Florida Health Insurance News
"The Budget & Health Insurance"
Flexible - But Not on Health Care
March 2009 -- In his televised news conference, President Obama said, "that he was willing to be flexible on negotiating with Congress on the budget for the 2010 fiscal year, but that he would stand firmly by his commitment to 'health care reform.'" It sets off the question of what he and others mean by that term.
Here is a brief explanation of what he’s probably referring to.
As a horizontal economist lying in a hospital bed, I, like most patients, tend to think of health care as a caring human activity in which I repose my trust.
As a vertical economist, however, I naturally think of health care as just another economic sector with the following distinct facets:
- a demand side (by which I mean patients or their agents, private and public health insurers, who procure health care and pay for that care)
- a supply side (the providers of health care and of health care products)
- a health-insurance system, intended to protect individuals and households from excessive financial loss due to medical bills, and also to help patients procure health care at negotiated prices
- an information infrastructure supporting and linking patients, insurers and providers of care with one another, and
- a regulatory infrastructure intended to keep transactions in this market honorable, fair to both sides, and oriented toward the ultimate social goals of a health system.
Ambitious as he is, the president would like to reform all of these facets of the health sector.
First, on the demand side, he would like to move the United States closer to the almost-century-old goal of attaining universal health-insurance coverage. The idea is to endow with adequate purchasing power the rapidly growing number of low-income Americans who cannot afford to pay for health care of a satisfactory quality.
On the demand side, the president would like to reform the manner by which we pay the providers of health care. The general idea is to align payments with actual “performance” through what is now known as “pay-for-performance” or simply P4P. Ideally such a system would be based on so-called “bundled payments” for an entire medical case treated in accordance with evidence-based clinical practice guidelines.
Although an old idea, it has eluded implementation so far, because it is horrendously difficult to achieve in practice.
The ultimate objective of this demand-side policy, however, is to goad the supply side through financial incentives into delivering genuinely clinically integrated health care, in place of the traditionally fragmented care they now deliver. It would require a major realignment of professional and economic power on the supply side.
Third, on the health insurance facet, the president would like to develop a well-functioning market for individually purchased health insurance, as an alternative to the employment-based system which covers most insured non-elderly Americans.
There now is such a market, but it covers only a small fraction of non-elderly Americans, primarily because it is highly fragmented and, moreover, in most states pegs the individual’s insurance premiums to that individual’s health status. To reform this market, the president would establish a National Insurance Exchange.
This can be thought of as the analogue to a farmers’ market on which competing insurers offer their products, subject to a set of regulations that make transactions in the market transparent and honorable, and the competition among insurers fair.
A major contentious issue here is whether the insurers competing in this market should include a newly established public insurance plan like Medicare, but for the non-elderly.
Fourth, on the information facet supporting both sides of the market, the president and Congress jointly already have earmarked close to $50 billion for the development of an electronic health-information infrastructure.
That infrastructure would contain an electronic medical record, through which clinicians anywhere in the health system can have access to an individual patient’s medical record, intended to safeguards of the patient’s right to privacy.
Over the longer run, there would also be a so-called personal electronic health record that links individual patients electronically to their medical record and to their primary care physicians.
Such an information infrastructure would make available, to patients and other users, information on the quality of health care rendered by individual providers of health care — e.g., hospitals and physicians. This access would facilitate better cost- and quality-control emanating from the demand side of the system.
It would also disseminate information from what should be called “cost-effectiveness analysis,” but, as was discussed in earlier posts, has been constrained to be mere “comparative effectiveness analysis” (see this and this for more on this subject).
Finally, to make all of these pieces work harmoniously together — toward the social goals of improving the health status of Americans by providing all of them with access to timely care, and of protecting their budgets from undue inroads of medical bills — there would have to be a whole set of additional government regulations, mainly on the health insurance industry.
About Deceptive Health Insurance
U.S. Senator Jay Rockefeller, chairman of the Senate Committee on Commerce, Science & Transportation, held a committee hearing this week on “Deceptive Health Insurance Industry Practices-- Are Consumers Getting What They Paid For?”
The hearing examined how the health insurance industry reimburses consumers for health care services. There was focus on the way the industry calculates “usual, customary and reasonable” reimbursement rates for consumers who choose to receive care from out-of-network doctors and other health care providers.
A recent investigation by the New York Attorney General concluded that the insurance industry has systematically under-estimated the out-of-network reimbursement rates it pays policy holders, costing consumers billions of dollars. The victims of this deceptive practice are more than 100 million Americans who pay for health insurance coverage that allows them to go outside of their provider network for medical care.
“The health insurance industry has been promising to pay a certain share of consumers’ medical bills, but then they have been rigging health charge data to avoid paying their fair share,” Rockefeller said. “The result is that billions of dollars in health care costs have been unfairly shifted to millions of American consumers.”
In written testimony, Dr. Mary Jerome, a cancer patient, shared her personal experience with unfair practices and fees.
“When I was diagnosed with cancer, I thought the most difficult hurdle I would face would be the disease,” she said. “Little did I know, that dealing with my insurance company would be my greater battle, because unknown to me, they were operating with deceptive methods of reimbursement. I had to battle cancer -- and I am still battling it -- and I had to battle my insurance company to try and get fair coverage. It was almost too much to bear.”
“Nationwide, medical costs are the leading cause of individual bankruptcy, even though the individual usually had insurance,” testified Linda Lacewell, representing the New York Attorney General’s Office. “Fraudulent under-reimbursement for insured Americans is one part of this negative equation for consumers.”
Representing the Consumers Union, Chuck Bell explained that for the last ten years, the primary databases that are used by insurers to determine “usual, customary and reasonable” rates have been owned by Ingenix, a wholly-owned subsidiary of United Health Group.
Dr. Nancy Nielsen, president of the American Medical Association, was joined by several other parties in bringing a class-action lawsuit against United Health Group for using skewed data to determine payment rates.
“After nearly a decade of litigation, the AMA is pleased that United Health Group recognized the importance of restoring its relationship with patients and physicians and is settling the AMA’s lawsuit by agreeing to pay $350 million toward reimbursing the patients and physicians it short-changed, and by confirming in federal court its separate agreement with New York Attorney General Cuomo to end the use of this database and trust its repair and operation to a not-for-profit institution,” Dr. Nielsen testified.
Should We Have Mandatory Health Insurance?
The Obama administration’s pledge to reform health care has set in motion one of the most important debates affecting small businesses in recent memory. Next to tax reform, the cost of health care and health insurance ranks highest on surveys of small business owners’ concerns.
As the debate unfolds in the coming months, small business owners will need to get up to speed on the current system’s problems. A recent hearing before the House Committee on Energy and Commerce’s subcommittee on Health provided some eye-opening testimony on the current system’s problems and why mandatory, universal health insurance should be a cornerstone of reform efforts.
"Insurance, in its simplest form, works by pooling risks: many pay a premium up front, and then those who face a bad outcome (getting sick, being in a car accident, having their home burn down) get paid out of those collected premiums," explained Katherine Baicker, a professor of health economics at Harvard’s School of Public Health.
"Uncertainty about when we may fall sick and need more health care is the reason that we purchase insurance, not just because health care is expensive," Baicker explained. "It is impossible to ‘insure’ against an adverse event that has already happened, for there is no longer any uncertainty. Try purchasing insurance to cover your recent destruction of your neighbor’s Porsche; the premium will be the cost of a new Porsche. You wouldn’t need car insurance, you’d need a car."
The same logic explains why insurance companies attempt to weed out or deny coverage to those who are already sick, or have so-called pre-existing conditions. "The reality of the health insurance market is that a carrier’s success depends on its ability to minimize its risk. This means that each company is better off if it only insures people who will not need medical care. This provides incentives to cherry-pick healthy people, and limit the number of unhealthy people covered," Mila Kofman, Maine’s superintendent of insurance, told the committee.
"Since an estimated 20 percent of people account for 80 percent of health care spending, avoiding even a small number of high-cost individuals can substantially reduce an insurer’s losses," Kofman noted. "While the desire of insurance companies to reduce risk is rational from a free market perspective, it creates a market which many Americans cannot access. No one competes to insure sick people."
