We now have health care reform bill sfrom both the House and the Senate. They will be debated over the next few weeks and then come to a final vote in each House. Then a conference committee will negotiate a final bill to be voted on by each House of congress. Its projected that the final bill could be signed by President Obama in time for Christmas.
Coverage Highlights-**Provides coverage for 96% of legally residing Americans.
** Subidizes coverage for the poorest Americans
** Caps annual out-of-pocket costs
** Eliminates Pre-x condition exclusions
Fiscal and Cost Issues
** Cuts federal deficit by $30 mill over ten years according to the CBO
** Individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge.
** Cuts Medicare expenditures by 1.3% annually
** The House bill imposes a fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
** Requires larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
CNN, conforming with the rest of our wonderful media, ignores the question of whether true cost controls and waste reduction strategies exist within this bill.
I'll get a copy of the bill and research those questions.
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From CNN, October 31, 2009
The battle over health care reform reached another milestone Thursday as top House Democrats unveiled sweeping legislation that includes a highly controversial public health insurance option.
The nearly 2,000-page bill -- a combination of three versions passed by House committees -- would cost $894 billion over 10 years to extend insurance coverage to 36 million uncovered Americans, according to House Speaker Nancy Pelosi.
However, the bill's total cost, including Medicare changes, is expected to be higher and could push the price tag over $1 trillion, according to an initial CNN analysis.
The bill guarantees that 96 percent of Americans have coverage, Pelosi stated. The claim is based on an analysis by the non-partisan Congressional Budget Office.
Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It would also cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Pelosi's office said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.
Specifically, individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge. Medicare expenditures would be cut by 1.3 percent annually.
"Today, we are ... laying the foundation for a brighter future for generations to come," Pelosi said on Capitol Hill.
"For Americans struggling with the cost of health care, this is an urgently needed bill," said House Majority Leader Steny Hoyer, D-Maryland. "This is an idea whose time has come."
President Obama praised House Democrats for forging "a strong consensus that represents a historic step forward."
Republicans tore into the bill, characterizing it as a series of tax increases and new regulations that would destroy jobs while doing little to stop spiraling health care costs.
"This really is a government takeover of health care in America," said Rep. Mike Pence, R-Indiana. "It appears for all of the world like a massive government-run insurance plan paid for with a freight train of mandates and taxes and bureaucracy."
Critics argue that the Democrats' $894 billion price tag excludes the cost associated with closing the Medicare "donut hole" prescription drug coverage gap.
The donut hole refers to some drug costs left uncovered by Medicare before catastrophic coverage kicks in. Pelosi highlighted plans to close the gap while discussing the bill Thursday.
Under the public option in the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government, according to Democratic leadership aides.
Pelosi and other liberal Democrats had argued for a more "robust" public option that ties reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, complained that doctors and hospitals in their districts would be shortchanged under such a formula.
The Democratic leadership "pushed as hard as they could" for the robust option but couldn't win majority support for it, said liberal New York Rep. Jerrold Nadler. "There is no point crying over spilt milk."
The House bill differs from legislation now being considered by the Senate in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan. Reid would allow for the creation of nonprofit health care cooperatives; the House bill does not include such a measure.
A bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would instead impose a new tax on high-end health care policies, dubbed "Cadillac plans" by critics. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.
Individuals under the $829 billion Senate Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
The Senate Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers receive a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an antitrust exemption that has been in place since the end of World War II.
Moderate House Democrats, whose votes are needed to pass the bill, appeared to be cautiously optimistic. They didn't, however, offer any definitive judgments.
"I'm not leaning one way or the other right now, but I just have to get into the bill and read it for myself," said Rep. Baron Hill, D-Indiana. "I'm hoping to be able to vote for it."
The House Democratic leadership posted the bill online Thursday and agreed to give members at least 72 hours to read it before a vote. Under that timetable, the full House could begin debating the bill next week.
Any bill passed by the House of Representatives will eventually have to be merged with legislation passed by the Senate. Both chambers would then have to pass a revised measure before sending it to Obama to be signed into law.
One thorny issue remaining to be resolved among House Democrats is the final abortion language in the bill. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under new health care reforms.
Stupak has vowed that if he isn't allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.
Leadership aides admit that they need to find compromise wording on abortion but say they are confident the issue will be resolved by the time the bill gets to the floor.
Friday, October 30, 2009
Wednesday, October 28, 2009
Examples of Lean Processes
The following appeared in the Oshkosh Northwestern:
by Lakshmi U. Tatikonda • for The Northwestern • October 27, 2009
The healthcare industry is in a mess, riddled with haphazard and outdated management systems, inefficiencies and waste, excess bureaucracy and costs, and greedy insurance companies. Waste is rewarded while innovation is ignored or penalized says Dr. John Toussaint, president and CEO of ThedaCare Center for Healthcare Value.
Lean methods (Toyota Production Systems) helped organizations reduce costs, improve quality and customer satisfaction. Critics say that healthcare is different from automobile industry, patients are not cars, and Lean methods don't apply to healthcare. This is not true. According to Dr. W. Edwards Deming, 80 percent of problems are process (system) related. Healthcare, like automobile industry, is a collection of processes and can gain from lean applications.
The causes of waste in healthcare are numerous:
Bureaucracy. Rigid adherence to policies and procedures costs U.S. residents $294.3 billion in healthcare and accounts for at least 31 percent of total U.S. health spending in 1999.
Overhead cost. Between the years 1970 and 2000 physician costs increased about 250 percent, whereas healthcare administrative costs increased by a whopping 2,500 percent.
Errors. The Institute of Medicine estimates that medical errors cost the United States $39.7 billion a year. Dr. Toussaint of ThedaCare, says that quality waste could be as high as 40 percent to 50 percent of costs. It is estimated that 44,000 to 95,000 people die every year from medical errors. Every year more than one million people in the United States suffer from preventable injuries caused by medical errors.
Excesses. One hospital found that 25 percent of the surgical supplies picked for use in operating rooms were never used and returned to the shelf requiring unnecessary re-sterilization.
Complexity. Medical billings cost hospitals $487 per person, and $561 for physicians. In my opinion, medical billings are not just complex, they are incomprehensible and unconscionable.
Overdoing. Ordering unnecessary tests, procedures and unnecessary brand name prescriptions, using many forms that are only slightly different, pharmaceutical companies spending more money on advertising than on R&D are like cracking a nut with sledgehammer.
