Will Medicare and Medicaid End Up Paying For J&J's Hip Replacement Recall?

Drug giant Johnson & Johnson's subsidiary DePuy Orthopaedics recently issued a massive hip replacement recall of 93,000 hip implants.  DePuy now admits that the recalled hip implants have a failure rate of at least 13%, which means that more than 12,000 people will have to undergo a surgery to remove an replace the defective devices.

Who will pay for these surgeries, each which can cost $50,000 or more?  Government programs (Medicaid and Medicare) already have paid substantial costs to surgically remove the recalled hip replacement parts, and assuming $50,000 for each surgery, the total medical costs of DePuy's hip implant recall could exceed $600 million.  DePuy tells patients that these costs should be submitted to the patient's insurance company for payment.  In many cases, this will be the federal government through Medicare or the State governments through Medicaid system.

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It's a Shame

It would be a damned shame if we finally lost a constituency as prized as seniors because of the current Democratic president. And yet that appear to be exactly what’s happening. In the summer of 2009, there were reports of a Democratic “problem” with seniors. Victoria McGrane and Chris Frates, writing in POLITICO, described how the town hall rage was being fueled by senior citizens. Seniors, angered by proposed cuts to Medicare floating around Congress, controversial talk of “death panels,” and the like, promised to be a concern for Democrats in the upcoming midterm elections. In 2008 they backed John McCain over Barack Obama by 8 points.

More than a year later, the news hasn’t gotten any better according to The Washington Post. A full 66% of older voters are enthusiastic about voting in November and most of them ready to cashier the Democrats. And they should be. Since they are free of the responsibilities of governing, the vocal conservative opposition has often been right.

In addition to the ones that exist with private insurance, governmental rationing regimes are not beyond the realm of possibility. People often confuse them with the completely innocuous concept of end-of-life counseling, which had been supported by Republicans in years past. The death panels, however, are notions of governmental bureaucrats—full of fulsome praise for the British system of rationing—with the power to deny care for the sake of cost-cutting. Responding to the criticism his work has engendered, bioethicist and administration official Ezekiel Emanuel assured us he was “writing really for political philosophers. [T]he average person, it's not what they're used to reading.”

As far back as 2009, there were new reports contradicting the president’s public statements that there were no cuts to Medicare in any of the proposed legislation. These days you find conservative activists warning us in the pages of The Wall Street Journal that the new reform law will: “Cut $818 billion from Medicare Part A (hospital insurance) from 2014-2023, the first 10 years of its full implementation; [Cuts] for Medicare Part B (physicians fees and other services) brings the total cut to $1.05 trillion over the first 10 years.”

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Weekly Pulse: What Would Jesus Insure?

By Lindsay Beyerstein, Media Consortium blogger

Christian groups are trying to create a run around health care reform by setting up alternative, unregulated religious health care bill collectives—and movement conservatives are cheering them on.

Religious right-watcher Sarah Posner reports on so-called Christian health care-sharing ministries in the American Prospect. Health-sharing ministries (HCSM) bill themselves as godly alternatives to health insurance. HCSM are groups of Christians who promise to cover each other’s heath care costs. About a hundred thousand people nationwide belong to these collectives. The Alliance of Health Care Sharing Ministries and its army of lobbyists convinced Senate lawmakers to exempt HCSMs from health care reform’s individual mandate.

Obliterating patient privacy

According to Posner, anti-reform conservatives are talking up these groups because they see them as a way to undermine the individual mandate. But if you think HCSM are a convenient loophole to avoid paying for insurance, think again. Posner describes the criteria for joining Samaritan Ministries International (SMI), one of the largest HCSM:

“To join the HCSM, applicants must agree to a statement of faith that they are a ‘professing Christian, according to biblical principles’ set out in Romans 10:9-10 and John 3:3. They must agree to adhere to guidelines that include no sex outside of “traditional Biblical marriage,” no smoking or drugs, and mandatory church attendance.

SMI members pay their own health care costs out of pocket and seek reimbursement from the group. What about privacy? In order to get reimbursed, they have to publish their health care “needs” in a monthly newsletter and hope someone sends cash. Lifetime benefits are capped at $100,000. Members waive their right to sue for any reason. SMI won’t cover treatment for sexually transmitted diseases, addictions, or the pregnancies of single mothers.

It doesn’t take a genius to see that this free-for-all won’t end well. You can’t just start a quasi-health insurance scheme in your garden shed and expect it to work out. Real insurance companies are subject to oversight to make sure that they have enough money on hand to cover their claims. Who knows what HSCM are doing with people’s money? These outfits have all the disadvantages of private insurers and none of the benefits. Members are a single major illness away from bankruptcy.

Bartering for health care?