Insurance works because not everyone will fall sick at the same time, so it is possible to make payments to those who do fall sick even though their care costs more than their premium, by tapping the pooled insurance premiums. Thus, the system is undermined by the uninsured, both healthy and unhealthy.
For uninsured or under-insured individuals who are sick, uncertainty is no longer a factor. They need health care -- not health insurance -- but lack the money to pay for it, because they lose the benefit of tapping a pool of insurance premiums.
By the same token, when healthy individuals choose to go uninsured, the model breaks down as well, because they are limiting the pool of reserves available for those who are sick. If they wait until they are sick to get insurance, they defeat the purpose of insurance, too. That’s why Massachusetts, one of the states leading health care reform efforts, requires universal participation in its health program.
Today, two years after enacting sweeping health care reform, 97.4 percent of Massachusetts’ residents have health insurance coverage, compared with 85 percent on average nationally, said Jon Kingsdale, executive director of the state’s Commonwealth Health Insurance Connector Authority.
"As a result, financial barriers to obtaining care have fallen markedly, Kingsdale said. In 2007, the first full year of reform, the number of people in Massachusetts who deferred needed health care because of high costs declined to between one-half and one-third of the national average. "And it is reasonable to expect that financial barriers continued to decline in the second year of reform, as the number of newly enrolled continued to grow," he added.
Although it’s been widely reported that 47 million Americans have no health coverage, millions more are underinsured, defined as families that have out-of-pocket medical spending amounting to 10 percent or more of their income. According to one study by the Commonwealth Fund, 25 million adults who had health coverage were underinsured in 2007, a 60 percent increase from the 15.6 million Americans who were underinsured in 2003. In short they are living on the precipice, one serious medical emergency away from financial disaster.
Indeed, nearly half of all bankruptcies in the United States are related, at least in part, to health care expenses. And, of those facing medical bankruptcies, roughly three-quarters had health insurance at the onset of their bankrupting illness, according to Judy Feder, senior fellow at the Center for American Progress Action Fund, a Washington, D.C.-based think tank.
Seven out of 10 respondents in a recent survey of borrowers in foreclosure reported unmanageable medical bills as an underlying cause of their foreclosure, or had experienced other medical disruptions to their income, such as lost work due to illness or using home equity to pay medical bills, Feder said.
Under the current system, the widespread lack of adequate health coverage is estimated to cost our economy $60 billion to $130 billion annually. One way or another, taxpayers pick up that cost, whether it’s through tax write-offs by hospitals for unreimbursed care, federal programs like Medicaid, or through the worst possible outcome -- medical related bankruptcies and foreclosures
That’s why reform needs to begin with mandatory, universal health insurance coverage, ideally offered through private carriers with some sort of government safety net. It’s critical to getting a handle on both direct and indirect health care costs and bringing the level of care up to the standards of other developed nations.
Democrats Want Health Care
Efforts to overhaul the health care system have moved ahead rapidly, with the insurance industry making several major concessions and the chairmen of five Congressional committees reaching a consensus on the main ingredients of legislation.
Gov. Kathleen Sebelius on Tuesday at her Senate hearing on confirmation as secretary of health and human services.
The chairmen, all Democrats, agree that everyone must carry insurance and that employers should be required to help pay for it. They also agree that the government should offer a public health insurance plan as an alternative to private insurance.
But members of Congress are just now turning to the most explosive issues, which could delay or derail the process.
They have yet to tackle the question of how to pay for coverage of the uninsured.
They have not wrestled with vehement Republican objections to the idea of a new government-run insurance plan, competing directly with private insurers.
And they have not figured out the role of state insurance regulators, who enforce hundreds of state laws mandating coverage of a myriad of items, including infertility treatments, prostate cancer screening and acupuncture.
“There’s too much happy talk,” said Senator John D. Rockefeller IV, Democrat of West Virginia. “It’s time to start thrashing out decisions on the tough issues.”
The White House, displaying a surprisingly light touch, has encouraged Democrats in Congress to make the hard decisions while the administration holds forums around the country to hear suggestions from ordinary citizens.
Congressional leaders have set an ambitious timetable, under which the House and the Senate would vote on separate bills by the end of July. Senator Edward M. Kennedy, Democrat of Massachusetts, has kept the heat on negotiators.
President Obama’s pick for secretary of health and human services, Gov. Kathleen Sebelius of Kansas, told senators at a hearing on Tuesday that “health reform would be my mission” if the Senate confirmed her nomination. Ms. Sebelius backed Mr. Obama’s call for giving Americans the option of a government health plan as an alternative to private coverage — “a public option, side by side with private insurers,” she said.
Nancy-Ann DeParle, director of the White House Office for Health Reform, who is on Capitol Hill almost every day, said, “In my view, there’s been a steady progression toward getting a health care reform bill done this year, as the president has urged and requested.”
Asked if she had recommended any specific policy options to Congress, Ms. DeParle said, “That has not come up yet.”
Since last fall, Senate Democrats have been meeting regularly with consumer advocates and lobbyists for the health care, insurance and pharmaceutical industries. The talks have narrowed the differences.
In November, two weeks after the presidential election, the health insurance industry said it would accept all applicants, regardless of illness or disability, if Congress required everyone to have coverage. The industry went a step further last week, offering to end the practice of charging higher premiums to sick people in the individual insurance market.
But each point of agreement raises a host of questions. The government cannot require people to have insurance if they cannot afford it, so lawmakers must decide: Who would get subsidies? How much? And if the government subsidizes insurance, should it also prescribe the items and services that must be covered — the specific benefits or their overall value?
Leading the effort on Capitol Hill are the five committee chairmen, Representatives George Miller and Henry A. Waxman of California and Charles B. Rangel of New York, Senator Max Baucus of Montana and Mr. Kennedy.
The serious negotiations are being conducted in a secretive process that looks a little like the one that President Bill Clinton and the first lady, Hillary Rodham Clinton, used to devise their ill-fated plan for universal health insurance in 1993.
To be sure, the players are different this year. Congress, rather than the White House, has taken the lead in drafting a proposal to reorder one-sixth of the nation’s economy. Ms. DeParle, the White House official, said: “My job is to work with members of Congress. They are the ones doing the hard work. We are providing technical assistance. We help them with the nuts and bolts.”
And whereas the Clintons attacked special interests and excluded them from policy-making deliberations, Kennedy aides have welcomed them to twice-weekly meetings of stakeholders, known as the “workhorse group.”
Still, including the lobbyists in the negotiations does not guarantee that they will support whatever emerges. “The lobbyists talk more gently,” Mr. Rockefeller said, “but could be just as lethal to health care reform as they were 15 years ago.”
Mr. Baucus, the chairman of the Senate Finance Committee, periodically summons senators to his office for meetings of the “board of directors,” a group of six Democrats and five Republicans mulling ways to steer health legislation through the Senate.
Democrats insist that consumers should have a choice between private insurance and a government health plan. Private insurers will hold down costs and improve care if they have to compete with a public plan, said the House Democratic leader, Representative Steny H. Hoyer of Maryland.
But Republicans say a government plan would have unfair advantages and could drive private insurers from the market.
Lobbyists and Congressional aides have discussed a possible compromise: Congress would authorize a new government-run insurance program, but it would come into existence only if certain conditions were met — if, for example, private insurers failed to rein in health costs by a certain amount after several years. Such a condition would serve as a strong incentive for insurers to ratchet down payments to doctors and hospitals.
Representative Roy Blunt of Missouri, the chairman of a 21-member group that is shaping health policy for House Republicans, said he saw the Medicare prescription drug benefit as a model, “a good pattern of how a competitive marketplace works.”
The drug benefit is delivered entirely by private insurers under contract with the federal government, which supervises their activities. Costs have been far lower than originally expected.
The 2003 Medicare law allowed the government to establish a prescription drug plan in any geographic area with fewer than two private plans. But insurers, seeing a lucrative business opportunity, rushed into the market, and the government never had to establish a plan of its own.
The cost of universal coverage is likely to be one of the most difficult issues. Democrats readily concede that their proposals will be expensive.
