If you look around Wisconsin, they’re everywhere
On Sunday, August 23 there was a very informative article in the Wisconsin State Journal on heath care coops and their prevalence in society today. Link-http://www.madison.com/wsj/arch_local/462964
For instance in Wisconsin we have several examples-
Group Health Cooperative (Madison)- provides health care for 62,000 members, owns five clinics. Doctors do not bill by procedure, are paid by salary, and emphasize preventive medicine and alternative therapies. U.S. News and World Report named GHC the 8th best health plan in the country the last 3 years. Their slogan you may have heard is: “Better, Together.”
Group Health Cooperative (Eau Claire)- Similar model as GHC in Madison but they are independent of each other.
The Alliance- is a health care purchasing cooperative made up of 160 employers. It negotiates contracts directly with providers instead of through an insurer. Most of the employer members self-fund their health care.
Rural Wisconsin Health Cooperative- This coop, based in Sauk City, is composed of 35 rural hospitals that share services such as technology and quality improvement to maximize rural resources.
The Farmer’s Health Cooperative- consists of 2,700 independent farmer members that access health care through the co-op. The co-op spreads risk among a large group of farmers and contracts with Aetna to offer 6 different benefit plans.
These are all not-for-profit coops that enhance Wisconsin residents access to affordable, quality health care. Building on these models would be a great start.
Thursday, August 27, 2009
Wednesday, August 26, 2009
Give Me a Break, and how exactly is this helpful?
http://www.jsonline.com/news/wisconsin/55224367.html
This is a story on a Middleton, WI "public forum" on Wednesday evening.
Here's a brief excerpt from the story:
A meeting billed as a two-sided discussion on national health care turned into a giant pep rally Wednesday night for those against the current House legislation.
More than 1,700 people packed a hotel ballroom at an event sponsored by a conservative group, Americans for Prosperity, which opposes the pending bill.
Americans for Prosperity state director Mark Block said he couldn't persuade U.S. Rep. Tammy Baldwin (D-Madison) or other supporters of the bill to attend or play a formal role. (Only reform supporters who also run with bulls in Pamplona would consider attending this forum.- Insuring Resources)
In fact, very few reform supporters appeared to be part of the crowd, though a few hecklers interrupted speakers at several points.
In Madison, police provided a highly visible security presence at the Marriott West. Signs announced: "No weapons allowed in the hotel" - a nod to participants who might have been tempted to show support for open-carry laws, police said.
ABC News "20/20" co-anchor John Stossel, a commentator critical of President Barack Obama's approach to health care, revved up the crowd. He was brought in by AFP.
Stossel said Obama's reform proposals would "make things much worse" and actually increase costs and reduce consumer choice.
He also called Medicare a Ponzi scheme gone broke that if left unfixed would lead to limits on care.
"There will be death panels if we do nothing," Stossel said of Medicare, using the phrase that former GOP vice presidential candidate Sarah Palin made famous in relation to the health-reform bill, which does not directly affect Medicare.
Stossel and other speakers endorsed a free-market approach, including higher-deductible insurance coverage that would push people to pay more attention to their health and to compare prices on health procedures.
Pam Galloway, founder of Breast Center of Central Wisconsin, said she believed both the House bill and the Medicare program were unconstitutional because Congress has no authority over the issues.
--------------
Shame on you Stossel, this is ridiculous. He was a reporter, now he's a hack.
His big suggestion is increased deductibles!!!! Wow, that's progress? How about elimination of pre-x or instituting episodes of care payment reform or new ideas to truly control health costs. Its unreal his lack of understanding and yet he had the crowd eating it up. The "debate" is simply illogical.
And Ms. Galloway says Medicare, with a 44 year history of offering millions of seniors and those with disabilities quality care is unconstitutional. Brilliant.
These are the people that are controlling the debate and denigrating the process. It must turn around.
This is a story on a Middleton, WI "public forum" on Wednesday evening.
Here's a brief excerpt from the story:
A meeting billed as a two-sided discussion on national health care turned into a giant pep rally Wednesday night for those against the current House legislation.
More than 1,700 people packed a hotel ballroom at an event sponsored by a conservative group, Americans for Prosperity, which opposes the pending bill.
Americans for Prosperity state director Mark Block said he couldn't persuade U.S. Rep. Tammy Baldwin (D-Madison) or other supporters of the bill to attend or play a formal role. (Only reform supporters who also run with bulls in Pamplona would consider attending this forum.- Insuring Resources)
In fact, very few reform supporters appeared to be part of the crowd, though a few hecklers interrupted speakers at several points.
In Madison, police provided a highly visible security presence at the Marriott West. Signs announced: "No weapons allowed in the hotel" - a nod to participants who might have been tempted to show support for open-carry laws, police said.
ABC News "20/20" co-anchor John Stossel, a commentator critical of President Barack Obama's approach to health care, revved up the crowd. He was brought in by AFP.
Stossel said Obama's reform proposals would "make things much worse" and actually increase costs and reduce consumer choice.
He also called Medicare a Ponzi scheme gone broke that if left unfixed would lead to limits on care.
"There will be death panels if we do nothing," Stossel said of Medicare, using the phrase that former GOP vice presidential candidate Sarah Palin made famous in relation to the health-reform bill, which does not directly affect Medicare.
Stossel and other speakers endorsed a free-market approach, including higher-deductible insurance coverage that would push people to pay more attention to their health and to compare prices on health procedures.
Pam Galloway, founder of Breast Center of Central Wisconsin, said she believed both the House bill and the Medicare program were unconstitutional because Congress has no authority over the issues.
--------------
Shame on you Stossel, this is ridiculous. He was a reporter, now he's a hack.
His big suggestion is increased deductibles!!!! Wow, that's progress? How about elimination of pre-x or instituting episodes of care payment reform or new ideas to truly control health costs. Its unreal his lack of understanding and yet he had the crowd eating it up. The "debate" is simply illogical.
And Ms. Galloway says Medicare, with a 44 year history of offering millions of seniors and those with disabilities quality care is unconstitutional. Brilliant.
These are the people that are controlling the debate and denigrating the process. It must turn around.
Health Care Debate Based on Total Lack of Logic- Sociologists
Hopefully this title got your attention, but the article may not be what you’re expecting.
The gist of it:
After reading this I saw myself and my own “policy illogic” at times. I saw this in myself many times as an Alderman some years ago. I was careful to realize it, when I could, and not make decisions in conscious disregard. We do get locked in to our own beliefs and logic is sometimes thrown out the window. To combat this, the article suggests that we get as informed as possible through a two-sided debate. I hope my readers see that I have tried to address both sides and acknowledge positives and negatives from both the left and right. In that regard I have tried very hard to understand arguments, that on their face, I disagree with. As an example of that see the link on the left to my WPRI journal article analyzing Cong. Paul Ryan’s (R) health care reform proposal. I hope my illogicism (coining a new term) has not tarnished readers as I try, and sometimes fail, to walk the thin line down the middle of this health care reform debate.
Here’s the article ---- The source is: LiveScience.com
Heated partisan debate over President Obama's health care plan, erupting at town hall meetings and in the blogosphere, has more to do with our illogical thought processes than reality, sociologists are finding.
The problem: People on both sides of the political aisle often work backward from a firm conclusion to find supporting facts, rather than letting evidence inform their views.
The result: A survey out this week finds voters split strongly along party lines regarding their beliefs about key parts of the plan. Example: About 91 percent of Republicans think the proposal would increase wait times for surgeries and other health services, while only 37 percent of Democrats think so.
Irrational thinking
A totally rational person would lay out - and evaluate objectively - the pros and cons of a health care overhaul before choosing to support or oppose a plan. But we humans are not so rational, according to Steve Hoffman, a visiting professor of sociology at the University of Buffalo. "People get deeply attached to their beliefs," Hoffman said. "We form emotional attachments that get wrapped up in our personal identity and sense of morality, irrespective of the facts of the matter."
And to keep our sense of personal and social identity, Hoffman said, we tend to use a backward type of reasoning in order to justify such beliefs.
Similarly, past research by Dolores Albarracin, a psychology professor at the University of Illinois at Urbana-Champaign, has shown in particular that people who are less confident in their beliefs are more reluctant than others to seek out opposing perspectives. So these people avoid counter evidence all together. The same could apply to the health care debate, Albarracin said.
"Even if you have free press, freedom of speech, it doesn't make people listen to all points of view," she said. Just about everybody is vulnerable to the phenomenon of holding onto our beliefs even in the face of iron-clad evidence to the contrary, Hoffman said. Why? Because it's hard to do otherwise. "It's an amazing challenge to constantly break out the Nietzschean hammer and destroy your world view and belief system and evaluate others," Hoffman said.