Band-Aids. Failure to understand and identify root causes of waste, applying Band-Aid solutions, treating onetime special issues as normal occurrence.
Use of personnel. Using highly skilled and highly paid personnel such as an M.D. doing routine low level tasks that can be done by a qualified nurse practitioner.
Despite the many wastes there are success stories using Lean management methods:
Schaumburg, Ill.,-based Cancer Treatment Centers of America reduced the number of chemotherapy process steps from 32 to 16 and the amount of walking from the pharmacy to the chemo lab from 3,570 feet to 608 and increased the in chemotherapies delivered by 30 percent.
New York City Health and Hospitals Corp., once carried $10.2 million in inventory which included expired and useless items and 20 varieties of gloves. By reducing glove variety to two, they negotiated price per case from $58 to $28, saved about $4 millions a year, and realized a one-time gain of $5 million.
By improving its Cardiovascular Health Clinic, Mayo Clinic in Rochester, Minn., reduced process steps from 16 to six and wait time from 33 days to three.
EVirginia Mason Medical Center of Seattle, Wash., reduced staff walking distance by 60 miles per day.
St. Vincent Indianapolis Hospital reduced number of walking steps for emergency department nurses by 78 percent.
By implementing in-room devices for physicians in exam rooms, Virginia Mason reduced errors, lead time for documentation and cost of transcription per patient from $2.56 to $0.24.
ThedaCare cut cost of its in-patient care by 25 percent. "If all hospitals achieve similar results, $400 billion could be saved in Medicare and another $1.3 trillion on the non-Medicare side," says Dr. Dean Gruner, CEO of ThedaCare.
Healthcare cost is not just a political issue, it is also economic, competitive and moral issue. A 10 percent reduction in the $2.4 trillion spent on health care saves $240 billion, which can be used for improving schools, rebuilding roads, retraining unemployed workers and regaining our global competitiveness. Unfortunately, in today's convoluted political environment, the voices of reform are drowned by meaningless chatter.
The U.S. auto industry failed to accept deficiencies and make improvements to gain competitiveness. They acted like spoiled brats crying for candy and got government imposed sanctions, tariffs, quotas and domestic content requirements. You know what happened. Trying to reduce costs without eliminating root causes is like rearranging chairs on the deck of Titanic. Next bailout may be the healthcare industry.
by Lakshmi U. Tatikonda • for The Northwestern • October 27, 2009
The healthcare industry is in a mess, riddled with haphazard and outdated management systems, inefficiencies and waste, excess bureaucracy and costs, and greedy insurance companies. Waste is rewarded while innovation is ignored or penalized says Dr. John Toussaint, president and CEO of ThedaCare Center for Healthcare Value.
Lean methods (Toyota Production Systems) helped organizations reduce costs, improve quality and customer satisfaction. Critics say that healthcare is different from automobile industry, patients are not cars, and Lean methods don't apply to healthcare. This is not true. According to Dr. W. Edwards Deming, 80 percent of problems are process (system) related. Healthcare, like automobile industry, is a collection of processes and can gain from lean applications.
The causes of waste in healthcare are numerous:
Bureaucracy. Rigid adherence to policies and procedures costs U.S. residents $294.3 billion in healthcare and accounts for at least 31 percent of total U.S. health spending in 1999.
Overhead cost. Between the years 1970 and 2000 physician costs increased about 250 percent, whereas healthcare administrative costs increased by a whopping 2,500 percent.
Errors. The Institute of Medicine estimates that medical errors cost the United States $39.7 billion a year. Dr. Toussaint of ThedaCare, says that quality waste could be as high as 40 percent to 50 percent of costs. It is estimated that 44,000 to 95,000 people die every year from medical errors. Every year more than one million people in the United States suffer from preventable injuries caused by medical errors.
Excesses. One hospital found that 25 percent of the surgical supplies picked for use in operating rooms were never used and returned to the shelf requiring unnecessary re-sterilization.
Complexity. Medical billings cost hospitals $487 per person, and $561 for physicians. In my opinion, medical billings are not just complex, they are incomprehensible and unconscionable.
Overdoing. Ordering unnecessary tests, procedures and unnecessary brand name prescriptions, using many forms that are only slightly different, pharmaceutical companies spending more money on advertising than on R&D are like cracking a nut with sledgehammer.
Band-Aids. Failure to understand and identify root causes of waste, applying Band-Aid solutions, treating onetime special issues as normal occurrence.
Use of personnel. Using highly skilled and highly paid personnel such as an M.D. doing routine low level tasks that can be done by a qualified nurse practitioner.
Despite the many wastes there are success stories using Lean management methods:
Schaumburg, Ill.,-based Cancer Treatment Centers of America reduced the number of chemotherapy process steps from 32 to 16 and the amount of walking from the pharmacy to the chemo lab from 3,570 feet to 608 and increased the in chemotherapies delivered by 30 percent.
New York City Health and Hospitals Corp., once carried $10.2 million in inventory which included expired and useless items and 20 varieties of gloves. By reducing glove variety to two, they negotiated price per case from $58 to $28, saved about $4 millions a year, and realized a one-time gain of $5 million.
By improving its Cardiovascular Health Clinic, Mayo Clinic in Rochester, Minn., reduced process steps from 16 to six and wait time from 33 days to three.
EVirginia Mason Medical Center of Seattle, Wash., reduced staff walking distance by 60 miles per day.
St. Vincent Indianapolis Hospital reduced number of walking steps for emergency department nurses by 78 percent.
By implementing in-room devices for physicians in exam rooms, Virginia Mason reduced errors, lead time for documentation and cost of transcription per patient from $2.56 to $0.24.
ThedaCare cut cost of its in-patient care by 25 percent. "If all hospitals achieve similar results, $400 billion could be saved in Medicare and another $1.3 trillion on the non-Medicare side," says Dr. Dean Gruner, CEO of ThedaCare.
Healthcare cost is not just a political issue, it is also economic, competitive and moral issue. A 10 percent reduction in the $2.4 trillion spent on health care saves $240 billion, which can be used for improving schools, rebuilding roads, retraining unemployed workers and regaining our global competitiveness. Unfortunately, in today's convoluted political environment, the voices of reform are drowned by meaningless chatter.
