Medicare – Michmutters

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Australia

Female GPs say ‘inadequate’ Medicare rebates, pressure to bulk bill patients adds to emotional burn out

Female GPs say 'inadequate' Medicare rebates, pressure to bulk bill patients adds to emotional burn out

For two years, Sarah McLay has dipped into her personal savings, sacrificed a take-home wage and run her central Queensland medical practice at a loss of “several hundred thousand dollars”.

Regardless of the hours Dr McLay worked or the patients she saw, the numbers did not stack up.

“We were really subsidizing the public’s health care,” Dr McLay said.

“Nothing is ever truly free. Everything costs someone something.”

Most patients probably don’t think about the finances of a medical clinic — and that’s provided you can get into the waiting room in the first place.

Yet financial strain is part of a hidden toll that Dr McLay and other general practitioners say is disproportionately affecting women and adding to skills shortages as burnt-out doctors leave the profession.

A financial and emotional gender disparity has emerged because female GPs tended to see more patients needing longer consultations.

A woman with mid-length brown hair smiles at the camera, she is wearing a stethoscope around her neck.
Dr McLay says Clermont will have no permanent doctor if she was forced to close her clinic.(Supplied)

“Yes, I did medicine because I wanted to help people, but I can’t change the reality that our Medicare rebate is actually completely inadequate to pay our bills,” Dr McLay said.

“I can’t keep sacrificing and suffering because the government doesn’t value what we do.”

Short appointments more lucrative

General practitioners across the board have reported struggling to provide care with Medicare rebates that have not increased with inflation.

Louise Stone, a Canberra GP and medical educator said short consultations received a higher rebate per minute than longer appointments.

Dr Stone said she would “earn four times as much” doing back-to-back vaccination appointments than a 40-minute consult for someone with mental health or chronic physical conditions.

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Categories
US

Here’s what’s in the Inflation Reduction Act, the sweeping health and climate bill passed Sunday

Here's what's in the Inflation Reduction Act, the sweeping health and climate bill passed Sunday

The Senate passed Democrats’ Inflation Reduction Act on a party-line vote Sunday afternoon, delivering the long-awaited centerpiece to President Biden’s agenda.

Democrats rallied behind the $430 billion climate, health care and tax overhaul after Senate Majority Leader Charles Schumer (DN.Y.) reached a last-minute deal with Sen. Joe Manchin (DW.Va.), who had held up previous proposals.

The House is expected to approve the legislation on Friday and send it to Biden’s desk.

Here’s a summary of what’s in the Inflation Reduction Act:

ENVIRONMENT, ENERGY AND CLIMATE

Businesses would get incentives for deployment of lower-carbon and carbon-free energy sources.

  • Tax credits are extended for energy production and investment in technologies including wind, solar and geothermal energies. The investment tax credit also now applies to battery storage and biogas.
  • Tax credits would be created or extended for additional technologies and energy sources including nuclear energy, hydrogen energy coming from clean sources, biofuels and technology that captures carbon from fossil fuel power plants.
  • Many of the incentives also contain bonuses for companies based on how much they pay their workers and offer credits for manufacturing their steel, iron and other components in the US

Consumers and businesses get incentives to make cleaner energy choices.

  • Tax credits are extended for residential clean energy expenses including rooftop solar, heat pumps and small wind energy systems. Consumers can get credits for 30 percent of expenditures through 2032, and the credit phases down after that.
  • Tax credits of up to $7,500 are offered to consumers who buy electric vehicles — but this credit comes with stipulations that may make it difficult for vehicles to actually qualify.
  • A tax credit would be expanded for energy efficiency in commercial buildings.

Some fossil fuel production on public lands would be bolstered.

  • The future of solar and wind on public lands and wind in public waters would be tied to requirements to hold lease sales that open up new oil and gas production.
  • The bill reinstates the results of a recent offshore oil and gas lease sale that was struck down on environmental grounds. The Interior Department would be required to hold at least three more offshore oil and gas lease sales by next October.

New programs boost investment in climate.

  • A new program aims to reduce emissions of the planet-warming gas methane from oil and gas by both providing grants and loans to help companies reign in their emissions and levying fees on producers with excess methane emissions.
  • $27 billion would go to a green bank that would provide more incentives for clean energy technology.

