Insuring Resources Commentary:
For long-term readers of this blog you'll recognize this article as hitting on my number one issue, health care quality and cost incentives to reduce waste in our fractured health care delivery system.
It is my firm belief that insurance reform cannot succeed without quality and cost reduction health care provider incentives to eliminate waste and focus on improved, quality health outcomes for all Americans.
This proposal, I believe, holds tremendous promise in reshaping the delivery and financing of American health care to finally focus on quality, rather than quantity.
I'll keep you updated as the Center for Health Care Delivery Science is launched.
- -- --- ---- ----- ------
By Jim Yong Kim and James N. Weinstein
Guest Editorial in the Washington Post
Monday, May 17, 2010
Health insurance reform is now law, giving millions of Americans access to the full resources of our health-care system for the first time. The question becomes: How can we ensure that they -- and all of us -- receive value-based and high-quality care?
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.
We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.
We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.
This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.
What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.
Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.
The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.
We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.
The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.
Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.
Showing posts with label waste. Show all posts
Showing posts with label waste. Show all posts
Tuesday, May 18, 2010
Friday, March 5, 2010
If Only We Could do it like Singapore- the only way to do it correctly with HSAs
Insuring Resources Commentary:
Health Savings Accounts give individuals who buy insurance a tax deduction for money they set aside for a high-deductible plan. Since tax deductions are worth more to people in higher tax brackets, and since high-deductible plans appeal more to those with lower medical expenses, the plans attract the rich and healthy, leaving the poor and sick behind. This is why the Republican's plan is not workable for most Americans.
Singapore does it by setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive.
-------------------- -------------------
An article on Singapore's very effec tive health care insurance system....
by Matt Miller at the Washington Post 3/3/10
The only rich nation that boasts universal coverage with health outcomes better than ours while spending one-fifth as much per person on health care. Introducing (drum roll please): Singapore.
Yes, it's an island city-state of just 5 million people. Yes, it's more or less a benevolent dictatorship. And, yes, until recently, bringing chewing gum into Singapore could land you in jail. But Singapore, a poor country a few decades ago, now boasts a higher per capita income (when adjusted for local purchasing power) than the United States. And here's the astonishing fact: Singapore spends less than 4 percent of its GDP on health care. We spend 17 percent (and Singapore's somewhat younger population doesn't begin to explain the difference). Matching Singapore's performance in our $15 trillion economy would free up $2 trillion a year for other public and private purposes.
Do I have I your attention?
Today we can't find cash to recruit a new generation of great teachers, rebuild our roads and bridges, pay down the national debt, or invest in better airports, high-speed rail, a clean energy revolution or any of a hundred other things sensible patriots know we should do to renew the country. We can't do these things in large part because the Medical Industrial Complex vacuums up every spare dollar in sight. It's only slightly melodramatic to assert that if we could run our health-care system as efficiently as Singapore's, we could solve most of our other problems.
So how does Singapore do it?
In health circles it's always conservatives who bring up Singapore, because of the primacy it places on personal responsibility. According to Phua Kai Hong of the National University of Singapore, roughly one-third of health spending in Singapore is paid directly by individuals (who typically buy catastrophic coverage as well); in the United States, by contrast, nearly 90 percent is picked up by third-party insurers, employers and governments. Singaporeans make these payments out of earnings as well as from health savings accounts. The system is chock-full of incentives for thrift. If you want a private hospital room, for example, you pay through the nose; most people choose less expensive wards.
Conservatives are right: Singaporeans have the kind of "skin in the game" that promotes prudence.
But that's only half the story. There's also a massive public role. For starters, adequate savings for retirement and health expenses are mandated by government (employees must sock away 20 percent of earnings each year, to which employers add 13 percent). Public hospitals provide 80 percent of the acute care, setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive than similar notions Hillary Clinton pushed in the '90s. And in Singapore, if a child is obese, they don't get Rose Garden exhortations from the first lady. They get no lunch and mandatory exercise periods during school.
There's more (including an ample safety net for the poor), but you get the gist: Singapore achieves world-class results thanks to a bold, unconventional synthesis of liberal and conservative approaches. It's further to the left and further to the right than what President Obama or his foes now seek. The island's real ideology is pragmatic problem-solving. It works thanks to cultural traditions that let this eclectic blend flourish. The system is nurtured by talented, highly paid officials who have the luxury of governing for the long-term without being buffeted much by politics.
We obviously can't transplant Singapore's approach wholesale to the United States. But the reason we can't emulate even some of Singapore's success has to do with that iron law of health-care politics: Every dollar of health-care "waste" is somebody's dollar of income. As a stable advanced democracy, we're so overrun by groups with stakes in today's waste that real efficiency gains are perennially blocked.
Any hope for something better starts with tallying the price of today's paralysis. Think about that $2 trillion the next time you see states, citing budget woes, shut the door to college on tens of thousands of poor American students. Or when the next firm moves jobs overseas because health costs here are soaring. Or when the next bridge collapses. Thanks, Medical Industrial Complex!
We return now to our regularly scheduled political battle, which (no matter the outcome, according to some projections) will leave health costs headed to more than 20 percent of GDP by 2019.
Health Savings Accounts give individuals who buy insurance a tax deduction for money they set aside for a high-deductible plan. Since tax deductions are worth more to people in higher tax brackets, and since high-deductible plans appeal more to those with lower medical expenses, the plans attract the rich and healthy, leaving the poor and sick behind. This is why the Republican's plan is not workable for most Americans.
Singapore does it by setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive.
-------------------- -------------------
An article on Singapore's very effec tive health care insurance system....
by Matt Miller at the Washington Post 3/3/10
The only rich nation that boasts universal coverage with health outcomes better than ours while spending one-fifth as much per person on health care. Introducing (drum roll please): Singapore.
Yes, it's an island city-state of just 5 million people. Yes, it's more or less a benevolent dictatorship. And, yes, until recently, bringing chewing gum into Singapore could land you in jail. But Singapore, a poor country a few decades ago, now boasts a higher per capita income (when adjusted for local purchasing power) than the United States. And here's the astonishing fact: Singapore spends less than 4 percent of its GDP on health care. We spend 17 percent (and Singapore's somewhat younger population doesn't begin to explain the difference). Matching Singapore's performance in our $15 trillion economy would free up $2 trillion a year for other public and private purposes.
Do I have I your attention?
Today we can't find cash to recruit a new generation of great teachers, rebuild our roads and bridges, pay down the national debt, or invest in better airports, high-speed rail, a clean energy revolution or any of a hundred other things sensible patriots know we should do to renew the country. We can't do these things in large part because the Medical Industrial Complex vacuums up every spare dollar in sight. It's only slightly melodramatic to assert that if we could run our health-care system as efficiently as Singapore's, we could solve most of our other problems.
So how does Singapore do it?
In health circles it's always conservatives who bring up Singapore, because of the primacy it places on personal responsibility. According to Phua Kai Hong of the National University of Singapore, roughly one-third of health spending in Singapore is paid directly by individuals (who typically buy catastrophic coverage as well); in the United States, by contrast, nearly 90 percent is picked up by third-party insurers, employers and governments. Singaporeans make these payments out of earnings as well as from health savings accounts. The system is chock-full of incentives for thrift. If you want a private hospital room, for example, you pay through the nose; most people choose less expensive wards.
Conservatives are right: Singaporeans have the kind of "skin in the game" that promotes prudence.
But that's only half the story. There's also a massive public role. For starters, adequate savings for retirement and health expenses are mandated by government (employees must sock away 20 percent of earnings each year, to which employers add 13 percent). Public hospitals provide 80 percent of the acute care, setting affordable pricing benchmarks with which private providers compete. Supply-side rules that favor training new family doctors over pricey specialists are more extensive than similar notions Hillary Clinton pushed in the '90s. And in Singapore, if a child is obese, they don't get Rose Garden exhortations from the first lady. They get no lunch and mandatory exercise periods during school.
