Drug companies and doctors (despite the denial) choosing to line their own pockets because bilking insurers (and the government) is a victimless crime:http://www.tampabay.com/news/health/tale-of-two-eye-drugs-plays-out-in-medicares-doctor-reimbursements/2175218"Lucentis and Avastin have been shown equally effective in combating age-related macular degeneration, the leading cause of blindness in the elderly. They share a similar molecular make-up and even the same manufacturer.But the cost per dose is much different: $2,000 versus $50. With a recommended two-year, 24-injection course of treatment, the difference per patient is huge.Ophthalmologists, who buy the drugs and are then reimbursed for them, used the pricier Lucentis often enough to account for about $1 billion in Medicare spending in 2012, according to recently released data from Centers for Medicare and Medicaid Services. Indeed, Lucentis is a key reason ophthalmologists are at the top of the Medicare list.Critics say the way doctors are reimbursed under Medicare — the average cost of the drug, plus 6 percent of the cost — sets up a financial incentive to choose the costlier medication. An Ohio ophthalmologist who has been outspoken on the debate, Dr. J. Gregory Rosenthal, said doctors shouldn't use Lucentis."It has no reason to exist," said Rosenthal. "No medical reason. Of course, it has an economic reason."
The Trustees of the Medicare program have released their annual report on the solvency of the program. They calculate that the program is “expected to remain solvent until 2024, the same as last year’s estimate.” But what that headline obfuscates is that Obamacare’s tax increases and spending cuts are counted towards the program’s alleged “deficit-neutrality,” Medicare is to go bankrupt in 2016. And if you listen to Medicare’s own actuary, Richard Foster, the program’s bankruptcy could come even sooner than that.Here’s how the Centers for Medicare and Medicaid Services summarize the findings, which carry the formal title “2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds” :“[Medicare Hospital Insurance Trust Fund] expenditures have exceeded income annually since 2008 and are projected to continue doing so under current law in all future years. Trust Fund interest earnings and asset redemptions are required to cover the difference. HI assets are projected to cover annual deficits through 2023, with asset depletion in 2024. After asset depletion, if Congress were to take no further action, projected HI Trust Fund revenue would be adequate to cover 87 percent of estimated expenditures in 2024 and 67 percent of projected costs in 2050. In practice, Congress has never allowed a Medicare trust fund to exhaust its assets.The financial projections for Medicare reflect substantial cost savings resulting from the Affordable Care Act, but also show that further action is needed to address the program’s continuing cost growth.The Trustees, by saying that Medicare will go bankrupt in 2024, instead of 2016, are simultaneously saying that the program will increase the deficit by several hundred billion dollars. This is precisely the insight that Charles Blahous, one of the Medicare Trustees, explained in his recent report on the program.Think of it this way: if supporters of the Affordable Care Act came clean, they would say one of two things: (1) Medicare is going bankrupt in 2016, but the CBO scores the ACA as deficit neutral; or (2) Medicare is going bankrupt in 2024, and Blahous’ score of the ACA as increasing the deficit by $300-500 billion is accurate.
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