Insuring Resources Commentary:
This could be quite constructive especially since Gregg is open to creating Accountable Care Organization's which have been proven to provide efficient, quality care. Sen. Gregg (R- New Hampshire) is a moderate and focuses his reform ideas on preventive care, disease management, and wellness program incentives for employers. The Democrats need to compromise by including Gregg's proposals and scaling back just a bit. There appears to be some room in the middle here particularly if Gregg can bring along some of his GOP colleagues like Sen. Olympia Snowe (R-Maine).
---------------------------
From Politico, 2/11/2010
Is Judd Gregg a tease or a real potential partner for President Barack Obama in trying to salvage some health care reform in this Congress?
That’s one question the White House has to answer for itself before the much-ballyhooed televised sit-down with Republicans on Feb. 25 on how to break the current stalemate. But it’s clear already that Gregg’s restless energy is drawing him back into the fray, and the New Hampshire conservative brings both a proven ability to swing Republican votes and a background in health care and deficit issues.
In a letter to Obama released late Tuesday, Gregg welcomed the meeting as a chance for “constructive dialogue” and is promoting his own lower-cost approach focused on preventive care and guaranteed catastrophic coverage for all families.
His letter warns the president that the House- and Senate-passed health care bills can’t be the sole basis for the discussions. But in a series of interviews with POLITICO, Gregg has been open to specific deficit-reduction and cost-containment steps that could be taken to win Republicans’ support for health reform.
“I’m not on their reach-out list, so nothing may come of this,” Gregg said in an interview Wednesday. “But I’m ready to sit down and try to be helpful.”
Obama may feel burned already by Gregg, who famously accepted then gave back the president’s nomination to be commerce secretary last year. And the changes Gregg will want are sure to aggravate the White House’s already frayed relationship with the left.
Yet the same qualities that first made Gregg attractive as a Cabinet nominee remain. He brings a record of bipartisan deal making and good personal ties to Senate Majority Leader Harry Reid (D-Nev.). And getting Gregg on board makes it far easier for Maine’s two moderate Republicans, Sens. Olympia Snowe and Susan Collins, to work with the White House.
If anything, the political ground has shifted in his direction since he gave up the Commerce option. And Obama’s own budget projections this month make it harder for Congress to separate health care from the debate over the government’s mounting deficits and debt — Gregg’s natural turf.
What’s more of a mixed blessing is his lame-duck status since he will step down from the Senate at the end of this year.
Gregg is anxious to make a difference in his last months. At the same time, conservatives recently used his retirement date as a way to isolate Gregg and undercut his bipartisan plan — embraced by Obama — to create a statutory fiscal commission empowered to force votes on deficit reduction after the November elections.
Going into the Feb. 25 meeting, the White House is still pursuing a more comprehensive and costly package than Gregg can accept. The half-day session may prove a last gambit by the president to help him bring Democrats together for a final push.
DETAILS
Below is the Essentials of Greg's plan:
The centerpiece is his plan to begin reform by first guaranteeing access to a low-premium policy that protects against catastrophic costs but also expressly allows preventive benefits and disease management under the deductible. He would modify the existing Health Insurance Portability and Accessibility Act to allow employers greater freedom to reward workers who participate in wellness programs, such as giving up smoking or losing weight. And given his New Hampshire roots, he subscribes to a host of the so-called Dartmouth reforms to promote accountable care organizations and incentivize “shared decision making” between physicians and elderly patients about treatment options.
His approach is sure to face criticism for being too late and too small bore. But Gregg’s already shown a willingness to work with Democrats on a compromise related to the HIPAA changes he wants. Having a true catastrophic, major medical option for people being mandated to buy insurance fits his mode of “middle working out.”
“We can all agree that no American should lose their life savings or their home because of illness or injury and that the rising cost of health care severely burdens individuals, families and businesses,” Gregg wrote in his letter to Obama this week. “Report after report also confirms that health care costs are a systemic risk to the long-term fiscal health of our nation.”
Rea
Showing posts with label Compromise. Show all posts
Showing posts with label Compromise. Show all posts
Thursday, February 11, 2010
Tuesday, September 8, 2009
Health Compromise Floated Before Obama Speech
Below are excerpts from a NY times article on Sen. Baucus' health care reform compromise. I've edited the article to highlight what Baucus' plan would do, what it wouldn't and what it will cost.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
Wednesday, September 2, 2009
Sen. Grassley (R- Iowa) : No public option in health reform
It appears the Public option is out as any compromise between the House and senate versions would seem to eliminate the public option. Its not clear if co-ops remain in play as a pseudo public option to compete against private plans.
-------------
Sen. Grassley weighs in on health reform
By MIKE GLOVER (Associated Press
DES MOINES, Iowa — Iowa Republican Sen. Charles Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package.
Senate Finance Chairman Max Baucus, D-Mont., meanwhile, said an overhaul measure will be presented this year with or without bipartisan support — though he said a compromise would be far better than any bill pushed through solely by Democrats.
The senators are among a group of three Democrats and three Republicans on the pivotal Finance Committee who are negotiating a proposal to overhaul the nation's health care system. Both said Monday they were hopeful a bipartisan deal could be reached.
"I think the chances are still good," Baucus told The Associated Press. "I talked to (the Republicans) and they all want to do health care reform. But the sad part is a lot of politics have crept in."
Grassley, the GOP's key negotiator, expressed similar determination, but made clear he doesn't expect a public health care option sought by President Barack Obama to be in a final deal.
"I'm still hopeful, but I'm hopeful based on I think you're talking about something a little less sweeping than what we talked about before," Grassley told the AP in a telephone interview.
Grassley in the past has roundly criticized the public option, but went a step further Monday in saying the core group of senators agreed such a provision would not be in a bill.
-------------
Sen. Grassley weighs in on health reform
By MIKE GLOVER (Associated Press
DES MOINES, Iowa — Iowa Republican Sen. Charles Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package.
Senate Finance Chairman Max Baucus, D-Mont., meanwhile, said an overhaul measure will be presented this year with or without bipartisan support — though he said a compromise would be far better than any bill pushed through solely by Democrats.
The senators are among a group of three Democrats and three Republicans on the pivotal Finance Committee who are negotiating a proposal to overhaul the nation's health care system. Both said Monday they were hopeful a bipartisan deal could be reached.
"I think the chances are still good," Baucus told The Associated Press. "I talked to (the Republicans) and they all want to do health care reform. But the sad part is a lot of politics have crept in."
Grassley, the GOP's key negotiator, expressed similar determination, but made clear he doesn't expect a public health care option sought by President Barack Obama to be in a final deal.
"I'm still hopeful, but I'm hopeful based on I think you're talking about something a little less sweeping than what we talked about before," Grassley told the AP in a telephone interview.
Grassley in the past has roundly criticized the public option, but went a step further Monday in saying the core group of senators agreed such a provision would not be in a bill.
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.
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