"The health care debate would be vulnerable to motivated reasoning, because it is, and has become, so highly emotionally and symbolically charged," Perrin said during a telephone interview, adding that images equating the plan with Nazi Germany illustrate the symbolic nature of the arguments.
In addition, the town hall settings make for even more rigid beliefs. That's because changing one's mind about a complex issue can rattle a person's sense of identity and sense of belonging within a community. If everyone around you is a neighbor or friend, you'd be less likely to change your opinion, the researchers say.
"In these one-shot town hall meetings, where you have an emotionally laden complex issue like health care, it's very likely you're going to get these ramped up emotionally laden debates. They're going to be hot debates," Hoffman told LiveScience.
Two-sided discussion
To bring the facts from both sides to the table, Hoffman suggests venues where a heterogeneous group of people can meet, those for and against the proposed health care system overhaul. And at least some of these gatherings should include just a handful of people. In groups of more than about six people, one or two members will tend to dominate the discussion, he said.
For either side, logical arguments might not be the key.
"I think strategically it's important that the Obama administration and advocates of a health care plan really pay attention to how people feel and the symbolism they are seeing, and not just the nuts and bolts of the policy," Perrin said. "People don't reason with pure facts and logic alone."
As always, read as much as you can- from every possible source- even Foxnews.com
The gist of it:
After reading this I saw myself and my own “policy illogic” at times. I saw this in myself many times as an Alderman some years ago. I was careful to realize it, when I could, and not make decisions in conscious disregard. We do get locked in to our own beliefs and logic is sometimes thrown out the window. To combat this, the article suggests that we get as informed as possible through a two-sided debate. I hope my readers see that I have tried to address both sides and acknowledge positives and negatives from both the left and right. In that regard I have tried very hard to understand arguments, that on their face, I disagree with. As an example of that see the link on the left to my WPRI journal article analyzing Cong. Paul Ryan’s (R) health care reform proposal. I hope my illogicism (coining a new term) has not tarnished readers as I try, and sometimes fail, to walk the thin line down the middle of this health care reform debate.
Here’s the article ---- The source is: LiveScience.com
Heated partisan debate over President Obama's health care plan, erupting at town hall meetings and in the blogosphere, has more to do with our illogical thought processes than reality, sociologists are finding.
The problem: People on both sides of the political aisle often work backward from a firm conclusion to find supporting facts, rather than letting evidence inform their views.
The result: A survey out this week finds voters split strongly along party lines regarding their beliefs about key parts of the plan. Example: About 91 percent of Republicans think the proposal would increase wait times for surgeries and other health services, while only 37 percent of Democrats think so.
Irrational thinking
A totally rational person would lay out - and evaluate objectively - the pros and cons of a health care overhaul before choosing to support or oppose a plan. But we humans are not so rational, according to Steve Hoffman, a visiting professor of sociology at the University of Buffalo. "People get deeply attached to their beliefs," Hoffman said. "We form emotional attachments that get wrapped up in our personal identity and sense of morality, irrespective of the facts of the matter."
And to keep our sense of personal and social identity, Hoffman said, we tend to use a backward type of reasoning in order to justify such beliefs.
Similarly, past research by Dolores Albarracin, a psychology professor at the University of Illinois at Urbana-Champaign, has shown in particular that people who are less confident in their beliefs are more reluctant than others to seek out opposing perspectives. So these people avoid counter evidence all together. The same could apply to the health care debate, Albarracin said.
"Even if you have free press, freedom of speech, it doesn't make people listen to all points of view," she said. Just about everybody is vulnerable to the phenomenon of holding onto our beliefs even in the face of iron-clad evidence to the contrary, Hoffman said. Why? Because it's hard to do otherwise. "It's an amazing challenge to constantly break out the Nietzschean hammer and destroy your world view and belief system and evaluate others," Hoffman said.
"The health care debate would be vulnerable to motivated reasoning, because it is, and has become, so highly emotionally and symbolically charged," Perrin said during a telephone interview, adding that images equating the plan with Nazi Germany illustrate the symbolic nature of the arguments.
In addition, the town hall settings make for even more rigid beliefs. That's because changing one's mind about a complex issue can rattle a person's sense of identity and sense of belonging within a community. If everyone around you is a neighbor or friend, you'd be less likely to change your opinion, the researchers say.
"In these one-shot town hall meetings, where you have an emotionally laden complex issue like health care, it's very likely you're going to get these ramped up emotionally laden debates. They're going to be hot debates," Hoffman told LiveScience.
Two-sided discussion
To bring the facts from both sides to the table, Hoffman suggests venues where a heterogeneous group of people can meet, those for and against the proposed health care system overhaul. And at least some of these gatherings should include just a handful of people. In groups of more than about six people, one or two members will tend to dominate the discussion, he said.
For either side, logical arguments might not be the key.
"I think strategically it's important that the Obama administration and advocates of a health care plan really pay attention to how people feel and the symbolism they are seeing, and not just the nuts and bolts of the policy," Perrin said. "People don't reason with pure facts and logic alone."
As always, read as much as you can- from every possible source- even Foxnews.com
Tuesday, August 25, 2009
ThedaCare touted as national model
This is from Fox News:
Maybe its because ThedaCare employs LEAN process adopted from manufacturing. Whatever the reason, FoxNews seems to understand one basic element of health care reform. Medical costs are driving the need for health care reform. Reforming the insurance side will not achieve the true savings that are needed. This is a lesson that has fallen on deaf ears so far on Democratic decision-makers despite this writer's repeated efforts, letters and phone calls to Congressional offices.
ThedaCare institued these measures to cut costs but amazingly they also IMPROVED patient health outcomes.
See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Maybe its because ThedaCare employs LEAN process adopted from manufacturing. Whatever the reason, FoxNews seems to understand one basic element of health care reform. Medical costs are driving the need for health care reform. Reforming the insurance side will not achieve the true savings that are needed. This is a lesson that has fallen on deaf ears so far on Democratic decision-makers despite this writer's repeated efforts, letters and phone calls to Congressional offices.
ThedaCare institued these measures to cut costs but amazingly they also IMPROVED patient health outcomes.
See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Medicare in the Cross-hairs
From today's Wall street Journal
The Republican Natl Committee just released its Health Care Bill of Rights for Seniors. It includes protecting Medicare from cuts and rationing of services. The WSJ says the statement highlights an irony in the health debate, as illustrated during some of the emotional town-hall meetings this month: Many Americans say they fear a government takeover of health care, even as they resist any cuts to Medicare, the federal government's largest health program.
WSJ: "The new RNC position doesn't offer any significant cost-cutting ideas and instead focuses on preserving Medicare and health benefits for military families." Katie Wright, an RN!spokeswoman, said Republicans still believed in controlling Medicare costs but think "money shouldn't be taken from Medicare to fund a new entitlement."
Republicans and Democrats have feuded over Medicare since its inception in 1965, and it is usually Democrats who adopt the stance of protecting the program against cost-cutters. Ronald Reagan proposed cutting $1 billion in Medicare spending while president in 1981, when the program cost just $40 billion a year.
-------------
This underlies the basic misunderstanding the public has of american healthcare. The government currently operates 30% of the "healthcare market" through Medicare and Medicaid. When seniors say they fear the government will end up controlling their healthcare its more than ironic since its worked pretty well for 44 years.
Some on the right do however understand what's needed. Fox News recently suggested ThedaCare of Appleton as a national model. This is exactly what we should do to make health care reform affordable. See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
The Republican Natl Committee just released its Health Care Bill of Rights for Seniors. It includes protecting Medicare from cuts and rationing of services. The WSJ says the statement highlights an irony in the health debate, as illustrated during some of the emotional town-hall meetings this month: Many Americans say they fear a government takeover of health care, even as they resist any cuts to Medicare, the federal government's largest health program.
WSJ: "The new RNC position doesn't offer any significant cost-cutting ideas and instead focuses on preserving Medicare and health benefits for military families." Katie Wright, an RN!spokeswoman, said Republicans still believed in controlling Medicare costs but think "money shouldn't be taken from Medicare to fund a new entitlement."
Republicans and Democrats have feuded over Medicare since its inception in 1965, and it is usually Democrats who adopt the stance of protecting the program against cost-cutters. Ronald Reagan proposed cutting $1 billion in Medicare spending while president in 1981, when the program cost just $40 billion a year.
-------------
This underlies the basic misunderstanding the public has of american healthcare. The government currently operates 30% of the "healthcare market" through Medicare and Medicaid. When seniors say they fear the government will end up controlling their healthcare its more than ironic since its worked pretty well for 44 years.