In his budget, Mr. Obama showed he was serious when he asked Congress to set aside more than $600 billion as a down payment on efforts to remake the health care system over the next 10 years, partly by limiting the income tax deductions that the most affluent taxpayers claim.
Neither the House nor the Senate has accepted Mr. Obama’s specific proposals. Both chambers are expected to vote later this week on spending plans that would allow Congress to move forward on health legislation, provided it does not increase the deficit.
The leading Democratic proposals would not only subsidize the purchase of private insurance, but also expand Medicaid, to cover more poor people, and Medicare, to eliminate a two-year waiting period for people with severe disabilities.
The White House and Democrats in Congress are operating on two optimistic assumptions.
One is that if everyone had health insurance, it would be easier to control health costs.
The other premise is that the nation could sharply reduce the growth of health care spending if doctors made less use of aggressive treatments that raise costs but do not result in better outcomes.
But no combination of tax increases and Medicare savings comes near to covering the full cost of the proposals, which Democrats say could easily top $1 trillion over 10 years.
Questions About Health Insurance
President Barack Obama has launched a drive to overhaul the healthcare system, an undertaking most Americans believe is needed but are unsure about how to accomplish.
Congress is beginning work on legislation that leaders in the Senate and House hope to send to Obama by the end of the year.
Kansas Governor Kathleen Sebelius, if she is confirmed as health and human services secretary, will be tasked with ushering the measure through Congress and keeping various groups behind comprehensive legislation.
WHAT'S THE PROBLEM?
Americans spend more on healthcare than any other country, yet some 46 million lack health insurance. The cost of care and insurance has been rising rapidly, hurting businesses that provide health coverage to their workers. Most workers get healthcare coverage through their employers. When workers lose their jobs, many also lose health insurance. Government programs for the elderly and poor fill in some of the gaps, but not all.
WHO IS FOR THE OVERHAUL?
Business, consumer and health industry groups and lawmakers agree the current system is not working for many Americans and needs to be fixed. They agree costs are too high and too many people are left with inadequate or no coverage. But beyond that basic agreement lie some deep differences that Obama will have to bridge if he is to succeed where others have failed.
WHAT DO BUSINESSES WANT?
Most large employers and many small businesses offer healthcare coverage to their workers. For workers, this is the most cost-effective way to receive coverage even if they have to pay some or all of the cost, because insurance is cheaper when the risk is shared among a pool of people. Self-employed people and others seeking insurance in the individual market pay the highest costs because they are not part of a risk-sharing pool. Reducing cost is businesses' primary goal.
WHAT DO CONSUMERS WANT?
Affordable, effective healthcare that does not disappear when one becomes seriously ill or loses a job. Medical bills can pile up fast and lead to bankruptcy.
WHAT'S IN IT FOR INSURERS?
A consensus is emerging on requiring everyone to obtain health insurance, a mandate that would bring insurers millions of new clients. But how such a mandate would work remains to be settled - whether it would be through an individual mandate, a requirement of employers to provide workers coverage or, more likely, a mixture of both.
Such a mandate would involve government subsidies to help low-income people afford insurance. The insurance industry has offered to end the practice of charging higher premiums for the sick and excluding pre-existing conditions from coverage in exchange for the mandate.
Insurers also oppose creating a new a government-run plan that would compete with them for business. Republicans also oppose a government plan, arguing it would drive private insurers out of business. Democrats back the idea, arguing it would ensure competition in the health insurance market.
WHAT ABOUT HOSPITALS AND DOCTORS
Hospitals want an overhaul that results in fewer uninsured people arriving at their doors and also promotes health and wellness programs instead of just treating sickness.
A shortage of primary care doctors is a major concern and they are seeking more money for training. Primary care doctors could benefit from proposals that would improve their compensation for overseeing the care of patients.
The goal is to reward doctors for good outcomes, rather than pay for individual procedures and treatments that can lead to repeated hospitalizations and higher costs.
The American Medical Association also wants insurers to be more open about how they set reimbursement rates for treatments, arguing that some payments are artificially low.
WHAT'S IN IT FOR DRUG AND MEDICAL DEVICE INDUSTRIES
Covering every American means more people can afford prescription drugs and treatments and thus increase demand. But the overhaul will aim to lower the cost of those drugs and treatments. Measures promoting the use of generic drugs and requiring more information about the effectiveness of various treatments could affect these industries.
WHERE ARE THE BIGGEST BATTLE GROUNDS?
Obama has called for a bipartisan effort on the healthcare overhaul, but he is keeping open an option of fast-tracking the legislation through a budget process called reconciliation. Such a move would enrage Republicans who would be limited in their ability to insist on changes to any legislation.
Big partisan battles can be expected over how much government programs will be involved.
Democrats and their liberal allies want a government plan to be part of the mix of insurance options available to consumers to lower the cost of coverage.
Insurers, Republicans and conservatives oppose the idea, arguing it would be the first step toward a complete government takeover of the health industry.
A number of Republicans also oppose gathering and providing more information on the effectiveness of treatments. They argue it would eventually lead to rationing of care.
Health Care Reform Is Vital
WASHINGTON --- Reform of the U.S. healthcare system is vital this year because of growing costs and worsening care, the Health and Human Services Department said in a report on Monday.
The HHS report, published at www.healthreform.gov, compiles findings of dozens of studies that have been used to justify calls for a complete overhaul of the healthcare system.
While the need for change is not controversial, conservatives and liberals differ on how that should be approached. President Barack Obama has said he wants legislation this year but is leaving the details up to Congress to work out.
"Today's report outlines the high cost of waiting to fix a system that has left too many Americans without the affordable, quality care they deserve," HHS spokeswoman Jenny Backus said in a statement.
The report points out that the United States spent $2.2 trillion on healthcare in 2007, or $7,421 per capita. Healthcare accounts for more than 16 percent of gross domestic product, nearly twice the average of other developed nations.
Healthcare costs doubled from 1996 to 2006, and are projected to rise to 25 percent of GDP in 2025; 49 percent by 2082 if something does not change.
"Employer-sponsored health insurance premiums have more than doubled in the last nine years," the report reads. "As a result of these crushing health care costs, American businesses are losing their ability to compete in the global marketplace."
More than 160 million Americans get health insurance through employers. "Health care at General Motors puts the company at a $5 billion disadvantage against Toyota (7203.T), which spends $1,400 less on health care per vehicle," the report added -- quoting former General Motors Corp's (GM.N) chief executive officer Rick Wagoner. [ID:nSP207882]
"In spite of the vast resources invested, the health care system has not yet reached the goal of high-quality care," the report said.
"Across 37 performance indicators, the United States achieved an overall score of 65 out of a possible 100," it said, citing the non-profit Commonwealth Foundation. The Obama administration has relied heavily on such reports in setting its healthcare strategy.
Is Health Insurance Plan Too Expensive?
President Obama says we can’t afford not to pass health care reform, even as our economy faces its biggest challenges in decades.
Mr. Obama argues that American companies are at a competitive disadvantage because of high health costs. But health costs wouldn’t vanish under his plan; they would just get switched to another ledger through higher taxes.
The president is working with congressional leaders to write legislation that would require companies to provide a rich health benefits package. The entire plan is expected to cost at least $1.5 trillion over the next decade. This is far too much to be taking on in this economy.
To pay for this and many other changes to our health sector, the White House has set aside $634 billion as a “down payment” on health reform. But even this is difficult for Congress to swallow because it involves increasing taxes on mortgage interest deductions and charitable contributions for affluent taxpayers and cutting Medicare Advantage programs that serve lower-income seniors.
You’ve heard the naysayers complaining that President Barack Obama’s $634 billion down payment on health care reform costs too much. We’re in a global economic crisis, they say. How can we afford it?
Their argument for leaving our health care system broken doesn’t compute. By looking at costs but not benefits, they pretend not to know what the advantage of health care reform really is — and why it’s a major benefit to us all.
Health care costs have been rising by 6 percent each year; families now spend on average nearly $13,000 per year for their insurance.