There's more (including an ample safety net for the poor), but you get the gist: Singapore achieves world-class results thanks to a bold, unconventional synthesis of liberal and conservative approaches. It's further to the left and further to the right than what President Obama or his foes now seek. The island's real ideology is pragmatic problem-solving. It works thanks to cultural traditions that let this eclectic blend flourish. The system is nurtured by talented, highly paid officials who have the luxury of governing for the long-term without being buffeted much by politics.
We obviously can't transplant Singapore's approach wholesale to the United States. But the reason we can't emulate even some of Singapore's success has to do with that iron law of health-care politics: Every dollar of health-care "waste" is somebody's dollar of income. As a stable advanced democracy, we're so overrun by groups with stakes in today's waste that real efficiency gains are perennially blocked.
Any hope for something better starts with tallying the price of today's paralysis. Think about that $2 trillion the next time you see states, citing budget woes, shut the door to college on tens of thousands of poor American students. Or when the next firm moves jobs overseas because health costs here are soaring. Or when the next bridge collapses. Thanks, Medical Industrial Complex!
We return now to our regularly scheduled political battle, which (no matter the outcome, according to some projections) will leave health costs headed to more than 20 percent of GDP by 2019.
Wednesday, January 6, 2010
Health bills would shift Medicare money to Marshfield, Mayo and other 'high-value' hospitals
Insuring Resources Commentary:
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
Wednesday, December 30, 2009
News Alert- Sen. Kohl offered lean methodology amendment on Dec. 15th
Insuring Resources Commentary:
My apologies for getting this news to you all this late. Please call your Senators to have the language below reintroduced during the conference committee negotiations. We must, at the very least, get a pilot or demonstration in place illustrating the cost savings of the lean methodology. Thank you Senator Kohl for introducing this amendment.
The amendment introduced by Sen. Herb Kohl did not pass and is not contained within the Senate bill that was passed Dec. 24th.
Amendment language:
On page 731, between lines 16 and 17, insert the following:
‘‘(xix) Implementing the lean methodology through a network
of provider systems across the country in varying geographic
areas and across sites of care that offer a patient-centered
approach to improving quality, reducing medical errors, and
enhancing value to patients.
http://www.createhealthcarevalue.com/data/blog/ThedaCare%20amendment.pdf
Source: The Congressional Record- Dec. 15th
My apologies for getting this news to you all this late. Please call your Senators to have the language below reintroduced during the conference committee negotiations. We must, at the very least, get a pilot or demonstration in place illustrating the cost savings of the lean methodology. Thank you Senator Kohl for introducing this amendment.
The amendment introduced by Sen. Herb Kohl did not pass and is not contained within the Senate bill that was passed Dec. 24th.
Amendment language:
On page 731, between lines 16 and 17, insert the following:
‘‘(xix) Implementing the lean methodology through a network
of provider systems across the country in varying geographic
areas and across sites of care that offer a patient-centered
approach to improving quality, reducing medical errors, and
enhancing value to patients.
http://www.createhealthcarevalue.com/data/blog/ThedaCare%20amendment.pdf
Source: The Congressional Record- Dec. 15th
Monday, December 7, 2009
Reaction from Insurance Industry to Current Bills
Insuring Resources Commentary:
Readers know I do not push the health insurance industry's agenda except when they are correct on an issue. In Wisconsin, we're very lucky to have several health insurance plans who focus on quality outcomes and effcient care -- Group Health Coop, Gunderson Lutheran, ThedaCare, Dean Health Plan and others. These plans have very low administrative costs and are very efficient in the care they provide. They have assessed the waste in their systems and make every attempt to extract it. The rest of the nation is not so lucky.
This is why AHIP is right and I said these same things that AHIP mentions in this space months ago. Voluntary pilot waste reduction programs do not go far enough, We need fundamental health CARE and PAYMENT reform.
Insurance reforms like eliminating pre-x conditions are vital to improving access and insurance for as many American;s as we can. A public plan option for those shut out of the system and for the smallest of employers would be great.
But, all the insurance reforms will matter very little if we do not CHANGE the WAY WE PAY for HEALTH CARE. In fact if health care reform does not change the financing of health care, insurance premiums will go up with 30-40 million more people seeking more care and Medicare will be in danger.
AHIP is right and the data from Mercer on health plans avoiding the tax that will help finance the expansion sends up a huge warning flag.
----------------------- ------------------------
Health insurers push back as debate heats up
Reuters) - The health insurance industry on Thursday struck back at provisions in Congress' healthcare proposals that it said would do little to curb the nation's spiraling costs or provide people more affordable coverage.
U.S. | Healthcare Reform
Congress is tip-toeing toward incremental healthcare reform that does not address what insurance companies see as the major issue -- containing costs, America's Health Insurance Plans president Karen Ignagni said in a speech in Detroit on Wednesday.
"The bills before Congress settle for timid pilot programs, rather than requiring major changes; creating incentives that apply only to Medicare, rather than across the board; and establishing a new oversight body, but severely limiting its scope of review," Ignagni, a top lobbyist for the health insurance industry, told the Detroit Economic Club.
The group represents 1300 insurers such as Aetna Inc, Cigna Corp, UnitedHealth Group Inc, among others.
Her comments come as the Democrats try to make good on President
Barack Obama's goal of expanding health insurance coverage to tens of millions of more Americans without adding to the nation's deficit. The Senate is debating an $849 billion bill that, if passed, must be merged with the House of Representatives' $1 trillion bill passed last month.
Ignagni visited Michigan, the state with the highest unemployment rate, as part of a national outreach to convince Americans of the need for lower medical costs.
Michigan, also home to the ailing U.S. auto industry, has more than 1 million people without healthcare insurance, or nearly 12 percent of its population, according to a Kaiser Family Foundation report. Nationally, about 46 million people, or about 15 percent, are uninsured in the United States where most working-age people get coverage through their employer.
True reform to cut healthcare costs has been sidetracked this year by too much emphasis on whether congressional bills will include a "public option," Ignagni said, echoing concerns heard from many others who both support and oppose the bill.
"Indeed, as far as cost containment is concerned, it's as though the house is on fire and the strategy is to rush to the scene with an eight-ounce glass of water," she said.
Democrats and other supporters acknowledge there are some areas that could be strengthened but argue the reform plans are a good first step toward reining in the nation's $2.5 trillion healthcare sector that is growing at a rate far surpassing inflation.
The Obama administration separately on Thursday blasted an industry analysis that said the Senate bill would raise health insurance premiums for individuals and small groups that try to buy policies.
The report, released by insurance network Blue Cross Blue Shield Association, said the bill will drive more sick people who need costly treatment into the system while not enticing younger, healthier customers into the insurance pool. It will also raise costs by requiring insurers to provide more minimum benefits, it said.
Whitehouse spokesman Dan Pfeiffer, in a blog posting on the White House's website, said the study did not take a number of the bill's provisions into account, including subsidies to help people afford insurance policies as well as protections included for people to keep their current insurance plan.
"We're closer than ever before to passing meaningful health insurance reform," Pfeiffer wrote. "And you can bet as we continue to make progress, the insurance industry will continue to try and distract and misinform because they know their very profitable status quo is in grave danger."
In a separate study on Thursday, employee benefit manager Mercer said nearly two-thirds of companies would trim the health benefits they offer if final legislation includes a tax on more generous, so-called "Cadillac" health insurance plans.
Mercer, a Marsh & McLennan Companies Inc company that serves many Fortune 500 companies, surveyed 465 employers of all sizes, with 63 percent saying they would reduce benefits to avoid the tax.
Readers know I do not push the health insurance industry's agenda except when they are correct on an issue. In Wisconsin, we're very lucky to have several health insurance plans who focus on quality outcomes and effcient care -- Group Health Coop, Gunderson Lutheran, ThedaCare, Dean Health Plan and others. These plans have very low administrative costs and are very efficient in the care they provide. They have assessed the waste in their systems and make every attempt to extract it. The rest of the nation is not so lucky.