Some on the right do however understand what's needed. Fox News recently suggested ThedaCare of Appleton as a national model. This is exactly what we should do to make health care reform affordable. See this link for an informative video on ThedaCare's lean practices and cost cutting collaborative care model:
http://www.foxnews.com/search-results/m/25995515/collaborative-care.htm#q=ThedaCare
Friday, August 21, 2009
Reducing Medical Costs Largely Ignored
Affordability remains the primary issue in Congress.
As I've noted many times, affordability will be a huge concern if nothing is done to curtail the skyrocketing health care costs we're seeing. We have to rein in the cost of treatment at the same time we increase access and insurance affordability. There is little being done to address the ACTUAL COST of health care. See earlier blog entries for the specifics on how to do it. Congress continues to miss the vital target.
The article below does however do a nice job of laying out the actual cost to consumers in the various proposals Congress is considering. I think this article will be informative for readers with questions about plans for consumer cost-shares (premium, subsidies, deductibles) and the expansion of Medicaid. There's a lot of detail here but its important stuff.
Debate Over Affordability Remains At Forefront Of Health Reform
Inside Health Reform
August 19, 2009
While the public plan option -- and its potential impact on private insurance -- have been at the forefront of the debate over health care reform for months, advocates of universal coverage, one of the main tenets of President Barack Obama’s health reform promise, are still fighting over what they see as a perhaps even greater concern: making sure insurance is affordable, especially as opposition to an individual mandate grows in states across the country.
The generous mix of subsidies and Medicaid expansion in the House bill would cost $1.042 trillion (excluding a $239 billion fix to Medicare physician payments, which isn’t paid for), according to a recent rundown by the House Education and Labor Committee: About 60 percent to provide affordability credits that help Americans buy coverage and 35 percent in additional funding to Medicaid and the Children’s Health Insurance Program (CHIP) to strengthen the programs and get more people insured, with the rest going to tax credits for small businesses who want to offer coverage to their employees.
The Senate health committee bill, meanwhile, has been scored by the Congressional Budget Office at a little over $600 billion, but doesn’t include the Medicaid expansion. And a Senate Finance draft has been scored at less than $900 billion but likely includes a physician payment fix that’s much less ambitious than the House version.
That panel’s bipartisan “gang of six” has yet to unveil a compromise as lawmakers seek agreement on an array of policies -- including Medicaid expansion, subsidy levels and limits on cost-sharing.
Differences remain notably on the question of what minimum percentage of medical costs health insurance should pick up, with Sen. Mike Enzi (R-WY) in particular continuing to push for a lesser share than the 65 percent currently under discussion.
“I am sorry that the topic of affordability has not gotten as much attention as I think it deserves,” says Ron Pollack, the founding executive director of Families USA. “The size of subsidies is going to be critically important for how the American public reacts to health care reform.”
Families USA is particularly happy with the expansion of Medicaid in the House bill, which would cover all legal residents up to 133 percent of the federal poverty level (about $29,300 a year for a family of four). The Senate health committee does not have jurisdiction over Medicaid, but it has stated its intention to cover everyone up to 150 percent of FPL.
An early draft of the Senate Finance Committee bill wasn’t as generous, with the “gang of six” compromise extending Medicaid to children and pregnant women up to 133 percent of the FPL and to parents and childless adults up to 100 percent of FPL. But the expansion is now at 133 percent for all.
Pollack and other advocates say Medicaid is a better choice for the low-income because it covers services such as screenings and transportation while providing cost-sharing protections that don’t exist in the private sector. But the Finance Committee, which doesn’t plan to seek tax increases outside of the health care system and must therefore keep federal costs low, is also running into opposition from state officials who don’t want to pick up the tab, now or later, for a federally mandated expansion. In particular, a proposal last month by Finance Chair Max Baucus (D-MT) that states use bonds to fund the expansion led to a revolt by governors who placed a conference call to Baucus.
The Finance Committee is also at odds with the other panels in terms of subsidies, which it proposes to extend to people making up to 300 percent of the FPL ($66,150 for a family of four) versus 400 percent (or $88,200) in the House and Senate health committees, which is what Families USA and other advocacy groups want.
But lawmakers on the panel have other policies at their disposal to keep costs low for consumers, notably in the design of benefits.
In particular, they have yet to reach agreement on what percentage of medical bills -- the actuarial value -- insurance companies will have to foot, at a minimum. The committee started at 76 percent, leaving consumers to pay the remaining 24 percent of their bills; after insurance companies weighed in, the current split is 65 percent -- 35 percent. Finance members are also considering tiers and a maximum out-of-pocket limit for catastrophic events.
The health committee, meanwhile, is offering three tiers of plans:
• Basic Plan: Requires the qualified health plan to provide coverage for not less than 76 percent of the total allowed costs of the benefit provided. Limits the out of pocket limitation (excluding premium costs) from being greater than the limit for high deductible plans that are eligible for HSAs ($5,950 per person/$11,900 per family in 2010, according to the IRS).
• Tier II: Requires the cost sharing percentage to be equal to the cost sharing percentage of the basic plan increased by 8 percentage points, or 84 percent. Restricts the dollar value of the out of pocket limitation to 50 percent of the dollar value of the basic plan ($2,975 per person/$5,950 per family).
• Tier III: Requires the cost sharing percentage to be equal to the cost sharing percentage of the basic plan increased by 17 percentage points (or 93 percent). Restricts the dollar value of the out of pocket limitation to 15 percent of the dollar value of the basic plan ($829.5/$1,785).
The House, meanwhile, offers three levels of plans -- basic, enhanced and premium -- with the newly created Health Choices Commissioner tasked with coming up with cost-sharing rules for each. The House has also set annual limits on out-of-pocket costs at $5,000 for an individual, $10,000 for a family.
In the Finance Committee, Sen. Enzi, in particular, has pushed for a lower actuarial value floor -- one that’s still higher than 50 percent -- “to make sure that there are affordable health insurance plans with affordable premiums,” particularly for young people, an aide tells Inside Health Policy. (Enzi is pushing for a rate differential between younger and older people that’s greater than the 2:1 allowable under the House and Senate health bills for the same reason).
In addition, the aide says, “plans with lower actuarial values could help bring down health care spending by putting the onus on individuals to keep costs down.”
As I've noted many times, affordability will be a huge concern if nothing is done to curtail the skyrocketing health care costs we're seeing. We have to rein in the cost of treatment at the same time we increase access and insurance affordability. There is little being done to address the ACTUAL COST of health care. See earlier blog entries for the specifics on how to do it. Congress continues to miss the vital target.
The article below does however do a nice job of laying out the actual cost to consumers in the various proposals Congress is considering. I think this article will be informative for readers with questions about plans for consumer cost-shares (premium, subsidies, deductibles) and the expansion of Medicaid. There's a lot of detail here but its important stuff.
Debate Over Affordability Remains At Forefront Of Health Reform
Inside Health Reform
August 19, 2009
While the public plan option -- and its potential impact on private insurance -- have been at the forefront of the debate over health care reform for months, advocates of universal coverage, one of the main tenets of President Barack Obama’s health reform promise, are still fighting over what they see as a perhaps even greater concern: making sure insurance is affordable, especially as opposition to an individual mandate grows in states across the country.
The generous mix of subsidies and Medicaid expansion in the House bill would cost $1.042 trillion (excluding a $239 billion fix to Medicare physician payments, which isn’t paid for), according to a recent rundown by the House Education and Labor Committee: About 60 percent to provide affordability credits that help Americans buy coverage and 35 percent in additional funding to Medicaid and the Children’s Health Insurance Program (CHIP) to strengthen the programs and get more people insured, with the rest going to tax credits for small businesses who want to offer coverage to their employees.
The Senate health committee bill, meanwhile, has been scored by the Congressional Budget Office at a little over $600 billion, but doesn’t include the Medicaid expansion. And a Senate Finance draft has been scored at less than $900 billion but likely includes a physician payment fix that’s much less ambitious than the House version.
That panel’s bipartisan “gang of six” has yet to unveil a compromise as lawmakers seek agreement on an array of policies -- including Medicaid expansion, subsidy levels and limits on cost-sharing.
Differences remain notably on the question of what minimum percentage of medical costs health insurance should pick up, with Sen. Mike Enzi (R-WY) in particular continuing to push for a lesser share than the 65 percent currently under discussion.
“I am sorry that the topic of affordability has not gotten as much attention as I think it deserves,” says Ron Pollack, the founding executive director of Families USA. “The size of subsidies is going to be critically important for how the American public reacts to health care reform.”
