US Home Care Patients Worry over Possible Cuts.

Since the details of how cuts will be made in Medicare remain unclear patients are bound to worry if the passage of the bill will impact negatively on their care in spite of reassurances from the Obama administration. It is hard to believe that large cuts can be made without impacting the care that is given. Because of this many may think of the bills as not real reforms at all but simply changes that may impact negatively on their own personal care. This is from the NYTimes.


December 5, 2009
Home Care Patients Worry Over Possible Cuts
By ROBERT PEAR
CARIBOU, Me. — Dozing in a big lift chair, propped up by pillows in the living room of her modest home here, Bertha G. Milliard greeted the nurse who had come to check her condition and review the medications she takes for chronic pain, heart failure, stroke and dementia.

Ms. Milliard, 94, said those visits had been highly effective in keeping her out of the hospital. But the home care she receives could be altered under legislation passed by the House and pending on the Senate floor as Congress returned to work this week.

As they are across the nation, Medicare patients and nurses in this town in northern Maine are anxiously following the Congressional debate because its outcome could affect Medicare’s popular home health benefit in a big way. The legislation would reduce Medicare spending on home health services, a lifeline for homebound Medicare beneficiaries, which keeps them out of hospitals and nursing homes.

Under the bills, more than 30 million Americans would gain health coverage. The cost would be offset by new taxes and fees and by cutbacks in Medicare payments to health care providers.

The impact of the legislation on Medicare beneficiaries has been a pervasive theme in the first week of Senate debate, which is scheduled to continue through the weekend.

Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?

Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says.

The House bill would slice $55 billion over 10 years from projected Medicare spending on home health services, while the Senate bill would take $43 billion.

Democratic leaders in the House and Senate justify the proposed cuts in nearly identical terms. “These payment reductions will not adversely affect access to care,” but will bring payments in line with costs, the House Ways and Means Committee said. The Senate Finance Committee said the changes would encourage home care workers to be more productive.

The proposed cuts appear to be at odds with other provisions of the giant health care bills. A major goal of those bills is to reduce the readmission of Medicare patients to hospitals. Medicare patients say that is exactly what home care does.

“It helps me be independent,” said Mildred A. Carkin, 77, of Patten, Me., as a visiting nurse changed the dressing on a gaping wound in her right leg, a complication of knee replacement surgery. “It’s cheaper to care for us at home than to stick us in a nursing home or even a hospital.”

Delmer A. Wilcox, 89, of Caribou, lives alone, is losing his vision, uses a walker and has chronic diseases of the lungs, heart and kidneys. He said his condition would deteriorate quickly without the regular visits he received from Visiting Nurses of Aroostook, a unit of Eastern Maine Home Care.

The Aroostook County home care agency, which lost $190,000 on total revenues of $1.9 million in the year that ended Sept. 30, estimates that it would lose an additional $313,000 in the first year of the House bill and $237,000 under the Senate bill.

The prospect of such cuts has alarmed patients and home care workers. “We would have to consider shrinking the area we serve or discontinuing some services,” said Lisa Harvey-McPherson, who supervises the Aroostook agency as president of Eastern Maine Home Care.

“Our staff are scared,” Ms. Harvey-McPherson said, “but it’s our patients who will pay the price if Congress makes the cuts in home care.”

The four agencies under the umbrella of Eastern Maine Home Care cover a huge geographic area. Its nurses aim to see five patients a day, and they drive an average of 25 miles between patients, traversing potato fields and forests of spruce, birch and maple trees — and a few bear, moose and lynx. In winter, they may need a snowmobile, or even cross-country skis, to reach patients in remote areas.

President Obama has said that the savings in Medicare would be achieved by eliminating “waste and inefficiency” and that “nobody is talking about reducing Medicare benefits.” Moreover, he said, health care providers stand to benefit because they would gain tens of millions of new paying customers.

Home care executives question the arithmetic.

“No family or individual should ever go without health care coverage,” Ms. Harvey-McPherson said, as she drove up to a patient’s home here. “But an increase in the number of people with insurance would not necessarily help our agency because we depend so heavily on caring for seniors, with 80 to 90 percent of our home care revenue coming from Medicare.”

The impact on Medicare is a major concern for Maine’s senators, Susan Collins and Olympia J. Snowe, both Republicans being courted by the White House. Ms. Collins, a longtime champion of home care, has indicated she will resist the proposed cuts.

“Deep cuts to home health care would be completely counterproductive to our efforts to control overall health care costs,” Ms. Collins said. “Home care and hospice have consistently proven to be cost-effective and compassionate alternatives to institutional care.”

Private insurance companies often follow Medicare’s lead. So cuts in home-care payments could also jeopardize home care for privately insured patients like Christopher M. Hayes, a 35-year-old police officer in Presque Isle, Me. His left leg was crushed when he was struck by a car while jogging. He is learning to walk again with the help of a physical therapist.

In trying to slow the growth of Medicare, Democrats in Congress assume that health care providers can increase their productivity at the same pace as the overall economy.

But Saundra Scott-Adams, executive vice president of Eastern Maine Home Care, said: “That’s a joke for home health care. We provide one-on-one care.”

Her doubts are shared by Richard S. Foster, chief actuary of the federal Centers for Medicare and Medicaid Services. Mr. Foster said the health care industry was “very labor-intensive” and could probably not match the productivity gains of the overall economy.

