I wrote in the last post that “Candidates at all levels are promoting dangerous ideas to privatize Medicare. In every case, the bottom line is that Medicare recipients will pay more for health care, and there is no guarantee the change will save the government any money.”

In 2012 we’ll be electing a president and every member of the U.S. House of Representatives. Many of you also will be electing a senator. Do you or a family member depend on Medicare, Medicaid, or other government assistance for health care? Have you lost insurance or are worried you could lose insurance? Do you or a loved one have a life-threatening disease such as mesothelioma? The election results could determine how much access you will have to medical care in the future.

In recent months, every so often a politician will come forward with a new plan for “saving” Medicare by turning more of it over to private insurance companies. And whenever that happens, all the newspaper and cable news “pundits” praise the new plan and talk about how “serious” and “bold” it is.

And then a few days later, economists and health care experts come forward to say they have crunched the numbers, and the plan won’t work as promised. All it will do is put more burden on Medicare recipients to pay for their own healthcare, and probably won’t save the federal government any money, either.

The most recent of these plans was released a few days before Christmas. The Wyden-Ryan Medicare Plan is being called “bold” and “serious,” and also “bipartisan,” because the plan was proposed by one Republican (Rep. Paul Ryan of Wisconsin) and one Democrat (Senator Ron Wyden, Oregon). However, so far other Democrats have only opposed the plan. So it’s not really all that bipartisan.

Ryan and Wyden call their plan “managed competition” or “premium support.” They propose that the government provide a subsidy to Medicare beneficiaries to choose among competing insurance plans. These would include private insurance plans as well as traditional fee-for-service Medicare. Competition among insurance companies would keep cost down, they say. They also think that requiring Medicare recipients to pay more for their health care will force people to shop for better deals in the health care market, and this will lower health care costs.

Now economists are coming forward to say that sounds fine, but there’s no real-world evidence it would work to either lower health care costs or save taxpayers’ money. Laura D’Andrea Tyson of the Haas School of Business at the University of California, Berkeley, says “The cost savings from managed competition are hypothetical and uncertain – in fact, there are reasons to fear that such a system could actually increase costs.”

Princeton economics professor Uwe E. Reinhardt say the only certainty about the Ryan-Wyden plan is that it would shift the burden of health-care cost increases “from taxpayers into the household budgets of the elderly.”

The professors point out that people don’t shop for medical care the way they shop for toasters, and Medicare already is better at holding costs down than private insurance. Making more use of private insurance would more likely raise cost, not lower them. But the Wyden-Ryan plan limits the rate of increase of the insurance subsidies, so as costs go up seniors would have to pay more and more out of their own pockets.

This is a reckless and wrong-headed proposal, and politicians who support it do not deserve election.

Ready or not, it’s a new year. Worse, it’s a presidential election year. Take a deep breath, and get ready for non-stop politics from now until election day, November 6.

The Iowa Caucus is January 3, followed by the New Hampshire primary on January 10, the South Carolina primary on January 21, and the Florida primary on January 31. The very last primary, Utah, is June 26.

And then if you want more politics, the Republican National Convention will be August 27-30 in Tampa, Florida, followed by the Democratic convention, September 3-6, in Charlotte, North Carolina.

If you’ve ever promised yourself you’d turn off the television and read the complete works of Dostoevsky, this would be the year. However, as aggravating as it might be, we have a duty as citizens to pay attention to where candidates stand on issues. And this is true also of your candidates for Congress, not just presidential candidates.

For example, politicians continue to bicker over health care policies. The makeup of the next Congress could determine whether you and your family will have access to affordable health care. This is not an exaggeration.

If you or a family member depends on Medicare, or Medicaid, or is uninsured, or is worried about losing employee benefits, the results of the next election could have a major impact on your life. For Americans with life-threatening diseases like mesothelioma, the election results are even more critical. Don’t be fooled by fiery rhetoric and big promises.

Issues to watch for:

Candidates at all levels are promoting dangerous ideas to privatize Medicare. In every case, the bottom line is that Medicare recipients will pay more for health care, and there is no guarantee the change will save the government any money.

Why are these ideas being promoted? Because they would divert a lot of tax dollars into the private insurance industry. Somebody could make a lot of money. Don’t be fooled.

