Health, out-of-control costs
No seu primeiro discurso, esta noite (24.02.09), na sessão do Congresso (effectively his first State of the Union), o presidente Barack Obama, vai, por certo, defender a necessidade de fazer muito mais pela economia para que os EUA possam sair da crise. link
Sobre a Saúde, as últimas notícias são deveres preocupantes.
Segundo um relatório do Department of Health and Human Services, publicado hoje, os gastos com a Saúde atingirão este ano $8.160 per capita, (um aumento de 356 dólares em relação a 2007).
Face aos cortes de receitas fiscais e ao crescimento incontrolável dos custos, "feitas as contas", o Medicare cairá na insolvência em 2016. Três anos mais cedo do que a anterior previsão.
Entretanto, o número de cidadãos sem seguro de saúde cresceu este ano para cerca de 48 milhões (Kaiser Family Foundation).
Um estudo da “Health Affairs”, “National Health Spending By Medical Condition, 1996-2005”, também publicado hoje, conclui que as doenças com maior peso no crescimento dos gastos da Saúde, são as do foro psiquiátrico - incluindo a doença de Alzheimer - e os problemas cardíacos. link
Sobre a Saúde, as últimas notícias são deveres preocupantes.
Segundo um relatório do Department of Health and Human Services, publicado hoje, os gastos com a Saúde atingirão este ano $8.160 per capita, (um aumento de 356 dólares em relação a 2007).
Face aos cortes de receitas fiscais e ao crescimento incontrolável dos custos, "feitas as contas", o Medicare cairá na insolvência em 2016. Três anos mais cedo do que a anterior previsão.
Entretanto, o número de cidadãos sem seguro de saúde cresceu este ano para cerca de 48 milhões (Kaiser Family Foundation).
Um estudo da “Health Affairs”, “National Health Spending By Medical Condition, 1996-2005”, também publicado hoje, conclui que as doenças com maior peso no crescimento dos gastos da Saúde, são as do foro psiquiátrico - incluindo a doença de Alzheimer - e os problemas cardíacos. link
Com gastos fora de controlo, a Reforma da Saúde, prometida por Obama, não conseguirá arrancar .
Dados do estudo: Na projecção (2008-2018), a taxa média de crescimento anual na despesa nacional estimada em saúde atinge os 6,2 por cento - 2,1 pontos percentuais mais rápido do que o crescimento médio anual do produto interno bruto (PIB). A percentagem do PIB destinado à Saúde, estima-se que cresça rapidamente de 16,2 por cento em 2007 para 17,6 por cento em 2009, em grande parte resultado da recessão e atinja 20,3 por cento em 2018. Prevê-se também que o financiamento público da Saúde cresça rapidamente tornando-se a maior fonte de financiamento em 2016 e a fonte de pagamento de mais de metade de todas as despesas nacionais de saúde em 2018. [Health Affairs 28, no.2 (2009), (publicado on-line 24.02.09]
Para consulta: Dois estudos do Congressional Budget Office (CBO) sobre a politica e opções financeiras da reforma da saúde: “Key Issues in Analyzing Major Health Insurance Proposals” link and "Budget Options, Volume I: Health Care" link
Etiquetas: USA health
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Health costs increase despite recession
The latest one- and ten-year outlook for health care spending from the Center for Medicare and Medicaid Services projects health care spending growing 50 percent faster than growth in the overall economy. By 2018, health care will account for fully one in every five dollars of gross domestic product, according to the projection. The biggest jump in health's share of economic activity will come in the next two years as the sector continues to grow while the rest of the economy shrinks.
And that's the good news.
There were several unrealistic assumptions built into the projections. First, the CMS economists assumed Medicare's physician payments will be cut by 20 percent at the end of next year when the current payment fix expires. As anyone who follows that issue closely knows, that never happens. Congress always steps in and restores the cuts.
The second major assumption was that health care expenditure growth will average around 6.2 percent per year over the next decade, which is about equal to last year, the slowest growth in the past decade. It's possible, but only if some form of health care reform is enacted, and the reforms include an effective health care cost containment strategy. That's a lot of ifs.
