What terrible things has “Obamacare” delivered since the Affordable Care Act was passed in 2010?  According to the Center for Medicare Advocacy, here is how the healthcare reform law has affected Medicare:

• Closing the Medicare Drug Coverage Gap. 2011 is the first year of a multi-year phase out of the “donut hole”.  For 2011, beneficiaries pay only 50% of the cost of brand name drugs in the donut hole and 93% of the cost of generic drugs.
• Medicare Preventive Services. This provision requires Medicare to eliminate cost-sharing for Medicare-covered preventive services rated as A or B by the U.S. Preventive Services Task Force. It also waives the Medicare deductible for colorectal screening and authorizes coverage for an individualized prevention plan.
• Changes to Increased Medicare Premiums for Higher-Income Beneficiaries. Since 2007, Medicare beneficiaries with incomes above a certain level have been required to pay higher Part B premiums. The ACA froze the income level at which such premium surcharges apply at $85,000/year through 2019 and expanded the surcharge to also apply to Part D premiums.

• Medicare Extra Payments. For the years 2011 through 2015, Medicare will pay a 10 percent bonus for primary care services; it will also pay a 10 percent bonus to general surgeons practicing in areas with a shortage of health professionals.
• Medicare Advantage (MA) Payment Changes. Beginning in 2011, Medicare Advantage payments are restructured at an increasingly smaller percentage of original Medicare rates. Prior to the restructuring, MA payments were, on average, 13% higher than those for traditional Medicare. Also beginning in 2011, MA plans are prohibited from charging higher cost-sharing than original Medicare for skilled nursing facility care, chemotherapy and kidney dialysis.  In 2012, MA plans with four or five stars on a five star quality rating system are entitled to bonuses. The Centers for Medicare & Medicaid Services has expanded the bonus payment program to include plans with three stars. NOTE: This is good news for MA plans in Arizona!

• Medicare Independence at Home Demonstration. This provision creates a demonstration program to provide high-need Medicare beneficiaries with primary care services in their home.
• Medicare Value-Based Purchasing. Beginning October 1, 2012, Medicare will pay hospitals based on their performance on certain quality measures and will move toward making such payments applicable to skilled nursing facilities, home health agencies and ambulatory surgical centers.
• Reduced Medicare Payments for Hospital Readmissions. Beginning October 1, 2012, Medicare will reduce payments to hospitals for preventable readmissions within 30 days.
• Data Collection to Reduce Health Care Disparities. Effective March 23, 2012, the ACA requires the collection and reporting of certain data on race, ethnicity, sex, primary language, and disability status.

The Affordable Care Act (ACA) included a number of changes to Medicare that are already helping seniors and people with disabilities.  Medicare now covers more preventive services at no cost to the patient, including an annual wellness exam.  Many of these preventive services can identify serious and chronic diseases that would cost Medicare billions of dollars if they go undiagnosed and untreated.

According to a press release from CMS (Centers for Medicare and Medicaid Services):

• 18,907,851 people with Original Medicare, or 55.6 percent of those enrolled in the program, received one or more free preventive services this year, through the end of August.
• During the same time period, 1,295,373 Americans with Original Medicare have taken advantage of the new Annual Wellness Visit, up from 1.06 million through the end of July and 780,000 through mid-June.

 Help with Part D high drug costs:

Because of the Affordable Care Act,  nearly 1.3 million people have received a 50 percent discount on their brand name prescription drugs when they hit the donut hole, saving a total of $660 million so far this year.

For people who hit the coverage gap (known as the “donut hole”):

• 1.28 million have received discounts on brand-name drugs this year through the end of July, up from 899,000 through the end of June and 478,000 through the end of May;
• These discounts have totaled $660 million in savings for seniors and people with disabilities so far this year; up from $462 million through June and $260 million through May;
• Individuals who have received this discount saved an average of $517 so far this year.

For state-by-state information on utilization of free preventive services and the Annual Wellness Visit, please visit http://www.cms.gov/NewMedia/02_preventive.asp

My primary care physician has three employees to handle phone calls, set appointments, and check in patients. Those are the front desk duties of the office staff, but there is much more:  Checking a person’s insurance coverage to determine the patient’s  co-pay;  Contacting insurance companies to get prior approval for tests and referrals;  Resubmitting documentation to insurance companies that won’t pay  a bill until they get one more piece of paper.  The list goes on and on.

I always figured the way the American health care system works, with dozens of insurance companies requiring different paperwork and paying different fees for services rendered, was inefficient.  But now there is a study that shows just how inefficient and expensive our convoluted system is.

A study published in the Health Affairs Journal says that American doctors pay out more than four times as much as Canadian doctors because American doctors must deal with dozens of insurance companies (and Medicare).

The study surveyed physicians and administrators in Ontario, Canada about time spent interacting with payers, and compared the results with a national companion survey in the United States.

The findings: Physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States.

More findings: US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts.

Billions could be saved:

The study found that if US physicians had administrative costs similar to those of doctors in Ontario, the total savings would be approximately $27.6 billion per year.

Americans are told they have to pay more for their care, but I haven’t heard any talk about fixing the payment system for health care that is clearly inefficient and expensive. Why hasn’t this issue been addressed? Have the hundreds of insurance companies, each negotiating prices with doctors, kept health care costs from rising each year? The answer is clearly “no”, and the current system is clearly broken. So, before our government pushes more cost onto seniors and working people, why not fix the system?