Costs increase for fossil fuel production on public lands.

  • Minimum royalties increase for companies to pay the government for oil and gas they extract on public lands and waters. A royalty is added to the extraction of gas that is later burned off or released as waste instead of sold as fuel.

Communities that face high pollution burdens get relief.

  • $3 billion would go to environmental justice block grants — community-led programs addressing harms from climate change and pollutants, including $20 million for technical assistance at the community level, through fiscal 2026.
  • More than $3 billion is allocated to funds for air pollution monitoring in low-income communities. Nearly half of the funds — $117 million — would specifically go to communities in close proximity to industrial pollutants.
  • An excise tax on imported petroleum and crude oil products to fund the cleanup of industrial disaster sites increases from 9.7 cents to 16.4 cents per barrel. The reinstatement of the tax is projected to raise $11 billion.
  • The bill permanently extends and increases the Black Lung Disability Trust Fund, a tax on coal production to finance claims from workers with the condition. Black lung, caused by long-term exposure to and inhalation of coal dust, is believed to affect at least 10 percent of coal miners with at least 25 years’ experience, according to a 2018 study by the National Institute for Occupational Safety and Health.

— Rachel Frazin and Zack Budryk

HEALTH CARE

Medicare can negotiate lower prices.

The bill would allow Medicare to negotiate prices for some drugs for the first time, a policy Democrats have been trying to enact for years over the fierce objections of the pharmaceutical industry. The provisions save more than $200 billion over 10 years.

  • It would allow Medicare to negotiate lower prices for 10 high-cost drugs beginning in 2026, ramping up to 20 drugs by 2029. There is a steep penalty if a drug company doesn’t come to the table: a tax of up to 95 percent of the sales of the drug. There is also a ceiling that the negotiated price cannot rise above.
  • In a deal with moderates including Sen. Kyrsten Sinema (D-Ariz.), only older drugs are subject to negotiation after a period of nine years for most drugs and 13 years for more complex “biologic” drugs. That means the negotiations are more limited than many Democrats wanted.

Drug costs can be capped but largely only for Medicare.

The bill includes other measures to cap drug costs. The provisions still largely apply only to seniors on Medicare, not the millions of people who get health insurance through their jobs, in part because complex Senate rules limited how expansive the provisions would be.

  • If drug companies raise prices in Medicare faster than the rate of inflation, they must pay rebates back to the government for the difference.
  • Democrats tried to apply this provision to the private market, but the parliamentarian ruled it violated the Senate rules used to bypass a GOP filibuster.
  • In one of the most tangible provisions for patients, the bill caps out-of-pocket drug costs at $2,000 a year for seniors on Medicare, starting in 2025.
  • The bill also caps patients’ insulin costs at $35 a month, but only for seniors on Medicare. Republicans voted against overruling the Senate parliamentarian to extend that protection to patients with private insurance.

People enrolled in ACA plans get an extension on premium assistance.

The measure also builds on the Affordable Care Act (ACA) by extending enhanced financial assistance to help people enrolled in ACA plans afford premiums for three years. The extra help would otherwise have expired at the end of this year, setting up a cliff. The provision expands eligibility to allow more middle-class people to receive premium help and increases the amount of help overall.

—Peter Sullivan

TAXES

Large corporations will pay for climate and health measures within the bill.

The bill introduces new taxes on corporations to pay for its climate and health care measures.

The centerpiece of its tax plan is a 15 percent minimum tax on the income that big corporations report to their shareholders, a tax known as the minimum book tax. Initial proposals put the amount of revenue raised by the book tax at $313 billion — more than 40 percent of the $740 billion raised by the legislation as a whole.

The tax applies to companies reporting $1 billion in annual earnings. It would impact only around 150 large firms, according to the Joint Committee on Taxation.

Sinema demanded some last-minute exclusions to the minimum tax that were favorable to the US manufacturing sector and private equity firms.

  • The tax will exempt companies taking advantage of accelerated depreciation, a popular deduction that helps pay for capital investments such as new equipment.
  • Small businesses that are subsidiaries of highly profitable private equity firms will also be exempted from the minimum tax.