This staggering increase in cost hurts businesses as well as families. The majority of Americans get insurance through their job — but now, because fewer businesses can afford to offer the benefit, they’re canceling it or passing the cost on to their employees. It’s simply unacceptable that access to medical care is dependent on having a job. No one is safe in a bad economy. The question isn’t can we afford to reform health care right now, but can we afford not to?
A Health Plan for All
As policy makers in Congress and elsewhere debate the nation’s health insurance options, especially for the nearly 50 million uninsured in our country, it appears that the main argument against Medicare-like coverage is that private insurers would be unable to compete with government on costs, and might be driven from the market.
Isn’t that like saying we should not strive for a peaceful planet because it would be bad for the armaments industry? Am I missing something?
Private health insurance companies complain that they can’t compete against a government-run insurance plan. The response to this objection is obvious.
The private insurers will have to find a way to deliver the same or better quality care to all patients (no cherry-picking allowed), for a fee that is the same or less than what the government can offer. If they can do this, they will be able to stay in the market. If they can’t, it’s time for them to fold their tents and leave.
What is at issue here is not how to support private health insurance companies. The issue is how to best provide quality, affordable health care for all.
Your article lists possible alternatives, none of which appear to be satisfactory.
One option that has not yet been discussed is a model based on the familiar rate-setting process followed in most states for setting the rates that public utilities, insurers and nursing homes may charge. State regulatory agencies’ rate-setting powers are limited by law to assure the provider a fair return.
A plan for universal health coverage could allow the government to use its bargaining power to lower costs of health care, limited by standards that would allow the providers of care, medicines and equipment a fair return and require them to charge private insurers the same prices that the government pays. The result should be universal coverage, control of costs, fair compensation to providers and competition between private insurers and the government.
Whatever the outcome of efforts to negotiate our way toward an improved health system, changes that avoid restructuring the way it’s financed and delivered will fall woefully short of addressing its skyrocketing costs and ever-widening inequities in access to care. Enacting a national single-payer system would be best, and it’s also inevitable, but in the short run, we may be headed toward more ill-fated, incremental tweaks to the current patchwork mess.
That said, of all the recommendations on the table, the proposal we should be least willing to give up is the creation of a federal, Medicare-like alternative to private insurance.
A public insurance alternative that’s available to everyone offers a tiny ray of hope, but not if it’s hamstrung to look and behave like insurers in the private sector — think failures of Medicare Advantage.
We must own up to the shell game of cost-shifting inherent in a multitiered, multipayer system. Otherwise, significant reform will continue to elude us.
As a physician in private practice for 35 years, I do not fear a public plan as part of health care reform. I would welcome it.
Medicare and private insurance fees are the same: most private insurers base their fees on those paid by Medicare. But it is much more difficult to collect these fees from private insurance companies than from Medicare.
The H.M.O.’s require that I submit and resubmit claims several times. And then they even have the chutzpah to offer a lower payment soon, rather than their contractually agreed-upon payment sometime in the future. I prefer Medicare, which mostly pays promptly and with far fewer hassles for me and my staff.
It would be just as wrong for the government to compete with private insurers to provide health insurance as it would be for the government to compete with G.M. or Ford to build taxpayer-subsidized “public automobiles.”
The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve.
Re:: “Insurers Offer to Soften a Key Rate-Setting Policy” (Business Day, March 25): Before we give insurance companies a pat on the back for their promise to stop basing premium rates on the insured’s medical history if Congress passes a plan requiring all Americans to carry insurance, let’s make sure this is really a meaningful concession.
A true change in practice requires that insurers offer a policy to everyone regardless of medical history. And it’s not enough to just “phase out the practice of varying premiums based on health status,” as the presidents of the major industry trade groups wrote to Congress.
Most individuals with pre-existing conditions can’t get any policy for any amount of money. Rates aren’t even a factor. And group insurance rates are not set based on medical history at all.
So all the insurers are agreeing to do is to use age, gender, geography and other criteria instead of illness for the individuals whom they are willing to insure, meaning healthy people without pre-existing conditions.
Those of us with pre-existing conditions need coverage and fair rates, not one or the other. If Congress can get the insurers to agree to that, we’ll have meaningful reform.
Health Care Increases With Prevention
As the economy falters, working Americans pay the price, with some losing their health insurance benefits when employers look to cut costs, and when they lose their jobs. It's time for us to fix the health care system so it works for all Americans and ensure that it can stand the test of an economy in recession.
Doctors see the repercussions the failing health care system has on the uninsured. Despite the fact that nearly 70 percent of physicians provide charity care, most uninsured patients don't have regular access to the preventive care they need to lead healthier lives.
Many serious health problems are preventable, and if we can help Americans live healthier, we can reduce disease and decrease health care spending in the long run.
The American Medical Association is working toward national health care reform that ensures a choice of affordable health insurance for all Americans, whether they get health insurance on their own or through an employer.
Nancy Nielsen, president, American Medical Association, Washington
AMA talks about insure while their own doctors charge ridiculous amounts. I had a doctor look at my back I pretty much knew the diagnosis but I wanted to be sure (torn muscle). He saw me for a mere 5-7 minutes moved my leg a bit and agree with what I had said. It cost me $300+ (emergency I have to pay my deductible-which I never hit since I rarely need doctors), for nothing but him and 2 400mg IBprofin. When the costs wer broken down his part was $196.00 for the few minutes he saw me. There was nothing else to examine as their were no x-rays of anything else.
So maybe the AMA should question why at the above rate the doctor would be paid $1200/hr before they start pointing fingers at the insurance companies.
BTW I think they are all out of control, but I in no way want national care. I just learned from my experience don't ever go to the emergency room until you are bleeding out serveral orifaces.
Health Care Needed for the Working Poor
Uninsured patients and hospitals in Missouri got a double dose of bad news last week.
The House rejected a creative proposal to expand health coverage to 35,000 people. And a new report showed hospitals and communities are straining to care for uninsured patients.
The state’s severe cuts in Medicaid eligibility in 2005 coincided with noticeable increases in patients who showed up at hospitals with no way of paying, according to a report commissioned by the Missouri Foundation for Health in St. Louis.
Using data from 152 of the state’s hospitals, researchers showed that uncollectible bills — known as bad debt — increased from less than $700 million in 2005 to nearly $1 billion in 2007.
Hospitals coped with the debt in various ways. They wrote off expenses as charity care, increased rates for insured patients, pleaded for help from communities and searched for federal reimbursement.
“While the overall changes … may have saved the state monies, those savings have either been passed on to the commercial market in increased charges or have been absorbed by (hospitals) through increases in charity care and/or bad debts,” the report states.
The report helps explain why hospitals in Missouri have offered to pay the state an extra $52.5 million a year to expand Medicaid coverage. With that money, Missouri would qualify for an additional $93 million in federal funds for health care.
An agreement between Gov. Jay Nixon and the Missouri Hospital Association depends on the General Assembly increasing Medicaid eligibility limits to 50 percent of the poverty level.
Current eligibility stops with adults who earn more than 20 percent of the poverty level. That amounts to $4,410 a year for a family of four, a shockingly low threshold.
The proposal would ease the health care burden for families, hospitals and communities. People could seek treatment earlier and for less cost. Hospitals would be less inclined to increase rates for insured customers.
In other words, everyone wins. But the package went nowhere when the House passed its budget proposal last week.
Some members were concerned about expanding Medicaid eligibility without assurances that the aid from hospitals would be ongoing in future years, House Speaker Ron Richard said.
That’s a valid concern the Hospital Association should address.
But other House members simply object to the state paying for expanded health care.
Last week, in a debate about children’s health insurance, Rep. Rob Schaaf made the reprehensible comment that forcing taxpayers to help provide health policies for other people amounted to “slavery.”
Unfortunately, Schaaf, a Republican physician from St. Joseph, is chairman of the House’s Healthcare Transformation Committee, and in a position to kill other legislators’ proposals.
The good news is that the Missouri Senate appears receptive to expanding health coverage to more citizens.
“Coverage has been an issue that the Senate’s been interested in for four or five years,” said Senate President Pro Tem Charlie Shields, a Republican from St. Joseph.