The U.S. auto industry failed to accept deficiencies and make improvements to gain competitiveness. They acted like spoiled brats crying for candy and got government imposed sanctions, tariffs, quotas and domestic content requirements. You know what happened. Trying to reduce costs without eliminating root causes is like rearranging chairs on the deck of Titanic. Next bailout may be the healthcare industry.
Tuesday, October 27, 2009
Senate Bill Now Includes Public Option
Senate Majority Leader Harry Reid thinks he has 60 votes to pass a health care reform bill that includes a public option. There are 58 Democrats and 2 independents. The bill includes the allowance that states can "opt out" if they choose within a specified timeframe.
Its important to remember we're still a long way off from a final bill to be voted on by the Senate. It could be mid to late November before a final vote on the Senate bill is taken. It still needs to be reconciled with the House's final version.
It looks very likely that the House will approve a bill that includes a public option. Even if two dozen "blue dogs" vote against it, the house bill with a public option will still pass.
Reaction from key Senators
The reaction from moderate Democrats - they fear a public plan could drive insurers out of business and take over the marketplace - ranged from muted to skeptical.
Snowe
The one Republican who has so far lent her support to Democratic health overhaul proposals, Sen. Olympia Snowe of Maine, said she was "deeply disappointed" by Reid's decision. Snowe had supported allowing government insurance in individual states only if the private market wasn't providing sufficient choice and competition. Its likely that "deeply disappointed" signals a NO VOTE from Snowe.
Among the moderates whose support is in question are Democratic Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana.
Landrieu said in a statement that she's still "very skeptical" about a government plan run from Washington but would keep working with Reid to find a "principled compromise."
Nelson "is not committing how we will vote regarding any proposal Sen. Reid is advancing," said spokesman Jake Thompson.
Lincoln, who's up for re-election in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.
Lieberman
Connecticut Sen. Joseph Lieberman (Ind.) said Tuesday that while he won't vote to block Majority Leader Harry Reid's plan from going to the Senate floor for debate, he would ultimately oppose the measure because it includes a public option. Lieberman's vote is often counted within the 60 votes needed to pass a Senate bill.
Collins
Meanwhile, Maine Republican Susan Collins, who had earlier indicated interest in trying to pass a bipartisan bill this year, issued a statement underscoring her opposition to "a taxpayer-subsidized, government-run health insurance company."
This information is from the Associated Press.
Its important to remember we're still a long way off from a final bill to be voted on by the Senate. It could be mid to late November before a final vote on the Senate bill is taken. It still needs to be reconciled with the House's final version.
It looks very likely that the House will approve a bill that includes a public option. Even if two dozen "blue dogs" vote against it, the house bill with a public option will still pass.
Reaction from key Senators
The reaction from moderate Democrats - they fear a public plan could drive insurers out of business and take over the marketplace - ranged from muted to skeptical.
Snowe
The one Republican who has so far lent her support to Democratic health overhaul proposals, Sen. Olympia Snowe of Maine, said she was "deeply disappointed" by Reid's decision. Snowe had supported allowing government insurance in individual states only if the private market wasn't providing sufficient choice and competition. Its likely that "deeply disappointed" signals a NO VOTE from Snowe.
Among the moderates whose support is in question are Democratic Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana.
Landrieu said in a statement that she's still "very skeptical" about a government plan run from Washington but would keep working with Reid to find a "principled compromise."
Nelson "is not committing how we will vote regarding any proposal Sen. Reid is advancing," said spokesman Jake Thompson.
Lincoln, who's up for re-election in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.
Lieberman
Connecticut Sen. Joseph Lieberman (Ind.) said Tuesday that while he won't vote to block Majority Leader Harry Reid's plan from going to the Senate floor for debate, he would ultimately oppose the measure because it includes a public option. Lieberman's vote is often counted within the 60 votes needed to pass a Senate bill.
Collins
Meanwhile, Maine Republican Susan Collins, who had earlier indicated interest in trying to pass a bipartisan bill this year, issued a statement underscoring her opposition to "a taxpayer-subsidized, government-run health insurance company."
This information is from the Associated Press.
Monday, October 26, 2009
More ammo: US healthcare system wastes at least $505 bln a year
The disease is Waste. The treatment method is implementation of LEAN processes on the surgical table of health care reform.
There is now pervasive evidence everywhere we turn. Is Congress paying attention?
Does your Member of Congress or Senator know this stuff? Isn't it your job to find out?
CALL THEM.
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Article from Reuters News Service
The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.
The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters (TRI.TO), found.
"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.
"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."
One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.
"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.
Some other findings in the report from Thomson Reuters, the parent company of Reuters:
* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
There is now pervasive evidence everywhere we turn. Is Congress paying attention?
Does your Member of Congress or Senator know this stuff? Isn't it your job to find out?
CALL THEM.
----------------------- --------------------------------
Article from Reuters News Service
The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.
The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters (TRI.TO), found.
"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.
"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."
One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.
"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.
Some other findings in the report from Thomson Reuters, the parent company of Reuters:
* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
Tuesday, October 20, 2009
More Small Business Stats- The Case for Reform
This is from a report from the U.S. Dept. of Human Services-
A new report, "Insurance at Risk: Small Business Employees Risk Losing Coverage" details how small businesses are increasingly dropping health insurance and why.
The report notes:
Employees of small businesses are 50 percent more likely to lose coverage as workers at large businesses. Half of workers in small firms that do not offer health benefits remain uninsured.
Premiums for employer-based health insurance have more than doubled since 2000, rising three times faster than wages. As a result, fewer small businesses provide coverage for their employees. In 2000, 57 percent of firms employing less than 10 workers provided coverage. In 2009, only 46 percent of similar-sized firms provided coverage.
In one national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason, and on average small businesses pay up to 18 percent more than large firms for the same health insurance policy. This is due in part to high broker fees (which can be up to 10 percent of premiums)and health plan administrative costs that are three to four times those in the large group market.
A new report, "Insurance at Risk: Small Business Employees Risk Losing Coverage" details how small businesses are increasingly dropping health insurance and why.
The report notes:
Employees of small businesses are 50 percent more likely to lose coverage as workers at large businesses. Half of workers in small firms that do not offer health benefits remain uninsured.
Premiums for employer-based health insurance have more than doubled since 2000, rising three times faster than wages. As a result, fewer small businesses provide coverage for their employees. In 2000, 57 percent of firms employing less than 10 workers provided coverage. In 2009, only 46 percent of similar-sized firms provided coverage.
