only 12 percent of it.”
And others point out that you also need to account for the innovations and investments that our spending on health care is squeezing out. “There are opportunity costs,” says Reinhardt, an economist at Princeton. “The money we spend on health care is money we don’t spend educating our children, or investing in infrastructure, scientific research and defense spending. So if what this means is we ultimately have overmedicalized, poorly educated Americans competing with China, that’s not a very good investment.”
But as simple an explanation as “the prices are higher” is, it is a devilishly difficult problem to fix. Those prices, for one thing, mean profits for a large number of powerful — and popular — industries. For another, centralized bargaining cuts across the grain of America’s skepticism of government solutions. In the Medicare Prescription Drug Benefit, for instance, Congress expressly barred Medicare from negotiating the prices of drugs that it was paying for.
The 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which would bring more transparency to this issue, and it gives lawmakers more tools and more information they could use to address prices at some future date. The hope is that by gathering more data to find out which treatments truly work, the federal government will eventually be able to set prices based on the value of treatments, which would be easier than simply setting lower prices across-the-board. But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don’t think we’ll be paying anything like what they’re paying in other countries anytime soon.
“There is so much inefficiency in our system, that there’s a lot of low-hanging fruit we can deal with before we get into regulating people’s prices.” says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. “Maybe, after we’ve cut waste for 10 years, we’ll be ready to have a discussion over prices.”
And some economists warn that though high prices help explain why America spends so much more on health care than other countries, cutting prices is no cure-all if it doesn’t also cut the rate of growth. After all, if you drop prices by 20 percent, but health-care spending still grows by seven percent a year, you’ve wiped out the savings in three years.
Even so, Anderson says, “if I could change one thing in the United States to bring down total health expenditures, it would definitely be the prices.”