For Profit Insurance
It's Annual Enrollment Time: Brace Your Wallet
Published November 02, 2009 @ 05:00AM PT
Halloween tricks were a warm-up. While Congress argues partisan, special-interest driven healthcare reform politics these next few weeks, many employees will be faced with a stark reminder of the need for reform. Yes, November is here – annual enrollment time for 60% of insured Americans. It is rapidly becoming known as “spend more, get less” time for group health plan participation.
Now, Joe Lieberman thinks healthcare reform is going too far, that a public option is “just unnecessary” and private health plan premiums will go up. He’s threatening to join a Republican filibuster because of his “concerns.” Uh, Joe? Don’t you dare. Those premiums have already gone up, with medical costs rising three times as fast as inflation. Premiums are skyrocketing with no public option, and AHIP has promised they will continue to do so. So if you filibuster to strip the people of their power, Joe, we will strip you of yours within the Senate.
But back to reality outside the Beltway. Group health plan premiums have risen 131% in the last 10 years, according to the Kaiser Family Foundation. Employee contributions have risen 128%. Since 2006, the percentage of individual insured employees responsible for deductibles of $1,000 or more has more than doubled, from 10 to 22%. Companies still offering health benefits in 2009 downsized them – 86% now offer only one plan. That group ironically includes Blue Cross Blue Shield of Florida, whose 5,000 employees will now be offered only a high-deductible plan. Meanwhile AHIP is decrying government involvement in healthcare due to supposed lack of consumer choice.
Understand Healthcare Reform in 2 Easy Steps
Published November 01, 2009 @ 05:00AM PT
If you’re tired of ignorant political sound bites in the healthcare debate, I have the cure. Better yet, it’s virtually free of public and private insurance discussions, with their associated pointed fingers. The film Money-Driven Medicine explores the reasons why the US spends more than twice what the next developed country does on healthcare, with terrible health outcomes. The story is told by in-the-trenches doctors, patients and their family members, a physician healthcare improvement leader, and a medical ethicist. It’s unique, highly educational and fascinating.
Join the Watch-In! for America’s Health now through November 10 for a systemic look at what’s really driving the cost and quality of our healthcare. Find out what’s compelling our healthcare spending, and why tweaking around the edges of our public health disaster won’t change a thing. In a nutshell, our country is unique in turning patients into profit centers.
Why join the Watch-In? Because Money-Driven Medicine:
“help(s) viewers distinguish between structural change and sham reform. It will convince them that a sound, sustainable medical infrastructure is crucial not just to their personal futures but to the economy and society as a whole – why curing America’s healthcare crisis could be a matter of national life and death.”
I couldn’t have said it better myself. Make a pledge to join the Watch-In! for America’s Health today. Of course, if you can stand more discourse on the insurance industry and public versus private insurers and providers, read and watch on.
I made the mistake of watching T.R. Reid’s special, Can We Really Fix U.S. Healthcare?, about his experience exploring international universal healthcare systems, the night before the House revealed its new bill, HR 3962. As a result, I’m feeling a bit underwhelmed by Nancy Pelosi’s hard-fought victory. The LinkTV special is a summary of Reid’s book, The Healing of America, which explores both the how and the why of these healthcare systems. It’s an excellent primer on the 4 main types of healthcare systems, distinguished by who pays for and who provides the care. Watch it and be both entertained and sobered simultaneously, when you consider how far we have to go to even catch a glimpse of the best ones on the horizon.
Reid is also the creator of PBS’ special Sick Around the World, which gives an excellent summary of 5 international universal healthcare systems. No, it’s not just theory: he took his injured shoulder around the world with him, to see how each healthcare system would treat it.
But remember, before you click over to Reid’s insurer-patient-provider view of true developed nations, join the Medicine For Profit Watch-In for a refreshing, insurance-light look at some root problems in American health "care". Thanks to Change.org member CherokeeGirl for Change, who alerted me to both very worthwhile programs.
Photo http://farm4.static.flickr.com/3174/2689975613_187194cdaa.jpg //CC BY 2.0
Triggers, Politics and Party Tricks
Published October 28, 2009 @ 06:00AM PT
A public option “trigger” has received a lot of attention lately. Thankfully Harry Reid bypassed it for an opt-out solution instead, because it’s a proven Really Bad Idea. Since the Wonk Room's Igor Volsky thinks it's a fabulous idea to combine an opt-out public option with a trigger, let's put this one to bed once and for all. Following is a quick lesson in political science, so you can recognize this underhanded trick when you see it in future.
Consider: the intent of a trigger is to activate a remedy (a public option) in the event that certain conditions aren’t met by existing forces (private insurers.) Now, we wouldn’t be considering healthcare reform unless there were already significant, long-standing problems in virtually every aspect of our system-less healthcare. That includes $850 billion of waste every year, almost enough to pay for 10 years of reformed healthcare. The insurance reform gun has already fired. So why design a trigger to potentially address this urgent issue sometime in the distant future when things are even worse, perhaps catastrophically so?
The short answer is that doing nothing is the politically safe route. It’s a proven way to get re-elected by not rocking the boat. Olympia Snowe knows that, and probably hoped a trigger would allow her to claim she voted for a public option (what her constituents want) and at the same time kill it (what most Republicans want.) Under the trigger, a public plan would be created only if private insurers didn’t make “meaningful, affordable” coverage available to all Americans within “several years.” Believe it or not, none of these terms has been defined. So what would trigger a public option? You guessed it – nothing.
What Happened to the Healthy Americans Act?