This is why AHIP is right and I said these same things that AHIP mentions in this space months ago. Voluntary pilot waste reduction programs do not go far enough, We need fundamental health CARE and PAYMENT reform.
Insurance reforms like eliminating pre-x conditions are vital to improving access and insurance for as many American;s as we can. A public plan option for those shut out of the system and for the smallest of employers would be great.
But, all the insurance reforms will matter very little if we do not CHANGE the WAY WE PAY for HEALTH CARE. In fact if health care reform does not change the financing of health care, insurance premiums will go up with 30-40 million more people seeking more care and Medicare will be in danger.
AHIP is right and the data from Mercer on health plans avoiding the tax that will help finance the expansion sends up a huge warning flag.
----------------------- ------------------------
Health insurers push back as debate heats up
Reuters) - The health insurance industry on Thursday struck back at provisions in Congress' healthcare proposals that it said would do little to curb the nation's spiraling costs or provide people more affordable coverage.
U.S. | Healthcare Reform
Congress is tip-toeing toward incremental healthcare reform that does not address what insurance companies see as the major issue -- containing costs, America's Health Insurance Plans president Karen Ignagni said in a speech in Detroit on Wednesday.
"The bills before Congress settle for timid pilot programs, rather than requiring major changes; creating incentives that apply only to Medicare, rather than across the board; and establishing a new oversight body, but severely limiting its scope of review," Ignagni, a top lobbyist for the health insurance industry, told the Detroit Economic Club.
The group represents 1300 insurers such as Aetna Inc, Cigna Corp, UnitedHealth Group Inc, among others.
Her comments come as the Democrats try to make good on President
Barack Obama's goal of expanding health insurance coverage to tens of millions of more Americans without adding to the nation's deficit. The Senate is debating an $849 billion bill that, if passed, must be merged with the House of Representatives' $1 trillion bill passed last month.
Ignagni visited Michigan, the state with the highest unemployment rate, as part of a national outreach to convince Americans of the need for lower medical costs.
Michigan, also home to the ailing U.S. auto industry, has more than 1 million people without healthcare insurance, or nearly 12 percent of its population, according to a Kaiser Family Foundation report. Nationally, about 46 million people, or about 15 percent, are uninsured in the United States where most working-age people get coverage through their employer.
True reform to cut healthcare costs has been sidetracked this year by too much emphasis on whether congressional bills will include a "public option," Ignagni said, echoing concerns heard from many others who both support and oppose the bill.
"Indeed, as far as cost containment is concerned, it's as though the house is on fire and the strategy is to rush to the scene with an eight-ounce glass of water," she said.
Democrats and other supporters acknowledge there are some areas that could be strengthened but argue the reform plans are a good first step toward reining in the nation's $2.5 trillion healthcare sector that is growing at a rate far surpassing inflation.
The Obama administration separately on Thursday blasted an industry analysis that said the Senate bill would raise health insurance premiums for individuals and small groups that try to buy policies.
The report, released by insurance network Blue Cross Blue Shield Association, said the bill will drive more sick people who need costly treatment into the system while not enticing younger, healthier customers into the insurance pool. It will also raise costs by requiring insurers to provide more minimum benefits, it said.
Whitehouse spokesman Dan Pfeiffer, in a blog posting on the White House's website, said the study did not take a number of the bill's provisions into account, including subsidies to help people afford insurance policies as well as protections included for people to keep their current insurance plan.
"We're closer than ever before to passing meaningful health insurance reform," Pfeiffer wrote. "And you can bet as we continue to make progress, the insurance industry will continue to try and distract and misinform because they know their very profitable status quo is in grave danger."
In a separate study on Thursday, employee benefit manager Mercer said nearly two-thirds of companies would trim the health benefits they offer if final legislation includes a tax on more generous, so-called "Cadillac" health insurance plans.
Mercer, a Marsh & McLennan Companies Inc company that serves many Fortune 500 companies, surveyed 465 employers of all sizes, with 63 percent saying they would reduce benefits to avoid the tax.
Thursday, December 3, 2009
Dear Orszag: Please come to Wisconsin
Insuring Resources Commentary:
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Wednesday, November 18, 2009
WI Firms Pay 22% More for Health Insurance- with Soultions Offered by Insuring Resources
Insuring Resources Commentary:
Wisconsin business is at a huge disadvantage in the national marketplace because we pay so much more for health insurance, according to new research by Mercer. Part of the reason, I believe, is because Wisconsin health care providers get paid less on average for treating people on Medicare so the costs are shifted on to the private sector side.
Now if health care reform includes a public plan option that covers small businesses and uses Medicare reimbursement rates the situation will get much worse for Wisconsin businesses.
Solution:
Health care reform must
1. level the Medicare reimbursement to bring Wisconsin up where it should be. Wisconsin providers are paid much less by Medicare than the national average.
2.if we have a public plan option that includes coverage for small businesses it must not use Medicare reimbursement rates UNLESS, Medicare can finally start to negotiate rates with providers. Right now, Medicare reimbursement rates are set by the feds, NOT negotiated in the marketplace. With the purchasing power of the federal government insuring tens of millions of people on Medicare this should be a no-brainer.
3. In addition, as I've said all along, providers need reimbursement incentives to make their care more efficient and reduce the waste. The Senate bill includes pilots for this but that doesn't go far enough, we need these efficiency incentives to be standard across the entire system.
4. And finally, Wisconsin cannot be penalized for having a higher rate of insured persons. There are incentives in the House bill that gives grant money to states with higher uninsured pct.s to help them along. This actually hurts states like Wisconsin that have been proactive. For instance- Wisconsin covers childless adults through BadgerCare up to 200% of FPL. Louisiana covers them up to 26% of FPL!!! If the House reform language passes Lousiana gets extra money to bring their insured numbers up to 150% while Wisconsin already surpasses that. By the way-- thanks to Wisconsin DHS Secretary Karen Timberlake for providing the Louisiana stat at a health care forum I attended in Madison yesterday.
----------------------- -----------------------
State firms pay 22% more for health insurance than U.S., survey shows By Rick Romell of the Journal Sentinel
Posted: Nov. 18, 2009 10:14 a.m.
Wisconsinites continue to pay more for health insurance than Americans generally, and the costs here have increased more rapidly, a new survey by benefits consulting firm Mercer shows.
Wisconsin companies and their employees paid an average of $10,888 per worker for health insurance in 2009 - nearly 22% above the national average of $8,945, Mercer found.
And the cost gap between Wisconsin and the rest of the country widened. Nationally, the cost of health benefits for active employees rose 5.5% for the year, the smallest annual increase in a decade. In Wisconsin, costs increased by 6.8%.
Mercer's findings are based on a late-summer survey of more than 2,900 employers with at least 10 employees each. Eighty-eight Wisconsin employers were surveyed.
Wisconsin business is at a huge disadvantage in the national marketplace because we pay so much more for health insurance, according to new research by Mercer. Part of the reason, I believe, is because Wisconsin health care providers get paid less on average for treating people on Medicare so the costs are shifted on to the private sector side.
Now if health care reform includes a public plan option that covers small businesses and uses Medicare reimbursement rates the situation will get much worse for Wisconsin businesses.
Solution:
Health care reform must
1. level the Medicare reimbursement to bring Wisconsin up where it should be. Wisconsin providers are paid much less by Medicare than the national average.
2.if we have a public plan option that includes coverage for small businesses it must not use Medicare reimbursement rates UNLESS, Medicare can finally start to negotiate rates with providers. Right now, Medicare reimbursement rates are set by the feds, NOT negotiated in the marketplace. With the purchasing power of the federal government insuring tens of millions of people on Medicare this should be a no-brainer.
