Karen Ignagni lie of the day, part 68

Karen Ignagni lie of the day, part 68


6a00d8341c909d53ef0105371fd47b970b-320wiThe big insurers now seem to be doing anything they can to prevent a Medicare-equivalent public plan 
being launched to beat them up. Yes AHIP has apparently decided to throw the schlockmeisters off the boat, and more or less agree to end medical underwriting.

Those of you who listened to my interview with Tom Epstein of California Blue Shield will recall the cognitive dissonance he was suffering when he had to defend Blue Shield and other insurers’ behavior in the individual insurance market (hey, it’s the man’s job), while at the same time calling for policies that would essentially end the individual market and create a near-universal purchasing pool. By definition, that would require some level of uniformity of benefits and some risk-adjustment mechanism, and consequently it would put several currently profitable lines of insurers business out of business—yes I am talking about Tonik and Mega Life & Health among others. In general this might be a good trade for the bigger plans as they’d add a bunch more younger healthier lives at a higher price point (although what Wellpoint’s actuaries and accountants really think about it is yet to be determined—note their opposition to the similar ArnieCare legislation).

So as AHIP makes this big cognitive leap—presumably to be traded for Baucus getting rid of the public plan in the forthcoming legislation—it sends its head lobbyist out to tell the world how different they all are.

Except that she just can’t help it. In a live blog of Ignagni’s presentation at USA Today there’s this little gem (assuming it’s not a misquote and it does fit with her “record”):

2:15 p.m. ET: On the subject of health care costs, Ignagni says "we've got a very good record in our health plan community of bringing costs under control." And insurers, she says, are developing "a new 3.0 version of those tools" to keep costs from soaring even more than they have.

This is what drives me nuts about health plans in general and Ignagni in particular. There ought to be a role for properly incented intermediaries to manage providers in terms of improving cost & quality on behalf of their members. Medicare FFS sure as hell doesn’t do it well.

But in what universe was Ignagni living in the last decade if she thinks that "we've got a very good record in our health plan community of bringing costs under control."

And what level of credibility can we give the “health plan community” if they allow their main lobbyist to spout this kind of nonsense. If the big plans have decided to throw some AHIP members overboard, perhaps it might be time to throw the organization’s President with them. Defending the egregiousness of the Bush/Cheney health plan years isn’t what AHIP needs to be doing, and apparently Ignagni just can’t stop.

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49 Comments on "Karen Ignagni lie of the day, part 68"

Apr 26, 2010

The Center for Media Research has released a study by Vertical Response that shows just where many of these ‘Main Street’ players are going with their online dollars. The big winners: e-mail and social media. With only 3.8% of small business folks NOT planning on using e-mail marketing and with social media carrying the perception of being free (which they so rudely discover it is far from free) this should make some in the banner and search crowd a little wary.


Apr 7, 2010

1. There’s a movement to radically change California government, by getting rid of career politicians and chopping their salaries in half. A group known as Citizens for California Reform wants to make the California legislature a part time time job, just like it was until 1966.


Aug 10, 2009

So, a little history here.
In 1973, Congress passed the HMO Act, and provided millions of dollars in taxpayer financing for startup health plans. Among these were the original “community” not-for-profit health plans that converted over a period of time to for-profit status, and which then became the public behemoths now known as Coventry Health Plans, United HealthCare, Aetna Healthcare, many of the various Kaiser plans and Blue Cross health plans, and so many others.
Take the case of Coventry Health Care, founded by the current Governor of Tennessee, Phillip Bredeson. In the mid 1980s, Bredeson did a “roll up” of a dozen local not-for-profit taxpayer financed health plans through a public offering of stock under the name HealthPlans Corp. The Federal government allowed him to convert these to profit making companies with a small concession to minimally fund for a limited time a local foundation to ease public perception of the scam. HealthPlans became HealthAmerica, and HealthAmerica continued to acquire other not-for-profit, as well as for-profit health plans and become a multi billion dollar player in the health care game.
Take the case of Charter Med, the company know known as United HealthCare. A physician named Bill McGuire helped found this not-for-profit company in the Minneapolis area in the mid 1970s and soon it was on a mission to merge other federally-financed local HMOs into what has now become United HealthCare. McGuire, never one to shy away from a “big play” was found to have been involved in back-dating United stock options several years ago and between he and the company, a nearly billion dollar settlement banished him to a still luxurious retirement. Note that United bought The Lewin Group, which is churning out dubious data about our current health care system’s success.
The “HMO revolution”, funded nearly entirely by Federal tax dollars, became a revolution of millionaires and billionaires, as the early leaders took their companies public and enriched themselves and their colleagues beyond their wildest dreams. The original intent to revolutionize health care and make it more affordable, putting people and primary care physicians first and foremost in the front lines of health care, degraded into pure profit making.
When questioned as to why health plans do so little to collaborate in any efforts aimed at cost containment as health care costs have risen to absorb over 20% of our GDP, one health plan executive shared with me “the dollar value of an 8% profit margin on a $200 premium is much nicer than on 8% of a $100 premium”.
The list is very long of these taxpayer funded entities who now control the health care debate and whose industry trade organization, AHIP, is quietly but assertively attempting to kill any effort to diminish their profit making potential. AHIP, formerly known as the Group Health Association of America, the American Association of Health Plans and the Health Insurance Association of America, is an organization run for one purpose: to protect the profits of that industry.
Nothing at all is being written about this. It is easy to research. It is easy to connect the dots. This should be squarely out there in the health care debate.