The IRS gets a funding boost.

Another key measure allocates $80 billion to increase enforcement at the IRS. Democrats hope that, with more employees and better technology, the IRS can more closely examine wealthy individuals and ensure they aren’t dodging taxes. That extra revenue is expected to lower the deficit by $203 billion over the next decade.

Stock buybacks will get an additional tax.

The bill enacts a 1 percent excise tax on stock buybacks to replace the revenues lost by appeasing Sinema. Democrats expect the provision to raise $74 million over a decade.

Share repurchases by S&P 500 companies have soared in recent years and are on track to surpass $1 trillion this year. Companies buy back their stock to reward shareholders and increase their stock price by artificially limiting supply.

  • The tax will impact the nation’s largest companies that rely on multibillion-dollar buybacks to raise their stock price, including Apple, Nike and Exxon Mobil.
  • Democrats have criticized the practice, arguing that companies should invest in workers and innovation instead of repurchasing stock.

To further recover revenue lost to the private equity sector, the bill also extends a set of limitations on losses that businesses can deduct from their taxes. The limits prevent wealthy individuals from significantly bringing down or even wiping out their income tax liability. Sen. Mark Warner (D-Va.) said that extending the caps would raise $52 billion.

— Tobias Burns and Karl Evers-Hillstrom

.

Categories
US

Here’s what’s in the Inflation Reduction Act, the sweeping health and climate bill passed Sunday

Here's what's in the Inflation Reduction Act, the sweeping health and climate bill passed Sunday

The Senate passed Democrats’ Inflation Reduction Act on a party-line vote Sunday afternoon, delivering the long-awaited centerpiece to President Biden’s agenda.

Democrats rallied behind the $430 billion climate, health care and tax overhaul after Senate Majority Leader Charles Schumer (DN.Y.) reached a last-minute deal with Sen. Joe Manchin (DW.Va.), who had held up previous proposals.

The House is expected to approve the legislation on Friday and send it to Biden’s desk.

Here’s a summary of what’s in the Inflation Reduction Act:

ENVIRONMENT, ENERGY AND CLIMATE

Businesses would get incentives for deployment of lower-carbon and carbon-free energy sources.

  • Tax credits are extended for energy production and investment in technologies including wind, solar and geothermal energies. The investment tax credit also now applies to battery storage and biogas.
  • Tax credits would be created or extended for additional technologies and energy sources including nuclear energy, hydrogen energy coming from clean sources, biofuels and technology that captures carbon from fossil fuel power plants.
  • Many of the incentives also contain bonuses for companies based on how much they pay their workers and offer credits for manufacturing their steel, iron and other components in the US

Consumers and businesses get incentives to make cleaner energy choices.

  • Tax credits are extended for residential clean energy expenses including rooftop solar, heat pumps and small wind energy systems. Consumers can get credits for 30 percent of expenditures through 2032, and the credit phases down after that.
  • Tax credits of up to $7,500 are offered to consumers who buy electric vehicles — but this credit comes with stipulations that may make it difficult for vehicles to actually qualify.
  • A tax credit would be expanded for energy efficiency in commercial buildings.

Some fossil fuel production on public lands would be bolstered.

  • The future of solar and wind on public lands and wind in public waters would be tied to requirements to hold lease sales that open up new oil and gas production.
  • The bill reinstates the results of a recent offshore oil and gas lease sale that was struck down on environmental grounds. The Interior Department would be required to hold at least three more offshore oil and gas lease sales by next October.

New programs boost investment in climate.

  • A new program aims to reduce emissions of the planet-warming gas methane from oil and gas by both providing grants and loans to help companies reign in their emissions and levying fees on producers with excess methane emissions.
  • $27 billion would go to a green bank that would provide more incentives for clean energy technology.

Costs increase for fossil fuel production on public lands.

  • Minimum royalties increase for companies to pay the government for oil and gas they extract on public lands and waters. A royalty is added to the extraction of gas that is later burned off or released as waste instead of sold as fuel.

Communities that face high pollution burdens get relief.