Published October 25, 2009 @ 09:00AM PT
Watching the Senate difficulties this week – failing to work around fancy math, having to dump fair physician payments as a result, and trying to substitute an ineffective opt-out public option for even more impotentco-ops – it makes you wonder about Wyden-Bennett. Remember S. 391, aka the Healthy Americans Act? It was billed as market-provided “single payer”, supposedly had bipartisan support, and was universally recognized as superior to the Baucus bill. And we’ve heard … nothing. Why ignore HAA (much more personal than a number, no?), a bill with much higher credibility and without a pesky public option at all? The answer turns out to be two-fold.
First though, let’s review what it had going for it. Back in August, HAA had 5 republicans and 7 democrats publicly backing it in an op-ed, including Mary Landrieu and Joe Lieberman (both none too keen on a public option.) However, three of its co-sponsors, Maria Cantwell, Jeff Merkley, and Arlen Specter, were remarkably quiet. It seems they didn’t want to step on any White House dictates, and Baucus’ process was one of them. Still, the bill was truly a bipartisan feat: it incorporated universal coverage in free-market exchanges designed to empower consumers to shop for the best value.
CBO scored HAA as revenue-neutral, the holy grail of healthcare coverage. Further, it empowered consumers to seek out the best healthcare value in a larger pool of Americans that meant better risk spread. And the basic plan was to be equivalent to the Federal Employee Health Benefits Program. Not bad! Even better, premiums could only vary based on geography and smoking status. No age or health status discrimination, period.
But on to the bad news …
Health Reform Lite or Value Meal?
Published October 21, 2009 @ 06:00AM PT
For anyone fazed by healthcare reform histrionics, take heart. We’ve been here many times before. The real question is, for all the political, capitalistic, and social angst, what’s changed? According to medical economist J.D. Kleinke, who first arrived on the scene in 1989, only one big thing: now everybody gets to whine about the status quo on Facebook. He goes so far as to call the healthcare bills moving forward today “a violent endorsement of the status quo.” I can’t say I disagree with his logic, but two women just gave me hope for this go-round.
Kleinke points out that in 1989 we had a dysfunctional third-party payer insurance system based on fee-for-service. Some insurers, hospitals, doctors, drug companies, and even employers figured out how to game the system and make out like bandits. Medicare was forecasted to become insolvent, Medicaid programs were underfunded, and malpractice costs were supposedly bankrupting healthcare. Costs were skyrocketing along with the number of uninsured. Does all this sound familiar?
Yet in 20 years, he says, all we can come up with is to fit more insured patients into our current mess and make it harder for insurers to kick them out. Each time the smallest of reforms is proposed (like adding prescription benefits to Medicare) entrenched US stakeholders rally mass hysteria, and the result is government funding of more corporate services. That’s true, J.D., but times have changed; about that Facebook phenomenon …
Big Insurance Promotes a Public Option
Published October 13, 2009 @ 06:00AM PT
Big Insurance just made the most convincing argument yet for a public insurance option. In a memo explaining a highly questionable study that AHIP commissioned from PriceWaterhouseCoopers, Karen Ignani explicitly promised that private insurance prices would rise dramatically under proposed healthcare reforms (I didn’t think they would confirm my wallet-stealing point so quickly.) Now we have it straight from the horse’s mouth – thanks, AHIP!
Actually, private insurance prices have already risen dramatically with NO healthcare reform. We can rest assured they will continue to rise. But it’s nice to have a scapegoat, isn’t it? Obviously the point of this study is to disrupt the passage of Max Baucus’ bill. AHIP isn’t satisfied with the millions of new enrollees it will reap, or the no-strings-attached government handouts (otherwise known as subsidies) to pay for those enrollees’ inflated premiums. Nope, they want more for all their lobbying millions.
First, they want a stronger individual mandate to lock in the maximum number of captive customers. Second, they want the excise tax on high-cost plans to go away. Third, they assume reflexive higher provider private insurance reimbursement rates due to Medicare cuts (though a Milliman, Inc. study already debunked the myth of cost-shifting.) Fourth, they promise to pass any industry taxes straight on to consumers – yep, we told you that was a lame idea. Is there any better combined argument for a public option to remove the private insurance choke-hold on our outlandish healthcare costs?
Faulty Math in CBO Senate Healthcare Bill Analysis
Published October 08, 2009 @ 06:00AM PT
Well, the CBO definitely got one thing right in its financial analysis of the Senate Finance Committee’s health bill. In commenting on Kent Conrad’s nonprofit co-op idea, it wrote that they "seem unlikely to establish a significant medical presence in many areas of the country." I already shared my opinion on co-ops as destined-to-fail recycling attempts.
Other than that, though, here is their 10 year breakdown of the bill:
- Cost: $829 billion
- Benefit: $81 billion in reduced federal deficits
- Coverage: Increase from 83% to 94% of Americans
- Uninsured Reduction: 29 million
- Missing: $200 billion in Medicare physician payment increases
- Risk: 15% low-income subsidy cuts to abide by Obama’s budget-neutral failsafe mechanism
The SFC bill’s lower cost sent House Democrats scrambling to reduce HR 3200’s cost under the $900 billion limit set by the president, even though their plan would cover 8 million more people than the SFC’s. Part of their strategy may be to move 7 million low-income individuals onto Medicaid instead of providing subsidies for private insurance.
Which brings me to my point. They realized something most of us haven’t. Much of the budgeting exercise has been based on faulty math because the largest cost factor is an unknown – private insurance costs. Higher education provides a useful, though painfully similar, example.