In one national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason, and on average small businesses pay up to 18 percent more than large firms for the same health insurance policy. This is due in part to high broker fees (which can be up to 10 percent of premiums)and health plan administrative costs that are three to four times those in the large group market.
Friday, October 16, 2009
This is madness
This is what our crazy system has driven some people to do. The military health insurance system (TRICARE) covers pre-existing conditions so this man joined the army to try to save his wife's life because that's the only reasonable soultion he had.
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A family’s health-care struggle
After losing his job, he joins the Army so his wife can battle cancer
From the Oct. 16th Milwaukee Journal Sentinel Online edition
On a rainy morning in mid-October, Bill Caudle joined the Army.
An unremarkable occurrence, except just about everything about it was remarkable.
Caudle is 40. He was laid off from his job of 20 years. And his wife, Michelle, 39, was sick with ovarian cancer. Indeed, Bill Caudle was leaving precisely because his wife was sick.
His severance package had provided several months’ salary, but by August the paychecks were winding down. Soon the cost of his family health coverage was going to triple, then a few months after that, nearly triple again. They needed health-care coverage so Michelle could fight her cancer.
The solution: a four-year hitch in the Army.
The two are not fond of politics. They have paid little attention to the shouting over health-care reform. They have not gone to any of the town hall meetings.
But this year the national story of lost jobs became their story. And the saga of families losing health insurance was about to become theirs, too.
Except that Bill wouldn’t let it.
Look for their story in Sunday’s print editions of the Journal Sentinel and on JSOnline on Monday.
-----------
A family’s health-care struggle
After losing his job, he joins the Army so his wife can battle cancer
From the Oct. 16th Milwaukee Journal Sentinel Online edition
On a rainy morning in mid-October, Bill Caudle joined the Army.
An unremarkable occurrence, except just about everything about it was remarkable.
Caudle is 40. He was laid off from his job of 20 years. And his wife, Michelle, 39, was sick with ovarian cancer. Indeed, Bill Caudle was leaving precisely because his wife was sick.
His severance package had provided several months’ salary, but by August the paychecks were winding down. Soon the cost of his family health coverage was going to triple, then a few months after that, nearly triple again. They needed health-care coverage so Michelle could fight her cancer.
The solution: a four-year hitch in the Army.
The two are not fond of politics. They have paid little attention to the shouting over health-care reform. They have not gone to any of the town hall meetings.
But this year the national story of lost jobs became their story. And the saga of families losing health insurance was about to become theirs, too.
Except that Bill wouldn’t let it.
Look for their story in Sunday’s print editions of the Journal Sentinel and on JSOnline on Monday.
Lessons from Wisconsin- A national model?
This is from the Robert Wood Johnson Foundation lauding Wisconsin's effort to expand health insurance. They also provide details on Vermont efforts as well. Links to the reports are provided.
Again I fail to understand why Congress insists on creating new programs and creating ever more complexity in the already fractured and stressed health care system. Learn from what works and expand it nationally--- i.e. episodes of care based reimbursement and Lean processes. We have the evidence to do this correctly.
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Expand and Simplify: Lessons from Wisconsin and Vermont
New Issue Briefs Identify Important Lessons for Health Reform From Vermont and Wisconsin
Having reached maximum enrollment levels just three months after its launch, Wisconsin’s BadgerCare Plus is receiving increased attention from health reformers around the country. According to a new issue brief released today, the program’s enrollment success holds important lessons about program design for those involved in health reform at both the state and national level. The brief, released by the Robert Wood Johnson Foundation-funded State Health Access Reform Evaluation (SHARE) program, finds that substantial increases in enrollment can be achieved by designing programs with key elements including:
--Whole family coverage via expanded eligibility for lower-income parents and caretaker;
--Targeted auto-enrollment;
--Expanded income eligibility limits;
--Relaxed anti-crowd-out provisions for lower income applicants;
--Shift of employer insurance verification responsibilities away from applicants to program administrators; and
--Aggressive outreach and enrollment strategies conducted with community partners.
A second issue brief released from SHARE today finds that the percentage of Vermonters without health insurance has decreased significantly since reform began in 2006, and insurance coverage in Vermont has increased more rapidly than in other New England states during this time. According to the brief, most of the increase in Vermont’s coverage is a result of expanded public coverage—enrollment in Catamount Health has increased sharply and steadily during the program’s initial months. Researchers also found that key stakeholders in the state were generally satisfied with enrollment levels to date, despite barriers to enrollment.
Links:
Read the Wisconsin BadgerCare Plus issue brief. http://www.rwjf.org/healthreform/product.jsp?id=49949
Read the Vermont issue brief.
http://www.rwjf.org/healthreform/product.jsp?id=49948
Again I fail to understand why Congress insists on creating new programs and creating ever more complexity in the already fractured and stressed health care system. Learn from what works and expand it nationally--- i.e. episodes of care based reimbursement and Lean processes. We have the evidence to do this correctly.
------------------------------ ----------------------
Expand and Simplify: Lessons from Wisconsin and Vermont
New Issue Briefs Identify Important Lessons for Health Reform From Vermont and Wisconsin
Having reached maximum enrollment levels just three months after its launch, Wisconsin’s BadgerCare Plus is receiving increased attention from health reformers around the country. According to a new issue brief released today, the program’s enrollment success holds important lessons about program design for those involved in health reform at both the state and national level. The brief, released by the Robert Wood Johnson Foundation-funded State Health Access Reform Evaluation (SHARE) program, finds that substantial increases in enrollment can be achieved by designing programs with key elements including:
--Whole family coverage via expanded eligibility for lower-income parents and caretaker;
--Targeted auto-enrollment;
--Expanded income eligibility limits;
--Relaxed anti-crowd-out provisions for lower income applicants;
--Shift of employer insurance verification responsibilities away from applicants to program administrators; and
--Aggressive outreach and enrollment strategies conducted with community partners.
A second issue brief released from SHARE today finds that the percentage of Vermonters without health insurance has decreased significantly since reform began in 2006, and insurance coverage in Vermont has increased more rapidly than in other New England states during this time. According to the brief, most of the increase in Vermont’s coverage is a result of expanded public coverage—enrollment in Catamount Health has increased sharply and steadily during the program’s initial months. Researchers also found that key stakeholders in the state were generally satisfied with enrollment levels to date, despite barriers to enrollment.