Families USA is particularly happy with the expansion of Medicaid in the House bill, which would cover all legal residents up to 133 percent of the federal poverty level (about $29,300 a year for a family of four). The Senate health committee does not have jurisdiction over Medicaid, but it has stated its intention to cover everyone up to 150 percent of FPL.
An early draft of the Senate Finance Committee bill wasn’t as generous, with the “gang of six” compromise extending Medicaid to children and pregnant women up to 133 percent of the FPL and to parents and childless adults up to 100 percent of FPL. But the expansion is now at 133 percent for all.
Pollack and other advocates say Medicaid is a better choice for the low-income because it covers services such as screenings and transportation while providing cost-sharing protections that don’t exist in the private sector. But the Finance Committee, which doesn’t plan to seek tax increases outside of the health care system and must therefore keep federal costs low, is also running into opposition from state officials who don’t want to pick up the tab, now or later, for a federally mandated expansion. In particular, a proposal last month by Finance Chair Max Baucus (D-MT) that states use bonds to fund the expansion led to a revolt by governors who placed a conference call to Baucus.
The Finance Committee is also at odds with the other panels in terms of subsidies, which it proposes to extend to people making up to 300 percent of the FPL ($66,150 for a family of four) versus 400 percent (or $88,200) in the House and Senate health committees, which is what Families USA and other advocacy groups want.
But lawmakers on the panel have other policies at their disposal to keep costs low for consumers, notably in the design of benefits.
In particular, they have yet to reach agreement on what percentage of medical bills -- the actuarial value -- insurance companies will have to foot, at a minimum. The committee started at 76 percent, leaving consumers to pay the remaining 24 percent of their bills; after insurance companies weighed in, the current split is 65 percent -- 35 percent. Finance members are also considering tiers and a maximum out-of-pocket limit for catastrophic events.
The health committee, meanwhile, is offering three tiers of plans:
• Basic Plan: Requires the qualified health plan to provide coverage for not less than 76 percent of the total allowed costs of the benefit provided. Limits the out of pocket limitation (excluding premium costs) from being greater than the limit for high deductible plans that are eligible for HSAs ($5,950 per person/$11,900 per family in 2010, according to the IRS).
• Tier II: Requires the cost sharing percentage to be equal to the cost sharing percentage of the basic plan increased by 8 percentage points, or 84 percent. Restricts the dollar value of the out of pocket limitation to 50 percent of the dollar value of the basic plan ($2,975 per person/$5,950 per family).
• Tier III: Requires the cost sharing percentage to be equal to the cost sharing percentage of the basic plan increased by 17 percentage points (or 93 percent). Restricts the dollar value of the out of pocket limitation to 15 percent of the dollar value of the basic plan ($829.5/$1,785).
The House, meanwhile, offers three levels of plans -- basic, enhanced and premium -- with the newly created Health Choices Commissioner tasked with coming up with cost-sharing rules for each. The House has also set annual limits on out-of-pocket costs at $5,000 for an individual, $10,000 for a family.
In the Finance Committee, Sen. Enzi, in particular, has pushed for a lower actuarial value floor -- one that’s still higher than 50 percent -- “to make sure that there are affordable health insurance plans with affordable premiums,” particularly for young people, an aide tells Inside Health Policy. (Enzi is pushing for a rate differential between younger and older people that’s greater than the 2:1 allowable under the House and Senate health bills for the same reason).
In addition, the aide says, “plans with lower actuarial values could help bring down health care spending by putting the onus on individuals to keep costs down.”
Wednesday, August 19, 2009
Fact Check: Exploding Health Care Reform Myths
FACT CHECK: Health overhaul myths appear to be taking root
By CALVIN WOODWARD, Associated Press Writer Calvin Woodward, Associated Press Writer – Wed Aug 19, 4:11 pm ET
WASHINGTON – The judgment is harsh in a new poll that finds Americans worried about the government taking over health insurance, cutting off treatment to the elderly and giving coverage to illegal immigrants. Harsh, but not based on facts.
It appears that President Barack Obama's lack of a detailed plan for overhauling health care is letting critics fill in the blanks in the public's mind. In reality, Washington is not working on "death panels" or nationalization of health care.
Obama is promoting his changes in something of a vacuum, laying out principles, goals and broad avenues, some of which he's open to amending. As lawmakers sweat the nitty gritty, he's doing a lot of listening, and he's getting an earful.
A new NBC News poll suggests some of the myths and partial truths about the plans under consideration are taking hold.
Most respondents said the effort is likely to lead to a "government takeover of the health care system" and to public insurance for illegal immigrants. Half said it will probably result in taxpayers paying for abortions and nearly that many expected the government will end up with the power to decide when treatment should stop for old people.
A look at each of those points:
THE POLL: 45 percent said it's likely the government will decide when to stop care for the elderly; 50 percent said it's not likely.
THE FACTS: Nothing being debated in Washington would give the government such authority. Critics have twisted a provision in a House bill that would direct Medicare to pay for counseling sessions about end-of-life care, living wills, hospices and the like if a patient wants such consultations with a doctor. They have said, incorrectly, that the elderly would be required to have these sessions.
House Republican Leader John Boehner of Ohio said such counseling "may start us down a treacherous path toward government-encouraged euthanasia."
The bill would prohibit coverage of counseling that presents suicide or assisted suicide as an option.
Republican Sen. Johnny Isakson of Georgia, who has been a proponent of coverage for end-of-life counseling under Medicare, said such sessions are a voluntary benefit, strictly between doctor and patient, and it was "nuts" to think death panels are looming or euthanasia is part of the equation.
But as fellow conservatives stepped up criticism of the provision, he backed away from his defense of it.
___
THE POLL: 55 percent expect the overhaul will give coverage to illegal immigrants; 34 percent don't.
THE FACTS: The proposals being negotiated do not provide coverage for illegal immigrants.
___
THE POLL: 54 percent said the overhaul will lead to a government takeover of health care; 39 percent disagree.
THE FACTS: Obama is not proposing a single-payer system in which the government covers everyone, like in Canada or some European countries. He says that direction is not right for the U.S. The proposals being negotiated do not go there.
At issue is a proposed "exchange" or "marketplace" in which a new government plan would be one option for people who aren't covered at work or whose job coverage is too expensive. The exchange would offer some private plans as well as the public one, all of them required to offer certain basic benefits.
That's a long way from a government takeover. But when Obama tells people they can just continue with the plans they have now if they are happy with them, that can't be taken at face value, either. Tax provisions could end up making it cheaper for some employers to pay a fee to end their health coverage.
___
THE POLL: 50 percent expect taxpayer dollars will be used to pay for abortions; 37 percent don't.
THE FACTS: The House version of legislation would allow coverage for abortion, but the bill says a beneficiary's own money — not taxpayer funds — must be used to pay for the procedure. How that would be enforced has not been determined.
The truth is out there, unfortunately so are opportunists looking to propogate fear.
Read all you can and engage in the debate.
By CALVIN WOODWARD, Associated Press Writer Calvin Woodward, Associated Press Writer – Wed Aug 19, 4:11 pm ET
WASHINGTON – The judgment is harsh in a new poll that finds Americans worried about the government taking over health insurance, cutting off treatment to the elderly and giving coverage to illegal immigrants. Harsh, but not based on facts.
It appears that President Barack Obama's lack of a detailed plan for overhauling health care is letting critics fill in the blanks in the public's mind. In reality, Washington is not working on "death panels" or nationalization of health care.
Obama is promoting his changes in something of a vacuum, laying out principles, goals and broad avenues, some of which he's open to amending. As lawmakers sweat the nitty gritty, he's doing a lot of listening, and he's getting an earful.
A new NBC News poll suggests some of the myths and partial truths about the plans under consideration are taking hold.
Most respondents said the effort is likely to lead to a "government takeover of the health care system" and to public insurance for illegal immigrants. Half said it will probably result in taxpayers paying for abortions and nearly that many expected the government will end up with the power to decide when treatment should stop for old people.
A look at each of those points:
THE POLL: 45 percent said it's likely the government will decide when to stop care for the elderly; 50 percent said it's not likely.
THE FACTS: Nothing being debated in Washington would give the government such authority. Critics have twisted a provision in a House bill that would direct Medicare to pay for counseling sessions about end-of-life care, living wills, hospices and the like if a patient wants such consultations with a doctor. They have said, incorrectly, that the elderly would be required to have these sessions.
House Republican Leader John Boehner of Ohio said such counseling "may start us down a treacherous path toward government-encouraged euthanasia."
The bill would prohibit coverage of counseling that presents suicide or assisted suicide as an option.
Republican Sen. Johnny Isakson of Georgia, who has been a proponent of coverage for end-of-life counseling under Medicare, said such sessions are a voluntary benefit, strictly between doctor and patient, and it was "nuts" to think death panels are looming or euthanasia is part of the equation.
