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MANDATE MINUS PRICE CONTROLS MAY INCREASE HEALTHCARE COSTS By Noam N. Levey and James Oliphant Los Angeles Times September 24, 2009
In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years. The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive." But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector. As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman "I just don't think the support would be there for that kind of a change." Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
But even the insurance industry's leading representative in Washington acknowledged that those reforms may not slow the rising cost of premiums soon. "You can't restrain premiums unless you restrain medical costs," said Karen Ignagni, president of America's Health Insurance Plans, on the industry's view of the problem. "So far, members of Congress have been allergic to that."
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HOW DOES THE QUALITY OF U.S. HEALTH CARE COMPARE INTERNATIONALLY? By Elizabeth Docteur and Robert A. Berenson Urban Institute August 2009
While the evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the "U.S. health care is the best in the world." In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional. Instead, the picture that emerges from the information available on technical quality and related aspects of health system performance is a mixed bag, with the United States doing relatively well in some areas -such as cancer care- and less well in others -such as mortality from conditions amenable to prevention and treatment. Many Americans would be surprised by the findings from studies showing that U.S. health care is not clearly superior to that received by Canadians, and that in some respects Canadian care has been shown to be of higher quality.
Like other countries, the United States has been found to have both strengths and weaknesses in terms of the quality of care available, and the quality of care the population receives. The main ways in which the United States differs from other developed countries are in the very high costs of its health care and the share of its population that is uninsured.
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EMPLOYEES FACE BIG HIKE IN HEALTH-CARE COSTS By Steve Vogel The Washington Post September 30, 2009
Employees enrolled in the Federal Employees Health Benefits Program will pay an average 8.8% more in health-care costs, according to figures released by the Office of Personnel Management. Blue Cross Blue Shield rates will increase 15% for self-only coverage and 12 percent for family coverage, the company said. Enrollees will have to pay more thanks to a wider range of benefits and the company's wide network of providers, said Jena Estes, vice president of Blue Cross Blue Shield's federal employee program.
"We have a very strong commitment to managing the costs and managing that trend. You'll see a real strong focus on coordinating the care and managing the total care," Estes said. "This is an enormous increase that erodes federal employees' standard of living," Colleen M. Kelley, president of the National Treasury Employees Union, said in a statement. The American Federation of Government Employees expressed "grave concern" at the news. "FEHBP is getting more and more unaffordable for more people," said Jacqueline Simon, AFGE public policy director.
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DISCRIMINATION BY INSURERS LIKELY EVEN WITH REFORM By David S. Hilzenrath The Washington Post October 4, 2009
If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center. Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.
And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions. At a more nuts-and-bolts level, AHIP has been trying to shape the legislation in ways that could help insurers attract the healthy and avoid the sick, though it has given other reasons for advancing those positions.
By itself, a ban on discrimination would not eliminate the economic pressure to discriminate.
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THE ORGANIZATION FOR ECONOMIC COOPERATION AND DEVELOPMENT AND HEALTH CARE REFORM IN THE USA By Don R. McCanne International Journal of Health Services Volume 39, Number 4 / 2009
Among OECD nations, the United States is an outlier in having the highest per capita health care costs in a system that unnecessarily exposes many individuals to financial hardship, physical suffering, and even death. President Obama and Congress are currently involved in a process to reform the flawed health care system. The OECD has contributed to that process by releasing a paper, "Health Care Reform in the United States," which describes some of the problems that must be addressed, but then provides proposed solutions that omit consideration of a more equitable and efficient universal public insurance program. The same omission is taking place in Washington, DC. By reinforcing proposals that support the private insurance industry, the source of much of the waste and inequities in health care, the authors of the OECD paper have failed in their responsibility to inform on policies rather than politics.