The Senate is expected in coming days to debate both Nixon’s agreement with the Hospital Association and a separate proposal to make state funding available to help the working poor purchase private insurance policies.
With thousands of Missourians unemployed and dealing with dwindling incomes, legislative leaders must make a renewed effort to work with Nixon and approve a plan to expand access to medical care.
The Missouri Hospital Association has made an offer that lawmakers really can’t afford to refuse. It’s incredible that the House has done so. The Senate must undo the damage
Overhauling The Health System
The Obama administration and House leadership are reported to have resolved to accomplish health care reform by September even if it takes use of a Senate process that requires only 51 votes rather than the usual 60. The Democrats have 58 votes. If health care reform is enacted in this way it will not be subject to the normal Republican/Democratic debate and compromise.
What this “health care reform” would mean, if it succeeds, is that 47 million uninsured Americans will finally be covered. But from what I’ve learned in my posts in a congressional fellowship, health forums and Washington think tanks, it does not mean any serious action to decrease the cost of health care. The annual expense to taxpayers will be at least $110 billion, a cost that will grow at nearly twice the rate of the economy, like the rest of health care.
The uninsured must be covered. However, the absence of a workable plan to manage cost should be a major cause for concern. According to Dr. Amy Finkelstein, Professor of Economics at MIT, when Medicare was enacted, U.S. hospital spending rose 37 percent within 4 years, the result of a hospital building boom financed by newly insured seniors.
Here are a couple of facts:
• • According to Thomas Saving, a Medicare trustee, in 2006 Medicare accounted for 11 percent of our income tax payments; by 2030 the figure will be 34 percent.
• • According to Medicare’s trustees, the program’s hospital benefit will begin taking in 20 percent less than it pays out by 2019 — it will be insolvent without a tax increase.
No matter whether the uninsured are covered by public or private programs, it will be with tax money. Without serious steps to decrease health care spending such a plan will accelerate the day of a health care financial meltdown that could emulate the banking crisis.
The new guard in Washington is underestimating the magnitude of the task of health care transformation and the ability of the federal government to engineer it. Sound bites substitute for reality. A perfect example is the assurance that billions of dollars in federally funded health information technology will decrease health care cost. Most physicians who have studied the matter think that the result will be the opposite — putting information technology into a health care system where providers are paid for the volume of their services, not its quality or efficiency, will be like installing a computer in the home of a 90-year-old.
Here are the realities that should guide health care transformation:
• • Doctors and hospitals are paid by the quantity of services they deliver, not the results of those services — that is, providers are paid more the sicker you get.
• • Americans have only a 50 percent chance of receiving appropriate care when they go to the doctor — the result of a payment system that dictates assembly-line medicine.
• • Because they are paid for volume, doctors and hospitals provide enough unnecessary services to fund the uninsured 7 times over. At least one-third of health care spending is waste.
• • Ten percent of people account for 70 percent of health care spending; they have chronic illnesses such as heart disease, cancer and lung failure.
• • The average Medicare patient sees seven doctors who can have no idea what the others are doing, leading to poor outcomes and high cost.
These facts have common-sense implications. The only way that we will decrease the cost of health care and also improve quality is to implement a three-fold plan, one that will require re-engineering what happens inside clinics and hospitals and create a new business model.
High-cost patients must anchor themselves to one doctor of their choice who manages their conditions and is their first point of contact with the health care system. Providers must be paid for the quality and results of the services they provide, not just their quantity. And we must establish, measure and report benchmarks of quality in medical practice.
It will be left up to the states to accomplish transformation of their own health care. There are remarkable differences in the cost and quality of health care among the states that are not related to their demographics but to the habits of practice of their doctors. For example, in 2000-2001 the cost of care of a Medicare patient in Texas was $8,000 but was $5,000 in Utah, the difference being the number of interventions, not the prices. Yet Utah ranked near the top on measures of quality and Texas was tied for bottom.
Texans should begin planning right now how they will reconfigure their health care to withstand a cost tsunami that could easily dismantle state and federally funded health care programs and no less threaten the ability of Texas’ small businesses to fund health care.
Health Insurers Pull a fast one
The industry says it will treat all people fairly in return for a government requirement that everyone has to buy their product. But they want to charge different prices for different levels of coverage
It might have looked as if real progress toward healthcare reform was made last week when leading insurers proposed ending their long-standing practice of charging higher rates to sick people and denying coverage to those with chronic conditions.
But not so fast. A closer look at the insurance industry's plan reveals a potentially huge loophole that could short-circuit genuine reform. The insurers are saying that they'll treat all people fairly in return for a government requirement that everyone buy their product.
Yet if you read the fine print in their plan, it turns out that they're reserving the right to charge different prices for different levels of coverage -- a practice that would effectively keep us where we are, with sick (or potentially sick) people paying more for insurance.
Q:: Are private health insurers the best to achieve universal coverage?
A:: Yes. They already know what they're doing. -- Maybe, if they're forced to keep prices down. No. Their track record speaks for itself.
The loophole was included -- "hidden" is a more apt word -- in a letter sent to prominent senators from a pair of industry leaders: Karen Ignagni, president of America's Health Plans, an industry group; and Scott P. Serota, president of the Blue Cross Blue Shield Assn.
The letter featured insurers' willingness to adopt a more inclusive coverage policy in return for "an effective, enforceable requirement that all Americans assume responsibility to obtain and maintain health insurance."
In other words, a government mandate that everyone become the industry's customers.
That's not quite as self-serving as it sounds. Universal coverage is feasible only if the insurance risk is spread among the entire population, thus making coverage affordable
for everyone. A government mandate will probably be part of any healthcare reform solution.
But Ignagni and Serota go on to say, almost in passing, that "benefit design" will be needed to keep policies affordable.
That's insurance-speak for offering bare-bones coverage at relatively low prices and more complete coverage at higher prices -- basically the same sort of system we have now.
"We're telegraphing that if people are allowed to buy more, then it will cost more," Ignagni told me. "You wouldn't charge the same for a Cadillac as you would for a Ford."
The danger, however, is that younger, healthier people would probably gravitate toward the cheaper basic policies, while older people with more health issues would feel compelled to buy the more comprehensive plans.
"It's a very potent way of segregating sick people from healthy people," said Karen Pollitz, a research professor at Georgetown University's Health Policy Institute. "It's essentially a way of continuing to charge more based on people's health."
Which is exactly what the insurers are saying they won't do in return for that much-desired government mandate.
I'll give the insurance industry credit for coming to the table with something halfway constructive, even if it took them decades to get there. But let's be realistic.
If all Americans were required to purchase health insurance from private companies, the industry would still offer as little coverage as possible for the most amount of money. These people have businesses to run, after all, and their track record speaks for itself.
A mandate would benefit the industry, and it could help address the shameful problem of nearly 46 million people in this country now lacking health insurance.
But it wouldn't guarantee the best possible coverage for the public. Nor would it improve things for the millions of people who have insurance but are still one catastrophic illness away from bankruptcy.
To solve these problems, we'd need clear criteria from the government as to what should be covered and at what prices. And if we're going that far, I have to wonder why private insurers even need to be part of the equation.
President Obama has said he's interested in the idea of the federal government offering some sort of public insurance program that would compete with private insurers.
But in an online town hall Thursday, he said he favors keeping the employer-based system that has provided coverage for most Americans since World War II. "I don't think the best way to fix our healthcare system is to scrap what everybody is accustomed to," he said.
The president should take a closer look at the insurance landscape. More than half of all Americans are already covered by -- and thus accustomed to -- public coverage in the form of Medicare, Medicaid and veterans assistance.
We're already well down the road toward fairly priced universal coverage. We just need to make it the rest of the way.
If private insurers want to be part of that process, they'll need to be a good deal less disingenuous than they were last week.
Retiree Care to Rise
Deflation? It hasn't shown up yet in retiree medical costs.
In a new study, Fidelity Investments estimates a couple retiring this year can expect to shell out a combined $240,000 on average for health care over their remaining lives. The study assumes both spouses are 65, the husband will live 17 more years and the wife 20 years, and that neither spouse qualifies for employer-provided health coverage but both qualify for Medicare.