One eye opener in the data, which was published on the Health Affairs website, was the increasing role that public sector finance plays in health care. All public sector programs -- Medicare, Medicaid, public health, the Veterans Administration, etc. -- will surpass half of all health care spending in 2016, according to the projection, and reach 51.3 percent by 2018. When you subtract individual out-of-pocket spending from the total, what's covered by private insurance will shrink to about a third of spending.
The projections serve as an interesting backdrop to yesterday's fiscal summit organized by the Obama administration, which wound up focusing almost exclusively on health care as the "entitlement" problem. That's accurate. Social Security is a paragon of fiscal health compared to Medicare and Medicaid. Peter Orszag, the chief of the Office of Management and Budget, told the forum that "the path to fiscal responsibility must run directly through health care."
So here's my prediction: Based on my reading of the Congressional Budget Office health care "options" report issued last December, the Obama administration will make a move toward putting budget caps on Medicare and Medicaid spending sometime during his first term.
Everyone knows there is a tremendous variation in utilization around the country and the system everywhere deploys a tremendous amount of wasteful medical procedures, tests, drugs, devices, and durable medical equipment. Comparative effectiveness research, properly deployed, is one way to wean the system from wasteful expenditures. That's the scientific carrot.
But budget caps are the fiscal stick. If officials knows that spending can't go over a certain level, they will be forced to make decisions about what constitutes high quality, affordable care. That's how it's done in other advanced industrial countries grappling with aging societies and skyrocketing health care costs.
Merrill Goozner
Pensar na sustentabilidade de um Sistema Universal de Saúde nos EUA é meter-se em ciclópicos trabalhos, dada a gigantesca dimensão da Federação e os efeitos da actual crise financeira, económica e social.
Muito embora, para nós o preocupante seja a sustentabilidade do "nosso" SNS, pensar "em grande", pode ser um bom exercício intelectual.
Assim,
Só os custos com projectos do tipo EHR (Electronic Health Record) representam - para um País da dimensão norte-americana com cerca de 300 000 000 habitantes vivendo em 50 Estados -investimentos faraónicos, segundo tenho lido em diversos papers, uma quantia compreendida entre os 75 e os 100 mil milhões de dólares.
Ora, Obama prometeu investir cerca de $10 mil milhões de dólares por ano, o que perfaz cerca de 10 anos para completar este ambicioso projecto.
Qual a qualidade e a capacidade de resposta deste sistema EHR?
Teria de possuir um âmbito alargado e abrangente com sobrevida média operacional longa (alguns anos) e, para além disso segura (capaz de manter a confidencialidade dos dados colhidos) e incluir o registo automático de admissões, precrição electrónica e um eficaz sistema de comunicação em rede entre hospitais, médicos e companhias de seguros.
Em contrapartida, um sistema nacional de saúde electrónico totalmente automatizado ( objectivo que excede os eventuais mandatos possíveis para Obama) e que se mantivesse funcional poderia induzir ganhos anuais da ordem dos $200 mil milhões de dólares.
Logo, o problema não é a vontade política de Obama para proceder a uma Reforma da Saúde, mas sim a liquidez financeira necessária para iniciar a Reforma em velocidade de cruzeiro (tem tido alguma s dificuldades em negociar com o Congresso) e manter a perseverança nesse objectivo (um entre muitos) durante uma década.
Mas a nossa amiga Joana que deposita enormes esperanças no sector privado da saúde é que nos podia dar uma achega a estes problemas norte-americanos, com os quais nós, mantendo-nos cá longe e se calhar de fora do habitual paradigma de pensar em coisas públicas, lidamos com alguma estreiteza de visão. Não é?
OBAMA'S HEALTH CARE PLAN EXPECTS AN INDIVIDUAL MANDATE.
I've now been able to confirm with multiple senior administration sources that the health care proposal in Obama's budget will have a mandate. Sort of.
Here's how it will work, according to the officials I've spoken to. The budget's health care section is not a detailed plan. Rather, it offers financing -- though not all -- and principles meant to guide the plan that Congress will author. The details will be decided by Congress in consultation with the administration.
One of those details is "universal" health care coverage.
That word is important: The Obama campaign's health care plan was not a universal health care plan. It was close to it. It subsidized coverage for millions of Americans and strengthened the employer-based system. The goal, as Obama described it, was to make coverage "affordable" and "available" to all Americans.