Politicians continue to promise to “repeal and replace” the Affordable Care Act of 2010, also called “Obamacare.” But after all these months, no serious and original ideas have been put forward to replace it. The Republican nominee, whoever he or she is, will be pressured to come up with specific ideas to control health care costs and get more Americans access to health care. But we don’t yet know what that plan will be.

Speaking of “Obamacare,” sometime this summer the U.S. Supreme Court is expected to decide whether or not the health care reform act is constitutional. That decision could have a huge impact on election campaigns, not to mention your health care.

Sometime in the next couple of months, a bipartisan conference committee is supposed to come up with a bill that will extend current rates of Medicare reimbursement. As explained a few days ago, a 1997 law setting Medicare reimbursement rates has to be overridden periodically to keep the amount of money physicians receive for Medicare patients from dropping through the floor. The current override will run out March 1, and if it does, reimbursement rates will drop by more than 27 percent.

So, happy new year. Best wishes. And good luck!

Following up the last post — today House Republicans relented and agreed to approve a two-month extension of current Medicare reimbursement rates, along with a two-month extension of a payroll tax cut and unemployment benefits.

The current legislation was going to expire on January 1. Unless action was taken, Medicare physician reimbursement rates would have been cut by 27 percent, possibly causing many physicians to drop their Medicare patients. Payroll taxes would have gone up by 2 percent, and about 3 million people would have lost unemployment benefits.

Of course, this law is just kicking the can down the road. We will face another deadline on March 1. The two-month extension was just to give Congress more time to negotiate a more long-term deal.

The payroll tax cut got most of the media attention, but the Medicare reimbursement issue possibly was the more serious one. This is not the first time that U.S. physicians faced a potential cut in Medicare reimbursement, and every time it this happens it casts a shadow on their practices. Earlier this week, one physician told CNN Money that such a big cut in Medicare reimbursement might cause him to move his practice to a community with fewer Medicare patients.

This should be frustrating to all of us. Politicians like to thump their chests and claim to have plans to “save” Medicare. But earlier this week a majority of the House of Representatives appeared to be ready to let a 27 percent cut in reimbursement rates go through. Further, there is a lack of will to change the law that is causing the threats.

Medicare may make a nice political football, but for American seniors it’s a matter of life and death. This includes the majority of Americans diagnosed with mesothelioma, since the deadly lung cancer takes decades to develop and usually isn’t diagnosed in younger people.

The law mandating the cuts was part of the Balanced Budget Act of 1997, and was meant to limit the growth of Medicare costs. But the formula established in 1997 for setting the rates lagged behind costs, and beginning in 2003 Congress periodically voted to override the law.

So, all this time, the law hasn’t been followed. But if it had been followed, Medicare reimbursement rates would be 27 percent lower than they are now. If the overrides are allowed to expire, the 1997 formula goes into effect, and Medicare is cut.

You might ask, why doesn’t Congress change the law? Changes to the law have been introduced in Congress but don’t go very far. An early version of the Patient Protection Act (PPA) of 2010 — that’s the health care reform law called “Obamacare” — contained a provision to scrap the 1997 law. It was removed from the final version to make the PPA less expensive.

Then Democrats introduced a separate bill to scrap the formula and replace it with an advisory panel of health care experts. Republicans and conservative Democrats defeated the bill. The reason for this soon became clear.

Last year Congress fought over the annual “doc fix” and passed several short-term “fixes” before finally passing a one-year override. But several politicians told constituents and the media that “this year we passed a health care reform bill, and now Medicare reimbursements are about to be cut.” They didn’t bother to explain that one thing had nothing to do with the other. This is how elections are won, folks.

So now we’ve got a two-month reprieve, just in time for Christmas. But we’ll be going through this again in February.

Today the U.S. House of Representatives rejected a Senate  bill that would have kept Medicare reimbursements at their current level for at least a couple of months. If an agreement isn’t reached by the end of the year, a whopping 27 percent cut in what physicians’ receive for treating Medicare patients will go into effect on January 1.

How did this happen? Well, back in 1997, Congress adopted a formula to slow the rate of Medicare spending. It is called the “sustainable growth rate,” or SGR. The measure tied the rate of increase in Medicare reimbursement rates to the Gross National Product (GNP). That way, Medicare costs would not grow faster than the economy.