The 2009 figure is up 6.7 percent from an estimate of $225,000 in health costs for people retiring last year.
According to the study, health care is likely to be the largest expense in retirement for most people. Of note, Fidelity's estimate excludes over-the-counter medications, most dental services and long-term care.
Fidelity recommends saving specifically for health needs and seeking preventative care to lessen long-term costs. Retirees should also check medical bills for accuracy, consider supplemental health insurance and research providers.
Unfunded Medicare costs - that means costs the Federal govt has agreed to pay but doesn't have any money set aside for - amounts to over $34 TRILLION right now. (source- IOUSA.com)
Should have never been something that the govt provided. No way we can pay it....never was. The promise was only good for votes.
Now everyone can understand why BO and the Dems want to nationalize health care. Since they know that there's no way to pay for the health care, they need to control it all so they can make determinations as to what (and whom?) is going to be treated. Who lives and dies will be in the hands of the govt....if they're allowed to continue down the path they have started.
Don't believe it? Didn't believe that the govt would tell GM who could be their CEO either I imagine.
Bloomberg & Obama on Health Care
During his visit to Washington, D.C., on Tuesday, New York City Mayor Michael R. Bloomberg reinforced his support for President Obama’s comprehensive national health care reform, and urged both Republican and Democratic mayors to support this initiative and work toward finalizing the plan in 2009.
He also urged federal government to draw from New York City’s health reform experience, and to address increasing health care costs and the growing number of people without health insurance.
On Wednesday, the Mayor reviewed New York City’s health reform initiatives to promote wellness, disease prevention and improved patient care at the Ryan-NENA Community Health Center in Manhattan. He also highlighted NYC’s efforts in increasing accountability and transparency of the health care providers and investing in innovative technologies.
“President Obama has identified critical nonpartisan principles that should guide any health care reform package and I support his push to enact comprehensive health care reform this year,” said Mayor Bloomberg. “Our challenge is to keep Congress at the table until they come up with a workable solution—and commit to not walking away when the going gets tough,” he continued.
“We need to ensure that federal reform strengthens and meets the needs of immigrants. At the same time, we will continue to advance our innovative efforts here in New York City to reduce smoking, encourage healthy food choices, and invest in health information technology,” further noted the Mayor. “We’ve heard a lot about how government has to step in when a company is ‘too big to fail.’ This push for health care reform is too important to fail. It’s too important to our cities. It’s too important to our nation. It’s a challenge we can’t flinch from—and it’s an opportunity we must seize,” he added.
George Gresham, president of 1199 SEIU United Healthcare Workers East, voiced his support by stating: “We are proud to stand with Mayor Bloomberg today to support President Obama’s health care reform agenda. The President's reform agenda will help over 2 million uninsured New Yorkers gain health care coverage. During this economic crisis, it is more important than ever that we protect working families who have lost their jobs and benefits by providing them with access to quality healthcare.”
Take Care New York initiative was implemented in 2004 to promote public wellness and disease prevention. Through its identification of action-oriented goals to aid NYC residents in improving their health, the program reported surpassing its 2008 targets in colon cancer screening, primary health care access, tobacco smoking, and intimate partner homicide as early as 2007.
“New York City is a leader in developing innovative, pragmatic programs which help to tackle some of our most complicated urban challenges like poverty, improving access to primary care physicians, and expanding healthy food choices,” said Deputy Mayor for Health and Human Services Linda I. Gibbs. “But we need our federal partners to enact comprehensive healthcare reform to address the growing numbers of uninsured and underinsured New Yorkers and to bolster our safety net.”
New York City also invested in the nation’s largest primary care electronic health record (HER) community network, by providing prevention-focused EHRs to over 1,100 doctors who treat over 1 million patients in low-income communities. President Obama has included over $20 billion for EHRs in the federal stimulus funding, since national estimates show that only less than 2 percent of hospitals currently use comprehensive EHRs. These records enable doctors efficient access to information regarding patient vaccinations, screenings and other preventative disease controls, as well as enable them to track success rates in preventative measures across their patient populations.
“New Yorkers are living longer, healthier lives today because New York City invested in programs that reduce preventable illness and death,” said Health Commissioner Dr. Thomas Frieden. “By creating a comprehensive public health and health care policy, and promoting electronic health records for primary care physicians, we are focusing on what works and saving lives.”
As part of the public hospital system’s transparency initiative, the New York City Health and Hospitals Corporation (HHC) has voluntarily reported health and safety outcomes, such as infection and mortality rates across its participating hospitals on the City’s website (www.nyc.gov/hhc).
The 2008 data showed that HHC’s mortality rate decreased by 13 percent since 2003, and continued to be below the national benchmark despite an increase in the acuity of patient cases. Its infection rates in the intensive care units across 11 participating hospitals have decreased for 3 consecutive years, with a 90 percent decrease in ventilator-associated pneumonia infections and a 65 percent decrease in the central line bloodstream infections. The decline in infection rates represents over 1,000 prevented infections prevented and approximately $16 million saved in healthcare costs.
“Greater access, more transparency, robust primary and preventive care, wide-scale use of electronic health records, and more effective chronic disease management are all priorities of the Obama administration reform agenda,” said HHC President Alan D. Aviles. “They also have been the hallmark of our transformed New York City public hospital system.”
The William F. Ryan Community Health Network was also established to provide access to affordable primary and preventive health care across New York City’s medically underserved communities. Approximately 85 percent of patients who benefit from this program fall below 200 percent of the federally defined poverty level.
“No other city has put public health at the forefront like New York City has, and we are proud to work with Mayor Bloomberg and his administration to expand the availability of quality and affordable healthcare to those who need it,” said president and CEO of the William F. Ryan Community Health Network Barbra E. Minch. “The Ryan Network’s guiding principle is that health care is a right, not a privilege—and what we are seeing today is a renewed commitment by our local and national leaders to help fulfill those goals for all New Yorkers.”
A recent poll from CBS News found that the tightening economy is forcing people to make some tough choices. Alarmingly, these kinds of decisions are spilling over into an area where they don't belong -- health care. More than one in three Americans is delaying care. Around 30 percent are skipping screenings, tests, and other treatments. And 27 percent aren't filling their prescriptions.
In the most advanced and wealthiest nation on earth, people should never have to make these kinds of choices with their health. It's as clear a sign as any that our current healthcare system is overdue for an overhaul -- and I've spent over 30 years analyzing opinion polls.
But fixing our broken healthcare system presents a huge challenge -- one that can't be solved through partisan politics. If it could, we'd have fixed the problem long ago.
The simple fact is neither side has the complete answer. As a centrist committed to nonpartisan solutions, I'd like to offer some middle-of-the-road approaches that bare serious consideration.
First, we need a renewed emphasis on disease prevention. Promoting wellness and healthy lifestyles is a lot cheaper than paying for someone's hospital care. Prevention campaigns, like those spearheaded by Mayor Bloomberg in New York, will pay huge dividends in the future for everyone.
The obesity epidemic, for example, is ravaging the nation -- the Centers for Disease Control estimate more than one-third of all adult Americans are obese. Obesity drives up healthcare spending and costs untold billions of dollars in lost productivity.
Fighting obesity, particularly in children, will, in the long run, reduce healthcare costs and strengthen our economy. But it will require a joint public-private approach just like the successful efforts to reduce and curb smoking.
Public and private partnerships shouldn't end there. While most Americans agree that the eventual goal of healthcare reform should be universal coverage -- that is, health insurance for all -- there is more than one way to get there. The political right generally opposes completely government-run health care, and the left distrusts the private sector to get the job done by itself.
But a public-private partnership, similar to the very successful and lauded healthcare systems in the Netherlands and Switzerland, may strike the right balance between privately-organized but publicly-guaranteed health insurance.
Our government already has effective programs in place to identify and enroll the 12 million Americans currently without any health insurance yet eligible for Medicaid and the State Children's Health Insurance Program. But only privately-run insurance plans have the experience, ability, and impetus to push the healthcare system forward to innovate and adapt. Indeed, the insurance industry is ideally positioned to address the uninsured crisis.