But it did not make coverage universal. Affordability can be achieved through subsidies. But without a mandate for individuals to purchase coverage or for the government to give it to them, there was no mechanism for universal coverage. It could get close, but estimates were that around 15 million Americans would remain uninsured. As Jon Cohn wrote at the time, "without a mandate, a substantial portion of Americans [will] remain uninsured."
The budget -- and I was cautioned that the wording "is changing hourly" -- will direct Congress to "aim for universality." That is a bolder goal than simple affordability, which can be achieved, at least in theory, through subsidies. Universality means everyone has coverage, not just the ability to access it. And that requires a mechanism to ensure that they seek it.
Administration officials have been very clear on what the inclusion of "universality" is meant to communicate to Congress. As one senior member of the health team said to me, "[The plan] will cover everybody. And I don't see how you cover everybody without an individual mandate." That language almost precisely echoes what Senate Finance Chairman Max Baucus said in an interview last summer. "I don’t see how you can get meaningful universal coverage without a mandate," he told me. Last fall, he included an individual mandate in the first draft of his health care plan.
The administration's strategy brings them into alignment with senators like Max Baucus. Though they're not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.
The reliance on Congress also helps the administration overcome the hangover from the campaign. During the primaries, Hillary Clinton attacked Obama's health care plan for lacking a mandate and, thus, not covering every American. "If you don't start with the goal of covering everybody," Clinton said, "you'll never get there." In reply, the Obama team struck back with charges that Clinton would "force people to get health insurance" and require "harsh, stiff penalties on those who don’t purchase it."
But even in the heat of the campaign, Obama's advisers sought to quietly signal their candidate's openness to an individual mandate. "The fact is," said David Cutler, the Harvard health economist who served as one of Obama's key health care advisers, "the policy differences on the mandate issue aren’t that large at all. Senator Obama believes they’re an option down the road, if other approaches don’t work.” And administration insiders then and now emphasized that the Obama campaign didn't start the mandate fight: They felt blindsided by the attacks and compelled to respond in kind. But it was a question of politics, not of principle. In principle, they were open to a mandate if they could be convinced that it was superior policy and superior politics.
Evidently, they're convinced.
EK, AP
.../ For that same reason, we must also address the crushing cost of healthcare.
This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages. And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it's one of the largest and fastest-growing parts of our budget.
Given these facts, we can no longer afford to put healthcare reform on hold.
Already, we have done more to advance the cause of healthcare reform in the last 30 days than we have in the last decade. When it was days old, this Congress passed a law to provide and protect health insurance for 11 million American children whose parents work full-time. Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives. It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time. And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.
This budget builds on these reforms. It includes an historic commitment to comprehensive healthcare reform - a down-payment on the principle that we must have quality, affordable healthcare for every American. It's a commitment that's paid for in part by efficiencies in our system that are long overdue. And it's a step we must take if we hope to bring down our deficit in the years to come.
Now, there will be many different opinions and ideas about how to achieve reform, and that is why I'm bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.
I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our healthcare has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: healthcare reform cannot wait, it must not wait, and it will not wait another year. .../
Excerto do discurso de Obama sobre a saúde, proferido terça-feira no Congresso. link
For the Obama Administration Health Care Reform Will Require Really Tough Cost Containment—Coming and Going
The President has made a powerful argument—America cannot get its economic house under control without comprehensive health care reform. The cost of existing entitlements—public and private—and any new ones are just too big a ball and chain on our short and long-term economic health.
The President has also argued that there could be no better time to fix this mess than now—when it is so critical to get our economic house in order once and for all.
The President is right on both counts.
As any of us who have studied this issue know, the number of those uninsured in America are not really the problem—they are a symptom of health care costs run amuck as individuals, employers, and government just can’t afford to insure everyone. Adding more people to this unaffordable mess without fixing it first is not an answer—it’s a prescription for even more fiscal irresponsibility.
So if cost is the real problem then cost containment is the whole ballgame.
As the Congressional Budget Office (CBO) pointed out in its December tour de force on costs and options, the cost containment “lite” proposals out there will not get the job done. Things like more health information technology, wellness efforts, comparative research, and pay-for-performance are all fine and important but individually, or all taken together, result in hardly a rounding error on the huge health care bill America faces.