The OECD has a mission of bringing together governments "committed to democracy and the market economy." Their release of a paper supporting a private insurance model of reform for the United States seemed to be a fulfillment of this mission. But even their paper added nothing that would refute what we already know from our efforts at reform: the private insurance model is an expensive, wasteful, inequitable, and a fairly ineffective model of ensuring affordable, high quality care for everyone.
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IBM CEO SEES BIG OPPORTUNITY IN HEALTH-CARE TECHNOLOGY By Peter Loftus The Wall Street Journal October 6, 2009
The chief executive of International Business Machines Corp. sees a huge business opportunity in making the U.S. health-care system more efficient.
Mr. Palmisano sees IBM providing everything from electronic-health records technology to ultra-tiny personal devices that read DNA and cost less than $1,000. He likened those technologies to health-care equivalents of universal bar-codes in the retail industry, which made that industry more efficient.
But Palmisano acknowledged that single-payer, government health systems outside the U.S. make it easier to use technology for health-information sharing, because health information is more centralized.
"The advantage of a government payer or centralized system is they can begin to create incentives for change much more so than you can in a fragmented model," he said.
He said the federal government could save itself $900 billion over 10 years in health-care spending by simply managing it better.
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GIVE PEOPLE BREATHING ROOM By Sen. Charles E. Schumer USA Today October 8, 2009
Sen. Olympia Snowe of Maine and I decided to give some breathing room to families faced with the uneasy choice of buying insurance they can't afford or paying a stiff penalty that they also can't afford. Our proposal, which passed the Senate Finance Committee 22-1, exempts Americans from the requirement to buy insurance if the cost of the available plans exceeds 8% of their income. We also reduced the amount of the penalty and phased it in over time, to make sure the reformed system works before we punish people for not participating.
EINO: Let's say a family is earning a total pre-tax income at 300% of the Federal Poverty Level (in fact still very poor) that would be gross income $66,150 for a family of four. They could pay up to another $5,290 for insurance and that would be fine for Schumer and Snowe, add to that any out-of-pocket medical expenses (the proposed 8% was just to limit premiums), then taxes, then good luck with food and rent !! Clothes for kids to go to school in ?? Nonetheless BCBS criticized Snow and Shumer for being too liberal with allowing low-income workers off the hook of the mandate to buy private insurance. ( CLICK HERE )
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IS THERE ANY WAY OUT FOR OBAMA? By Leonard Rodberg, PNHP Blog Site
Progressives worry that, if Obama's health reform plan (hereafter called the "Plan") fails to pass, a latter-day right-wing Gingrich movement will take over the Congress in 2010 and the White House in 2012. What I have not heard, but what I am increasingly coming to believe, is that, if the Plan passes in any of its current forms, things will go just as badly for him! Why is that?
The general reason is that the Plan is a DOG. It is a terrible, complex plan that will accomplish almost nothing. Relatively few people will benefit from it, while everyone who has to use health care will continue to experience the mess that is, and will continue to be, the American health care system. And, because of the new requirements built into the Plan, health care finance will become even more complex and confusing.
For example:
1. The large majority of people, who receive their insurance from their employer, will see no benefit whatsoever from the Plan. Most will, in fact, find their premiums rising as new requirements imposed by the Plan (e.g., the elimination of lifetime limits) raise the cost of insurance. And, of course, to their undoubted surprise, most of them will not have access to the public option, even if there is one.
2. Most provisions of the Plan will not become effective until 2013. This gives four years for Republicans to criticize the Plan, including (1) its use of cuts in Medicare reimbursements and Medicare Advantage premiums as principal sources of funding, (2) its lack of any real or believable mechanism for containing costs, and (3) its bureaucratic complexity.
3. During the four years of waiting for the Plan to take effect, costs will continue to rise. By the time the Plan takes effect, costs are likely to be at least 25% greater than now. Even more people will find insurance and health care unaffordable. People will ask "What was health reform about?" The disillusionment will be great.