While nurses can monitor some patients with electronic telecommunications devices, they said they still needed to provide hands-on care to many.

Phillip H. Moran, a 65-year-old diabetic in Houlton, Me., lost his right leg several years ago. His kidneys are failing. Without regular visits from a home health nurse, Mr. Moran said, he would be in danger of losing his other leg because of complications from diabetes. As a double amputee, he would be more likely to go into a nursing home.

“The nurses’ visits are really important,” Mr. Moran said. “If they are cut, it could cost people their lives.”

Keeping troops in Iraq for 1.5 years. 800 dollars for very American

The continued tax cuts and cuts in social programs will simply increase the divide between rich and poor in the US. I imagine most Americans would prefer the 800 dollars to be spent on something other than the war in Iraq.


Bush Budget Hikes War Funding
By ANDREW TAYLOR, Associated Press Writer

Friday, February 2, 2007







(02-02) 19:14 PST WASHINGTON, (AP) --


Keeping troops in Iraq for another year and a half will cost nearly a quarter-trillion dollars — about $800 for every man, woman and child in the U.S. — under the budget President Bush will submit to Congress Monday.


Bush will ask for $100 billion more for military and diplomatic operations in Iraq and Afghanistan this year and seek $145 billion for 2008, a senior Pentagon official said Friday. Those requests come on top of about $344 billion spent for Iraq since the 2003 invasion that toppled Saddam Hussein.


At the same time, Bush's budget request will propose cost curbs on Medicare providers, a cap on subsidy payments to wealthier farmers and an increase to $4,600 in the maximum Pell Grant for low-income college students.


Bush's proposal, totaling almost $3 trillion for the budget year starting Oct. 1, will kick off a major debate with the new Democratic-controlled Congress. Democrats are sure to press for more money for domestic programs, and they've signaled they won't consider renewing Bush's tax cuts until closer to 2010, when they are to expire.


The White House plan will produce a surplus in 2012, budget director Rob Portman said Friday — assuming strong growth in tax revenues, continued curbs on domestic agencies' spending and relatively modest cuts to farm programs, Medicare and the Medicaid health care program for the poor and disabled.


Bush's plan assumes Congress extends the two rounds of tax cuts that were passed in 2001 and 2003.


Portman said Bush's budget submission contains about a 1 percentage point cut in the rapid growth in Medicare — which averages almost 8 percent a year without changes — to squeeze about $66 billion in savings over five years from the federal health care program for the elderly.


Bush would curb payments to health care providers such as hospitals, and would require more of the higher-income recipients to pay greater premiums.


"We need to get these unsustainable growth rates under control," Portman said, noting that Congress passed more ambitious cuts in 1997, when President Clinton and a GOP-controlled Congress enacted more than $160 billion in Medicare savings. "This is a good first step."


However, Congress has since given back much of the 1997 savings, particularly cuts in doctors' fees. Smaller cuts proposed last year got nowhere in a Congress controlled by Republicans.


The requests, to be released Monday, would bring war spending for fiscal 2007 to about $170 billion, with the $145 billion for 2008 representing a decline.


The additional request for the current year includes $93.4 billion for the Pentagon and $6 billion for foreign aid and State Department costs — on top of $70 billion approved by Congress in September.


The White House assumes war spending will be down to $50 billion in 2009 with none planned beyond then in hopes the war in Iraq will have wound down.


Bush's recent budgets have been met with skepticism by Democrats, partly because they have left out war costs and expensive changes to the alternative minimum tax, which is hitting an increasing number of middle class taxpayers. The Congressional Budget Office estimates updating the AMT for inflation would cost $93 billion in 2012 alone.


The increase in war spending — up from $120 billion approved by Congress for 2006 — have been prompted by large costs to replace equipment destroyed in combat or worn out in harsh conditions in Iraq and Afghanistan.


The Iraq requests are certain to face scrutiny by the Democrats, who already are debating whether to try to block Bush's request to increase troop levels in Baghdad.


Critics say the Pentagon is also using war-money requests to modernize the armed services with weaponry — such as the next-generation Joint Strike Fighters or the controversial V-22 tilt-rotor aircraft — unlikely to see action in Iraq or Afghanistan. The Pentagon counters that the planes are replacing aircraft that are no longer manufactured.


The additional budget request for Iraq is far below lists assembled by the military branches, which were given a green light last fall by Deputy Defense Secretary Gordon England. He instructed the four services that they could add projects connected to the broader fight against terrorism, though critics said that could be interpreted to cover almost anything.


Those lists were met with resistance in the White House and on Capitol Hill, and the Pentagon pared them back in the request it forwarded to the White House's Office of Management and Budget, which trimmed them further.


In addition to its share of the $245 billion for the wars, the Defense Department will seek $481.4 billion to run the department for 2008 — an 11.3 percent increase over the $432 billion amount approved by Congress for this year, according to a defense official and budget documents.


That total includes about $12 billion to increase the size of the Army and Marine Corps, to meet the growing strains of fighting wars on two fronts, said the Pentagon official, who requested anonymity because the budget has not yet been released.


___


Associated Press writers Kevin Freking and Lolita C. Baldor contributed to this story.