This was fine, as long as the economy was growing briskly. But then that growth slowed. Beginning in 2003, every year Congress votes a “doc fix” to defer the cuts.

Most of those years, the “doc fix” vote was uncontroversial. But last year Republicans in Congress balked, and the “doc fix” bill wasn’t passed until December. And now, as the year is coming to an end, House Republicans again have rejected a bill that contained the “doc fix.”

And here’s the kicker — the Senate already has adjourned for the rest of the year. The eight years of deferred cuts have snowballed into a 27 percent cut.

If the cuts are not deferred, after January 1 many doctors may refuse to see Medicare patients. This could put the health of many Americans at risk. This includes most Americans stricken with mesothelioma. Because this deadly cancer takes decades to develop, it is usually diagnosed when the patient has passed the age of 50.

The bill in question had three parts. One is an extension of this year’s payroll tax cut. Payroll taxes are the FICA taxes taken out of paychecks to pay for Social Security and Medicare. The second part is an extension of unemployment benefits. The third part is the “doc fix.”

These three extensions would only have been for two months. The legislators had been struggling with the bill for weeks, and were at an impasse. On Saturday the Senate passed a bill with a two-month extension, promising to revisit the bill when Congress reconvenes in January. But yesterday the House of Representatives rejected the bill, with all but seven House Republicans, and no Democrats, voting against the measure.

The House Republicans want more concessions from the Obama Administration, such as relaxation of environmental protection rules. They have said they don’t like the extensions, especially the one that continues the payroll tax cut. They want something in exchange for their votes. Apparently, they think Democrats and the Obama Administration will give them whatever they want in order to prevent disaster.

But the Democrats are not budging. They thought they had a deal on Saturday, they said. Seniors may want to get any planned medical procedures done before the end of the year.

Last year Congress voted on a plan proposed by Congressman Paul Ryan of Wisconsin that would have phased out the current Medicare program in favor one of that would have provided vouchers — Ryan prefers to call it “premium support” — to help seniors pay for privately purchased insurance. The plan passed in the House (although without a single Democratic vote), but failed in the Senate.

Ryan’s plan was criticized as “destroying Medicare as we know it.” Further, the Congressional Budget Office and many health care financial experts crunched numbers and concluded Ryan’s plan would have fallen many dollars short of what many seniors need to pay for health care.

Now Rep. Ryan has a new plan, co-authored with Sen. Ron Wyden of Oregon, that is being touted as the great bipartisan  (Ryan is a Republican; Wyden is a Democrat) that will save Medicare. They hope the new plan will be more popular with the public than the old one was.

Medicare is an overwhelmingly popular program that most Americans want to keep as it is. But rising health care costs threaten to compromise the program in a few years (although talk that it will “go broke” is hyperbole). Changes to the program need to be carefully scrutinized, since seniors depend on it for health care. This includes most Americans diagnosed with mesothelioma, who tend to be in their senior years.

So how does the Ryan-Wyden plan stack up? It’s still mostly a voucher — excuse me, “premium support” — plan that would largely privatize Medicare. But the new plan would leave “original” Medicare in place for those who prefer it.

Igor Volsky of the Center for American Progress warns that the Ryan-Wyden plan could still weaken regular Medicare. The private insurance companies would not have to offer seniors a standardized benefit package, meaning they could design policies that would be attractive to relatively healthy seniors but be less beneficial to patients with severe health problems. And if the least-healthy seniors are left behind in regular Medicare, costs will skyrocket.

The larger problem is that the program’s only cost control mechanism is a cap on what the government will pay, and if costs go up higher than that … too bad. According to the Washington Post, however, Ryan and Wyden have conceded their plan might not save the federal budget any money at all. Then why do it?

Conservatives push privatization as the magic solution for just about everything, on the theory that private business is more efficient than bloated government bureaucracies. In fact, however, private insurance plans are more costly than Medicare. For example, Medicare Advantage, which subsidizes private insurance companies to insure seniors, has been costing  taxpayers about 15% more than regular Medicare plans.

The problem with Medicare is not that Medicare costs too much; it’s that health care costs too much. Medicare may be doing a better job than private insurance at keeping costs down, but that’s not stopping the rising tide of cost. Instead of tweaking Medicare to death, Congress should be looking hard at why health care costs are going up higher and faster in the U.S. than anywhere else.