3. In addition, as I've said all along, providers need reimbursement incentives to make their care more efficient and reduce the waste. The Senate bill includes pilots for this but that doesn't go far enough, we need these efficiency incentives to be standard across the entire system.
4. And finally, Wisconsin cannot be penalized for having a higher rate of insured persons. There are incentives in the House bill that gives grant money to states with higher uninsured pct.s to help them along. This actually hurts states like Wisconsin that have been proactive. For instance- Wisconsin covers childless adults through BadgerCare up to 200% of FPL. Louisiana covers them up to 26% of FPL!!! If the House reform language passes Lousiana gets extra money to bring their insured numbers up to 150% while Wisconsin already surpasses that. By the way-- thanks to Wisconsin DHS Secretary Karen Timberlake for providing the Louisiana stat at a health care forum I attended in Madison yesterday.
----------------------- -----------------------
State firms pay 22% more for health insurance than U.S., survey shows By Rick Romell of the Journal Sentinel
Posted: Nov. 18, 2009 10:14 a.m.
Wisconsinites continue to pay more for health insurance than Americans generally, and the costs here have increased more rapidly, a new survey by benefits consulting firm Mercer shows.
Wisconsin companies and their employees paid an average of $10,888 per worker for health insurance in 2009 - nearly 22% above the national average of $8,945, Mercer found.
And the cost gap between Wisconsin and the rest of the country widened. Nationally, the cost of health benefits for active employees rose 5.5% for the year, the smallest annual increase in a decade. In Wisconsin, costs increased by 6.8%.
Mercer's findings are based on a late-summer survey of more than 2,900 employers with at least 10 employees each. Eighty-eight Wisconsin employers were surveyed.
Wednesday, November 4, 2009
Health Bills too Timid on Cutting Costs, Experts say
Insuring Resources Commentary
More evidence from the experts that we are potentially headed for disaster. We must address health care costs aggressively while expanding coverage of the uninsured or we risk exploding the system.
I'm not talking about price controls or rationing. We need to eliminate waste and reimburse services based on episodes of care and quality outcomes. Our current system does neither.
Yesterday I had my third conversation with staff from Sen. Feingold's office and have yet to make any sort of headway. I won't give up, but I need your help. Its time to call your senator or representative.
--------------------- ----------------------------
Proposals make only trims where broader changes are needed, critics argue
By Ceci Connolly
Washington Post Staff Writer
Wednesday, November 4, 2009
Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that.
"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."
In years past, policymakers tried taming health-care growth with price controls -- in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.
Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. In short, the goal is to save money by modernizing and improving.
Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:
-- A Senate plan to tax high-priced insurance policies saves far less money -- and is less likely to change medical consumption -- than eliminating the tax exemption for employer-sponsored coverage.
-- Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.
-- An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally -- if they ever were.
-- None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.
'Tried and true'
Overall, Democratic lawmakers have turned to "tried and true" strategies for reducing spending that merely ratchet down payments rather than fundamentally changing how the health-care system operates, said Drew Altman, head of the nonpartisan Kaiser Family Foundation.
More than $110 billion worth of Medicare "savings," for example, simply comes from a cut in reimbursements to insurers that run the private Medicare Advantage program, and much of the $80 billion extracted from drug companies is in the form of higher Medicaid rebates to the government. Both proposals would reduce costs but have little to do with fundamentally refashioning health care.
Unlike past reform efforts that barely gave a nod to tackling double-digit medical inflation, the bills this year "have some of the right rhetoric," but they fall short of real-world applicability, said Jack Lewin, chief executive of the American College of Cardiology. Without significant financial incentives and strict deadlines, he predicted, few doctors would rush to move toward the coordinated-care models reformers say are needed to save money and maintain high quality.
Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector."
Neas called on Congress to adopt up to $2 trillion worth of potential savings trumpeted by Obama and industry leaders at a White House event in May. Only a few of the specific ideas, such as streamlining insurance claims forms, have been included in the legislation.
"Voluntary efforts are never enough," Neas said. "There has to be some way to make it enforceable."
Richard Foster, the chief actuary of the federal Centers for Medicare and Medicaid Services, said lawmakers could achieve far greater savings in the health system if they aggressively pursued research that identifies the best, most cost-effective treatments.
"If you did comparative effectiveness in a way that looked at whether to approve a new therapy because it is cost effective and is an improvement, then you'd have a fighting chance of slowing down the rate of growth," he said in an interview. "Nobody's proposing that."
Taxing benefits
White House budget chief Peter Orszag said in an interview that changing the tax treatment of employer-sponsored health benefits "is among the most important single things that could be done to constrain costs and improve quality."
Employees currently do not pay taxes on insurance purchased through the workplace. Lifting the exemption would be likely to make workers more price sensitive and prompt insurance companies to market more affordable policies, according to most economists.
Eliminating the exemption could raise $250 billion a year and more than pay for the enormous expansion of coverage envisioned by Obama and Democrats. But the Senate compromised, with a proposal to tax only high-priced "Cadillac" plans. That approach is estimated to save $200 billion over a decade, and House Democrats have opposed the idea, raising concerns that it may be dropped.
Orszag also bragged that a set of Medicare pilot projects could dramatically reshape how medicine is practiced in this country. The proposals include reducing reimbursements to hospitals that have unnecessarily high readmission rates, "bundling" payments to medical teams that coordinate patient care and providing bonuses to doctors who meet quality standards.
"We're creating incentives for a more efficient system," he said. Because lawmakers are still negotiating and the proposals could change, Orszag said, it is impossible to quantify the eventual savings.
While Orszag says a go-slow approach will help determine the best course, others say the ideas are promising enough to pursue aggressively now.
"I wish they had the courage of their convictions," said Douglas Holtz-Eakin, a former Congressional Budget Office director and adviser to Sen. John McCain (R-Ariz.). "Just do it."
Mark McClellan, a physician who ran two health agencies in the Bush administration, endorsed the ideas in the legislation but warned that pilot projects take too long to adopt broadly and that not enough emphasis is being placed on financial rewards and penalties based on health outcomes.
Orszag has high hopes for a proposed Medicare cost commission as well, suggesting that the panel of independent experts would guide the government program to deliver more efficient care. But the hospital industry has already struck a deal exempting it from any suggested cuts for 10 years, and Congress is likely to limit the panel's power to recommendations that do not touch eligibility or benefits.
Many remain skeptical that Congress will let stand spending reductions included in this year's comprehensive reform initiative, particularly $400 billion in Medicare trims. They point to 1997's Balanced Budget Act, in which Congress set a Medicare fee schedule that would squeeze physician payments if costs rose too steeply. But nearly every year, at the behest of the American Medical Association, lawmakers override the scheduled reductions.
That history "teaches us that single provisions that can be easily lobbied against tend not to survive the political process," said Helen Darling, president of the National Business Group on Health.
But for Orszag, the cost-control efforts on Capitol Hill represent significant progress.
"There's always the potential to do more," he said. "When you look at the details in the legislation, it is a substantial step, especially within the realm of the politically viable and realistic, as opposed to a think tank or academic ideal."
More evidence from the experts that we are potentially headed for disaster. We must address health care costs aggressively while expanding coverage of the uninsured or we risk exploding the system.
I'm not talking about price controls or rationing. We need to eliminate waste and reimburse services based on episodes of care and quality outcomes. Our current system does neither.
Yesterday I had my third conversation with staff from Sen. Feingold's office and have yet to make any sort of headway. I won't give up, but I need your help. Its time to call your senator or representative.
--------------------- ----------------------------
Proposals make only trims where broader changes are needed, critics argue
By Ceci Connolly
Washington Post Staff Writer
Wednesday, November 4, 2009
Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that.
"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."
In years past, policymakers tried taming health-care growth with price controls -- in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.
Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. In short, the goal is to save money by modernizing and improving.
Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:
-- A Senate plan to tax high-priced insurance policies saves far less money -- and is less likely to change medical consumption -- than eliminating the tax exemption for employer-sponsored coverage.
-- Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.
-- An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally -- if they ever were.
-- None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.
'Tried and true'
Overall, Democratic lawmakers have turned to "tried and true" strategies for reducing spending that merely ratchet down payments rather than fundamentally changing how the health-care system operates, said Drew Altman, head of the nonpartisan Kaiser Family Foundation.
More than $110 billion worth of Medicare "savings," for example, simply comes from a cut in reimbursements to insurers that run the private Medicare Advantage program, and much of the $80 billion extracted from drug companies is in the form of higher Medicaid rebates to the government. Both proposals would reduce costs but have little to do with fundamentally refashioning health care.
Unlike past reform efforts that barely gave a nod to tackling double-digit medical inflation, the bills this year "have some of the right rhetoric," but they fall short of real-world applicability, said Jack Lewin, chief executive of the American College of Cardiology. Without significant financial incentives and strict deadlines, he predicted, few doctors would rush to move toward the coordinated-care models reformers say are needed to save money and maintain high quality.
Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector."
Neas called on Congress to adopt up to $2 trillion worth of potential savings trumpeted by Obama and industry leaders at a White House event in May. Only a few of the specific ideas, such as streamlining insurance claims forms, have been included in the legislation.
"Voluntary efforts are never enough," Neas said. "There has to be some way to make it enforceable."
Richard Foster, the chief actuary of the federal Centers for Medicare and Medicaid Services, said lawmakers could achieve far greater savings in the health system if they aggressively pursued research that identifies the best, most cost-effective treatments.
"If you did comparative effectiveness in a way that looked at whether to approve a new therapy because it is cost effective and is an improvement, then you'd have a fighting chance of slowing down the rate of growth," he said in an interview. "Nobody's proposing that."
Taxing benefits
White House budget chief Peter Orszag said in an interview that changing the tax treatment of employer-sponsored health benefits "is among the most important single things that could be done to constrain costs and improve quality."
Employees currently do not pay taxes on insurance purchased through the workplace. Lifting the exemption would be likely to make workers more price sensitive and prompt insurance companies to market more affordable policies, according to most economists.
Eliminating the exemption could raise $250 billion a year and more than pay for the enormous expansion of coverage envisioned by Obama and Democrats. But the Senate compromised, with a proposal to tax only high-priced "Cadillac" plans. That approach is estimated to save $200 billion over a decade, and House Democrats have opposed the idea, raising concerns that it may be dropped.
Orszag also bragged that a set of Medicare pilot projects could dramatically reshape how medicine is practiced in this country. The proposals include reducing reimbursements to hospitals that have unnecessarily high readmission rates, "bundling" payments to medical teams that coordinate patient care and providing bonuses to doctors who meet quality standards.
"We're creating incentives for a more efficient system," he said. Because lawmakers are still negotiating and the proposals could change, Orszag said, it is impossible to quantify the eventual savings.
While Orszag says a go-slow approach will help determine the best course, others say the ideas are promising enough to pursue aggressively now.
"I wish they had the courage of their convictions," said Douglas Holtz-Eakin, a former Congressional Budget Office director and adviser to Sen. John McCain (R-Ariz.). "Just do it."
Mark McClellan, a physician who ran two health agencies in the Bush administration, endorsed the ideas in the legislation but warned that pilot projects take too long to adopt broadly and that not enough emphasis is being placed on financial rewards and penalties based on health outcomes.
Orszag has high hopes for a proposed Medicare cost commission as well, suggesting that the panel of independent experts would guide the government program to deliver more efficient care. But the hospital industry has already struck a deal exempting it from any suggested cuts for 10 years, and Congress is likely to limit the panel's power to recommendations that do not touch eligibility or benefits.
Many remain skeptical that Congress will let stand spending reductions included in this year's comprehensive reform initiative, particularly $400 billion in Medicare trims. They point to 1997's Balanced Budget Act, in which Congress set a Medicare fee schedule that would squeeze physician payments if costs rose too steeply. But nearly every year, at the behest of the American Medical Association, lawmakers override the scheduled reductions.
That history "teaches us that single provisions that can be easily lobbied against tend not to survive the political process," said Helen Darling, president of the National Business Group on Health.
But for Orszag, the cost-control efforts on Capitol Hill represent significant progress.
"There's always the potential to do more," he said. "When you look at the details in the legislation, it is a substantial step, especially within the realm of the politically viable and realistic, as opposed to a think tank or academic ideal."
Monday, November 2, 2009
Charlie Wilson's War and Health Care Reform- can we ever get it completely right?
Insuring Resources Commentary
I finally just watched the movie, Charlie Wilson's War, the story of a renegade Congressman, a rich socialite and a rogue CIA agent who began the end of the Soviet Empire with the help of well-armed Afghan freedom fighters through a covert war.
The analogy to the battle for health care reform is apt as we inch closer and closer this fall to a reform package that could forever change the landscape of the American healthcare system. Or, like Charlie Wilson's War in Afghanistan it could come close and ultimately fail.
"These things happened. They were glorious and they changed the world... and then we screwed up the endgame"- U.S. Cong. Charlie Wilson.
Through the covert war in Afghanistan Congress spent over $1 Billion to oust the Soviets but failed to establish a sustainable infrastructure to support a democracy. As Charlie Wilson tried and failed to get just $1 million in funding to build Afghani schools and sustain the momentum from the war viewers are suddenly jolted into the present in our own minds with visions of Al Queda, the Taliban and our own futile overt war.
Full Circle
So what's all this mean for health care reform? Like rebuilding Afghani schools we need to ensure that health care reform brings us a sustainable health care future with incentives for quality care, reduction of waste through lean processes, and payment reform that incents quality and not quantity.
Let's get this right, THIS TIME, let's not do it halfway and leave the outcome unsustainable.
I finally just watched the movie, Charlie Wilson's War, the story of a renegade Congressman, a rich socialite and a rogue CIA agent who began the end of the Soviet Empire with the help of well-armed Afghan freedom fighters through a covert war.
The analogy to the battle for health care reform is apt as we inch closer and closer this fall to a reform package that could forever change the landscape of the American healthcare system. Or, like Charlie Wilson's War in Afghanistan it could come close and ultimately fail.
"These things happened. They were glorious and they changed the world... and then we screwed up the endgame"- U.S. Cong. Charlie Wilson.
Through the covert war in Afghanistan Congress spent over $1 Billion to oust the Soviets but failed to establish a sustainable infrastructure to support a democracy. As Charlie Wilson tried and failed to get just $1 million in funding to build Afghani schools and sustain the momentum from the war viewers are suddenly jolted into the present in our own minds with visions of Al Queda, the Taliban and our own futile overt war.
Full Circle
So what's all this mean for health care reform? Like rebuilding Afghani schools we need to ensure that health care reform brings us a sustainable health care future with incentives for quality care, reduction of waste through lean processes, and payment reform that incents quality and not quantity.
Let's get this right, THIS TIME, let's not do it halfway and leave the outcome unsustainable.
So this is a Gov't Takeover- 2% of the Market
Insuring Resources Commentary:
So after all the debate about the public plan option and all the skewed debate the actual numbers are in. The public plan will likely cover about TWO PERCENT.
Don't get me wrong the public plan will do wonders for those relegated to discriminatory coverage in the independent market and those abandoned and uninsured in our 35th best health care system.
Drew Altman from the Kaiser Family Foundation has it mostly correct. See below in italics. He says we need more discussion on "affordable coverage" , but even that doesn't get at the biggest issue of reducing HEALTH CARE costs.
While nearly the entire debate (as I've said all along) has focused attention on the public plan issue, we've all missed the boat. What about cost, waste elimination and PAYMENT REFORM?????
Debate on the public plan option has been the focus of 90% of the national discussion, yet in the end it will cover 2% of the population? Health Care reform should be about re-prioritizing our health care system.... shouldn't it?