But as fellow conservatives stepped up criticism of the provision, he backed away from his defense of it.
___
THE POLL: 55 percent expect the overhaul will give coverage to illegal immigrants; 34 percent don't.
THE FACTS: The proposals being negotiated do not provide coverage for illegal immigrants.
___
THE POLL: 54 percent said the overhaul will lead to a government takeover of health care; 39 percent disagree.
THE FACTS: Obama is not proposing a single-payer system in which the government covers everyone, like in Canada or some European countries. He says that direction is not right for the U.S. The proposals being negotiated do not go there.
At issue is a proposed "exchange" or "marketplace" in which a new government plan would be one option for people who aren't covered at work or whose job coverage is too expensive. The exchange would offer some private plans as well as the public one, all of them required to offer certain basic benefits.
That's a long way from a government takeover. But when Obama tells people they can just continue with the plans they have now if they are happy with them, that can't be taken at face value, either. Tax provisions could end up making it cheaper for some employers to pay a fee to end their health coverage.
___
THE POLL: 50 percent expect taxpayer dollars will be used to pay for abortions; 37 percent don't.
THE FACTS: The House version of legislation would allow coverage for abortion, but the bill says a beneficiary's own money — not taxpayer funds — must be used to pay for the procedure. How that would be enforced has not been determined.
The truth is out there, unfortunately so are opportunists looking to propogate fear.
Read all you can and engage in the debate.
Episodes of Care Based Healthcare Reimbursement Explained
I've talked a lot about changing healthcare reimbursement from basic fee-for-service to reimbursing based on outcomes called "episodes of care". Here's a non-technical, consumer friendly overview of it from the Robert Wood Johnson Foundation.
Using Episode Payment to Fix Our Fragmented Health Care System
Can Episode-of-Care Based Payments Be the Bridge That Finally Brings Accountability to America's Fragmented Health Care System?
A critical part of restructuring the health care delivery system is the need to develop an effective payment formula that rewards professionals for delivering high-quality, coordinated and efficient care.
Many argue that the current fee-for-service and per-patient (capitation)-style payment models have led to a fragmented U.S. health care system beset by poor performance and dysfunction. Rather than encouraging value-driven health care, these reimbursement models reward volume-driven care—where providers are paid for “doing things” (often too many or not enough), rather than working together to deliver quality services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.
In a Perspectives article published online in the New England Journal of Medicine, authors François de Brantes, Meredith Rosenthal and Michael Painter discuss how episode-based payments—and specifically the RWJF-funded PROMETHEUS Payment® model—might be the bridge that brings integration and accountability to America’s fragmented health care system.
A revolutionary payment model currently being piloted in communities across the country, PROMETHEUS Payment offers a potential blueprint for a new health care payment system. It effectively promotes and rewards high-quality, efficient, patient-centered care; provides common performance incentives for all parties; and creates an environment where doing the right things for patients also allows providers and insurers to do well financially.
LINK to the extended article: http://www.rwjf.org/qualityequality/product.jsp?id=47429
Using Episode Payment to Fix Our Fragmented Health Care System
Can Episode-of-Care Based Payments Be the Bridge That Finally Brings Accountability to America's Fragmented Health Care System?
A critical part of restructuring the health care delivery system is the need to develop an effective payment formula that rewards professionals for delivering high-quality, coordinated and efficient care.
Many argue that the current fee-for-service and per-patient (capitation)-style payment models have led to a fragmented U.S. health care system beset by poor performance and dysfunction. Rather than encouraging value-driven health care, these reimbursement models reward volume-driven care—where providers are paid for “doing things” (often too many or not enough), rather than working together to deliver quality services that are proven to keep people healthy, reduce errors and help avoid unnecessary care.
In a Perspectives article published online in the New England Journal of Medicine, authors François de Brantes, Meredith Rosenthal and Michael Painter discuss how episode-based payments—and specifically the RWJF-funded PROMETHEUS Payment® model—might be the bridge that brings integration and accountability to America’s fragmented health care system.
A revolutionary payment model currently being piloted in communities across the country, PROMETHEUS Payment offers a potential blueprint for a new health care payment system. It effectively promotes and rewards high-quality, efficient, patient-centered care; provides common performance incentives for all parties; and creates an environment where doing the right things for patients also allows providers and insurers to do well financially.
LINK to the extended article: http://www.rwjf.org/qualityequality/product.jsp?id=47429
Tuesday, August 18, 2009
Reform without the Public Plan Option- It could look like this
What will reform look like?
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
Monday, August 17, 2009
Important News about Insurance Agents and the Public Plan Option
Agents Win Key Health Reform Provision
As reported by National Underwriter, insurance agents have won a critical change in the House Energy and Commerce Committee version of healthcare reform legislation.
Through language negotiated by conservative Democrats as the House prepared to leave July 31, agents won explicit authority to sell within the health insurance exchanges that would be created under the legislation.
The provision in the bill reported out by the E&C Committee would also give agents the authority to sell the so-called public plan in the event that such entities are created under the final version of the legislation, according to officials of the Independent Insurance Agents and Brokers of America.
The key amendment to the E&C bill was added at the request of Rep. Charlie Melancon, D-La., Rep. Baron Hill, D-Ind., and Mike Ross, D-Ark., according to IIABA officials.
Other provisions sought by agents included in the E&C bill would double the small-business exemption from the employer mandate to $500,000 in payroll, from the former $250,000, and would add language explicitly allowing the creation of cooperatives, although the public plan is still in the bill.
They also cautioned that House Democratic leadership has given “no assurances” that the final bill that goes to the House floor in September would contain the provisions. That is because the E&C bill must be reconciled with versions of the legislation reported out by the House Ways and Means Committee and the Education and Labor Committee.
------
As I said in an earlier blog the public plan option would be unfair competition to private health plans IF agent commissions and other items like advertising costs were not included in the public plan option's costs. Now it seems possible that the public plan option may provide a fair competitor to private plans. It all depends on what happens in the conference committees which reconcile differences in the various bills that are passed by the House and Senate committees.
Stay tuned and participate in the debate on your health care future...
As reported by National Underwriter, insurance agents have won a critical change in the House Energy and Commerce Committee version of healthcare reform legislation.
Through language negotiated by conservative Democrats as the House prepared to leave July 31, agents won explicit authority to sell within the health insurance exchanges that would be created under the legislation.
The provision in the bill reported out by the E&C Committee would also give agents the authority to sell the so-called public plan in the event that such entities are created under the final version of the legislation, according to officials of the Independent Insurance Agents and Brokers of America.
The key amendment to the E&C bill was added at the request of Rep. Charlie Melancon, D-La., Rep. Baron Hill, D-Ind., and Mike Ross, D-Ark., according to IIABA officials.
Other provisions sought by agents included in the E&C bill would double the small-business exemption from the employer mandate to $500,000 in payroll, from the former $250,000, and would add language explicitly allowing the creation of cooperatives, although the public plan is still in the bill.
They also cautioned that House Democratic leadership has given “no assurances” that the final bill that goes to the House floor in September would contain the provisions. That is because the E&C bill must be reconciled with versions of the legislation reported out by the House Ways and Means Committee and the Education and Labor Committee.
------
As I said in an earlier blog the public plan option would be unfair competition to private health plans IF agent commissions and other items like advertising costs were not included in the public plan option's costs. Now it seems possible that the public plan option may provide a fair competitor to private plans. It all depends on what happens in the conference committees which reconcile differences in the various bills that are passed by the House and Senate committees.
Stay tuned and participate in the debate on your health care future...
Co-ops may be the compromise answer
Details on Co-ops
Kathy Sebelius, Secretary of the U.S. Dept of Health and Human Services, said the White House would be open to co-ops instead of a public option — a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
--------------
Co-ops may be the best compromise solution to still get the competition needed to reign in health care costs. In the end Co-ops may gain some votes from Republicans and may lose a few of the hardest line liberals. It should provide a net gain. But, we still need other elelments to achieve real reform - i.e.- payment reform based on episodes of care, quality-based incentives and incentives to implement LEAN techniques. See previous posts for details on these items.
Kathy Sebelius, Secretary of the U.S. Dept of Health and Human Services, said the White House would be open to co-ops instead of a public option — a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
--------------
Co-ops may be the best compromise solution to still get the competition needed to reign in health care costs. In the end Co-ops may gain some votes from Republicans and may lose a few of the hardest line liberals. It should provide a net gain. But, we still need other elelments to achieve real reform - i.e.- payment reform based on episodes of care, quality-based incentives and incentives to implement LEAN techniques. See previous posts for details on these items.
