The End Game and Lasting Disappointment

Insuring Resources Opinion:

So how did the Obama Administration get here? Here's where we're at and my answers on how bipartisan support could have been achieved:

1) Virtually no discussion on reigning in health care costs has occurred.
This should have been discussion point #1 daily by every liberal and THE basis for all proposals. The Conservatives can't argue against this. Obama and the liberals gave up on this argument in the Spring. This is the greatest disappointment because it encompasses the greatest promise of true reform.... provider incentives to get lean and efficient. What we have now in the bill is a weak voluntary, Medicare only pilot that provides provider incentives of a 1% higher reimbursement to increase efficiency. I bet the paperwork required eats up more than the 1%.

2) Improper focus on the public option. Yes, it could be included for individuals and small busineeses under ten employees as competition for private insurers. There could be language added to make it impossible to expand it into a single payer system by capping enrollment at 20-30 million members or similar mechanisms until whatever year is chosen (2100?).

3) Individual mandate to purchase coverage through an Exchange... The Senate Bill does have this. This provision eliminates the concept of adverse selection-- i.e. people waiting to purchase coverage until they're ill. The industry needs the individual mandate to streamline medical adversity.

4) Eliminate pre-x conditions. What a hollow victory if none of the rest happens but these last two items.

5) Employer mandate- yeah they botched this one, it doesn't exist except in the house bill which has been dead since the day it was passed. The penalty was miniscule compared to the cost of group insurance.

6) Medicare buy-in... Yep that one appears to be dead too thanks to Sen. Lieberman-- for once I agree with him. So the current compromise expands Medicare (expect this to be pulled from the compromise package soon) for 55 and up when the program already doesn't reimburse doctors enough and is responsible for huge cost-shifting on to the private employer-sponsored coverage side?? Dumb idea unless we somehow raise Medicare reimbursement by 15-20%. Oops, the bill actually cuts some Medicare reimbursement.


My solution:We should have a Health Insurance Exchange with regional / private sector insurance contracts administered by the feds with efficiency mandates based on CURRENT best practices that exist in Wisconsin and numerous other places. See (www.healthcarevalueleaders.org) Start with an initial five year competitive contract period for health plans to implement Efficiencies. From then on we should have revolving Three year COMPETITIVE contracts with efficiency teeth. If health plans fail on efficiency in the first two years, the contract ends after the third year and its opened to competition again, except that insurer or health plan is barred for say, 10 years. Period.

Mandate employer coverage for businesses with 10 + employees. Provide graduated subsidies for businesses with 10-49 employees. For businesses with 9 or fewer employees they can access coverage through the Health Insurance Exchange where individuals are mandated to get coverage or pay a graduated penalty based on income. If there is a public plan option it should be housed within the regional HIEs as an option for coverage.

Premiums will be less because of the power of large purchasing pools spreading the risk and the mandated coverage of individuals means they're in the pool also. And all providers must meet efficiency standards to get preferred reimbursement rates above current Medicare levels. Keep the paperwork easy and give them enough incentive to make it worthwhile- 5% let's say as a guess but whatever the Actuaries come up with. Oh and add bonuses for quality health outcomes achieved by the top 10% of insurers. But the bonuses don't go to the CEOs. They should be split evenly between the insurers and the member employers and individual insureds.

Final Analysis- But none of that above will happen. Its hard to say what the final product will look like... I'm scared to fathom it at this point. We'll probably cut the uninsured from about 47 million to 25 million or so and costs will go up because of it for the INSURED because there are no legitimate cost restraints anywhere. Add 20+ million insured persons with no health care cost restraints/ efficiency standards in place.

You ain't seen premium increases like those to come folks.