Speaking of wacky alternatives to health insurance, Sen. Harry Reid’s (D-NV) main Republican challenger, Sue Lowden, insists that patients can pay for their health care via a barter system, as Rachel Slajda reports for TPMDC. Great! How many chickens for an appendectomy?

Medicare expansion doesn’t equal bankruptcy

At Mother Jones, Kevin Drum debunks the latest right-wing myth about health care reform, that Medicare expansion will bankrupt the states. States pay part of the cost of Medicare, so it’s true that any expansion of the program will cost the states some money. However, the talking point is that the expansion will push state budgets to the breaking point. That’s false.

Drum explains that the health care reform bill exempts states from the extra cost until 2016. Even after that, the costs to the states will be minimal:

“[Health care reform] won’t cost states an extra dime through 2016, by which time our recession will presumably be over, and even after that states will only pay for a tiny fraction of the increased costs. As CBPP points out, states will pay about 4% of the total costs of Medicaid expansion over the next ten years. This represents an increase in overall state Medicaid spending of slightly over 1%.”

Abortion and ‘convenience’

Jessica Valenti of Feministing has been taking on manipulative, anti-choice ads in the New York City subway. These ads are sponsored by an anti-abortion group. They feature various distraught-looking models staring wistfully into space. The tagline is “Abortion Changes You.” The message is that if you have an abortion, you will be a guilt-racked wreck for the rest of your life. Some feminist with a wry sense of humor and a little glue pasted in another sentence on the ad (pictured above): “Now I can go to college and fulfill my dreams.”

Anti-choice blogger Lori Ziganto was scandalized by the anonymous culture jammer’s message. She sneered at the idea that women’s lives and hopes actually matter: “Want to go to college, but there is a pesky baby growing inside of you? Abort! A life is far less important than your co-ed fun and career plans, right?”

Valenti’s response: “It isn’t that anti-choicers don’t understand why women get abortions – it’s that they care so little about women’s lives that any reason given to obtain an abortion is seen as “convenient.” Some things that are convenient: Providing for your existing children. Going to college. Having enough money to eat, pay rent, keep the electricity on. Not dying.”

HSCMs and the subway ads are part of an enormous rift in contemporary politics: Opponents of health care reform say that they’re defending freedom, but in reality, they’re advocating control.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

Weekly Pulse: What Would Jesus Insure?

By Lindsay Beyerstein, Media Consortium blogger

Christian groups are trying to create a run around health care reform by setting up alternative, unregulated religious health care bill collectives—and movement conservatives are cheering them on.

Religious right-watcher Sarah Posner reports on so-called Christian health care-sharing ministries in the American Prospect. Health-sharing ministries (HCSM) bill themselves as godly alternatives to health insurance. HCSM are groups of Christians who promise to cover each other’s heath care costs. About a hundred thousand people nationwide belong to these collectives. The Alliance of Health Care Sharing Ministries and its army of lobbyists convinced Senate lawmakers to exempt HCSMs from health care reform’s individual mandate.

Obliterating patient privacy

According to Posner, anti-reform conservatives are talking up these groups because they see them as a way to undermine the individual mandate. But if you think HCSM are a convenient loophole to avoid paying for insurance, think again. Posner describes the criteria for joining Samaritan Ministries International (SMI), one of the largest HCSM:

“To join the HCSM, applicants must agree to a statement of faith that they are a ‘professing Christian, according to biblical principles’ set out in Romans 10:9-10 and John 3:3. They must agree to adhere to guidelines that include no sex outside of “traditional Biblical marriage,” no smoking or drugs, and mandatory church attendance.

SMI members pay their own health care costs out of pocket and seek reimbursement from the group. What about privacy? In order to get reimbursed, they have to publish their health care “needs” in a monthly newsletter and hope someone sends cash. Lifetime benefits are capped at $100,000. Members waive their right to sue for any reason. SMI won’t cover treatment for sexually transmitted diseases, addictions, or the pregnancies of single mothers.

It doesn’t take a genius to see that this free-for-all won’t end well. You can’t just start a quasi-health insurance scheme in your garden shed and expect it to work out. Real insurance companies are subject to oversight to make sure that they have enough money on hand to cover their claims. Who knows what HSCM are doing with people’s money? These outfits have all the disadvantages of private insurers and none of the benefits. Members are a single major illness away from bankruptcy.

Bartering for health care?

Speaking of wacky alternatives to health insurance, Sen. Harry Reid’s (D-NV) main Republican challenger, Sue Lowden, insists that patients can pay for their health care via a barter system, as Rachel Slajda reports for TPMDC. Great! How many chickens for an appendectomy?