Sunday, August 16, 2009
"The Public Plan Option Not Essential to Reform"- White House
As I've long predicted..... The public plan option is not a deal breaker, but a negotiating tool for Obama.
For more details: http://news.yahoo.com/s/politico/20090816/pl_politico/26158
Excerpt---- President Barack Obama and his top aides are signaling that they’re prepared to drop a government insurance option from a final health-reform deal if that’s what’s needed to strike a compromise on Obama’s top legislative priority.
Health and Human Services Secretary Kathleen Sebelius said Sunday that the public option was “not the essential element” of the overhaul. A day earlier, Obama downplayed the public option during a Colorado town hall meeting, saying it was “just one sliver” of the debate.
He even chided Democratic supporters and Republican critics for becoming “so fixated on this that they forget everything else” — a dig at some liberals in his own party who have made the public option the main rallying cry of the health reform debate.
----------
The President is right- the public plan option has been a fixation for Dems and a smokescreen for the GOP to avoid the real issues of payment reform, cost control and expanding access.
Now hopefully they'll all get to work on the real issues.... see an earlier post for that analysis.
For more details: http://news.yahoo.com/s/politico/20090816/pl_politico/26158
Excerpt---- President Barack Obama and his top aides are signaling that they’re prepared to drop a government insurance option from a final health-reform deal if that’s what’s needed to strike a compromise on Obama’s top legislative priority.
Health and Human Services Secretary Kathleen Sebelius said Sunday that the public option was “not the essential element” of the overhaul. A day earlier, Obama downplayed the public option during a Colorado town hall meeting, saying it was “just one sliver” of the debate.
He even chided Democratic supporters and Republican critics for becoming “so fixated on this that they forget everything else” — a dig at some liberals in his own party who have made the public option the main rallying cry of the health reform debate.
----------
The President is right- the public plan option has been a fixation for Dems and a smokescreen for the GOP to avoid the real issues of payment reform, cost control and expanding access.
Now hopefully they'll all get to work on the real issues.... see an earlier post for that analysis.
Tuesday, August 11, 2009
Baldwin's efforts on health care reform
Baldwin’s efforts to advance health care- some good, but I'm not sure she understands the public plan option.
The Good…
U.S. Rep. Tammy Baldwin has recently made an impact on some provisions in the health reform bill that will come up for a vote by the full House of Representatives in September. Baldwin won a late-minute approval for one of her amendments: to start a pilot program within Medicaid known as "accountable care" that would pay more for health results rather than individual services.
but…
Unfortunately the amendment only allows a pilot and not all out payment reform based on accountable care. Frankly there’s enough research and evidence already on this to simply start enacting this reform broadly. I presume that this is all she could get passed by the committee.
… and the misunderstood
(http://www.madison.com/archives/read.php?ref=/tct/2009/07/31/0907310169.php)
On another note, in the above linked Capital Times Op-ed piece Baldwin made the case for the public plan option currently being hotly debated. Sad to say her case fell way short in her comparison of Wisconsin’s SeniorCare program to the public plan option proposed in the health care reform bill working its way through the House.
Baldwin wrote, “since 2003, Wisconsin has been offering a public option for seniors in need of prescription drug coverage who do not select the private plans in Medicare Part D. While SeniorCare is both wildly popular and hugely effective, private prescription drug insurance plans continue to flourish in Wisconsin, with a large number of available plans and fair premium rates.” What Baldwin doesn’t say however is that SeniorCare is only for low-income seniors with incomes up to $35,000 annually for a couple. There is no premium. Instead they pay a $30 annual enrollment fee and have copays and an $850 deductible.
So in reality SeniorCare is for low-income seniors and the private Medicare Part D plans are for everyone else. They don't actually compete at all and opens up the question of her understanding of the public plan option.
The Good…
U.S. Rep. Tammy Baldwin has recently made an impact on some provisions in the health reform bill that will come up for a vote by the full House of Representatives in September. Baldwin won a late-minute approval for one of her amendments: to start a pilot program within Medicaid known as "accountable care" that would pay more for health results rather than individual services.
but…
Unfortunately the amendment only allows a pilot and not all out payment reform based on accountable care. Frankly there’s enough research and evidence already on this to simply start enacting this reform broadly. I presume that this is all she could get passed by the committee.
… and the misunderstood
(http://www.madison.com/archives/read.php?ref=/tct/2009/07/31/0907310169.php)
On another note, in the above linked Capital Times Op-ed piece Baldwin made the case for the public plan option currently being hotly debated. Sad to say her case fell way short in her comparison of Wisconsin’s SeniorCare program to the public plan option proposed in the health care reform bill working its way through the House.
Baldwin wrote, “since 2003, Wisconsin has been offering a public option for seniors in need of prescription drug coverage who do not select the private plans in Medicare Part D. While SeniorCare is both wildly popular and hugely effective, private prescription drug insurance plans continue to flourish in Wisconsin, with a large number of available plans and fair premium rates.” What Baldwin doesn’t say however is that SeniorCare is only for low-income seniors with incomes up to $35,000 annually for a couple. There is no premium. Instead they pay a $30 annual enrollment fee and have copays and an $850 deductible.
So in reality SeniorCare is for low-income seniors and the private Medicare Part D plans are for everyone else. They don't actually compete at all and opens up the question of her understanding of the public plan option.
No ‘death panel’ in health care bill
A provision in proposed health care reform bill would finance end-of-life care counseling — if patient wants it.
Former Republican vice presidential candidate Sarah Palin is once again showing she is not ready for prime-time when she says the current proposed health care overhaul bill would set up a "death panel." Palin inferred that federal bureaucrats would play God, ruling on whether ailing seniors are worthy enough to society to deserve life-sustaining medical care. Palin and other critics are dead wrong.
Perhaps this is obvious, but nothing in the legislation would carry out such a bleak vision. The provision that has caused this misguided and manufactured uproar, which opponents are all too glad to use to distract everyone from the real issues, would actually authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes.
Former Republican vice presidential candidate Sarah Palin is once again showing she is not ready for prime-time when she says the current proposed health care overhaul bill would set up a "death panel." Palin inferred that federal bureaucrats would play God, ruling on whether ailing seniors are worthy enough to society to deserve life-sustaining medical care. Palin and other critics are dead wrong.
Perhaps this is obvious, but nothing in the legislation would carry out such a bleak vision. The provision that has caused this misguided and manufactured uproar, which opponents are all too glad to use to distract everyone from the real issues, would actually authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes.
Friday, August 7, 2009
Health Care Reform Webcast today at 1:00 pm
Today Kathleen Sebelius, Secretary of the Department of Health and Human Services is doing a health care reform webcast. It begins at 1 PM EDT, 12:00 Noon Central time.
Sebelius will be joined by some of the top officials at the Department of Health and Human Services for a live webcast where they’ll answer questions from the public and discuss the many benefits of health insurance reform.
To watch the webcast live go to www.HealthReform.gov.
Sebelius will be joined by some of the top officials at the Department of Health and Human Services for a live webcast where they’ll answer questions from the public and discuss the many benefits of health insurance reform.
To watch the webcast live go to www.HealthReform.gov.
Thursday, August 6, 2009
Dental benefits
Dental Coverage Included in Health Care Reform?
At this point it is doubtful that dental coverage will be included in any health care reform legislation passed by Congress this year. According to CNN’s medical correspondent, Dr. Sanjay Gupta, for every one person without health insurance in the U.S., there are roughly two without dental insurance. That means 80-90 million Americans or more go without dental coverage.
For more on dental coverage issues and health care reform please see this brief video.
http://portal.tds.net/video/?vendid=18&vid=268733&sc_cid=wvtabb4
At this point it is doubtful that dental coverage will be included in any health care reform legislation passed by Congress this year. According to CNN’s medical correspondent, Dr. Sanjay Gupta, for every one person without health insurance in the U.S., there are roughly two without dental insurance. That means 80-90 million Americans or more go without dental coverage.
For more on dental coverage issues and health care reform please see this brief video.
http://portal.tds.net/video/?vendid=18&vid=268733&sc_cid=wvtabb4
Wednesday, August 5, 2009
Current Focus is on the Wrong Issues
Today’s topic: The real issues in the health care reform debate
Although the cost issues and the potential inclusion of a public plan option are important, there are real issues being largely ignored.
The primary issue in health care reform should be about increasing access and the best means to do it. Way back in April the health insurance industry offered some key concessions. AHIP, the largest national insurance trade association said that if the approved health care legislation were adopted without a public plan option, health insurers would drop two huge current health insurance practices.