Is there a way out? Not, in my view, as long as Obama sticks with this worthless and unworkable Plan. Only if we were to adopt a much simpler plan that would benefit everyone -- a Medicare for All plan -- would he be seen as actually addressing the problem and really offering a workable solution. Short of that, he, and all of us, are in real trouble.
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NEW BILL WOULD RAISE RATES, SAYS INSURANCE GROUP SO THEY SAY By Ceci Connolly The Washington Post October 12, 2009
After months of collaboration on President Obama's attempt to overhaul the nation's health-care system, the insurance industry is striking Oct 12 out against the effort with a report warning that the typical family premium in 2019 could cost $4,000 more than projected. Administration officials, who spent much of the spring and summer wooing the insurers, questioned the timing and authorship of the report, which was paid for by America's Health Insurance Plans (AHIP), an industry trade group.
"The report makes clear that several major provisions in the current legislative proposal will cause health care costs to increase far faster and higher than they would under the current system," Karen Ignagni, AHIP's president and chief executive, wrote to board members Sunday. "Between 2010 and 2019 the cumulative increases in the cost of a typical family policy under this reform proposal will be approximately $20,700 more than it would be under the current system." "Now that health-care reform grows ever closer, these health insurers are breaking out the same, tired playbook of deception to prevent millions of Americans from getting the affordable, accessible care they need," said Finance Committee spokesman Scott Mulhauser. "It's a health insurance company hatchet job, plain and simple."
"Those guys specialize in tax shelters," said Nancy-Ann DeParle, director of the White House Office of Health Reform. "Clearly this is not their area of expertise."
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OBAMA TAKES AIMS AT INSURANCE INDUSTRY'S ANTITRUST EXEMPTION Janice Simmons, for HealthLeaders Media, October 19, 2009
In the President's weekly address on 10/17 recent actions related to health reform -and implied he may push for legislation now pending on Capitol Hill to dissolve the industry's 60-year-old antitrust exemption. In his remarks, Obama thanked a variety of groups for support of the Senate Finance Committee's bill, the last healthcare reform measure pending approval by a congressional panel. He specifically cited the work of a "broad and growing coalition of doctors and nurses, workers and businesses, hospitals and even drug companies -folks who represent different parties and perspectives."
However, "there are still those who would try to kill reform at any cost," said the president, referring to efforts by the health insurance industry to challenge healthcare reform with a study that said insurance costs would rapidly increase under the Finance Committee plan. Obama even offered another study -one from the Business Roundtable -as counter to the findings from the health insurance industry. Their report said that annual healthcare costs for employers will rise 166% over the next decade, from $10,743 per employee today to $28,530 by 2019.
"This is the unsustainable path we're on, and it's the path the insurers want to keep us on. In fact, the insurance industry is rolling out the big guns and breaking open their massive war chest to marshal their forces for one last fight to save the status quo," said President Obama, referring to recent studies and advertisement campaigns by the insurance industry in several states challenging changes to the Medicare Advantage program.
Obama went on to say that the insurance industry "is making this last ditch effort to stop reform" as they're "earning these profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing."
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HOUSE DEMS WANT MEDICARE FOR EVERYONE By Mike Soraghan - 10/20/09
House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option. The strategy could benefit Democrats struggling to bridge the gap between liberals in their party, who want the public option, and centrists, who are worried it would drive private insurers out of business.
While much of the public is foggy on what a public option actually is, people understand Medicare. It also would place the new public option within the rubric of a familiar system rather than something new and unknown.
John Schadl, a spokesman for Oberstar, explained the congressman likes the idea because people are familiar with Medicare. One of his concerns is that people don¹t know what a public option is. Medicare is a public option,² Schadl said. He said Oberstar started talking about ³Medicare for Everyone² during August town hall meetings.
