This issue of Health Affairs is particularly reflective of the editors’ woke ideology, which leads to absolutely hilariously dumb articles. In this case many have to do with climate change. The woke health care nuts are eager to jump on the equally woke climate change bandwagon, so they make up supposed bad health results from fictitious global warming. Here is one clear fact they ignore, but really can’t. Cold weather kills far more people and causes far moree health issues than does warm weather. And in terms of climate, the ice ages came close to wiping humans and their predecessors out, but warm weather has been a boon for civilization’s advancement. So I am not even going to bother addressing the multiple climate fear-mongering articles in this issue. To call them research is beyond insulting to actual research. (HA Issue)
The first real study is an example of misleading research. It looks at skilled nursing facility access in Medicare Advantage plans compared to fee-for-service Medicare, out of concerns relating to narrow networks. It claims that MA enrollees are slightly more likely to go to a SNF that is farther away from their home and slightly more likely to go to one that doesn’t have a “five-star” rating, but gives absolutely zero evidence that this has any impact on actual clinical outcomes. In fact other evidence suggests MA plans deliver better quality outcomes than does FFS Medicare. and this journal has published studies relating to whether the star ratings used by Medicare have any real value or accuracy in terms of clinical outcomes.
The next article covers private equity acquisitions of hospices. As you might expect, in the FFS Medicare arm, these acquisitions led to longer stays in hospice and more spending by Medicare, while more of the beneficiaries ended up discharged to home from the hospice, indicating they had less severe illness. The injection of private capital into health care providers has some good aspects, including access to better management and more rigorous adherence to evidence-based medicine. But it also tends to raise prices and spending and Medicare needs to address that.
Most of our hospitals are supposedly not-for-profit and consequently tax exempt as well, but they don’t operate that way. In fact, they have very high prices, pay excessive executive compensation and build extremely fancy facilities. They are supposed to provide a lot of free care to low-income patients, but multiple studies have demonstrated that these non-profit organizations rarely meet their obligations in this regard. An article in this issue further suggests that there are issues, including transparency on eligibility criteria and criteria that actually help most low-income people. Some hospitals in high-need areas are not doing the best job of reaching people who need help paying the bill.
A couple of articles deal with Medicare’s reimbursement schedule for physicians which is based on work done by the American Medical Association and the fact that lobbying by doctors tends to push the prices up. That fee schedule is used by many commercial payers as well, so it plays a role in driving up overall spending. The authors suggest a need for Medicare to stop relying so much on data and prices that come from a physician organization. Another article deals with similar issues regarding Medicaid prices for doctors’ services.
Allowing some surgical procedures to be done outside of the inpatient hospital setting reduces spending for Medicare. Stopping the payment of commissions to insurance brokers reduces Medicare Advantage enrollment.