Shouldn't we be focusing on the real issues, health CARE reform... not insurance reform? Maybe now we can set aside the issue of the 2% public plan and focus on cost and quality- i.e. the real issues that affect the vast majority of Americans. But I'm too cynical to believe that we'll actually start having a real discussion, afterall the GOP finally gave us their proposal. Tune in tomorrow for a gallow's analaysis of what that would do to our health care system. At this very late hour, we must refocus on eliminating waste, and emhasizing quality--- the most important issues we face. The public plan will help, but there are other important issues that will play a much bigger role in reforming the system that are being completely ignored.
--------------------------- From the Associated Press
After all the fuss, public health plan covers few
By RICARDO ALONSO-ZALDIVAR
The Associated Press
Sunday, November 1, 2009 7:35 AM
WASHINGTON -- What's all the fuss about? After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.
That's the estimated share of Americans younger than 65 who'd sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.
The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.
Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.
"The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits."
The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.
The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.
It found that the scaled back government plan in the House bill wouldn't overtake private health insurance. To the contrary, it might help the insurers a little.
The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)
The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.
To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.
Who's likely to sign up?
The budget office said "a less healthy pool of enrollees" would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.
As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.
"The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted," said economist Karen Davis, president of the Commonwealth Fund. "It's not going to be taking away the insurance industry's core business."
It's unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan that the House would want.
Insurers aren't buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America's Health Insurance Plans responded with a curt "No."
While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.
For the same reason, employer groups also remain wary. Big companies don't want to lose control of their health care budgets and instead have the government send them a tax bill.
"That cost is going to come back to you one way or another ... and it's coming back in the way of taxes and liabilities," said Eastman Kodak's chief executive, Antonio M. Perez, speaking for the Business Roundtable. "We just don't believe that there are miracles out there."
If Congress passes a public plan that's not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.
So after all the debate about the public plan option and all the skewed debate the actual numbers are in. The public plan will likely cover about TWO PERCENT.
Don't get me wrong the public plan will do wonders for those relegated to discriminatory coverage in the independent market and those abandoned and uninsured in our 35th best health care system.
Drew Altman from the Kaiser Family Foundation has it mostly correct. See below in italics. He says we need more discussion on "affordable coverage" , but even that doesn't get at the biggest issue of reducing HEALTH CARE costs.
While nearly the entire debate (as I've said all along) has focused attention on the public plan issue, we've all missed the boat. What about cost, waste elimination and PAYMENT REFORM?????
Debate on the public plan option has been the focus of 90% of the national discussion, yet in the end it will cover 2% of the population? Health Care reform should be about re-prioritizing our health care system.... shouldn't it?
Shouldn't we be focusing on the real issues, health CARE reform... not insurance reform? Maybe now we can set aside the issue of the 2% public plan and focus on cost and quality- i.e. the real issues that affect the vast majority of Americans. But I'm too cynical to believe that we'll actually start having a real discussion, afterall the GOP finally gave us their proposal. Tune in tomorrow for a gallow's analaysis of what that would do to our health care system. At this very late hour, we must refocus on eliminating waste, and emhasizing quality--- the most important issues we face. The public plan will help, but there are other important issues that will play a much bigger role in reforming the system that are being completely ignored.
--------------------------- From the Associated Press
After all the fuss, public health plan covers few
By RICARDO ALONSO-ZALDIVAR
The Associated Press
Sunday, November 1, 2009 7:35 AM
WASHINGTON -- What's all the fuss about? After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.
That's the estimated share of Americans younger than 65 who'd sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.
The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.
Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.
"The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits."
The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.
The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.
It found that the scaled back government plan in the House bill wouldn't overtake private health insurance. To the contrary, it might help the insurers a little.
The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)
The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.
To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.
Who's likely to sign up?
The budget office said "a less healthy pool of enrollees" would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.
As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.
"The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted," said economist Karen Davis, president of the Commonwealth Fund. "It's not going to be taking away the insurance industry's core business."
It's unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan that the House would want.
Insurers aren't buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America's Health Insurance Plans responded with a curt "No."
While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.
For the same reason, employer groups also remain wary. Big companies don't want to lose control of their health care budgets and instead have the government send them a tax bill.
"That cost is going to come back to you one way or another ... and it's coming back in the way of taxes and liabilities," said Eastman Kodak's chief executive, Antonio M. Perez, speaking for the Business Roundtable. "We just don't believe that there are miracles out there."
If Congress passes a public plan that's not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.
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.
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.
----------------------- --------------------------------
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.
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."
Tuesday, September 29, 2009
Its not About Rationing, Stupid- Its About Waste
Whether or not we have quality health care reform appears to depend on how good the Democrats are at getting their waste cutting message across. While the other side claims the sky is falliing, i.e. "the Democrats are rationing your health care". - Orrin Hatch
In the end if health care reform fails because quality processes and waste reduction are not emphasized enough I'll know who to blame. And so should all Americans, but that's not how our politics works.
----------------------- --------------------------- ------------------------
In Delivering Care, More Isn't Always Better, Experts Say
By Ceci Connolly
Washington Post Staff Writer
Tuesday, September 29, 2009
A dirty word in health-care reform is "rationing," a term that conjures up the image of faceless government bureaucrats denying lifesaving therapies in the name of cutting costs.
But what if the real issue is not the specter of future rationing, but the haphazard, even illogical, way in which care is delivered today?
Medical professionals say the fundamental problem in the nation's health-care system is the widespread misuse and overuse of tests, treatments and drugs that drive up prices, have little value to patients, and can pose serious risks. The question, they say, is not whether there will be rationing, but rather what will be rationed, and when and how.
"More is not necessarily better," said Bernard Rosof, chairman of the board of directors of New York's Huntington Hospital and a board member of the independent National Quality Forum. "In many cases, less is better."
When the Senate Finance Committee resumes its consideration of health-care legislation Tuesday, the lawmakers will be wading into one of the most complex, emotionally charged aspects of today's $2.4 trillion system. Democrats, feeling politically singed by this summer's talk of "death panels," are struggling to explain how a bill that would take hundreds of billions of dollars out of the system would not affect care.
Republicans, sensing a political opening, intend to highlight provisions they say could lead to the denial of medical services, or rationing.
"We don't want to turn health care over to a bunch of bureaucrats in Washington, who then will determine what kind of health care we have," committee member Orrin G. Hatch (R-Utah) said recently. "And you know that rationing is going to happen."
Critics of the Democrats' bill cite places, such as Canada and Europe, where government experts prioritize the delivery of medical services. Wait times, particularly for specialists, may stretch for weeks or months under such a system, they fear.
"Here in the States, we get access to new drugs and medical devices," said Canadian-born Sally C. Pipes, president of the market-oriented Pacific Research Institute. "I have friends in Vancouver who can't get colonoscopies; they wait six or seven months."
Others, however, see problems of misalignment in the American system, fueled by industry advertising, physician fears about malpractice lawsuits and a culture that craves the latest, greatest everything. The situation here, they argue, is that there is not enough care for some, and too much for others.
Often, people with generous insurance plans can run up large bills and face life-threatening complications from unnecessary care: back surgeries that result in wound infections, when physical therapy might have been a more effective treatment; imaging scans that expose patients to radiation; medication-caused side effects that must be treated.
As much as $850 billion spent on medical care each year "can be eliminated without reducing the quality of care," according to a 2008 report by the New England Healthcare Institute. That is enough money to extend insurance coverage to more than 30 million people, according to the Congressional Budget Office.
In the end if health care reform fails because quality processes and waste reduction are not emphasized enough I'll know who to blame. And so should all Americans, but that's not how our politics works.
----------------------- --------------------------- ------------------------
In Delivering Care, More Isn't Always Better, Experts Say
By Ceci Connolly
Washington Post Staff Writer
Tuesday, September 29, 2009
A dirty word in health-care reform is "rationing," a term that conjures up the image of faceless government bureaucrats denying lifesaving therapies in the name of cutting costs.