May 24, 2009

MD as hell:
Are ER doctors’ rates so high due to collecting a dollar for every three billed?
I recently took my mother to the ER, she had a kidney infection, the doctor’s bill was $350. They checked her and prescribed Levaquin, that’s it. Is the price overinflated? Of course, I think so, but in your opinion…
Also, we went to the ER as she does not have a primary care physician and I didn’t know where else to take her, urgent care not being open until 5PM. She is without insurance but able afford care, though she hadn’t been to see a doctor in about 30 years.
She had a follow-up visit with a primarycare physician referred to us by a family member. He seemed peeved at her not having insurance though she paid for the visit in cash. He made mention of her essentially not having a medical history for him to refer to, since she’s been out of the “system” for so long. This made me think that the relationship to one’s doctor crucial to preventive care, if one is lucky enough to find a doctor that is interested in preventive care & not just prescribing antibiotics & steroid based medications on the fly.
Another question, how much care is being spent on people who are essentially half-dead, on life-support, etc, unable to live quality, meaningful lives? I imagine this must also be a question that anyone with a “higher” ethos asks. Peoples’ drive to squeeze out whatever little life is left must be some sort of crude philosophy.

Tom Leith
Mar 30, 2009

> Allow PCPs to capitate their services
> and you just created a medical home.
This is more or less what a big group (http://essehealth.com/faq.html) here in St. Louis is doing: they formed a Medicare Advantage plan of their very own. http://www.essencehealthcare.com. Of course, this simply can’t work for the typical practice. But then I think the typical practice is far too small.
Anyhow, if Esse/Essence get to the point they do this pretty well, maybe they’ll form a regular HMO as well — the staff model HMOs of the 1980s & early 1990s is where a lot of their docs come from. Culturally, they seem to have a “lean-ish” practice style, and they rely a great deal on tech. Lately they’re adding some clinical decision support tools built into the EMR/Practice Management/Rx system they use (http://www.thehealthcareblog.com/the_health_care_blog/2007/02/podcasttech_pur.html)
It seems to me they’re positioning themselves very well for whatever sort of “reform” comes along. I really admire them.

Mar 27, 2009

“One payer with a patient smart card and a predetermined price for the doc who gets his money promptly – now that’s efficiency, that’s simple. ”
Private insurance offers this now, how close do you think Medicare is?

Mar 27, 2009

Nate, my ability to fly to India for healthcare is not a statement of success for choice – it’s a symptom of failure for U.S. healthcare. So are the dental clinics in Mexico. Just because I can do it, or just because I can afford a HD plan AND actually have resources in the bank to pay the deductible as well as my prmiums as well as support myself if sick, does not mean this is the solution. It does serve a section of the economy, just not enough of it. It does not serve the majority of working people in this country. If this were only a PCP world we wouldn’t have an affordability crisis, but it’s also a hospital world where too few can afford the price of care. Trips to India are a backlash to unsustainable costs here because of the prices. Going to your PCP efficient, but not with 100s of insurance companies forcing docs and patients through paperwork and rules hoops just to get a $65 office visit paid for is rediculous. One payer with a patient smart card and a predetermined price for the doc who gets his money promptly – now that’s efficiency, that’s simple.