Medicare expansion doesn’t equal bankruptcy

At Mother Jones, Kevin Drum debunks the latest right-wing myth about health care reform, that Medicare expansion will bankrupt the states. States pay part of the cost of Medicare, so it’s true that any expansion of the program will cost the states some money. However, the talking point is that the expansion will push state budgets to the breaking point. That’s false.

Drum explains that the health care reform bill exempts states from the extra cost until 2016. Even after that, the costs to the states will be minimal:

“[Health care reform] won’t cost states an extra dime through 2016, by which time our recession will presumably be over, and even after that states will only pay for a tiny fraction of the increased costs. As CBPP points out, states will pay about 4% of the total costs of Medicaid expansion over the next ten years. This represents an increase in overall state Medicaid spending of slightly over 1%.”

Abortion and ‘convenience’

Jessica Valenti of Feministing has been taking on manipulative, anti-choice ads in the New York City subway. These ads are sponsored by an anti-abortion group. They feature various distraught-looking models staring wistfully into space. The tagline is “Abortion Changes You.” The message is that if you have an abortion, you will be a guilt-racked wreck for the rest of your life. Some feminist with a wry sense of humor and a little glue pasted in another sentence on the ad (pictured above): “Now I can go to college and fulfill my dreams.”

Anti-choice blogger Lori Ziganto was scandalized by the anonymous culture jammer’s message. She sneered at the idea that women’s lives and hopes actually matter: “Want to go to college, but there is a pesky baby growing inside of you? Abort! A life is far less important than your co-ed fun and career plans, right?”

Valenti’s response: “It isn’t that anti-choicers don’t understand why women get abortions – it’s that they care so little about women’s lives that any reason given to obtain an abortion is seen as “convenient.” Some things that are convenient: Providing for your existing children. Going to college. Having enough money to eat, pay rent, keep the electricity on. Not dying.”

HSCMs and the subway ads are part of an enormous rift in contemporary politics: Opponents of health care reform say that they’re defending freedom, but in reality, they’re advocating control.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

Another health insurance reform news thread

President Barack Obama gave House Democrats a pep-talk today, and his speech (which wasn't pre-written) got rave reviews from many Democrats. If only the Senate bill were as good as Obama made it sound.

As Nathan mentioned earlier today, House Democratic leaders have decided to ditch the "deem and pass" method for passing health insurance reform with a single vote, even though the legislative procedure isn't as rare or controversial as Republicans would have you believe. Instead, the House will hold an hour of flood debate tomorrow on "the rule to allow reconcilation to get to the floor," then House members will vote on the rule, then they will debate the Senate health insurance reform bill and vote on it. I assume this means that House Speaker Nancy Pelosi is confident she has the 216 votes she needs.

Bart Stupak is now claiming only about half a dozen Democrats are willing to vote against the bill unless it contains major new restrictions on private insurance coverage of abortion. Stupak was supposed to hold a press conference this morning, but he cancelled it, so maybe that means he didn't get the deal he was hoping for from Pelosi. David Dayen speculates on who is still in the Stupak bloc. David Waldman warns about the prospect that Stupak will use a "motion to recommit" to try to get his anti-abortion language into the reconciliation fix package.

Senator Tom Harkin and the three Iowa Democrats in the House "announced a major breakthrough today on the issue of Medicare payment reform in the final health care reform bill," according to a joint press release. Excerpt:

[Representatives Dave] Loebsack, [Senator Tom] Harkin, [Leonard] Boswell and [Bruce] Braley have been outspoken advocates for changing the way Medicare pays health care providers for services, from its current fee-for-service system into a quality and value-based system.

Loebsack, Harkin, Boswell and Braley helped negotiate a compromise adding language to the health care reform bill that provides an immediate $800 million to address geographic disparities for both doctors and hospitals, as well as written guarantees from Health and Human Services Secretary Kathleen Sebelius for further action to reform Medicare reimbursement rates that do not qualify for reconciliation under the Byrd Rule. The Senate bill previously only provided a Medicare reimbursement fix for doctors.

The House reconciliation package maintained automatic implementation of a value index as part of the reimbursement structures for doctors, beginning in 2015. This language was secured in the Senate bill with the help of Harkin and is based on Braley’s Medicare Payment Improvement Act, introduced in June 2009. Under the fixes secured in the Senate bill and the House reconciliation package, Iowa doctors will see five percent increases in current Medicare reimbursement rates in both 2010 and 2011.

I posted the whole press release, containing more details, at Bleeding Heartland. This deal appears to have secured the vote of Peter DeFazio (OR-04) as well. Yesterday he threatened to vote no because of language on the Medicare payments disparity.

Outside the Capitol, tea party protesters shouted racist insults and held signs threatening gun violence if health care reform passes. Congressional Republicans should disavow this reprehensible behavior, but of course they won't.

Share any relevant thoughts in this thread.

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