Government can also create new pooling mechanisms to extend health insurance to the self-employed, small businesses and the poor, and private health plans should compete for the business of those groups, working to generate both affordability and expanded access.
Government alone can't solve these problems. Nor can private industry. But working together, we can find the right innovation and infrastructure to effectively reform the system. From a renewed emphasis on prevention, early detection, and intervention to expanding the public safety net that will catch the neediest members of our society.
The healthcare crisis is not some incurable disease. It can be treated -- jointly -- with the best of private industry and the best of public programs.
Single-payer System -- A Good Start
The delivery and financing of healthcare is complicated business, and we don’t claim to know definitively what system would be best for the greatest number of Americans. What we do know is that the system we have doesn’t work, that costs are rising far faster than incomes, that it makes no sense to burden private business with having to provide care for the workforce and that a for-profit insurance model encourages the denial of treatment.
Without question, we’d like to see a swift shift to a national healthcare system that eliminates the profit motive, cuts out the money-sucking middlemen and allows businesses to focus on what they do and frees them from the crushing burden of financing medical care.
But we’re not the ones who have to sell the idea to an electorate that shudders at the mention of “socialism” and to elected officials who are terrified of those voters, or dodge the stones and arrows of the Rush Limbaughs of the world and stand up to the powerful medical, insurance and pharmaceutical lobbies that help finance campaigns.
That job belongs to President Barack Obama, who is in the process of rolling out a basic framework for national healthcare reform. Sadly, political realities make it imprudent to propose a seismic shift in the way healthcare is delivered and paid for, but from the sound of it, he’s taking baby steps in the right direction.
Obama wants to make medical care accessible to the roughly 46 million Americans who have no insurance. Yes, that’s 46 million people — 15 percent of the U.S. population — who can’t get basic and preventive care and must rely on expensive emergency-room care. He suggests financing the plan through a variety of means: reducing the value of itemized tax deductions for the nation’s top earners and ending George W. Bush’s tax cuts for the rich, and forcing private Medi-Cal providers to compete for the government’s business.
That last idea gives us hope that Obama won’t shrink from the insurance lobby.
If the insurance companies fight back, Obama has got to get tough — really tough — and use his considerable rhetorical skills to give the public some straight talk about the role of private insurance in the healthcare system. In other words, he needs to do what Michael Moore has tried to do but doesn’t have the gravitas or public popularity to effectively pull off. Conservatives love to say the doctors and patients should retain the ability to make decisions about medical care, but they don’t have that ability now; pointy-headed insurance-company paper jockeys do, and their masters are company shareholders.
We’re not so naïve to think that once private insurance is removed from the system, all will be hunky dory in Healthcare Land. Conventional wisdom has it that what’s driven up the overall cost of healthcare so dramatically is progress in medical technologies and treatments—high-tech equipment and designer drugs.
Even a single-payer, government-run system free of marketing expenses and outrageous executive salaries would have to contain costs so that taxpayers are reasonably charged, and, frankly, we’re not sure how to do that without some kind of tiered system in which people with money pay more for care that’s considered a luxury rather than essential and basic. And who decides what is essential care and what is not?
A writer for the blog Stubborn Facts not long ago used costly ACL surgery and the cholesterol-lowering drug Lipitor as examples of new-ish care that might not be essential. Like everything in this arena, that’s debatable.
In any case, we’re frustrated by claims that the country can’t afford a national healthcare system. It’s not like we’re not paying dearly for the broken private system we have now—the one in which the rich get excellent care, the shrinking middle class gets increasingly inadequate care and too many people get none at all, increasing the long-term cost for the rest of us.
For the long run, why not just convene a team of three healthcare economists to determine how much it would take to provide every American with preventive and essential care and come up with an equitable way to spread the cost among the taxpayers? Would that be so hard?
Meantime, we applaud the president for standing up to the status-quo crowd.
Illinois -- One Step Closer to Health Insurance
The record number of people who've lost their employer-sponsored health insurance, forced into the private market where they struggle to get the care they need -- received good news last night, they are one step closer to having a new law on their side. Legislation establishing stronger consumer protections in the private health insurance market passed the Illinois House Health Care Availability and Access Committee.
The Health Insurance Consumer Protection Act (House Bill 3923), introduced by State Representative Greg Harris (D-Chicago), addresses key barriers facing consumers who struggle with unfair and inconsistent industry practices. The legislation is being heavily opposed by the health insurance industry.
"Unfair practices in the insurance industry have put up a wall between people and their health care," said Bob Gallo, AARP Illinois State Director. "AARP commends Representative Harris for his leadership on this critical issue."
The Individual Health Insurance Fairness Act would:
-- Require insurance companies to spend at least 75% of premium dollars
on medical care rather than on executives' salaries, marketing, and
-- Establish an Office of Consumer Health Insurance to conduct external
independent reviews of denied claims and rate increases.
-- Simplify the complicated application process for both individual and
small group markets by creating a standard application, making it easier
for them to get coverage.
"The insurance industry is working hard to defeat this bill and keep the people of Illinois from the insurance reforms they deserve," added Gallo. "Getting this legislation signed into law is AARP's top priority and we urge the State House to pass it."
Nationally, nearly 4 million people have lost their health care since the recession began, while roughly 17 million purchase their own coverage. In the private market, an average annual premium for a family of four has risen to nearly $5,500, while an individual premium costs $2,500 in Illinois. A recent AARP study found that adults aged 50-64 spend roughly 10% of their income on health coverage, and paying three times as much as their peers with employer-sponsored coverage.
Considering Government Healthcare Reform
There is a need of an urgent and comprehensive health care reform in the United States of America and a number of organizations like the National Small Business Association (NSBA) have been vibrant proponents of this concept. Now it’s the turn of a panel of experts which is also giving voice to the same demand. What is the consideration of this group therefore?
According to the group, it’s high time for the government to initiate precise efforts to overhaul the U.S. healthcare system and only that can lead to the inclusion of essential maneuvers that provide better access to good food and recreation. It has also been concluded by the panelists in the report commissioned by the nonprofit Robert Wood Johnson Foundation that there is the need of innovative thoughts. Take for instance, the concept of providing requisite medicines and food to the sick people is normal and this also leads to the calculation of costs. But the panelists consider that it is more important to give people in schools and cities better access to nutritious food and places to exercise.
Speaking on this, Jim Marks, head of the foundation’s health group, which funds projects and research aimed at improving healthcare made it clear, “It’s clear that as a nation we have tried to spend our way to better health through medical care, and it hasn’t succeeded.”
What has been the government’s response? Well, both of Congress and White House, according to latest information, are taking stock of the reality and are therefore gearing up to refurbish healthcare delivery and insurance coverage. It is to be noted that the US President Barack Obama has made providing health insurance to the 46 million Americans without it a cornerstone of his plan, seeking a 10-year, $634 billion reserve fund as a “down payment” for the effort.
It has also been learnt that Congress is planning related legislation and has adopted steps to insure some children and boost electronic medical records.
HHS Health Care Report
Americans expressed serious concerns regarding health care in a new report released today by the Department of Health and Human Services. The report, Americans Speak on Health Reform: Report on Health Care Community Discussions, summarizes comments from the thousands of Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform health care.
The report is available on a new Web site dedicated to health reform: www.healthreform.gov. Unveiled today, the Web site will allow Americans to view today’s White House Health Forum, share their thoughts about health reform with the Obama Administration and sign a statement in support of President Obama’s commitment to enacting comprehensive health reform this year.
What Do You Think About Health Insurance?
What do you think? Do we have a right as Americans to have access to affordable health care or is it only for the wealthy and employed. Let's start with the basics. You may be vaguely aware that your tax dollars support health care for the disadvantaged, its called Medicaid. Your tax dollars also support Medicare, health care for the elderly and disabled. The health care system is beginning to split at the seams, I'll explain.
If you are in the vast majority of Americans you are not independently wealthy and probably have employer subsidized health care. Even if you can afford insurance without employer help, chances are the cost cuts deeply into your vacation fund every year. As your employer helps you with health insurance, your taxes help pay for Medicare and Medicaid. Unfortunately, the entire system is out of balance. An insurance pool, which is any group of people or things (homes, cars) insured for any reason, must have balanced risk.