*** Full disclosure: I consult extensively with AHIP so I’m fully acknowledging my perspective and biases. I also work with Medicaid policy to increase health insurance access for people with disabilities, so I see and understand both sides. ***
But the concessions AHIP offered are indeed huge.
1) No more individual plan underwriting. This means insurers propose to no longer cherry pick the healthiest potential customers seeking individual health insurance. They pledge to take all comers. Now of course they propose that because it’s beneficial to their business…. insuring more people, means more health insurance premium, and equals more revenue. Health insurance is a business and like every business, revenue is a good thing.
2) No more gender-based underwriting. This is a very good thing. This means that women of child-bearing age will not be charged a higher premium simply because they COULD become pregnant. Fellas, this of course means we might pay a little more, but I think we all agree it’s only fair. Ultimately, coupled with the first concession, this means that young, single women will no longer have the difficulty of obtaining health insurance on their own if their employer doesn’t offer it. And without the incredibly high premiums.
If there is mandated coverage on individuals and/or businesses it means that the insurers will benefit from an increased market and increased revenue so the elim- ination of underwriting and instituting equitable premium based on gender mean a fairer health insurance system.
Ok, So What Does This Mean?
Hopefully as the debate rages on Congress will realize it needs to resolve the public option issue speedily so that we get the more important issues of how best to increase access in the foreground. Those more important issues are- will coverage be mandated, how will it be financed, how will physicians be incentivized to achieve better health outcomes and reduce spiraling costs.
If health care reform does not eliminate the individual market and put us all into larger purchasing pools, therefore reducing insurer risk and decreasing premium, then we will have failed miserably. This needs much more attention than it currently is getting.
----------------
You might ask how this would affect state Medicaid programs, Medicare and state high-risk pools available to the currently uninsurable? I’m glad you asked as that will be the subject of a blog entry next week. Stay tuned and please join in the discussion.
Although the cost issues and the potential inclusion of a public plan option are important, there are real issues being largely ignored.
The primary issue in health care reform should be about increasing access and the best means to do it. Way back in April the health insurance industry offered some key concessions. AHIP, the largest national insurance trade association said that if the approved health care legislation were adopted without a public plan option, health insurers would drop two huge current health insurance practices.
*** Full disclosure: I consult extensively with AHIP so I’m fully acknowledging my perspective and biases. I also work with Medicaid policy to increase health insurance access for people with disabilities, so I see and understand both sides. ***
But the concessions AHIP offered are indeed huge.
1) No more individual plan underwriting. This means insurers propose to no longer cherry pick the healthiest potential customers seeking individual health insurance. They pledge to take all comers. Now of course they propose that because it’s beneficial to their business…. insuring more people, means more health insurance premium, and equals more revenue. Health insurance is a business and like every business, revenue is a good thing.
2) No more gender-based underwriting. This is a very good thing. This means that women of child-bearing age will not be charged a higher premium simply because they COULD become pregnant. Fellas, this of course means we might pay a little more, but I think we all agree it’s only fair. Ultimately, coupled with the first concession, this means that young, single women will no longer have the difficulty of obtaining health insurance on their own if their employer doesn’t offer it. And without the incredibly high premiums.
If there is mandated coverage on individuals and/or businesses it means that the insurers will benefit from an increased market and increased revenue so the elim- ination of underwriting and instituting equitable premium based on gender mean a fairer health insurance system.
Ok, So What Does This Mean?
Hopefully as the debate rages on Congress will realize it needs to resolve the public option issue speedily so that we get the more important issues of how best to increase access in the foreground. Those more important issues are- will coverage be mandated, how will it be financed, how will physicians be incentivized to achieve better health outcomes and reduce spiraling costs.
If health care reform does not eliminate the individual market and put us all into larger purchasing pools, therefore reducing insurer risk and decreasing premium, then we will have failed miserably. This needs much more attention than it currently is getting.
----------------
You might ask how this would affect state Medicaid programs, Medicare and state high-risk pools available to the currently uninsurable? I’m glad you asked as that will be the subject of a blog entry next week. Stay tuned and please join in the discussion.
Tuesday, August 4, 2009
Public Plan Option Debate
Will a public option be included in the final health care reform bill passed by Congress?
It seems the $64 million question in the health care reform debate centers on President Obama’s fondness for the Public Plan option.
Is the public plan option a Trojan horse disguising a government takeover of healthcare as some suggest? The best answer to that may be “not really, but”….
It’s perhaps the issue that has received the most attention and involves the most spin from both sides of the political aisle. Let’s tackle this from a Pros and Cons perspective.
Public Plan Option -- Pro
The U.S. Government currently pays for more than 30% of all health care expenditures in the U.S. through Medicare and Medicaid. In fact many seniors have been heard to say, “I don’t want the government to touch my Medicare!” Hmmm, I guess they don't realize that for the most part Medicare IS the Government.
Although in dire need of a benefit redesign, payment restructuring, and adjustments to 21st century realities Medicare really has served its initial role exceptionally well over the years. Medicaid, administered as a federal/ state partnership has also performed decently in providing coverage to our most vulnerable populations. Despite their size and impact on the health care landscape, many Americans understand little of how these programs are administered and who there participants are.
Therein lies the misperception perhaps of what a public plan option is exactly.
Public Plan Option -- Con
As described above Medicare and Medicaid have performed admirably considering the programs’ longevity and size. So of course it makes sense to expand them and build on their successes and have an expanded Medicare program run by a pseudo government entity, perhaps a Connector. The devil however is in the details. President Obama says a public plan option competing against private plans will keep them honest and keep costs down. That’s the administration’s argument, which you may have heard once or twice.
Let’s address the details. Private plans are sold by insurance agents and brokers and have marketing costs, commissions, advertising, etc. Would the public plan option have those costs as well? Not likely. If not, is the playing field level? It may be easy therefore for a public plan to compete very favorably against the private plans.
Then let’s add consumer choice into the mix. Would you choose the public plan option offered through a government program or website that included your doctors, your pharmacy, and your child’s pediatrician, the same as another private plan with equal benefits? What if the commission and advertising costs caused the private plan to price out at 15% more? Do you think reform could be implemented this way without a level playing field and be sustainable?
That’s why the public plan naysayers have a point, that the playing field will not be level and the majority of the public would flock to the public option putting the private plans in dire financial straits. Would that be a Trojan horse leading to nationalized healthcare? It depends on what the public plan administration costs include…. and more importantly... what they might not include.
Forecasting a Solution
So is there a compromise, endgame solution after the pundits and politicians say their piece? Will the dust settle in to something that a majority of Congress can live with and the public might actually understand? See this article (http://www.npr.org/templates/story/story.php?storyId=111441399) for more about the current debate’s confusing nature and why the message has been messed up. More on that topic later this week. But I digress…
Is there a compromise solution? Yes, I believe there is and it could be modeled in some part on the Medicare Advantage program. Through this program the feds contract with Medicare HMOs and Medicare Part D prescription drug plans in every region of the country. Revising Medicare Advantage is also part of the larger health care reform debate and I’ll address that specific topic next week. These Medicare HMO contracts could be used as a model to incorporate evidence-based quality care that includes provider incentives and could even easily incorporate payment reforms. We touched on that issue in the blog yesterday in case you missed it when I addressed the subject of cost. In that blog entry I suggested that payment reforms geared to “episodes of care” should be considered as the means to cut health care expenditures while improving health outcomes.
In short, Congress has a model for the compromise solution; it may take a lot more rhetoric, hand wringing, and frustration to get there, however. In the end, I believe if health reform is passed this fall the final package will include plan options built very similarly to the Medicare Advantage plans currently in existence.
It seems the $64 million question in the health care reform debate centers on President Obama’s fondness for the Public Plan option.
Is the public plan option a Trojan horse disguising a government takeover of healthcare as some suggest? The best answer to that may be “not really, but”….
It’s perhaps the issue that has received the most attention and involves the most spin from both sides of the political aisle. Let’s tackle this from a Pros and Cons perspective.
Public Plan Option -- Pro
The U.S. Government currently pays for more than 30% of all health care expenditures in the U.S. through Medicare and Medicaid. In fact many seniors have been heard to say, “I don’t want the government to touch my Medicare!” Hmmm, I guess they don't realize that for the most part Medicare IS the Government.
Although in dire need of a benefit redesign, payment restructuring, and adjustments to 21st century realities Medicare really has served its initial role exceptionally well over the years. Medicaid, administered as a federal/ state partnership has also performed decently in providing coverage to our most vulnerable populations. Despite their size and impact on the health care landscape, many Americans understand little of how these programs are administered and who there participants are.
Therein lies the misperception perhaps of what a public plan option is exactly.