Mar 27, 2009

I can’t remember where I read it last night but there is a small town just over the Mexico border with 350 dentist, 11% of the population practice dentistry. Some dentist have bed & breakfast set up and you can take chartered day bus trips from some company on the American side. I woke up this morning the lawn is covered in frost and piles of work waiting at the office, 2 days in Mexico for some minor dental work almost sounds appealing.
Your example is one of my best arguments against single payor/Medicare. Not everyone is alike, different people have different needs. When it comes to protecting against catastrophic conditions almost all of us need protection, true insurance can do that very well. Where we vary is on the day to day small items. That is why insurance for routine care is so inefficient. In your case you would best be served by a high deductible, save the premium you don’t pay to an insurance company, then once every five years when something comes up you have the money to pay for it. For those people that have chronic conditions or require more care capitation is the most efficient payment method. If you know you need to see Dr. Muney every month for years to come why not avoid the 20% mark up and just pay Dr. Muney direct? No matter if you or the insurance company pay him he needs to be paid, it’s just cheaper and more efficient for you to pay him yourself. For risk gauging, data collection, and public health Dr. Muney should still submit claims to the insurance company but with EDI today that cost pennies. Dr. Muney would also save money because he is not processing payments or waiting to collect.
I see only 1 downside to direct capitation, it’s illegal. This has baffled me for years, we looked into this for some larger self funded clients, we wanted to capitate certain care but every state we checked would not allow this. The reason is loss of regulation and tax revenue. Under current tax law the states would lose billions if providers accepted capitation outside of insurance companies. This is another example of regulation inhibiting cost effective care and innovation.
Consider the efficiency of capitation and dental care. Most people are more loyal to their dentist then their medical doctor. It’s very easy to calculate the annual cost of two cleanings and x-rays. Why would anyone insure these?
To get into a more complex discussion take what we are talking about and apply it to the numerous post on THCB about medical homes and upping reimbursement to PCPs. The complexity of the proposals including devising completely new reimbursement methodologies are all because states won’t allow direct capitation. Allow PCPs to capitate their services and you just created a medical home. No reinvention of the wheel, no billion dollar government program, no untried complex reimbursements. How much simpler of a solution could we ask for? But it will never fly…
1. It would greatly reduce carrier premium which would;
a. Greatly reduce carrier profit
b. Greatly reduce premium tax collection
c. Not give politicians billions of dollars to play with
2. It is too simple, people could understand it which would lead them to asking questions why the rest of the healthcare system is so complex and over regulated.
3. People might start taking responsibility for their health and realize we don’t need so much government intervention. Government is more afraid of a healthy America that doesn’t rely on public programs then it is of an unhealthy America barreling towards bankruptcy. Government thrives in 1.8 trillion dollar disasters where they can make undeliverable promises and dole out patronage. Government would wither and die in a 1 trillion private/personal healthcare system that didn’t need them.

Mar 27, 2009

Nate, I’ll need more information before I’ll accept your example of Dr. John Muney’s business plan at face value (concierge business). His statement, “I’m trying to help uninsured people here” is dubious. It may help people with cronic conditions (?) but not sure about many others. Would a family of 4 pay $316 per month + co-pay? I last saw a PCP for a lung infection a month ago, prior to that I hadn’t needed a doc for 5 years, cost me $65 for walk-in office visit + $72 for drugs at pharmacy across the road.
This is what I’m planning on doing:

Mar 26, 2009

I trained in Germany and can tell you that there (other countries may be different), end-of-life care is less aggressive, but there is no uniform standard, and care may vary tremendously (as it does here), but arriving at, on average, doing all in all less.
How much one could save? I don’t think anyone could tell for sure, since there is no good data and one can argue what is appropriate/benficial and what is not (for instance, should you get head and neck MRAs in every CVA as many neurologists do? I would say that in over 75 yo patients, it doesn’t matter – you will miss a few dissections and intracranial stenoses, but it doesn’t matter that much since the NNT to benefit someone is skyhigh. But most laypersons (and even a lot of MDs) in the US don’t want to acknowledge that.
But if you just aim for foolproof, undebatable savings by following just existing guidelines (i.e. no MRIs for episodic migraines in patients with nl exam, no MRIs for axial neck- and back pain etc.), I would guess that savings might be between 10-40% depending on the respective service area (and associated/subsequent costs of overtesting which are hard to estimate). Let me tell you an uncommon, but fairly typical story:
A. 30 yo person with axial neck pain hoes to the PCP
B. PCP orders neck MRI (against guidelines) C. neck MRI shows questionable MS plaque or artifact D. Neurology consult E. Neurologist thinks that plaque is an artefact but asks F. Radiologist for opinion. Rad. recommends repeating film E. Repeat MRI is normal, pt. relieved, end of story. I estimate the whole cost of superfluous costs (B to E) somewhere between 4000 and 5000 Dollar. Usually, it ends with B (2000 Bucks), but there are multiple cases with furter testing and visits F-K. And consider this variation: C. neck MRI shows disc prolapse D. Neurosurgeon does cervical fusion )mp good indication for this) E. Pain not better F. Pt. goes to pain clinic for chronic narcotics since neck sx made pain likely worse.