  • $3 billion would go to environmental justice block grants — community-led programs addressing harms from climate change and pollutants, including $20 million for technical assistance at the community level, through fiscal 2026.
  • More than $3 billion is allocated to funds for air pollution monitoring in low-income communities. Nearly half of the funds — $117 million — would specifically go to communities in close proximity to industrial pollutants.
  • An excise tax on imported petroleum and crude oil products to fund the cleanup of industrial disaster sites increases from 9.7 cents to 16.4 cents per barrel. The reinstatement of the tax is projected to raise $11 billion.
  • The bill permanently extends and increases the Black Lung Disability Trust Fund, a tax on coal production to finance claims from workers with the condition. Black lung, caused by long-term exposure to and inhalation of coal dust, is believed to affect at least 10 percent of coal miners with at least 25 years’ experience, according to a 2018 study by the National Institute for Occupational Safety and Health.

— Rachel Frazin and Zack Budryk

HEALTH CARE

Medicare can negotiate lower prices.

The bill would allow Medicare to negotiate prices for some drugs for the first time, a policy Democrats have been trying to enact for years over the fierce objections of the pharmaceutical industry. The provisions save more than $200 billion over 10 years.

  • It would allow Medicare to negotiate lower prices for 10 high-cost drugs beginning in 2026, ramping up to 20 drugs by 2029. There is a steep penalty if a drug company doesn’t come to the table: a tax of up to 95 percent of the sales of the drug. There is also a ceiling that the negotiated price cannot rise above.
  • In a deal with moderates including Sen. Kyrsten Sinema (D-Ariz.), only older drugs are subject to negotiation after a period of nine years for most drugs and 13 years for more complex “biologic” drugs. That means the negotiations are more limited than many Democrats wanted.

Drug costs can be capped but largely only for Medicare.

The bill includes other measures to cap drug costs. The provisions still largely apply only to seniors on Medicare, not the millions of people who get health insurance through their jobs, in part because complex Senate rules limited how expansive the provisions would be.

  • If drug companies raise prices in Medicare faster than the rate of inflation, they must pay rebates back to the government for the difference.
  • Democrats tried to apply this provision to the private market, but the parliamentarian ruled it violated the Senate rules used to bypass a GOP filibuster.
  • In one of the most tangible provisions for patients, the bill caps out-of-pocket drug costs at $2,000 a year for seniors on Medicare, starting in 2025.
  • The bill also caps patients’ insulin costs at $35 a month, but only for seniors on Medicare. Republicans voted against overruling the Senate parliamentarian to extend that protection to patients with private insurance.

People enrolled in ACA plans get an extension on premium assistance.

The measure also builds on the Affordable Care Act (ACA) by extending enhanced financial assistance to help people enrolled in ACA plans afford premiums for three years. The extra help would otherwise have expired at the end of this year, setting up a cliff. The provision expands eligibility to allow more middle-class people to receive premium help and increases the amount of help overall.

—Peter Sullivan

TAXES

Large corporations will pay for climate and health measures within the bill.

The bill introduces new taxes on corporations to pay for its climate and health care measures.

The centerpiece of its tax plan is a 15 percent minimum tax on the income that big corporations report to their shareholders, a tax known as the minimum book tax. Initial proposals put the amount of revenue raised by the book tax at $313 billion — more than 40 percent of the $740 billion raised by the legislation as a whole.

The tax applies to companies reporting $1 billion in annual earnings. It would impact only around 150 large firms, according to the Joint Committee on Taxation.

Sinema demanded some last-minute exclusions to the minimum tax that were favorable to the US manufacturing sector and private equity firms.

  • The tax will exempt companies taking advantage of accelerated depreciation, a popular deduction that helps pay for capital investments such as new equipment.
  • Small businesses that are subsidiaries of highly profitable private equity firms will also be exempted from the minimum tax.

The IRS gets a funding boost.

Another key measure allocates $80 billion to increase enforcement at the IRS. Democrats hope that, with more employees and better technology, the IRS can more closely examine wealthy individuals and ensure they aren’t dodging taxes. That extra revenue is expected to lower the deficit by $203 billion over the next decade.

Stock buybacks will get an additional tax.

The bill enacts a 1 percent excise tax on stock buybacks to replace the revenues lost by appeasing Sinema. Democrats expect the provision to raise $74 million over a decade.