In a notable incident last summer a man famously told Rep. Bob Inglis (R-S.C.), ³Keep your government hands off my Medicare.² Speaker Nancy Pelosi had planned to unveil a proposal to her caucus Oct 20 that would include the public option favored by liberals in the healthcare bill Democrats want to bring to the floor, according to two House sources. The plan, called the ³robust² option or ³Medicare Plus 5² in the jargon that has emerged on Capitol Hill, would have tied provider reimbursement rates to Medicare, adding 5 percent. Leaders actually failed to even try floating the bill out.
People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal ³Medicare Part E.
The idea of expanding Medicare while still keeping private insurance was proposed in 2007 by Johns Hopkins University Professors Gerard Anderson and Hugh Waters. They presented a paper at a forum of the Brookings Institution advocating ³Medicare Part E(veryone),² and said their proposal would expand Medicare to ensure universal coverage while allowing people to stay on their employers¹ health plans.
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HEALTH CARE ABROAD: TAIWAN An interview of William Hsiao, Ph.D., Professor of Economics at the Harvard School of Public Health The New York Times November 3, 2009
Q. What’s the most important lesson that Americans can learn from the Taiwanese example?
A. You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.
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OVER 2,200 VETERANS DIED IN 2008 DUE TO LACK OF HEALTH INSURANCE November 10, 2009 Physicians for a National Health Program
A research team at Harvard Medical School estimates 2,266 U.S. military veterans under the age of 65 died last year because they lacked health insurance and thus had reduced access to care. That figure is more than 14 times the number of deaths (155) suffered by U.S. troops in Afghanistan in 2008, and more than twice as many as have died (911 as of Oct. 31) since the war began in 2001.
"Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care," said Dr. Steffie Woolhandler, a professor at Harvard Medical School. While many Americans believe that all veterans can get care from the VA, even combat veterans may not be able to obtain VA care, Woolhandler said.
Dr. David Himmelstein commented, "On this Veterans Day we should not only honor the nearly 500 soldiers who have died this year in Iraq and Afghanistan, but also the more than 2,200 veterans who were killed by our broken health insurance system."
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HEALTH SAVINGS? NO ONE KNOWS By Carrie Budoff Brown Politico November 11, 2009
Barack Obama ran for president on a promise of saving the typical family $2,500 a year in lower health care premiums. But that was then. No one in the White House is making such a pledge now. It's one of the most basic, kitchen-table questions of the entire reform debate: Would the sweeping $900 billion overhaul actually lower spiraling insurance premiums for everyone?
Jonathan Gruber, the favorite economist of the White House, said the bill "really doesn't bend the cost curve."
Reminded that Obama demanded a bill that lowers health care spending, Gruber said: "That is what he would like to do. But he’s not doing it."
If premiums are the benchmark by which reform is judged, "we are setting ourselves up to fail," Gruber said.
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DOWNWARDLY MOBILE - THE ACCIDENTAL COST OF BEING UNINSURED By Heather Rosen, MD, MPH; Fady Saleh, MD, MPH; Stuart Lipsitz, ScD; Selwyn O. Rogers Jr, MD, MPH; Atul A. Gawande, MD, MPH Archives of Surgery
November 2009
The Centers for Disease Control and Prevention estimate that in 2004, there were 112,012 deaths related to unintentional injuries alone in the United States. Unintentional injury is within the top 10 causes of death for every age group and is the leading cause of death among persons aged 1 to 44 years. Uninsured trauma patients had a statistically significant higher adjusted odds of mortality compared with insured trauma patients. In younger patients (aged 18-30 years), the adjusted odds of mortality after trauma remained higher for uninsured patients compared with insured patients, indicating that the differences persist in a relatively healthy cohort. In the subgroup analyses of head-injured patients and those with 1 or more comorbidities, the adjusted odds of mortality in the uninsured population remained significantly high.