Is the U.S. Food and Drug Administration getting in the way of medical science? Some politicians say so. For example, the current front runner for the 2012 presidential nomination, former congressman Newt Gingrich, says on his campaign website that “The current obsolete, adversarial, inefficient, and obstructive FDA is a dangerous obstacle to life-saving innovations and dynamic American job creation.”

The biggest complaints are about the time and cost needed to test new drugs. It takes about 15 years, and investments of millions of dollars, for a new drug to travel from a scientist’s notebook to the shelves of your pharmacy. Much of that delay is caused by the FDA’s stringent testing policies.

Further, in recent years U.S. pharmaceutical companies have produced fewer and fewer genuinely innovative drugs. Mr. Gingrich and others blame the FDA for this, saying that a reformed and modernized FDA would streamline approval processes, lower costs, and stop getting in the way of innovation.

Defenders of the FDA say that the decreasing number of innovative drugs is a marketing choice made by the pharmaceutical industry and is not necessarily the FDA’s doing. They also point out that a 2006 Institute of Medicine study called for the FDA to be given more regulatory power to insure product safety.

We all want the medicines we take to be safe and effective, whether they are common over-the-counter cold remedies or the most recent treatments for mesothelioma cancer. But we also want to believe that scientists are always working on new cures, and that these will be available when we need them, not stuck in a regulatory pipeline somewhere. And if we do need a new life-saving drug, it would be nice if we didn’t have to take out a second mortgage to pay for it.

So, somewhere, a balance has to be struck between safety on one hand and getting new products on the market quickly and cheaply on the other. Many people may think they’d prefer “quick” and “cheap” over “safe,” until they’re the ones who suffer a bad reaction from a new drug. And then (if they survive) they’ll wonder why a dangerous drug was allowed on the market.

The fact is, the pharmaceutical industry itself could do some streamlining. A 2006 study by PricewaterhouseCoopers (PWC) said “the current pharmaceutical industry business model is both economically unsustainable and operationally incapable of acting quickly enough to produce the types of innovative treatments demanded by global markets.”

The FDA says it is not sitting on a pile of innovative drugs and keeping them off the market. Rather, the pharmaceutical companies have submitted fewer drugs for approval in recent years. A few years ago the big pharmaceutical companies decided to cut back on the number of new products in development to focus on producing a few “blockbuster” drugs that would dominate the market and enjoy huge global sales. This is one of the things the PWC study said has to change.

Earlier this year, however, the FDA announced the number of new drugs ready for approval is going up again. This is partly because more smaller companies are developing successful products.

The process of developing, testing, and approving new drugs is very complex, and no doubt there are many ways it could be improved. But FDA reform by itself is not a magic bullet that will solve all of the problems with the process.

In the last decade, the annual improvement in Americans’ health has declined by 69 percent. That’s the conclusion of the United Health Foundation, in its annual appraisal of the status of American health. This assessment is based on factors such as rates of smoking and obesity, preventable hospitalizations, and prevalence of heart disease, diabetes, and other illness.

The Foundation also documents that where you live has a lot to do with how healthy you are. According to the Foundation’s evaluations, these are the top ten states for living a healthier life -

1. Vermont
2. New Hampshire
3. Connecticut
4. Hawaii
5. Massachusetts
6. Minnesota
7. Utah
8. Maine
9. Colorado
10. Rhode Island

Why are these healthier states? Compared to the national average, most of these states have lower incidents of infectious disease, lower violent crime rates, safer workplaces, fewer children living in poverty, and higher use of prenatal and preventive care. Most of them have a higher than average percentage of residents with health insurance.

Good health is a personal responsibility. People who have a healthy diet, get regular exercise, and avoid smoking tend to be healthier. But good health also depends on factors outside of our control, such as violent crime and exposure to pollutants and toxins. For example, workers exposed to asbestos on construction sites or in shipyards now are in danger of developing the deadly lung cancer mesothelioma.

Where are you more likely to have health problems? These states are in the bottom ten:

41. West Virginia
42. Nevada
43. Kentucky
44. Texas
45. South Carolina
46. Alabama
47. Arkansas
48. Oklahoma
49. Louisiana
50. Mississippi

Compared to the national average, these states tend to have a higher percentage of uninsured residents. This leads to fewer people seeking preventive care, more infectious disease, more workplace accidents, more preventable hospital admissions.