Real cost containment means paying providers (doctors, hospitals, insurers, drug companies, nursing homes, device manufacturers, and all the rest) less than they would have gotten. It also means paying less out for beneficiaries than they would have received. That probably means more premium sharing, copays, adopting effective consumer-driven principles, and it probably has to include means testing as a progressive way to get wealthier people to pay more and ease the burden.
It might even mean redoing our decades old and now obsolete tax system that rewards too much easy money for health care.
Real cost containment will also absolutely mean more mandatory cost/benefit decisions on what will be covered—the kind of “big brother” intrusion into coverage decisions lots of people hate. But what good is comparative research if, as has been the case for years, it is more often ignored than used?
If you want to contain costs do you know what you have to do? You have to contain costs.
If the Obama administration and the Congress cannot produce these real and politically problematic savings then the same CBO that put everyone on notice about where the real money is in our bloated health care system is going to score the health plan effort as not in fact bringing our long-term entitlement costs under control.
That is where the Obama strategy meets itself coming and going.
If you say health care reform is needed now to bring our out of control health care costs under control and make a big difference in rebalancing our economy then you have to produce a bill that actually does that—that actually controls these costs by succeeding with those politically problematic cost containment challenges.
There will now be lots more “irrational exuberance” over the chances for health care reform in the wake of the President’s speech in the coming days just as there was in the days following the election.
I would rather we had a much more sobering discussion on just what it will take to craft a health care bill that does make the difference we so sorely need to bring our deficits, and our overall economy, back to an acceptable place.
That would be a discussion that included the incredibly politically problematic challenges we will need to face in order to get the health care special interests on the right side of this issue.
When I finally see that discussion taking place, I will be optimistic.
Otherwise our new President is just going to meet himself coming and going.
Posted by RL
I will be optimistic... but at any moment,
The Obama Health Program takes the risk of going down these steps:
Yes, we can;
Yes, we will;
Yes, he must.
Obama's speech - what does it mean for health reform?
Last night’s not-the-state-of-the-union speech covered a lot of ground, some of it rather superficially. Although health care was one of the President’s three key initiatives, he kept his comments at the proverbial thirty thousand foot level. He did take credit, and deservedly so, for his Administration’s (and Congress’) quick action on a variety of health care issues, stating: "Already, we have done more to advance the cause of health-care reform in the last 30 days than we have in the last decade," he said. "When it was days old, this Congress passed a law to provide and protect health insurance for 11 million American children whose parents work full-time."
Although his comments were very general there are three key takeaways.
Most significant is the sense of urgency. President Obama was quite forceful about his commitment to move on health reform quickly. He specifically noted that his 2010 budget will address health care reform, saying "This budget builds on these reforms [SCHIP etc]. It includes a historic commitment to comprehensive health care reform -- a down payment on the principle that we must have quality, affordable health care for every American."
That is the second key takeaway – this will be an incremental process, building towards universal coverage over time, not trying to cover everyone from the outset. This is consistent with Obama’s campaign platform, and also smart politically. If there are no more expansions of coverage this year, then he can point to SCHIP’s expanded coverage, COBRA subsidies, and Medicaid funding support as reforms that are resulting in more coverage and fewer uninsured.
Finally, the President explicitly acknowledged cost as the key barrier. But here he relied once again on the root out waste and inefficiency mantra as the method for reducing cost. That’s true, and comparative effectiveness research is a key weapon in that battle, Congress has already tried to blunt the impact of comparative effectiveness, demonstrating once again how tough this battle to ‘root out waste and inefficiency’ is going to be.
I’m quite sure President Obama understands the political difficulties inherent in reducing cost. And I’m also sure he is going to get what he can, and keep coming back till he gets what he wants.
What does this mean for you?
As I’ve said repeatedly, health care reform will be achieved incrementally, make lots of folks unhappy, and result in multiple bruising battles. And it will be very important for those who advocate sweeping change to reflect back on what has been accomplished. Obama is right – already this year more has been accomplished than in the previous eight.
posted by MCM
Um notável trabalho de acompanhamento da lufada de ar fresco que vem dos States.
O Saudesa, uma vez mais, está de parabéns.
O Xavier está de parabéns pelo entusiasmo e competência com que tem acompanhado o processo Obama. Este post é disso exemplo. Ao nível dos melhores Blogs americanos.
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