Share repurchases by S&P 500 companies have soared in recent years and are on track to surpass $1 trillion this year. Companies buy back their stock to reward shareholders and increase their stock price by artificially limiting supply.

  • The tax will impact the nation’s largest companies that rely on multibillion-dollar buybacks to raise their stock price, including Apple, Nike and Exxon Mobil.
  • Democrats have criticized the practice, arguing that companies should invest in workers and innovation instead of repurchasing stock.

To further recover revenue lost to the private equity sector, the bill also extends a set of limitations on losses that businesses can deduct from their taxes. The limits prevent wealthy individuals from significantly bringing down or even wiping out their income tax liability. Sen. Mark Warner (D-Va.) said that extending the caps would raise $52 billion.

— Tobias Burns and Karl Evers-Hillstrom

.

Categories
US

Ron Johnson suggests Medicare, Social Security be approved on an annual basis

Ron Johnson suggests Medicare, Social Security be approved on an annual basis

Sen. Ron Johnson (R-Wis.) said Wednesday that Social Security and Medicare should be up for congressional approval each year, instead of staying under their current status as federal entitlement programs.

“Social Security and Medicare, if you qualify for the entitlement, you just get it no matter what the cost,” Johnson said in an interview that aired Tuesday on “The Regular Joe Show” podcast.

The Wisconsin senator, who is up for reelection in a highly contested race this fall that will help determine which party holds the majority next year, argued that the mandatory spending status of funding for the federal programs should be switched to discretionary spending “so it’s all evaluated.”

“Our problem in this country is that more than 70 percent of our federal budget, of our federal spending, is all mandatory spending. It’s on automatic pilot. It never — you just don’t do proper oversight. You don’t get in there and fix the programs going bankrupt. It’s just on automatic pilot,” Johnson said.

“As long as things are on automatic pilot, we just continue to pile up debt,” he added.

I have argued that funding for the programs should instead come before Congress for annual approval.

A spokesperson for Johnson’s office told The Hill in a statement Wednesday that the senator “never suggested putting Medicare and Social Security on the chopping block.”

“The Senator’s point was that without fiscal discipline and oversight typically found with discretionary spending, Congress has allowed the guaranteed benefits for programs like Social Security and Medicare to be threatened. This must be addressed by Congress taking its responsibilities seriously to ensure that seniors don’t need to question whether the programs they depend on remain solvent,” the spokesperson said.

Social Security benefits are available to US retirees, and Medicare health insurance is available to citizens who are over the age of 65 or disabled. American workers’ taxes fund the programs, with workers paying into the federal programs. In the case of Social Security, benefits are linked in part to one’s earnings, which help determine a monthly payment.

Democrats quickly pounced on Johnson’s remarks, suggesting the majority party thinks they could hurt Johnson in his reelection bid.

Senate Majority Leader Charles Schumer (DN.Y.) said that Johnson’s comments showed that the programs could be cut by Republicans.

“They’re saying the quiet part out loud. MAGA Republicans want to put Social Security and Medicare on the chopping block,” Schumer wrote, referring to the Trump campaign slogan “Make America Great Again.”

Johnson’s spokesperson pushed back against the majority leader, saying in a statement that “Senator Schumer is lying about what Sen. Johnson said.”

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Categories
US

Ron Johnson suggests Medicare, Social Security be approved on an annual basis

Ron Johnson suggests Medicare, Social Security be approved on an annual basis

Sen. Ron Johnson (R-Wis.) said Wednesday that Social Security and Medicare should be up for congressional approval each year, instead of staying under their current status as federal entitlement programs.

“Social Security and Medicare, if you qualify for the entitlement, you just get it no matter what the cost,” Johnson said in an interview that aired Tuesday on “The Regular Joe Show” podcast.

The Wisconsin senator, who is up for reelection in a highly contested race this fall that will help determine which party holds the majority next year, argued that the mandatory spending status of funding for the federal programs should be switched to discretionary spending “so it’s all evaluated.”

“Our problem in this country is that more than 70 percent of our federal budget, of our federal spending, is all mandatory spending. It’s on automatic pilot. It never — you just don’t do proper oversight. You don’t get in there and fix the programs going bankrupt. It’s just on automatic pilot,” Johnson said.