Links:
Read the Wisconsin BadgerCare Plus issue brief. http://www.rwjf.org/healthreform/product.jsp?id=49949
Read the Vermont issue brief.
http://www.rwjf.org/healthreform/product.jsp?id=49948
Tuesday, October 13, 2009
Baucus Bill Passes 14-9 -- payment reform MIA
Now this and other bills will be negotiated into one final bill to be debated in the house and Senate probably in early November for a vote in mid November.
I am a member of the Wisconsin Insurance Commissioner's Health Insurance Advisory Council and at today's (link to the agenda) (http://www.oci.wi.gov/advcoun/hl_not20091013.pdf ) public meeting we heard from the Natl Assooc of Insurance Commissioners. They provided an analysis of the current issues in the Health Insurance Reform debate and particularly on the Baucus Bill.
I asked the presenter if my reading of the Baucus bill and the othewrs is correct- i.e. there are no comprehensive provisions that get at health CARE reform and particularly payment reform through episodes of care reimbursement structures, quality outcome incentives or waste elimination. He agreed with my analysis. He agreed that nothing comprehensive exists in any of the bills... only small voluntary Medicare demonstrations and pilots on those issues. Furthermore, he saw little chance of payment reform being added during the final debates.
Once again our congressional leaders don't understand what they're doing and are not addressing the key issues. They are getting this wrong, the results could be catastrophic.
------- -------
Below are the opinions of two Republicans. I happen to agree with the comments from Sen. Ensign.
Sen. John Ensign, R-Nev., complained about the lack of a CBO estimate of the effects of the AHFA proposal on overall health care costs. "We haven't brought health care costs down with this bill," he said.
Sen. Michael Enzi, R-Wyo., praised Baucus's work on the bill but noted that many of his constituents find the bill confusing, partly because detailed legislative language is not yet available.
Many people on Medicare, for example, wonder why Congress seems to be shifting Medicare funding to other uses while at the same time creating a commission that will look at ways to save Medicare from insolvency, Enzi said.
Doctors want to know why the Medicare commission will be looking at their reimbursement rates but not at hospitals' reimbursement rates, and they also want to know what Congress will do about the medical malpractice issue, Enzi said.
"They're really not seeing us doing anything about tort reform," Enzi said.
I am a member of the Wisconsin Insurance Commissioner's Health Insurance Advisory Council and at today's (link to the agenda) (http://www.oci.wi.gov/advcoun/hl_not20091013.pdf ) public meeting we heard from the Natl Assooc of Insurance Commissioners. They provided an analysis of the current issues in the Health Insurance Reform debate and particularly on the Baucus Bill.
I asked the presenter if my reading of the Baucus bill and the othewrs is correct- i.e. there are no comprehensive provisions that get at health CARE reform and particularly payment reform through episodes of care reimbursement structures, quality outcome incentives or waste elimination. He agreed with my analysis. He agreed that nothing comprehensive exists in any of the bills... only small voluntary Medicare demonstrations and pilots on those issues. Furthermore, he saw little chance of payment reform being added during the final debates.
Once again our congressional leaders don't understand what they're doing and are not addressing the key issues. They are getting this wrong, the results could be catastrophic.
------- -------
Below are the opinions of two Republicans. I happen to agree with the comments from Sen. Ensign.
Sen. John Ensign, R-Nev., complained about the lack of a CBO estimate of the effects of the AHFA proposal on overall health care costs. "We haven't brought health care costs down with this bill," he said.
Sen. Michael Enzi, R-Wyo., praised Baucus's work on the bill but noted that many of his constituents find the bill confusing, partly because detailed legislative language is not yet available.
Many people on Medicare, for example, wonder why Congress seems to be shifting Medicare funding to other uses while at the same time creating a commission that will look at ways to save Medicare from insolvency, Enzi said.
Doctors want to know why the Medicare commission will be looking at their reimbursement rates but not at hospitals' reimbursement rates, and they also want to know what Congress will do about the medical malpractice issue, Enzi said.
"They're really not seeing us doing anything about tort reform," Enzi said.
Wednesday, October 7, 2009
A Doc from Neenah Weighs in at the White House
You've heard or read this from me numerous times at this point but a Dr from Neenah was recently invited to the White House with 149 others to discuss health care reform with President Obama.
Two comments he made are what I'm most interested in pointing out.... here they are:
1) From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."
2)"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.
One poll I recently saw and posted a few weeks ago said that 60% plus of doctors favor the inclusion of a public plan. Docs are used to dealing with Medicare and Medicaid so its really telling that they are willing to add another government program and low reimbursement.
------------------------- -----------------------------
Neenah orthopedist joins White House push for health care reform
By LARRY BIVINS • Gannett Washington Bureau • October 6, 2009
Published in the Oshkosh Northwestern
President Barack Obama’s campaign for health care reform has found a solid ally in Dr. Jan Sarnecki, a semi-retired orthopedic surgeon from Neenah.
Sarnecki was among the 150 doctors from around the country recruited to talk about health care reform Monday with Obama at the White House. Obama wants to revamp the nation’s expensive health care system to provide coverage for millions of uninsured Americans, strengthen the plans of those who are covered and prohibit insurers from denying coverage to people because of existing medical conditions.
Obama’s latest push with physicians comes as the Senate Finance Committee is trying to wrap up its version of a health care bill. So far, three House committees and one Senate committee have passed their own versions of a bill. Obama wants a bill to sign by year’s end.
"At this point, we’ve heard all the arguments on both sides of the aisle," Obama told the white-coat-clad doctors gathered in the Rose Garden. "But when you cut through the noise and all the distractions out there, I think what’s most telling is that some of the people who are most supportive of reform are the very medical professionals who know the system best."
From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."
Sarnecki recalled the case of one employee who was forced to file for bankruptcy after being notified he had taken his pregnant wife to the "wrong hospital" for emergency care. Sarnecki said the insurance company told the employee that the hospital was not on the company’s list of approved hospitals.
That is part of the experience Sarnecki said is at the heart of his support for a government-run "public option" insurance plan.
"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.
Sarnecki, who works at Fox Cities Community Clinic in Menasha, also participated in a teleconference last week with Rep. Steve Kagen, D-Appleton, that was organized by the Wisconsin arm of Organizing for America, Obama’s campaign operation.
"The idea is simply to try to get some momentum toward health care reform," Sarnecki said Monday. "The system we have is just not working well for a large number of people."
