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The Takeaway: Who Benefits From New Medical Effectiveness Research Fee?; Cancer Screenings Not Always Free

Posted By Elizabeth Nolan Brown On December 28, 2011 @ 9:40 am In Bulletin Today | No Comments

[1]Health Plan Fee Sparks Debate: Beginning in 2012, a new $1-per-person fee on health insurance plans will be used to pay for medical effectiveness research—comparing drugs, medical procedures, tests and treatments to see which works best. But will the answers make a difference? The goal of the research, according to the Associated Press [2], is ‘to answer such basic questions as whether that new prescription drug advertised on TV really works better than an old generic costing much less.’ Which sounds like something us health care consumers could benefit greatly from knowing, right? But some equate the health insurance fee—which doubles to $2 per covered person in 2013 and rises with inflation thereafter—to a tax. And others are suspicious of the whole idea of medical effectiveness research in the first place.

The more concerning thing is … how the findings will be used in other areas,” said Kathryn Nix, a policy analyst for the conservative Heritage Foundation think tank. “Will they be used to make coverage determinations?”

That’s not the idea. Joe Selby, who heads the quasi-governmental agency created to carry out the research, said patients and doctors will make the decisions, not his organization. “We are not a policy-making body; our role is to make the evidence available,” Selby explained. And there are limitations on how the Health and Human Services department can use the research findings in decisions affecting Medicare coverage.

Still, insurance companies themselves could wind up using the research to make coverage decisions for workplace health plans. But I fail to see how this is exactly a bad thing—don’t we want patients being steered toward the most effective drugs and treatments? Some major insurers already do this, based on medical effectiveness research carried out by their own researchers or drug companies. At least government-sponsored studies—carried out by a semi-independent agency—should (ostensibly) be less biased, no?

Former Medicare administrator Gail Wilensky, a Republican, told AP that opposition to the institute’s work is shortsighted. “This just strikes me as a component of finding ways to treat better and spend smarter,” she said.

Free Preventative Care Not Always Free: While we’re on the subject of health care developments, let’s delve into the new free preventative services mandate for just a moment. The 1-year-old health law requires most insurance plans to cover all costs for preventive care, including cancer screenings.

But a loophole means you could still end up paying for some ‘preventative care’ [3] services. That’s because when a doctor finds and/or removes something suspicious during the course of a breast or colon cancer screening, the procedure goes from being considered a ‘preventative test’ to a ‘diagnostic test.’ And diagnostic tests aren’t free. “You could wake up with a $2,000 bill because they find that little bitty polyp,” said insurance agent Cindy Holtzman.

Answers, Please: With little time left before the Republican primaries in Iowa, many GOP presidential candidates have still said little concerning areas of import to older adults. Social Security and Medicare will be huge issues in the 2012 election. “Yet these issues have yet to receive a serious airing in the debates, aside from accusations about Social Security Ponzi schemes and general threats to replace Medicare with vouchers,” Reuters’ Mark Miller writes [4]. So he asked a few top retirement and aging policy experts what questions they would pose in a presidential debate.

Their questions range from the vague—”What do you recommend should be done to increase the ability of millions more to retire in dignity?”—to the quite specific, like “Do you oppose the 20/20 proposal, and other proposals that would cut 401(k) limits making it harder to save at work?”

Check them all out here [4]. Then see our guide to the 2012 GOP presidential candidates and their positions on key retirement security issues [5].

Wednesday Quick Hits: 

  • Have vegan diets gone mainstream [9]? Nutritionists now believe that a well-thought-out vegan eating plan could be the most healthy way to live for many people.

Photo: Snap Decision/Getty Images 


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URLs in this post:

[1] Image: http://aarpblog.files.wordpress.com/2011/12/300-federal-surcharge.jpg

[2] according to the Associated Press: http://www.aarp.org/health/medicare-insurance/news-12-2011/us--new-insurance-fee1.html

[3] a loophole means you could still end up paying for some ‘preventative care’: http://www.washingtonpost.com/national/health-science/health-overhaul-says-free-preventive-care-but-it-pays-to-ask-doc-first-1100-surprises-lurk/2011/12/28/gIQA9YltLP_story.html

[4] Reuters’ Mark Miller writes: http://www.reuters.com/article/2011/12/27/us-retirement-politics-idUSTRE7BQ10820111227

[5] guide to the 2012 GOP presidential candidates and their positions on key retirement security issues: http://www.aarp.org/politics-society/government-elections/info-09-2011/republican-presidential-candidates-2012.html

[6] by buying credit for extra years: http://www.usatoday.com/news/nation/story/2011-12-27/pension-perk-costs/52247140/1

[7] can accurately rule out heart attacks almost 99 percent of the time: http://www.webmd.com/heart-disease/news/20111227/sensitive-blood-test-rules-out-heart-attack

[8] could cost taxpayers, insurers, employers and others billions of dollars: http://www.nytimes.com/2011/12/28/business/the-high-cost-of-failing-artificial-hips.html?google_editors_picks=true

[9] Have vegan diets gone mainstream: http://health.usnews.com/health-news/diet-fitness/diet/articles/2011/12/27/the-mainstreaming-of-vegan-diets

[10] are piling on student debt: http://www.reuters.com/article/2011/12/27/us-studentdebt-middleage-idUSTRE7BQ0T620111227

[11] has risen to 80.6 years: http://www.bloomberg.com/news/2011-12-27/new-york-city-life-expectancy-rises-to-80-6-years-above-national-average.html

[12] older adults can be just as quick as young adults: http://www.medicaldaily.com/news/20111227/8443/elderly-seniors-older-adults-older-adults-children-tests-cognition-cognitive-ability-and-agi.htm

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