Most recent research has concentrated on decreased (or lack of) access to care as a result of being uninsured. However, we found that, even after admission to a hospital, trauma patients can have worse outcomes based on insurance status. This concerning finding warrants more rigorous investigation to determine why such variation in mortality would exist in a system where equivalent care is not only expected but mandated by law. We can only speculate as to the mechanism of the disparities we have exposed; the true causes are still unclear. Although the lack of insurance may not be the only explanation for the disparity in trauma mortality, the accidental costs of being uninsured in the United States today may be too high to continue to overlook.
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FOR PUBLIC, AFFORDABILITY A KEY ISSUE IN HEALTH BILL By Julie Rovner NPR November 24, 2009
Lawmakers debating health care on Capitol Hill have spent months worrying about the potential cost. But mostly it's been the total cost of the bill, not how much individual families who could soon be required to buy insurance for the first time might have to pay. That could be a costly miscalculation, says health economist Jonathan Gruber of MIT. "Let's put it this way: It is 10 times as important as the public option and has received one one-hundredth of the coverage".
Gruber says economists have different ways of defining exactly what is and is not affordable for people. One way is by looking at disposable income, or whether people have money left over after paying for other necessities. "We think no one should have to go without food or shelter to have health insurance," he says. Another test is whether people would buy something voluntarily. "And if they would then clearly it's affordable".
But there's also a third test -and it's that affordability is in the eye of the beholder. And for a lot of beholders in the real world, health insurance costs are quickly becoming unaffordable. (Under the proposed legislation) no family would have to spend more than 10 percent of its income on health insurance premiums; poor families wouldn't have to spend more than 2 percent on premiums.
But premiums are only the start of what people spend on health insurance. There are also deductibles, copayments and other out-of-pocket costs. And Gruber says that when it comes to that sort of spending, the House bill is far more generous than the Senate bill. For example, someone making two times the poverty level, or about $22,000 a year, in the House bill would get "something like a $500 deductible plan," he says. "On the other hand in that same range in the Senate ... now we're talking a $2,500 deductible plan."
Gruber is a "big believer" in the concept that people should pay more for their health care so they'll know what it really costs and have an incentive to save money. "I'm a believer in consumer skin in the game," he says. "But a $2,500 deductible is a lot to ask for someone making $22,000 a year." And it brings Gruber to the ultimate test of affordability, which he says is a political test -"which is, do people revolt if you say, 'I'm going to mandate you to pay this much'?"
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GOOD NEWS ON PREMIUMS The New York Times December 3, 2009
The health insurance industry frightened Americans -and gave Republicans a shrill talking point- when it declared in October that proposed reform legislation would drive up insurance costs for virtually everyone by as much as thousands of dollars a year. The nonpartisan Congressional Budget Office persuasively contradicted that claim the first week of December. Undaunted, the industry issued a rebuttal report, claiming again that premiums would soar. We find this second industry report no more persuasive than the first. The insurance industry is not giving up. Two days later, the Blue Cross and Blue Shield Association issued a report contending that the CBO underestimated the expected medical costs of people who will be buying policies on the individual (nongroup) market.
CBO notes that the legal mandate to obtain coverage, the penalties for noncompliance, and the generous subsidies for low- and middle-income people would encourage most people to enroll without waiting to become sick.
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HOW HEALTH CARE BILLS COMPARE TO LAWMAKERS' PLAN By Ricardo Alonso-Zaldivar The Washington Post December 6, 2009
You should get the same health insurance deal that members of Congress get. That was the gist of President Barack Obama's message as he tried to drum up enthusiasm for his health care overhaul. Government workers and members of Congress belong to the nation's largest employer-sponsored health plan, covering 8 million employees, dependents and retirees.
"We estimate there are about 250,000 federal employees who are uninsured. They're eligible, but they can't afford the premiums," said Jacqueline Simon, policy director for the American Federation of Government Employees.
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WHY I PREFER FRENCH HEALTH CARE By Matt Welch Reason January 2010
By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care. To put it plainly, when free marketers warn that Democratic health care initiatives will make us more "like France," a big part of me says, "I wish." It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has "the best health care in the world."
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.
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