blogs: Barbara Day 

Innovations in Senior Care Takes a Back Seat With Health Care Reform looming, many old geezers like me (I can't believe I am describing myself as a geezer but I'll be 60 this year), are wondering what the future holds for us and our health care. The plan underway, if passed, is to cut at least $½ trillion out of the Medicare budget. These cuts are not a savings plan for our government but actually a spending plan. The so-called money from Medicare savings will be put in another column on the balance sheet which will help bankroll the additional 30 million+ who are currently uninsured. Will seniors be happy with giving up some of their care so that 30 million uninsured can have a health insurance policy? Keep in mind, a health insurance policy does not actually insure a person really has access to care. There is a major shortage of physicians and health professionals. But since none of the benefits start until 2014, hopefully more health professionals can be trained to accommodate the actual of all the new health consumers on the horizon. Health Reform Bill Cuts Medicare Advantage Programs One of the major cuts under Medicare affects a program called Medicare Advantage. Medicare Advantage affects our community because Humana is one of the big providers of Medicare Advantage nationally. I used to be a nutrition consultant for Humana's Active Outlook Magazine and Live it Up Magazines. I wrote nutrition columns and developed nutrition classes for seniors. Both publications and classes were aimed at prevention and were designed to help seniors keep themselves healthy through effective nutrition and wellness strategies. The Medicare Advantage program's emphasis was on prevention and trying to get seniors on board with taking care of their health by being active, making good food choices, managing their stress and also education about an array of topics like drugs therapy and depression. Seniors May Have to Be Satisfied with Dr. Welby Standards of Care Some of the cuts in Medicare may affect diagnostic testing and high tech medical treatments for seniors such as echocardiograms, heart stents and so on. Some speculate that costly medical devices such pacemakers and implantable defibrillators will also be under scrutiny for seniors. In fact, treatment options under the new Health Reform plan may be different for a 65 year old versus a 75 year old, or a senior who is in good health versus a senior than has an assortment of medical issues. In one of my recent columns for Louisville Mojo regarding Medicare fraud, Tin Knocker commented that he had been told that doctors “when people were on their deathbed (perhaps a couple of day left) and knowing that the patients is going to die anyway, they order diagnostic procedures for them such as colonoscopy.” To Tin's point, with the deep cuts in Medicare, all procedures, tests and treatments will need to be heavily scrutinized so this may help to deter chronic fraud and waste in the system. This may just be speculation on my part or a reality when Congress passes the Health Reform and we actually see nuts and bolts of what is allowed or not which begins in 2014. Since the health reform bill has primarily been developed behind closed doors, very few specifics as to the day to day health care for seniors (or anyone for that matter) are not being discussed. Things like what will be covered, how much will we have to pay for premiums, what are the deductable levels, will all physicians and hospitals be forced to see patients in the government programs, etc. As Nancy Pelosi has recently suggested “we'll know what's in the bill when it's passed,” but by that time it may be too late for senior care. Pelosi's statement gives me some insight into what's wrong with Congress, they don't really know what's in the bills they are trying to pass. The bills have been so compromised and changed with amendments and earmarks due to deal making process to get Congressmen & women to vote, who even knows what our health care will look like in 2014. But for sure a $½ trillion will be cut for senior care. Death Panels for Seniors Not Needed When Access to Care Can Do the Same Job We have heard about death panels which seem absurd to me but cutting access to current diagnostic testing, high tech medical treatments and possibly even high cost prescription drugs due to cost constraints may end up being a reality. Seniors and/or their family members may be have to decide to pay out of pocket for higher cost diagnostic testing, medical devices and drug therapy that is not allowed under the new Medicare guidelines. Tests Denied to Seniors Could Cause More Lawsuits Because only several states have TORT reform, physicians worry that if some higher tech more expensive diagnostic tests and treatments may be banned for seniors due to cuts under Health Reform, they may actually bear the burden of possibly get sued even though the government forced the situation. If seniors want the advanced treatment modalities rather than basic treatments so be it, but they may have to burden the cost. The senior or family member may have to decide they want to pay out of pocket for the higher tech test or treatment rather than the traditional Dr. Welby approach of the 1960s. More Baby Boomers Retiring – But Less Dollars Will Be Spent on Medicare But, it no big secret more baby boomers are on the retirement horizon at the same time Medicare is on the chopping block for big bucks. The cuts and taxes begin right away but the insurance coverage for the 30 million+ doesn't begin until 2014. The hope is the money that is raised on higher taxes up front will actually be available to pay for all this new health care for the 30 million people. Since the federal government has taken money that was earmarked for Medicare and Social Security for other projects over the years, I don't have any hope that they will do this, do you? “Doc Fix” Not in Health Care Reform Bill but in JOBS BILL – Dems Trickery On the chopping block in the Health Care Reform Bill is a 21% cut to physician reimbursements. The JOBS Bill actually includes the money needed to reimburse physicians who see Medicare patients. Rather than add this $500 Billion + under the Health Reform Bills, Democrats decided to put this liability in another bill (or in another column on the government balance sheet). All the Health Reform Bills so far in both the House and the Senate have been scored by the CBO without the Doc Fix expenses. This seems like good old trickery to me! Student Loan Bill Added to Health Reform Bill to Get House Dems to Vote YES! More Trickery But, in an effort to get more Democratic House members to vote for this GREAT Health Reform bill, Pelosi added the Student Loan Bill which takes over the management of all the student loans. So rather than a student borrowing money from a bank, this bill forces students to borrow money from the government. This is supposed to save money for the government because there is no middle man – the bank. Under ObamaCare Seniors May Have Trouble Finding Physicians to Treat Them Before the 21% cuts to reimbursements, many physicians were considering if they could actually continue to see Medicare patients due to the poor reimbursements for care. If the 21% actually becomes a reality, seniors will have a challenge finding physicians who will care for them. Keep in mind, physicians are small business owners and they have to pay their bills, too. But it's not just seniors that have to worry, Medicaid patients will also have the same challenges finding physicians to care for them But Stay Tuned – ObamaCare May be Signed Into Law This Weekend Then… But stay tuned, ObamaCare may be signed into law this weekend according to White House Press Secretary Robert Gibbs. Once signed into law then all the interpretations will come out as Nancy Pelosi predicted. At this time, we might find out that some of the gibberish in the Health Reform bill might actually stipulate that a person over a certain age or with a number of health issues must have DO NOT RESUSCITATE whether the family wants it or that no expensive heart treatments or cancer treatments will be allowed as well. These were some of the ideas put forth by Dr. Ezekiel Emanual, MD, PhD, who is the bioethicist and advisor to President Obama. These types of strategies are a way of saving money. Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master's Degree in clinical nutrition. The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers. Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues. Barbara writes nutrition and health columns for www.LiveStrong.com. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 9 grandchildren.

ADD A COMMENT

chuck   tue mar 16 2010 at 10:57 am         ·  The 800 lb gorilla in the healthcare room is the insurance companies. They are entirely optional in most countries but they're an inherent and required middle man in America. If we want to save a fortune in costs we just need to kill the private health insurance companies. Doctors and hospitals could even get a PAY RAISE if necessary and we could still save a fortune. Here's the math: 1 out of every 3 dollars that goes into healthcare gets sopped up by the insurance companies for their overhead, salaries, dividends, junkets, executive bonuses, marketing, etc. That's 33% right there. America's healthcare system costs 40% more than other countries with well developed healthcare systems, most of whom provide universal healthcare. So why is America's healthcare system so expensive? Private health insurance companies. They need to be dis-intermediated (made optional if not removed) from the equation if we're to really become competitive on costs again. Best, - C