Sarnecki’s trip to Washington was coordinated by Doctors for America, a national group of more than 15,000 doctors. Among them is Sarnecki’s daughter, Meg Sarnecki, a family physician in Missoula, Mont.
Other groups that participated include the American Medical Association, the National Medical Association and the American College of Physicians.
Republicans have doctors who oppose Obama’s health care proposals. House Republican Leader John Boehner of Ohio said, "Members of the medical community - who deal with red tape day in and day out - rightly recognize that the Democrats’ government takeover would weaken the doctor-patient relationship that is so critical to making the right health care decisions."
Meanwhile, former Wisconsin Gov. Tommy Thompson, a Republican and secretary of Health and Human Services during the George W. Bush administration, issued a joint statement with former Rep. Dick Gephardt, a Missouri Democrat, pointing to the urgency of passing health care reform.
"Failure to reach an agreement on health reform this year is not an acceptable option," said the statement posted on Politico’s Web site. "Inaction will only increase the burden of rapidly rising health care costs and care denied for millions of American families."
Two comments he made are what I'm most interested in pointing out.... here they are:
1) From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."
2)"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.
One poll I recently saw and posted a few weeks ago said that 60% plus of doctors favor the inclusion of a public plan. Docs are used to dealing with Medicare and Medicaid so its really telling that they are willing to add another government program and low reimbursement.
------------------------- -----------------------------
Neenah orthopedist joins White House push for health care reform
By LARRY BIVINS • Gannett Washington Bureau • October 6, 2009
Published in the Oshkosh Northwestern
President Barack Obama’s campaign for health care reform has found a solid ally in Dr. Jan Sarnecki, a semi-retired orthopedic surgeon from Neenah.
Sarnecki was among the 150 doctors from around the country recruited to talk about health care reform Monday with Obama at the White House. Obama wants to revamp the nation’s expensive health care system to provide coverage for millions of uninsured Americans, strengthen the plans of those who are covered and prohibit insurers from denying coverage to people because of existing medical conditions.
Obama’s latest push with physicians comes as the Senate Finance Committee is trying to wrap up its version of a health care bill. So far, three House committees and one Senate committee have passed their own versions of a bill. Obama wants a bill to sign by year’s end.
"At this point, we’ve heard all the arguments on both sides of the aisle," Obama told the white-coat-clad doctors gathered in the Rose Garden. "But when you cut through the noise and all the distractions out there, I think what’s most telling is that some of the people who are most supportive of reform are the very medical professionals who know the system best."
From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."
Sarnecki recalled the case of one employee who was forced to file for bankruptcy after being notified he had taken his pregnant wife to the "wrong hospital" for emergency care. Sarnecki said the insurance company told the employee that the hospital was not on the company’s list of approved hospitals.
That is part of the experience Sarnecki said is at the heart of his support for a government-run "public option" insurance plan.
"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.
Sarnecki, who works at Fox Cities Community Clinic in Menasha, also participated in a teleconference last week with Rep. Steve Kagen, D-Appleton, that was organized by the Wisconsin arm of Organizing for America, Obama’s campaign operation.
"The idea is simply to try to get some momentum toward health care reform," Sarnecki said Monday. "The system we have is just not working well for a large number of people."
Sarnecki’s trip to Washington was coordinated by Doctors for America, a national group of more than 15,000 doctors. Among them is Sarnecki’s daughter, Meg Sarnecki, a family physician in Missoula, Mont.
Other groups that participated include the American Medical Association, the National Medical Association and the American College of Physicians.
Republicans have doctors who oppose Obama’s health care proposals. House Republican Leader John Boehner of Ohio said, "Members of the medical community - who deal with red tape day in and day out - rightly recognize that the Democrats’ government takeover would weaken the doctor-patient relationship that is so critical to making the right health care decisions."
Meanwhile, former Wisconsin Gov. Tommy Thompson, a Republican and secretary of Health and Human Services during the George W. Bush administration, issued a joint statement with former Rep. Dick Gephardt, a Missouri Democrat, pointing to the urgency of passing health care reform.
"Failure to reach an agreement on health reform this year is not an acceptable option," said the statement posted on Politico’s Web site. "Inaction will only increase the burden of rapidly rising health care costs and care denied for millions of American families."
Health Care Reform is like Watching Sausage Being Made
There's a popular saying in public policy circles and it goes something like this- Watching public policy being made or decided is like watching sausage being made. Its an ugly process filled with all kinds of questionable ingredients but in the end its hoped that it comes out tasting pretty good.
Well, health care reform sure has mirrored the process of making sausage. Let's hope what we get in the end is more Brat than wurst.
Here's a link to a New York Times story--
http://www.nytimes.com/2009/10/07/health/policy/07health.html?_r=2&emc=tnt&tntemail0=y
The article provides details on five individual senators and their widely different viewpoints/concerns on the Baucus Senate Bill that is getting the most attention and debate right now in the Senate Finance Committee. Four of these Senators are Democrats and Olympia Snowe is a Republican from Maine.
Legislation this huge and complex will definitely cause individual legislators, not to mention the American public, to have a wide variety of opinions on the legislation as a whole. Each individual Senator may also view the bill as having ten things they like and want and an equal number they cannot live with or vote for.
Below are excerpts from the article providing those Sentaors' individual concerns related to the bill.
---------- -------------- --------------
Sen. Rockefeller D- W.V. - he's upset that a health care bill poised for approval by the Finance Committee would turn nearly a half-trillion dollars over to insurance companies, whose profits he says are “out of sight.” He went on to say that, "It’s an imperfect bill, with a lot of pluses and minuses.”
Sen. Snowe R- Maine -- She worries that the bill would require people to buy insurance they cannot afford. Ms. Snowe’s views reflect the concerns of many centrist Democrats. She worries that some middle-income families will find insurance unaffordable, even with federal subsidies. And she wants to give the private insurance market an opportunity to work, under new federal rules, before setting up a government plan in states where affordable coverage proves unavailable.
Sen. Lincoln D- AR-- She fears that the bill would be too costly for the government.
Sen. Wyden D- OR -- He warns that the bill would lock many workers into health plans selected by their employers, without allowing them to shop for better, cheaper plans, an alternative that could help drive down costs for everyone. Wyden noted that the committee’s bill would not offer additional options to the overwhelming majority of Americans who already have insurance. His concern is shared by some Democrats and also by many Republicans, who say the bill does not do enough to let the marketplace spur competition.