These states also tend to have higher rates of poverty. Some of them, such as Texas, have more air pollution than average. They also tend to have more children living in poverty and higher infant mortality rates.

We should also note that at least two of these “worst” states, Mississippi and Texas, claim to have solved their health care problems through “tort reform” — laws that make it harder for residents to file malpractice suits and which limit the amount of damages that can be collected. Perhaps that idea needs more work.

When the Affordable Care Act — also called “Obamacare” — was signed into law last year, lots of people probably braced themselves for big changes to how they get health care. It must have been confusing when very little happened.

The ACA is something like a time-release capsule — its many provisions will go into effect at different times over a period of years. You won’t see most of it until 2014. By then, patients, doctors, and the insurance industry will have had time to adjust.

One provision went into effect last week, and it’s one that could affect you. It is a regulation that requires insurance companies to spend at least 80 percent of the premiums it receives on health care costs. The other 20 percent may be spent on advertising and administrative costs, or kept as profit. The amount of money health insurance companies spend on paying medical bills versus non-medical costs is called the “medical loss ratio.”

Naturally, insurance companies are not happy about having their medical loss ratios subject to federal regulation. They’ve been looking for loopholes and lobbying for exemptions. For example, they wanted sales commissions to be taken out of the ratio altogether and not counted as part of the 20 percent. But last week the Department of Health and Human Services said that commissions paid to insurance salespeople must be counted as part of the 20 percent.

If an insurance company spends less than 80 percent of premiums on health care, it must give the unspent premium money back to its customers. The federal government decided last week that policy holders do not have to pay taxes on those rebates.

Last week some news articles speculated that insurance companies would be driven to bankruptcy by this regulation. Others say that is nonsense. They point to the fact that health insurance stocks have climbed in value the past several months, even though the industry knew very well the medical loss regulation was coming.

Why are people optimistic about health insurance stocks? Because the Affordable Care Act also requires that most Americans have health insurance, or pay a penalty, beginning in 2014. The industry expects to have millions more customers in a few years.

And the truth is, many of the big insurance companies have kept their medical loss ratio at around 80-20, anyway, for its big group policies. Small groups policies, and individual policies, have tended to not favor the customer quite so well, however, and are sometimes more in the neighborhood of 70-30.

The real reason health care is such a big issue is that the costs keep going up. The cost of care, from baby deliveries to heart surgery to mesothelioma treatment, is rising faster in the U.S. than anywhere else and is threatening to eat the rest of the economy.

Many factors are driving these costs, and the amount spent on insurance advertising and sales commissions is ony a tiny sliver of the pie. However, the large numbers of uninsured people whose medical care is paid by the rest of us is a major driver of cost. Bringing down insurance premium prices and getting more people insured should make a real difference.

This regulation will see to it that health insurance policy holders are getting a fairer deal from their insurance providers. It will also encourage insurance companies to focus more on their policy holders’ needs.

Several of the candidates for the Republican presidential nomination next year advocate Medicaid “block grants” to the states. What does this mean? And who would be affected?

You probably know that Medicaid is a “safety net” program for the very poor. However, you might not know that Medicaid is American’s primary payer for long-term health care.

Medicaid pays for nearly half (43 percent) of all long-term health care services in the United States. This includes paying for nursing homes, assisted living facilities, adult day care, and in-home assistance such as visiting nurses. Although Medicaid is for people of all ages, the single biggest group receiving help from Medicaid to pay for long-term health care is the elderly disabled. Nearly 70 percent of nursing home residents depend on Medicaid to pay for their care.

Long-term care is one of many kinds of health care the private insurance industry would rather leave alone. Most private insurance plans pay for only a limited amount of home health care or nursing home care. This is fine for someone who is going to “get back on his feet,” but when a disability becomes permanent, private insurance may be of little help. Sooner or later, many privately insured people end up depending on Medicaid.

For this reason, Medicaid is a particular concern for seniors, including those not on Medicaid now. Physical disability is something that becomes more likely as we age. This is true of many serious medical conditions, such as mesothelioma cancer, which is usually diagnosed in people over the age of 50.