But what if the real issue is not the specter of future rationing, but the haphazard, even illogical, way in which care is delivered today?
Medical professionals say the fundamental problem in the nation's health-care system is the widespread misuse and overuse of tests, treatments and drugs that drive up prices, have little value to patients, and can pose serious risks. The question, they say, is not whether there will be rationing, but rather what will be rationed, and when and how.
"More is not necessarily better," said Bernard Rosof, chairman of the board of directors of New York's Huntington Hospital and a board member of the independent National Quality Forum. "In many cases, less is better."
When the Senate Finance Committee resumes its consideration of health-care legislation Tuesday, the lawmakers will be wading into one of the most complex, emotionally charged aspects of today's $2.4 trillion system. Democrats, feeling politically singed by this summer's talk of "death panels," are struggling to explain how a bill that would take hundreds of billions of dollars out of the system would not affect care.
Republicans, sensing a political opening, intend to highlight provisions they say could lead to the denial of medical services, or rationing.
"We don't want to turn health care over to a bunch of bureaucrats in Washington, who then will determine what kind of health care we have," committee member Orrin G. Hatch (R-Utah) said recently. "And you know that rationing is going to happen."
Critics of the Democrats' bill cite places, such as Canada and Europe, where government experts prioritize the delivery of medical services. Wait times, particularly for specialists, may stretch for weeks or months under such a system, they fear.
"Here in the States, we get access to new drugs and medical devices," said Canadian-born Sally C. Pipes, president of the market-oriented Pacific Research Institute. "I have friends in Vancouver who can't get colonoscopies; they wait six or seven months."
Others, however, see problems of misalignment in the American system, fueled by industry advertising, physician fears about malpractice lawsuits and a culture that craves the latest, greatest everything. The situation here, they argue, is that there is not enough care for some, and too much for others.
Often, people with generous insurance plans can run up large bills and face life-threatening complications from unnecessary care: back surgeries that result in wound infections, when physical therapy might have been a more effective treatment; imaging scans that expose patients to radiation; medication-caused side effects that must be treated.
As much as $850 billion spent on medical care each year "can be eliminated without reducing the quality of care," according to a 2008 report by the New England Healthcare Institute. That is enough money to extend insurance coverage to more than 30 million people, according to the Congressional Budget Office.
Thursday, September 24, 2009
Mandate Minus Price Controls may increase healthcare costs
This is what I've been blogging about since the beginning of Insuring Resources.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
--------------- ------------------- ---------------
With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
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Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Congress has been debating health insurance reform, what we need even more is health care reform to fundamentally reduce costs. To do it we need provider incentives to implement Lean processes. See my other post from earlier today on ThedaCare for more details on how to reform HEALTH CARE.
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With lawmakers reluctant to limit what insurers may charge, there's little to slow soaring premiums. Coupled with millions of new customers, that adds up to higher costs for taxpayers and consumers.
By Noam N. Levey and James Oliphant
LA times
September 24, 2009
E-mail Print Text Size
Reporting from Washington - In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.
The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate -- long sought by insurance companies -- that would mark the first time the federal government has compelled consumers to buy a single industry's product, effectively creating a captive market.
"We are about to force at least 30 million people into an insurance market where the sharks are circling," said California Lt. Gov. John Garamendi, a Democrat who served as the state's insurance commissioner for eight years. "Without effective protections, they will be eaten alive."
Soaring premiums coupled with millions of new customers forced to buy policies would likely mean higher costs for taxpayers to cover government subsidies for lower-income families and individuals.
They could also mean bigger bills for people who get benefits through work, as well as for their employers.
"I don't think there is any degree of confidence that our costs won't continue to go up," said Keith Ashmus, chairman of the National Small Business Assn.
If premiums continue to rise as quickly as they have over the last five years, the average annual cost of a family policy will exceed $24,000 in 10 years, up from $13,375 now, according to the nonprofit Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.
"If the government is going to require people to buy an insurance policy, they have to guarantee it is affordable," said Jamie Court, president of Consumer Watchdog. "It is unconscionable not to."
Soaring premiums could eventually stir market forces, increasing competition and potentially restraining costs. But that would be a lengthy process, and potential competitors would face huge start-up costs.
Many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't.
All of the major healthcare bills would penalize people who do not get health insurance.
But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.
As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.
"That would be a very substantial additional intervention in the marketplace," said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. "I just don't think the support would be there for that kind of a change."
Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge -- a strategy used by several European countries to control healthcare spending.
In those systems -- some of which, like the United States, feature a blend of private insurers and government programs -- the government sets prices that providers charge to everyone.
"That is just too tough a row to hoe in America," said Peter Lee, executive director of the Pacific Business Group on Health, an association of large employers in California, many of whom are nonetheless concerned about how much they are getting charged for medical care.
Senior House Democrats have proposed the most far-reaching government regulation of the insurance industry.
Their bill, which is still being debated, seeks to control insurance premiums in part by limiting how much companies can spend on nonmedical expenses such as marketing and dividends to shareholders.
The House bill also features a new government insurance program -- or "public option" -- that advocates believe could offer consumers a lower-priced alternative to private plans and, in turn, pressure insurers to rein in premiums.
Health Affairs article on ThedaCare's Lean Processes
This is what I have been advocating from the start and now Health Affairs, the prestigious journal on health policy, has published an article on their practices.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
The link-
http://content.healthaffairs.org/cgi/content/full/28/5/1343?ijkey=kECL9wF9SR8IE&keytype=ref&siteid=healthaff
This spells out the successes of ThedaCare and lessons for health care reform across America.
Below are small excerpts from the article
------------
Here's the abstract- U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.
ThedaCare's results- Since Collaborative Care began with a pilot unit in 2007, we have cared for 2,400 people and recorded dramatic improvement in patient satisfaction, quality performance, and medication reconciliation (Exhibit 1). The cost of care in a Collaborative Care ward is 30 percent less than in a traditional ward. These data convinced ThedaCare board members to convert all hospital beds to Collaborative Care. This decision was projected to improve the buildings’ net present value by 63 percent, or more than $25 million.
Conclusion-
The changes we have described involve a fundamental shift in the way people think about and deliver care. It is not just about saving money or doing less with more. This is about returning to the core scientific principles of modern medicine.
We begin with a hypothesis that performance could be better. Then we change the process, measure it, study its effect, and incorporate it into daily work. Before we can convince other health care organizations to join us in radically improving performance, however, there must be some incentive. If we prove that lean health care will put more money in a hospital’s pocket, only to have Medicare take it out of another pocket, we will not enlist many converts. Similarly, if a national insurance plan continues Medicare’s rules, paying more money for inefficient health care, we will get a lot more inefficient care. Quality will only thrive when quality is demanded.
There is much more than money at stake. We must find a way to reward and encourage more efficient, better-quality health care, and that’s what we will get.
Wednesday, September 23, 2009
Informational website from Humana Insurance
Here's the link- www.myhealthreform.org
To view a very informative, straightforward video go to:
https://www.myhealthreform.org/health_reform_video.php
------------------- -------------------- --------------------
This video is very straightforward and provides the basics on the issues involved in health care reform. It discusses reducing the waste currently in the health care system which would help everyone, not just insurers. It does discuss the public plan option but doesn't dis it, and does talk about taxes to pay for subsidies for low-income persons to make insurance more affordable.
When I first heard about the website I thought it would be insurer propaganda and simply be an advertisement for universal, market-based coverage, but its not. It even talks about one potential option being a government plan covering everyone even though that's really not an option currently on the table.
The website also offers a way to contact legislators and give them ideas and your opnion on what health care reform should include.