“As long as things are on automatic pilot, we just continue to pile up debt,” he added.

I have argued that funding for the programs should instead come before Congress for annual approval.

A spokesperson for Johnson’s office told The Hill in a statement Wednesday that the senator “never suggested putting Medicare and Social Security on the chopping block.”

“The Senator’s point was that without fiscal discipline and oversight typically found with discretionary spending, Congress has allowed the guaranteed benefits for programs like Social Security and Medicare to be threatened. This must be addressed by Congress taking its responsibilities seriously to ensure that seniors don’t need to question whether the programs they depend on remain solvent,” the spokesperson said.

Social Security benefits are available to US retirees, and Medicare health insurance is available to citizens who are over the age of 65 or disabled. American workers’ taxes fund the programs, with workers paying into the federal programs. In the case of Social Security, benefits are linked in part to one’s earnings, which help determine a monthly payment.

Democrats quickly pounced on Johnson’s remarks, suggesting the majority party thinks they could hurt Johnson in his reelection bid.

Senate Majority Leader Charles Schumer (DN.Y.) said that Johnson’s comments showed that the programs could be cut by Republicans.

“They’re saying the quiet part out loud. MAGA Republicans want to put Social Security and Medicare on the chopping block,” Schumer wrote, referring to the Trump campaign slogan “Make America Great Again.”

Johnson’s spokesperson pushed back against the majority leader, saying in a statement that “Senator Schumer is lying about what Sen. Johnson said.”

.

Categories
US

Biden poised to deliver on decades-long Democratic promise

Biden poised to deliver on decades-long Democratic promise

Democrats have been campaigning for 30 years on promises they’d let Medicare directly negotiate the cost of prescription drugs — and after all that time, they might finally be about to achieve it.

Why it matters: The Senate’s reconciliation bill would only open up negotiations for a small number of drugs, but even that is a threshold Democrats have never before been able to cross. And it opens the door to more aggressive policies in the future.

Flash back: Then-president Bill Clinton proposed direct negotiations between drug companies and the federal government in 1993.

  • Clinton, Al Gore, Barack Obama, Hillary Clinton, Joe Biden — and even Donald Trump — each embraced the idea while in office or as candidates, only to be warned by arguments it would squelch new drug development or limit seniors’ choices.
  • Federal law has prohibited Medicare from directly negotiating how much it will pay for drugs since 2003.

“Finally eliminating the prohibition and empowering the secretary to negotiate is a historic precedent, and is something to protect and strengthen over time,” said Chris Jennings, a health policy advisor to Presidents Clinton and Obama.

Yes but: The version of price negotiations contained in the Senate’s bill is much narrower than most of those ambitious campaign proposals.

  • “A baby step is the way I would describe this,” said Zeke Emanuel, a health policy advisor to former President Obama and chair of the department of medical ethics and health policy at the University of Pennsylvania.
  • “We’re talking about 10 drugs and moving up at the end of the decade to a whopping 20 drugs. And they can get insulin included, how many people are going to be affected unless it is, I think, a big question,” he said.

If negotiations make it into law now, however, future administrations and Congress could expand them and make more drugs subject to negotiations.

  • And despite the limitations built into the measure, the drug industry is still warning that it will have a disastrous impact.

The otherside: The drug industry and its allies have long argued that these sorts of policies — which they say are more like price controls than price negotiations — would weaken the incentives for smaller biotech firms to take the scientific risks required to develop new drugs.

  • The Congressional Budget Office estimated that under Democrats’ plan, the number of drugs introduced to the US market would fall by about 2 over the next decade, and by about 5 over the subsequent decade.

But the industry’s arguments aren’t resonating as much now, with prices still on the rise and the public gripped by broader inflationary fears. Polls show large majorities support giving the government the power to negotiate prices.

  • “In a moment where not just health care costs, but inflation, is the issue of the day, this policy resonates like never before.” Jennings said.

The bottom line: “We only pass things in a hurry when there’s a war, major economic upheaval, a once-in-a-century pandemic,” Emanuel said. “There’s only so long that when 90% of voters, Democrat and Republican, say we want price negotiation, that Congress can stand in the way… this shows you that at some point, that ends.”

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