Public Plan Option -- Con
As described above Medicare and Medicaid have performed admirably considering the programs’ longevity and size. So of course it makes sense to expand them and build on their successes and have an expanded Medicare program run by a pseudo government entity, perhaps a Connector. The devil however is in the details. President Obama says a public plan option competing against private plans will keep them honest and keep costs down. That’s the administration’s argument, which you may have heard once or twice.
Let’s address the details. Private plans are sold by insurance agents and brokers and have marketing costs, commissions, advertising, etc. Would the public plan option have those costs as well? Not likely. If not, is the playing field level? It may be easy therefore for a public plan to compete very favorably against the private plans.
Then let’s add consumer choice into the mix. Would you choose the public plan option offered through a government program or website that included your doctors, your pharmacy, and your child’s pediatrician, the same as another private plan with equal benefits? What if the commission and advertising costs caused the private plan to price out at 15% more? Do you think reform could be implemented this way without a level playing field and be sustainable?
That’s why the public plan naysayers have a point, that the playing field will not be level and the majority of the public would flock to the public option putting the private plans in dire financial straits. Would that be a Trojan horse leading to nationalized healthcare? It depends on what the public plan administration costs include…. and more importantly... what they might not include.
Forecasting a Solution
So is there a compromise, endgame solution after the pundits and politicians say their piece? Will the dust settle in to something that a majority of Congress can live with and the public might actually understand? See this article (http://www.npr.org/templates/story/story.php?storyId=111441399) for more about the current debate’s confusing nature and why the message has been messed up. More on that topic later this week. But I digress…
Is there a compromise solution? Yes, I believe there is and it could be modeled in some part on the Medicare Advantage program. Through this program the feds contract with Medicare HMOs and Medicare Part D prescription drug plans in every region of the country. Revising Medicare Advantage is also part of the larger health care reform debate and I’ll address that specific topic next week. These Medicare HMO contracts could be used as a model to incorporate evidence-based quality care that includes provider incentives and could even easily incorporate payment reforms. We touched on that issue in the blog yesterday in case you missed it when I addressed the subject of cost. In that blog entry I suggested that payment reforms geared to “episodes of care” should be considered as the means to cut health care expenditures while improving health outcomes.
In short, Congress has a model for the compromise solution; it may take a lot more rhetoric, hand wringing, and frustration to get there, however. In the end, I believe if health reform is passed this fall the final package will include plan options built very similarly to the Medicare Advantage plans currently in existence.
Remaining Unresolved Cost Issues in the Health Care Reform Debate
Today, I’ll tackle the cost side of the health care reform debate.
The case for health care reform is this. If federal reform efforts are not enacted—within 10 years the cost of health care for businesses could double, and the number of uninsured Americans could reach 65.7 million—with middle-income families hardest hit, according to a report by the Robert Wood Johnson Foundation.
So, what are the remaining cost issues that lawmakers are negotiating?
How is Congress going to pay for this?
a- The House Democrats' version as of Friday July 31, would mandate companies with payrolls above $250,000 to either insure employees or cough up an 8 percent-of-payroll penalty. That’s a $20,000 minimum penalty. If the company has five employees, that’s just about $333 a month per employee. If it has ten employees its half that. It’s unclear if it changes depending on the number of dependents covered.
b- Another proposal to fund the expansion of coverage to the uninsured includes a tax on Americans earning more than $350,000 per year. Another provision includes a tax on the benefits of so called “Cadillac” or high benefit plans.
c- A new development occurred on August 3rd when two of President Barack Obama's economic heavyweights said middle-class taxes might have to go up to pare budget deficits or to pay for the proposed overhaul of the nation's health care system. The tough talk from Treasury Secretary Timothy Geithner and National Economic Council Director Lawrence Summers contradicted an Obama campaign promise.
So those are the primary cost issues.
What’s missing is the fact that real cost savings can be achieved through payment reform. Obama has touched on this issue but has not seemed to embrace it wholeheartedly. Obama has talked several times in recent weeks about incentives for better outcomes tied to such things as lower rates of hospital readmissions, and better prescription drug management, and changing end of life care processes.
Some experts like those at Thedacare’s Center for Health Care Value in Appleton, WI say that payment reform is needed to establish payment for episodes of care rather than individual service reimbursement where doctors get reimbursed an amount per procedure performed. Instead, Thedacare and others argue doctors should get reimbursed for managing care for a longer period and tie higher levels of reimbursement to positive health outcomes. The better the outcome, the better the reimbursement and doctors would find efficiencies in the episodes of care rather than ordering a multitude of questionable tests. See this link for more on Thedacare http://www.createhealthcarevalue.com/about/.
So Congress is missing a large portion of the debate because payment reform would be true health care reform. Simply expanding coverage and adding other elements, but not fundamentally changing the way health care is rendered will not achieve the cost savings needed to pay for the expanded coverage of the uninsured.
Today, I’ll tackle the cost side of the health care reform debate.
The case for health care reform is this. If federal reform efforts are not enacted—within 10 years the cost of health care for businesses could double, and the number of uninsured Americans could reach 65.7 million—with middle-income families hardest hit, according to a report by the Robert Wood Johnson Foundation.
So, what are the remaining cost issues that lawmakers are negotiating?
How is Congress going to pay for this?
a- The House Democrats' version as of Friday July 31, would mandate companies with payrolls above $250,000 to either insure employees or cough up an 8 percent-of-payroll penalty. That’s a $20,000 minimum penalty. If the company has five employees, that’s just about $333 a month per employee. If it has ten employees its half that. It’s unclear if it changes depending on the number of dependents covered.
b- Another proposal to fund the expansion of coverage to the uninsured includes a tax on Americans earning more than $350,000 per year. Another provision includes a tax on the benefits of so called “Cadillac” or high benefit plans.
c- A new development occurred on August 3rd when two of President Barack Obama's economic heavyweights said middle-class taxes might have to go up to pare budget deficits or to pay for the proposed overhaul of the nation's health care system. The tough talk from Treasury Secretary Timothy Geithner and National Economic Council Director Lawrence Summers contradicted an Obama campaign promise.
So those are the primary cost issues.
What’s missing is the fact that real cost savings can be achieved through payment reform. Obama has touched on this issue but has not seemed to embrace it wholeheartedly. Obama has talked several times in recent weeks about incentives for better outcomes tied to such things as lower rates of hospital readmissions, and better prescription drug management, and changing end of life care processes.
Some experts like those at Thedacare’s Center for Health Care Value in Appleton, WI say that payment reform is needed to establish payment for episodes of care rather than individual service reimbursement where doctors get reimbursed an amount per procedure performed. Instead, Thedacare and others argue doctors should get reimbursed for managing care for a longer period and tie higher levels of reimbursement to positive health outcomes. The better the outcome, the better the reimbursement and doctors would find efficiencies in the episodes of care rather than ordering a multitude of questionable tests. See this link for more on Thedacare http://www.createhealthcarevalue.com/about/.
So Congress is missing a large portion of the debate because payment reform would be true health care reform. Simply expanding coverage and adding other elements, but not fundamentally changing the way health care is rendered will not achieve the cost savings needed to pay for the expanded coverage of the uninsured.
Monday, August 3, 2009
Introduction
Welcome-
The current debate on health care reform is as complex and frustrating as the system it attempts to alter. Weeding through the issues, not to mention the posturing and rhetoric, to get a true sense of potential solutions, is nearly impossible. As citizens attempt to engage in the debate about reforming our Trillion dollar health care system they often get bogged down in the minutiae. This blog will attempt to provide readers with balanced information and simplify the complexities involved so that they are informed and knowledgeable users and participants in both the health care and insurance systems AND the reform debate. Insuring Resources is your site to be informed about our health care and health insurance reform solutions. Please engage in and enrich the conversation.
meta name="verify-v1" content="7WytoDCkQ0a1fqDM5Pt0cVTpfFV/wI+xaGH0GLY4d1A=" >
The current debate on health care reform is as complex and frustrating as the system it attempts to alter. Weeding through the issues, not to mention the posturing and rhetoric, to get a true sense of potential solutions, is nearly impossible. As citizens attempt to engage in the debate about reforming our Trillion dollar health care system they often get bogged down in the minutiae. This blog will attempt to provide readers with balanced information and simplify the complexities involved so that they are informed and knowledgeable users and participants in both the health care and insurance systems AND the reform debate. Insuring Resources is your site to be informed about our health care and health insurance reform solutions. Please engage in and enrich the conversation.
meta name="verify-v1" content="7WytoDCkQ0a1fqDM5Pt0cVTpfFV/wI+xaGH0GLY4d1A=" >
Subscribe to:
Posts (Atom)