Right now, Medicaid is paid for by both state and federal taxes, and the Medicaid programs are administered by the states. States may opt out of the Medicaid program, although none do. States may also choose to subcontract with private insurance companies to pay out benefits, or they may pay for medical care directly.

Although states run the programs, the federal government (which pays 60 percent of the cost) requires the states to cover certain groups of people and to provide specific benefits. For example, pregnant women who meed the income criteria cannot be turned down; nor can dependent children and their parents.

For some time, many conservatives have argued that Medicaid would be better run if there were no federal strings attached at all. They argue that states could better respond to the needs of their people without federal regulations telling them what to do.

They also think block grants would save federal dollars. The Rep. Paul Ryan budget plan introduced to Congress last year included a block grant plan that would have reduced federal spending on Medicaid by $771 billion between 2012 and 2021, according to the Congressional Budget Office.

However, the Ryan plan (which failed to pass in the Senate) would have eliminated acute care benefits for the elderly.

This takes us to the “cons.” Critics of the block grant idea say that the “savings” to the federal government would amount to increasing costs being passed on to states, and to patients.

“The magnitude of the federal Medicaid spending reductions under this proposal would make it difficult for states to maintain their current Medicaid service levels against other state priorities for spending,” according to the non-partisan Congressional Research Service.

We all want to find ways to save money, but Medicaid block grants may just end up pushing costs from here to there. We’ll all still have to pay for it.

Right now former Congressman Newt Gingrich is the front runner for the Republican presidential nomination in 2012. In the last post, we began to look at Mr. Gingrich’s proposals on health care in detail. As we approach the presidential primary elections, it’s important to be aware of where candidates stand on health care-related issues. All of us, especially those with life-challenging diseases such as mesothelioma, will be affected by the coming election.

Mr. Gingrich presents a list of health care policy proposals on his website. One of the puzzling things about this list is that many of these items already are public policy or were passed into law last year as part of the Affordable Care Act, also called the “Obamacare” health care reform law.

For example, one of Mr. Gingrich’s policy suggestions is “Cover the sickest with a High Risk Pool set up by each state to cover the uninsured who have become too sick to buy health insurance.” A lot of people like this idea, which is why it’s already being done. Over the past 30 years, 35 states have created such pools.

The Affordable Care Act of 2010 provided $5 billion, to be divided among all 50 states, to be used to support existing high-risk pools or establish new ones. These pools are to be phased out after 2014. At that time, a provision of the ACA will go into effect that prohibits insurers from rejecting people with pre-existing conditions, so there shouldn’t be any need for high-risk pools.

The very next item on Mr. Gingrich’s list is “Protect consumers by reinforcing laws which prohibit insurers from cancelling or charging discriminatory rate increases to those who become sick while insured.” Again, this already is provided by the ACA. These provisions are scheduled to go into effect in 2014.

Other Gingrich ideas already covered by the ACA include structuring Medicare reimbursement incentives for providing better care; reducing cost and paperwork through electronic record keeping; reducing fraud; and funding more medical research.

Mr. Gingrich wants to repeal one part of the ACA, which is the individual mandate to purchase insurance. Beginning in 2014, nearly all Americans will be required to acquire health insurance, either as an employment benefit or by buying insurance themselves. Lawsuits have been filed challenging the constitutionality of the individual mandate. The Supreme Court is expected to rule on the individual mandate next summer.

The problem is that unless there is some strong incentive for everyone to buy insurance, it may be impossible to require insurance companies to insure people with pre-existing conditions. Why? Because if you can wait to buy insurance until after you need medical care, young and healthy people will opt to not get insurance. But insurance companies need some policyholders who pay more in premiums than they receive in benefits, or they can’t stay in business. If only older, sicker people buy insurance, the insurance business model can’t work.

Mr. Gingrich doesn’t address this problem, although he has a big headline on his website: “Newt Opposes Obamacare and the Unconstitutional Individual Mandate.” However, Mr. Gingrich proposed a reform plan with an individual mandate in the early 1990s. The Gingrich Group, a consulting group Mr. Gingrich founded, also has been pushing a plan that would “Require that anyone who earns more than $50,000 a year must purchase health insurance or post a bond.” which is an individual mandate.