Mar 26, 2009

Another interesting example of how government fights to keep insurance and healthcare expensive;
“The state is trying to shut down a New York City doctor’s ambitious plan to treat uninsured patients for around $1,000 a year. Dr. John Muney (pictured above) offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs. His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.”
Employer buys every employee a HDHP and pays 100% of the cost. THe employee pays $79 a month for this and his own Rx until they hit the HDHP. It’s this type of innovation and cost saving that regualtion and reform kills. Why does a doctor need an insurance license to capitate his own services?
Notice how when they are trying to regualte and collect premium tax how precisly they define insurance.

Barry Carol
Mar 26, 2009

I absolutely agree on the need to reduce wasteful and cost-ineffective utilization of healthcare services. To that end, I would be interested in your ballpark estimate of the potential cost savings that might be realized from (1) the reduction in defensive medicine over time if we enacted the tort reforms that you prefer and (2) a far more sensible approach to end of life care which I would define as something close to (I think) European practice patterns in these cases.

Mar 26, 2009

your last paragraph is 100% correct and why I oppose any bill that comes with a price tag. We don’t need to spend more money on healthcare, we need to more efficiently allocate what we spend now and take the eventual savings and redirect it to other problems or tax cuts.
We need to define our goals and educate the masses on the truth. There is so much misinformation out there the general public has no idea what is true. Most people not educated on HC when asked think the reforms being proposed today are in response to today’s problems. They don’t realize the solutions Democrats propose today are the same ones they proposed in 1970, 1960, 1950, 1940, and 1930’s. They have the same proposals just waiting for the right problem to come along, even if they have to create it.
100% coverage should not be the goal. 10-15 million of those that go without insurance for part of the year are already eligible and choose not to take it. Instead of fighting those people lets work on the 3-4 million that want insurance and don’t have it.
10 million of the uninsured are not citizens, time to show them the door.
We need to drastically change the distribution of funding. Instead of sending our money to Washington or the insurance company we need to keep it in our pocket and pay our own routine care. What we save in premium and taxes will more then pay for the care.
To curb large spenders we will need an evolution of utilization review. The biggest hurdle to this is government. Even when care is denied for legal and legit reasons insurers are still susceptible to getting sued and usually lose. You can have a policy that in plain English does not cover experimental or off label treatment and you can be sued and lose in court.
We need to strengthen ERISA and make it clear that insurers aren’t required to pay for care not provided for in the plan doc or by law. If someone wants to buy a policy that has experimental treatment coverage let them do so. We need policies that everyone can afford and everyone can’t afford to live forever.
We also need to fix malpractice claims. If a doctor follows approved treatment guidelines and documents it he should be immune from tort. We have to be able to tell people no and have to admit doctors are human and can’t be expected to work miracles.
We can’t afford to make any more John Edwards rich on trumped up science.
The bottom line was just mocking MMs bottom line, it didn’t have any meaning in the reply.
As to the aggression I believe war requires it. If you look back at the history of “reform” you will see Democrats have been pushing for compulsory national insurance for 70 years. At no time has the concept every been supported by even a majority of Americans. Democrats know this so in the late 30s and early 40s they decided to try to accomplish it in pieces. Even that did not interest the public. The only way the can pass pieces of their goal is to lie and trick the public.
“During the 1965 Senate Finance Committee hearings, Chairman Russell Long (D., La.) asked HEW Secretary Anthony Celebrezze, whose department had written the bill, “Why do you leave out the real catastrophes, the catastrophic illnesses?” (U.S. Senate Hearings 1965: 182). When Celebrezze replied that it was “not intended for those that are going to stay in institutions year-in and year-out,” Senator Long countered: “Well, in arguing for your plan you say let’s not strip poor old grandma of the last dress she has and of her home and what little resources she has and you bring us a plan that does exactly that unless she gets well in 60 days.”
“Celebrezze concurred, stating that means-tested public assistance would provide “additional help.” (U.S. Senate Hearings 1965: 182-83). Long added that “Almost everybody I know of who comes in and says we ought to have medicare picks out the very kind of cases that you and I are talking about where a person is sick for a lot longer than 60 days and needs a lot more hospitalization” (U.S. Senate Hearings 1965: 184). [14] Yet the very element that government officials continued to cite to win public support for Medicare was deliberately omitted from the administration’s bills.”
“When Rep. Albert Ullman (D., Ore.) cited allegations that the “public is somehow being hoodwinked” and “being misled” and asked HEW’s Wilbur Cohen about the degree to which the public misunderstood the program, Cohen stated that “we do recognize this problem and I think it has been complicated by the use of the term ‘medicare’ which is an erroneous term when applied to this program”
“As Marmor (1970, 1973: 17) put it, “Strategists expected support from families burdened by the requirement, moral or legal, to assume the medical debts of their aged relatives.” When Senator Clinton Anderson (D., N.M.) asked Celebrezze, “Isn’t it true that younger persons would have lifted a heavy financial burden sometimes as a result of taking care of the aged in their family?,” Celebrezze agreed (U.S. Senate Hearings 1965: 122). Warning that soon after enactment the public would discover the actual benefits to be much less than expected, Senator Allen Ellender (D., La.) stated on the Senate floor that “many sons and daughters whose mothers and fathers are growing old are of the belief that under the pending bill they will be able to get the Government to take care of their older parents, in the event they become ill for long periods of time” (U.S. Cong. Rec.-Senate 9 July 1965: 16072). The political undercurrent was that the “avoiding dependency” rationale gave a respectable gloss to adult children’s desire not to support their aging parents which could be counted on to buttress political support for the Medicare measures.”
Medicare was passed with lies and false promises. MM, EK, and the others like them are sowing the propaganda for the next big lie. These are all individuals that have no work experience in the field, no serious or broad research beyond the political aspects, and no desire to improve the system, they are all about the politics, just as the Democrats who passed Medicare where. Look at what we where promised with Medicare and what we actually have. Same for Medicaid and VA.
These individuals have never engaged in honest debate or discussion, I could give you pages of factual errors that have been pointed out to them and they refuse to correct. Blatant ones, like EK saying HSAs discriminate against women because they don’t cover mammograms and pap smears. He’s been sent the section of the law that specifically allows these to be covered at 100% without deductible and copies of carriers benefit plans showing they almost always are. Yet the inaccurate post still stays up…because it was never about fixing the system, all that matters is advancing their ideology. They know a majority of readers won’t go through all the comments and even fewer believe them, so they can post a complete lie and it serves their cause. All they need to do is confuse a vocal minority of the public into believing their false claims, ram some legislation through then on to the next segment of the population.
Look where we are today, they cover the old, the poor, children, and the sick in some cases. There is not much left. When someone comes for your freedom and fruits of your labor are you going to politely and calmly ask them not to take it or fight back with all the aggression you can and twice the effort they give trying to take it? It’s a lot harder to get your freedom back once you have lost it then it is to protect it in the first place. Is it really expecting to much every time some progressive claims private insurance has 30% overhead to call them a liar and correct it? When someone with no comprehension of insurance says single payor is more efficient and will save money take the time to call them a moron and point out Medicare is an example of the failure of single payor.
If you don’t get aggressive now you’re going to wake up one day with third world healthcare/insurance and a huge tax liability. Do you want to pay twice as much as you do now for Medicaid quality?