Sen. Ben Nelson D- Nebraska, says he believes the "laboratories of democracy typically work,” -- it might make sense for states to act as a testing ground for a public option. Rockefeller said this approach was unacceptable to him. State health plans would not be strong enough to compete effectively with big private insurance companies, he said.
Well, health care reform sure has mirrored the process of making sausage. Let's hope what we get in the end is more Brat than wurst.
Here's a link to a New York Times story--
http://www.nytimes.com/2009/10/07/health/policy/07health.html?_r=2&emc=tnt&tntemail0=y
The article provides details on five individual senators and their widely different viewpoints/concerns on the Baucus Senate Bill that is getting the most attention and debate right now in the Senate Finance Committee. Four of these Senators are Democrats and Olympia Snowe is a Republican from Maine.
Legislation this huge and complex will definitely cause individual legislators, not to mention the American public, to have a wide variety of opinions on the legislation as a whole. Each individual Senator may also view the bill as having ten things they like and want and an equal number they cannot live with or vote for.
Below are excerpts from the article providing those Sentaors' individual concerns related to the bill.
---------- -------------- --------------
Sen. Rockefeller D- W.V. - he's upset that a health care bill poised for approval by the Finance Committee would turn nearly a half-trillion dollars over to insurance companies, whose profits he says are “out of sight.” He went on to say that, "It’s an imperfect bill, with a lot of pluses and minuses.”
Sen. Snowe R- Maine -- She worries that the bill would require people to buy insurance they cannot afford. Ms. Snowe’s views reflect the concerns of many centrist Democrats. She worries that some middle-income families will find insurance unaffordable, even with federal subsidies. And she wants to give the private insurance market an opportunity to work, under new federal rules, before setting up a government plan in states where affordable coverage proves unavailable.
Sen. Lincoln D- AR-- She fears that the bill would be too costly for the government.
Sen. Wyden D- OR -- He warns that the bill would lock many workers into health plans selected by their employers, without allowing them to shop for better, cheaper plans, an alternative that could help drive down costs for everyone. Wyden noted that the committee’s bill would not offer additional options to the overwhelming majority of Americans who already have insurance. His concern is shared by some Democrats and also by many Republicans, who say the bill does not do enough to let the marketplace spur competition.
Sen. Ben Nelson D- Nebraska, says he believes the "laboratories of democracy typically work,” -- it might make sense for states to act as a testing ground for a public option. Rockefeller said this approach was unacceptable to him. State health plans would not be strong enough to compete effectively with big private insurance companies, he said.
Tuesday, October 6, 2009
Small Business and Health Care Reform
Here are four statistics that make a tremendous case for the need for comprehensive, cost-cutting health care reform:
* 28 million American small-business owners, their employees and their dependents are uninsured.
* Insurance premiums have jumped 129 percent since 2000.
* Small businesses pay an average of 18 percent more than big businesses for the same amount of coverage.
* Small businesses represent 99.7 percent of all employers.
Source: Milwaukee Business Times
* 28 million American small-business owners, their employees and their dependents are uninsured.
* Insurance premiums have jumped 129 percent since 2000.
* Small businesses pay an average of 18 percent more than big businesses for the same amount of coverage.
* Small businesses represent 99.7 percent of all employers.
Source: Milwaukee Business Times
Monday, October 5, 2009
Some Conservative Ideas on Health Care Reform- Analysis
Conservative Case for Reform- Bobby Jindal
Washington Post - Oct. 5th
Louisiana Gov. Bobby Jindal doesn’t like what’s happening within the healthcare debate. He says Democrats are over-reaching and reform will lead to huge deficits and major problems but he also says the Republicans have to engage in the debate and start proposing ideas and changes.
I enjoy analyzing these health care proposals and showing their difficulties. My comments are in bold/ italics. So far Jindal and other conservatives have offered virtually nothing that is helpful.
---------------------- -------------------- -----------------------------
Mr. Jindal-
A majority of so-called Republican strategists believe that health care is a Democratic issue. They are wrong; health care is an American issue, and the Republican Party has an opportunity to demonstrate that conservative principles work when applied to real-world problems.
But memo to Washington: The debate on health care has moved on. Democratic plans for a government takeover are passé. The people don't want it. Believe the polls, the town halls, the voters. Only Democrats in Washington would propose new taxes on businesses and families in the middle of a recession, $900 billion in new spending at a time of record deficits, and increased taxes on health insurance and products to reduce health-care costs.
Washington is the only place in the country that doesn't realize that this debate is over. Democrats may march forward anyway, but they will do so without the people, and at their own peril.
Yet hope for meaningful reform need not be lost. Only two things need to happen. First, Democrats have to give up on their grand experiment and get serious about bipartisan solutions. Second, Republicans have to join the battle of ideas.
To be clear, the Republicans in Congress who have led the opposition to the Obama-Pelosi vision of health-care reform have done the right thing for our country. If they had rolled over, the results could have been devastating for our health-care system and our nation's budget.
But Republicans must shift gears. Conservatives should seize the mantle of reform and lead. Conservatives either genuinely believe that conservative principles will work to solve real-world problems such as health care or they don't. I believe they will.
The people do not want Republicans to offer their own thousand-page plan to overhaul health care, and that is not what the nation needs.
So here are 10 ideas to increase the affordability and quality of health care. Some of these are buried within various Republican and Democratic plans that have been floated. They offer a path forward toward significant bipartisan reform. These proposals would require insurance companies to do their jobs and spread risk over large populations, restore patients' power to make their own health-care decisions, and focus our system on quality instead of activity.
1-- Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.
This is included in the Dems plans
-- Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to "own" their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.
If health plans are portable across state lines this may strip state mandates from plans and water down essential coverage protections- i.e. mammography and birth control for women, chiropractic care and others. Portability is good as long as the individual state rules apply.
-- Lawsuit reform: It makes no sense to ignore one of the biggest cost drivers in the system -- the cost of defensive medicine, largely driven by lawsuits. Worse, many doctors have stopped performing high-risk procedures for fear of liability.
This is a no-brainer.
-- Require coverage of preexisting conditions: Insurance should not be least accessible when it is needed most. Companies should be incentivized to focus on delivering high-quality effective care, not to avoid covering the sick.
Ditto- a no-brainer.