To view a very informative, straightforward video go to:
https://www.myhealthreform.org/health_reform_video.php
------------------- -------------------- --------------------
This video is very straightforward and provides the basics on the issues involved in health care reform. It discusses reducing the waste currently in the health care system which would help everyone, not just insurers. It does discuss the public plan option but doesn't dis it, and does talk about taxes to pay for subsidies for low-income persons to make insurance more affordable.
When I first heard about the website I thought it would be insurer propaganda and simply be an advertisement for universal, market-based coverage, but its not. It even talks about one potential option being a government plan covering everyone even though that's really not an option currently on the table.
The website also offers a way to contact legislators and give them ideas and your opnion on what health care reform should include.
Monday, September 21, 2009
So What Does Health Care Cost Us?
This article gets several things right. There is a ton of waste in the system. What it gets wrong however, is that it'll take years to amass the evidence to weed it out. The LEAN Institute and The ThedaCare Center for Health Care Value have already studied (www.healthcarevalueleaders.org) it and eliminated it from health care systems. It simply needs to be developed as the model to follow with the right incentives WITHIN health reform. Higher Medicare and Medicaid reimbursment for those implementing LEAN practices, Higher reimbursement under the public plan or co-op models, etc etc.
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"You Have No Idea What Health Costs- If You Did, You Might Just Want Real Reform"- Ezra Klein- Washington Post
The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey.
While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.
The truth is we all pay, and much more than we recognize, for health care.
For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.
As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.
Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.
Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.
That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.
Thinking Long-Term
Health-care reform concentrates on the people in acute distress: the uninsured and the underinsured and the poor few who've been left to the cruel chaos of the individual or small-group insurance markets. The public insurance option -- if it comes to pass -- would be open to only these groups, and the bill's hefty price tag is almost entirely devoted to helping them afford coverage. But what about the rest of us?
The problem for the White House has been that the proposed health reform policies meant to help the average American aren't specific. They're not a cash transfer or a new insurance card. These are the "curve benders," policies meant to cut long-term health-care costs. The problem is they're abstract, speculative and, at times, even unpopular.
The White House's favorite curve bender is called "comparative effectiveness review" -- a fancy way of saying "evidence." Study after study has shown that we waste an incredible amount of money on medical interventions that just don't work. If we can figure out which ones those are, we can stop using them and save money by not buying what we don't need. That may work. But the evidence will take a long time to amass, and we don't yet know what it will show. What if it finds that some brand-new and incredibly expensive treatments are wildly effective? That could raise spending. Industry stakeholders, however, had little interest in waiting around to find out: They made such a fuss that Congress quickly inserted a provision promising that the government wouldn't use any of this evidence in deciding what Medicare and Medicaid would cover. Because God forbid government programs rely on evidence.
Note from Write Resources- We do know the answer to the above, ThedaCare and others can prove to other plans how to do it.
The favorite proposal of liberals is the public insurance option. If the public plan were open to all Americans and partnered with Medicare, it could negotiate deep discounts with health-care providers. The Lewin Group, a health industry consultancy firm, and the Commonwealth Fund, a liberal-leaning health-care advocacy organization, have both estimated that this sort of plan could save the average American 20 to 30 percent on premiums.
Of course, providers don't much like the sound of that because they would see 20 to 30 percent less revenue. And insurers don't much like the sound of that because they could not compete with that sort of buying power. Republicans and centrist Democrats have banded together to weaken the public plan and maybe even remove it altogether. President Obama now promises that the public plan would be open only to the uninsured and wouldn't offer any advantages over private insurers. It won't, in other words, be allowed to save people money.
Conservatives favor the idea of taxing health-care benefits and popularizing "high-deductible health plans." In short, if people have to pay more for health care, they'll use less of it. This is true, but as you might expect, quite unpopular.
Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by "modernizing" the system over the next 10 years. The changes they examined weren't dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, "bundling" payments for the treatment of a single illness rather than shelling out separately for each doctor visit -- that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That's a lot of money for policies that have received virtually no attention in the debate.
And yet, this is the quiet promise of health-care reform. The grand theories might fail. They often do. But making the system a bit better, a bit quicker and a bit more agile -- we can do that. And until the stove gets hot enough, it may be all we can do.
------------- ------------------- -------------
"You Have No Idea What Health Costs- If You Did, You Might Just Want Real Reform"- Ezra Klein- Washington Post
The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey.
While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.
The truth is we all pay, and much more than we recognize, for health care.
For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.
As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.
Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.
Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.
That's the dilemma for Washington wonks trying to fix this mess: They look at the numbers and see health-care costs crushing our economy, overwhelming our government, swallowing our wages. But the public isn't feeling it. Virtually no one cuts a $13,375 check for health care. Most pay 27 percent of it, or even less. The surest way to cut health-care spending would be to make people shoulder more of the burden directly, as opposed to hiding it in taxes and lost wages. But that's about as popular as a puppy pot roast.
Thinking Long-Term
Health-care reform concentrates on the people in acute distress: the uninsured and the underinsured and the poor few who've been left to the cruel chaos of the individual or small-group insurance markets. The public insurance option -- if it comes to pass -- would be open to only these groups, and the bill's hefty price tag is almost entirely devoted to helping them afford coverage. But what about the rest of us?
The problem for the White House has been that the proposed health reform policies meant to help the average American aren't specific. They're not a cash transfer or a new insurance card. These are the "curve benders," policies meant to cut long-term health-care costs. The problem is they're abstract, speculative and, at times, even unpopular.
The White House's favorite curve bender is called "comparative effectiveness review" -- a fancy way of saying "evidence." Study after study has shown that we waste an incredible amount of money on medical interventions that just don't work. If we can figure out which ones those are, we can stop using them and save money by not buying what we don't need. That may work. But the evidence will take a long time to amass, and we don't yet know what it will show. What if it finds that some brand-new and incredibly expensive treatments are wildly effective? That could raise spending. Industry stakeholders, however, had little interest in waiting around to find out: They made such a fuss that Congress quickly inserted a provision promising that the government wouldn't use any of this evidence in deciding what Medicare and Medicaid would cover. Because God forbid government programs rely on evidence.
Note from Write Resources- We do know the answer to the above, ThedaCare and others can prove to other plans how to do it.
The favorite proposal of liberals is the public insurance option. If the public plan were open to all Americans and partnered with Medicare, it could negotiate deep discounts with health-care providers. The Lewin Group, a health industry consultancy firm, and the Commonwealth Fund, a liberal-leaning health-care advocacy organization, have both estimated that this sort of plan could save the average American 20 to 30 percent on premiums.
Of course, providers don't much like the sound of that because they would see 20 to 30 percent less revenue. And insurers don't much like the sound of that because they could not compete with that sort of buying power. Republicans and centrist Democrats have banded together to weaken the public plan and maybe even remove it altogether. President Obama now promises that the public plan would be open only to the uninsured and wouldn't offer any advantages over private insurers. It won't, in other words, be allowed to save people money.
Conservatives favor the idea of taxing health-care benefits and popularizing "high-deductible health plans." In short, if people have to pay more for health care, they'll use less of it. This is true, but as you might expect, quite unpopular.
Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by "modernizing" the system over the next 10 years. The changes they examined weren't dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, "bundling" payments for the treatment of a single illness rather than shelling out separately for each doctor visit -- that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That's a lot of money for policies that have received virtually no attention in the debate.
And yet, this is the quiet promise of health-care reform. The grand theories might fail. They often do. But making the system a bit better, a bit quicker and a bit more agile -- we can do that. And until the stove gets hot enough, it may be all we can do.
Thursday, September 17, 2009
Dems and GOP Agree- Baucus bill appears to be DOA
I guess Sen. Baucus has achieved what few others have. He's gotten Democrats and Republicans to agree... this is a horrible healthcare bill... except for widely different reasons.
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Thursday, September 10, 2009
Analysis of Obama's Speech
President Obama on Wednesday clearly laid out his vision for health care reform. Although the speech was long he actually succinctly stated his goals and laid out his vision in language that should make it difficult for opponents to mis-represent and lie about.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
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