What the heck does that mean?
It means an insurance pool (health insurance in this case) must have enough healthy people paying into the fund to pay for the sicker people using the insurance resources. In this model we share the risk equally. Right now this is not how it works in America. Private insurers ( the one you have at work) only want the healthy people. You may have noticed how hard it is to get private insurance if you have a pre-existing condition and don't have current insurance. Remember the sicker group of people that use the resources? The are mostly on Medicare if they are over 65, under 65 they are on Medicaid if they qualify.
Florida had to adjust its budget (place more money in Medicaid than planned) to qualify for the most Federal Stimulus possible. Should we not be funding Medicaid according to a standard? A Federal standard perhaps?
Is this any way to run a Health Care System? While we consider ourselves unique here in America, there is nothing unique about our health care system. It is poorly distributed and costs all of us too much money and gives us too little health care often too late. There are many models across the first world countries( not just Canada and Britain) that do a great job of caring for people, paying the health care providers what they are worth and cost less than our system.
Hmmm...... what is up with America?
Do you believe that your neighbor's child should die from cancer because his father lost his job? Should a young couple, both with jobs, have to take a loan to pay for the birth of their child? What will happen to you when you need care that your insurance won't cover and you can not afford? I think it is time we had a discussion with ourselves about how we should treat each other as Americans.
Need To Fix Health Care Now
During his first official conference with the heads of other major industrialized nations, Barack Obama is dealing with questions about America’s responsibility in the economic crisis currently gripping the world. Whether fair or not, delegates are pointing a collective finger in the direction of the newest delegate to the G20 union.
As always, the self-controlled Obama emphasized the need to move forward and look for solutions, rather than looking back to place blame. In the end, he explained that responsibility must be shared by all.
One problem the rest of these countries have long managed that we have yet to confront is health care. The rest provide their citizens with low-cost health care, while medical debt is responsible for roughly half the bankruptcies in the United States. Health care is right up there with unemployment and global warming as primary issues that must be addressed in order to solve our overall problems.
Some people fear that dealing with so many things at once will lead to failure in one or more areas. Obama counters by explaining that American families must deal with multiple problems at once, so why should the country be any different? But conservatives remain adamantly opposed to handing over more control to the government in this most personal service.
The argument is reminiscent of John McCain’s campaign claim that the problems of uninsured people and the high cost of medical services can be corrected by "market forces." Republicans ignore the fact that "market forces" caused the mess in the first place. They argue that depending on government to solve the problem will put medical decisions in the hands of bureaucrats, while we suffer from the current practice of allowing insurance company executives to deny medical care to people who need it, while receiving fat bonuses for performing that odious task.
Whenever McCain sounded the warning about government employees making "decisions" about our health care, I remembered that he's received government-administered medical care every day of his life. I never heard him mention the terrible experience he's had in the delivery of poor medical care or being denied necessary care as a result of any decision made by a government employee. He seems to be in excellent shape for a man of his age who was so badly injured during his North Vietnamese internment and has survived multiple cancers. I always wondered how McCain could say we'll receive care that is worse than the government program he seems to have benefitted from so well.
McCain wanted insurance to be portable between jobs but never mentioned how people would pay for coverage during time gaps between jobs. He wanted insurance companies to sell policies across state lines, which would threaten the control states now exercise over companies that do business within their borders and lead to more abuses than already exist.
Lastly, McCain wanted to segregate sick people into a "pool" so that healthy people wouldn’t help pay the cost of medical services for people who actually need them. He ignored the fact that such a practice would raise the already high cost of coverage for people who can least afford to pay for it. As a spokesman for the conservative point of view, John McCain’s plan for health care "reform" was "business as usual."
Progressives have Governor Howard Dean, a medical doctor who’s been fighting for true health-care reform throughout his political career. In the video below, Dr. Dean explains why all Americans must be provided with real choices for affordable health care immediately.
Obama Health Care - (Republican View)
The president’s opening offer of healthcare at a teaser rate fails to deliver what we actually need, value, and can afford.
The release by the Obama administration of its initial budget “outline” reinforced its strong commitment to step on the health spending accelerator, notwithstanding some rhetorical cover suggesting purported cost savings within its roadmap for universal coverage. Any selective application of the budgetary brakes would only maneuver around some tight political corners, because the overall goal is to re-allocate any “savings” to spend more and more, with Washington in the driver’s seat.
To be sure, the impact of annual budget documents, as first submitted, tends to be exaggerated. The president’s budget primarily provides a political marker suggesting the policy paths for future action. Even when such budgets profess to lay out master plans for vast sums of public funds flowing out over the next ten years, their transitory shelf-life reminds one of Dallas Cowboys running back Duane Thomas’s description of his first Super Bowl in 1970: “if [it’s]the ultimate game, how come they’re playing it again next year?”
Once one blows away the political smoke, there remains little evidence in the budget of a serious commitment to deliver more substantial and lasting savings.In any case, President Obama’s preliminary budget framework would make the healthcare sector that some critics claim is already too “unaffordable” even more so.
The soft numbers presented in the budget amounted to $634 billion over ten years, tucked within a reserve fund that serves as a “down payment” for comprehensive health reform more likely to cost at least twice as much. This initial tranche of subprime financing at a teaser rate would come predominantly from the usual suspects—reimbursement cuts imposed on focus group–tested targets (drug companies and private insurers) and higher taxes on the $250,000-plus income club.
Once one blows away the political smoke, there remains little evidence in the budget of a serious commitment to deliver more substantial and lasting savings. Proposals for overhauling inefficiencies in the care delivery system, sensitizing the privately insured to value trade-offs, and reacquainting senior beneficiaries with the full costs of their Medicare entitlements remain either illusory, underdeveloped, or discarded in this initial Obama budget.
One should not be surprised. The healthcare portion of this budget is largely an extension of broader bait-and-switch tactics, for which the primary objective is to quickly lock in long-term structural changes in who controls healthcare choices. Left to less-urgent “out years” will be worries about how to renege on the too-generous terms of offers of universal coverage, comprehensive benefits, and lower list prices.
The short, postcard version of Obama’s health reform pitch to the public represents a faith-based initiative that straddles the line between audacity and mendacity: Insurance coverage for everyone; more choices that include keeping what you already have; choices that will cost less but offer better benefits because “someone else” will pay more; reductions only in waste; and new wellness interventions that will make us all healthier anyway.
Assuming that last year’s presidential campaign rhetoric tries to engage the reality of legislative enactment and administrative implementation, the president’s health plan will rely on five new tools and structures:
A national health insurance exchange would facilitate centralized regulation of insurance offers and purchase—purportedly to reduce administrative costs and provide a broader menu of choices, but ultimately to crowd out competitive variation and meaningful choice within private insurance.
The exchange would include a new public plan option, the favored choice within the exchange menu to serve as a halfway house to Medicaid-for-all coverage much further down a political road.
Additional expansion of public program insurance coverage would build on the loosening of income-based eligibility limits for Medicaid and the State Children’s Health Insurance Program (SCHIP) in the recent stimulus package and on the crippling of private plan options in Medicare.
Mandates to ensure health coverage would start with employers but eventually move to all individuals, at least until affordability and enforcement hurdles become too visible and insurmountable.
Launching of more aggressive comparative effectiveness research would provide pseudo-scientific cover for the ensuing budgetary need to restrict coverage and limit reimbursements for higher-cost benefits, treatments, and products.
The short version of Obama’s health reform pitch to the public represents a faith-based initiative that straddles the line between audacity and mendacity.Beyond this sketchy framework, the president appears to be ready to subcontract most of the operational details behind this plan to the Democratic leadership and committee chairmen on Capitol Hill.
However, the clock is ticking as this latest window for political opportunism will narrow after this year. Although fiscal price tags seemed to matter little just months ago, ongoing difficulties in stimulating a stagnant economy may soon overload our political willingness to double down on bets on change we cannot quite believe in. At that point, we might begin to re-open the health policy debate to consider what we actually need, what we value, what we can afford, and the limits of what we can do through politics as usual.
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