-- Transparency and payment reform: Consumers have more information when choosing a car or restaurant than when selecting a health-care provider. Provider quality and cost should be plainly available to consumers, and payment systems should be based on outcomes, not volume. Today's system results in wide variations in treatment instead of the consistent application of best practices. We must reward efficiency and quality.
I'm glad he gets this, but quality outcomes and care should also be incentivized within payment reform.
-- Electronic medical records: The current system of paper records threatens patient privacy and leads to bad outcomes and higher costs.
Yup, a no-brainer again. So far I'm not real impressed.
-- Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.
This is a very slippery slope. HSAs are not the be-all, end-all answer the GOP hopes, but instead provide cost-savings for a niche market. Conservatives think HSA's are a savior but if you think reform is good if it means everyone has a $5,000 annual deductible while docs are not encouraged to increase quality and efficiency then we'd all be in for a wild ride to poor health.
-- Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.
Good idea, cost-share incentives could be included for those who test in the highest percentages of health.
-- Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have "aged out" of their parents' policies. Permitting young people to stay on their parents' plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools -- helping to lower premiums for everyone.
This is a good proposal, but often young people cannot afford the coverage in the first job's out of college because they make too little. I presume Mr. Jindal is thinking of only those with no access.
-- Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Redirecting some of the billions already spent on the uninsured will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market rather than forcing people into a government-run system. We should trust American families to make choices for themselves while we ensure they have access to quality, affordable health care.
Tax credits are the GOP solution that makes no sense. Reducing individuals taxable income by $5,000 does virtually nothing for their ABILITY to buy health insurance. I use dependent care reimbursement to get reimbursed for my daughter's daycare. The tax savings I enjoy from this amounts to about $1,000. My daughter's day care expenses are about $10,000 per year. This does so little to help its laughable. Health care is even worse.
Washington Post - Oct. 5th
Louisiana Gov. Bobby Jindal doesn’t like what’s happening within the healthcare debate. He says Democrats are over-reaching and reform will lead to huge deficits and major problems but he also says the Republicans have to engage in the debate and start proposing ideas and changes.
I enjoy analyzing these health care proposals and showing their difficulties. My comments are in bold/ italics. So far Jindal and other conservatives have offered virtually nothing that is helpful.
---------------------- -------------------- -----------------------------
Mr. Jindal-
A majority of so-called Republican strategists believe that health care is a Democratic issue. They are wrong; health care is an American issue, and the Republican Party has an opportunity to demonstrate that conservative principles work when applied to real-world problems.
But memo to Washington: The debate on health care has moved on. Democratic plans for a government takeover are passé. The people don't want it. Believe the polls, the town halls, the voters. Only Democrats in Washington would propose new taxes on businesses and families in the middle of a recession, $900 billion in new spending at a time of record deficits, and increased taxes on health insurance and products to reduce health-care costs.
Washington is the only place in the country that doesn't realize that this debate is over. Democrats may march forward anyway, but they will do so without the people, and at their own peril.
Yet hope for meaningful reform need not be lost. Only two things need to happen. First, Democrats have to give up on their grand experiment and get serious about bipartisan solutions. Second, Republicans have to join the battle of ideas.
To be clear, the Republicans in Congress who have led the opposition to the Obama-Pelosi vision of health-care reform have done the right thing for our country. If they had rolled over, the results could have been devastating for our health-care system and our nation's budget.
But Republicans must shift gears. Conservatives should seize the mantle of reform and lead. Conservatives either genuinely believe that conservative principles will work to solve real-world problems such as health care or they don't. I believe they will.
The people do not want Republicans to offer their own thousand-page plan to overhaul health care, and that is not what the nation needs.
So here are 10 ideas to increase the affordability and quality of health care. Some of these are buried within various Republican and Democratic plans that have been floated. They offer a path forward toward significant bipartisan reform. These proposals would require insurance companies to do their jobs and spread risk over large populations, restore patients' power to make their own health-care decisions, and focus our system on quality instead of activity.
1-- Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.
This is included in the Dems plans
-- Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to "own" their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.
If health plans are portable across state lines this may strip state mandates from plans and water down essential coverage protections- i.e. mammography and birth control for women, chiropractic care and others. Portability is good as long as the individual state rules apply.
-- Lawsuit reform: It makes no sense to ignore one of the biggest cost drivers in the system -- the cost of defensive medicine, largely driven by lawsuits. Worse, many doctors have stopped performing high-risk procedures for fear of liability.
This is a no-brainer.
-- Require coverage of preexisting conditions: Insurance should not be least accessible when it is needed most. Companies should be incentivized to focus on delivering high-quality effective care, not to avoid covering the sick.
Ditto- a no-brainer.
-- Transparency and payment reform: Consumers have more information when choosing a car or restaurant than when selecting a health-care provider. Provider quality and cost should be plainly available to consumers, and payment systems should be based on outcomes, not volume. Today's system results in wide variations in treatment instead of the consistent application of best practices. We must reward efficiency and quality.
I'm glad he gets this, but quality outcomes and care should also be incentivized within payment reform.
-- Electronic medical records: The current system of paper records threatens patient privacy and leads to bad outcomes and higher costs.
Yup, a no-brainer again. So far I'm not real impressed.
-- Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.
This is a very slippery slope. HSAs are not the be-all, end-all answer the GOP hopes, but instead provide cost-savings for a niche market. Conservatives think HSA's are a savior but if you think reform is good if it means everyone has a $5,000 annual deductible while docs are not encouraged to increase quality and efficiency then we'd all be in for a wild ride to poor health.
-- Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.
Good idea, cost-share incentives could be included for those who test in the highest percentages of health.
-- Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have "aged out" of their parents' policies. Permitting young people to stay on their parents' plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools -- helping to lower premiums for everyone.
This is a good proposal, but often young people cannot afford the coverage in the first job's out of college because they make too little. I presume Mr. Jindal is thinking of only those with no access.
-- Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Redirecting some of the billions already spent on the uninsured will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market rather than forcing people into a government-run system. We should trust American families to make choices for themselves while we ensure they have access to quality, affordable health care.
Tax credits are the GOP solution that makes no sense. Reducing individuals taxable income by $5,000 does virtually nothing for their ABILITY to buy health insurance. I use dependent care reimbursement to get reimbursed for my daughter's daycare. The tax savings I enjoy from this amounts to about $1,000. My daughter's day care expenses are about $10,000 per year. This does so little to help its laughable. Health care is even worse.
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