Harris County prosecutors complained to federal Medicare authorities for at least two years that rampant fraud involving private ambulances across the region was costing taxpayers millions of dollars, but say their concerns were ignored. "We have been beating our heads against a wall for two years now," Harris County District Attorney Pat Lykos said Monday, a day after the Houston Chronicle reported that Harris County leads the nation in the number of private ambulance companies, vehicles and Medicare payments. "They're totally unresponsive. This is tens of millions of dollars being wasted. This isn't rocket science." Lykos' office provided the Chronicle Monday with letters and records documenting prosecutors' frustration since 2009. "We need Centers for Medicare and Medicaid Services to address this staggering and out-of-control problem," Lykos wrote last year to Centers for Medicare and Medicaid Services Acting Director Jonathan Blum, calling Houston "the epicenter for a massive Medicare fraud scheme."
Let the post-mortem on the Class Act begin. The health and human services secretary, Kathleen Sebelius, charged with carrying out this first-ever national program of voluntary long-term care insurance, made official on Friday what had been speculated for several weeks: the administration was shutting down Class. After 19 months of research and consultation, "we have not identified a way to make Class work at this time," she said. But was it really unsound? Was it impossible to offer to those who needed help with the activities of daily living a $50-a-day benefit ($18,000 a year) that would help ease the huge financial burden of long-term care? The insurance industry veteran hired to serve as the program's chief actuary, Robert Yee, begs to differ -- or at least, he begs to defer judgment. Mr. Yee, whose dismissal last month first signaled that the program was in trouble, told me on Monday that when it came to setting benefits and premiums, planning for Class remained at a fairly early stage.
CareMore, a company based in Cerritos, CA, operates 26 care centers across the Southwest, serving more than 50,000 Medicare Advantage patients. Those numbers are likely to grow, perhaps dramatically, in the next few years: in August, CareMore was acquired by the insurer and health-services provider WellPoint, which serves 70 million people nationwide directly or through subsidiaries, and has plans to expand the CareMore model. CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24% below average; hospital stays 38% shorter; an amputation rate among diabetics 60% lower than average. Perhaps most remarkable of all, these improved outcomes have come without increased total cost.
We will all die, but the trajectory of our death will follow one of a few predictable patterns. According to statistics published in 2003 in the Journal of the American Medical Association, two-fifths of us will die with prolonged, dwindling illness on a slow downward slope typical of dementia or frailty. One-fifth will die with a sharp decline typical of, for example, metastatic cancer. Another fifth will die with intermittent dips, like a roller coaster, from heart or lung failure; and a small percent will die suddenly and unexpectedly, like falling off a cliff. Nearly 80% of us want to die at home, polls have shown, but most die in the hospital, often strapped to a bed in the intensive care unit.
We will all die, but the trajectory of our death will follow one of a few predictable patterns. According to statistics published in 2003 in the Journal of the American Medical Association, two-fifths of us will die with prolonged, dwindling illness on a slow downward slope typical of dementia or frailty. One-fifth will die with a sharp decline typical of, for example, metastatic cancer. Another fifth will die with intermittent dips, like a roller coaster, from heart or lung failure; and a small percent will die suddenly and unexpectedly, like falling off a cliff. Nearly 80% of us want to die at home, polls have shown, but most die in the hospital, often strapped to a bed in the intensive care unit.
Republican activists, increasingly optimistic they can win the White House and Senate next year, are beginning to lay the groundwork for a multi-pronged campaign in 2013 to roll back President Obama's sweeping healthcare overhaul. The push includes an effort to pressure Republican candidates to commit to using every available tool to fully repeal the law, a tactic pioneered by conservative activist Grover Norquist, who made an anti-tax pledge de rigeur for GOP politicians. Other conservative healthcare experts are developing an alternative to the law, an effort that could protect Republicans from past critiques that their healthcare plans left tens of millions of Americans without medical coverage. "The window for action comes and goes," said Tom Miller, a senior fellow at the American Enterprise Institute, one of several conservative groups involved in the effort. "We need to be ready."
On the Republican campaign trail, the healthcare debate has focused on the mandatory coverage that Mitt Romney signed into law as governor in 2006. But back in Massachusetts the conversation has moved on, and lawmakers are now confronting the problem that Mr. Romney left unaddressed: the state's spiraling healthcare costs. After three years of study, the state's legislative leaders appear close to producing bills that would make Massachusetts the first state — again — to radically revamp the way doctors, hospitals and other health providers are paid. Although important details remain to be negotiated, the legislative leaders and Gov. Deval Patrick, all Democrats, are working toward a plan that would encourage flat "global payments" to networks of providers for keeping patients well, replacing the fee-for-service system that creates incentives for excessive care by paying for each visit and procedure. "We have shown the nation how to extend care to everybody," Mr. Patrick said in an interview, "and we'll be the place to crack the code on costs."