Mar 26, 2009

I read your two last posts in their entirety, and I think you would help your cause by being more concise. (And cut down on gratuitous aggression as well).
For instance, you write multiple paragraphs about various issues, and then end with:
“Bottom Line: Medicare needs to stop losing ten cents of every dollar to fraud and waste. That level would never be acceptable in private insurance.” That is hardly a “bottom line” conclusion since it is an issue you did not bring up before (or was it hidden somewhere in the preceeding 15+ paragraphs?).
What MM was arguing and explicitely wrote is that NEITHER the public plans nor private insurance do much to control costs.
And I actually think that both you and MM (and this writer) can agree that the explosive growth of medical services is the main reason for the HC cost explosion.
If I read other posts of yours correctly, you would suggest high deductible insurance and health savings accounts. I cannot see how this would curb overall cost explosion in a meaningful way and in the long run … sure, many people who could afford these plans would reduce needed and unneeded care as long as they are in the deductible zone, but since there is no ceiling, expenses for the really sick and the people reaching their deductible would continue to mushroom …. how often did I have to hear nonsensical requests for MRIs and similar tests (like “do everything you would possibly want to do, I reached my deductible for this year”?).
There is no way around it – if we want to cover 100 or even just 90% of the population without dedicating our entire GDP, we have to curb utilization. Suggestions: Start telling patients that the current system with back MRIs for minor tingling in the great toe and PEGs for moribund and demented people is not sustainable. Enforce best practice guidelines (except for the people who want to pay themselves for the nonsensical staff). Cut reimbursement for invasive procedures (I think most of them are overpaid, although to varying degrees). Initiate tort reform in order to curb defensive medicine. Start bringing down prices of pharmaceuticals to European/Canadian levels (by negotiation).
There is more than enough money, technology and manpower (except, at present, PCPs and nurses) in the US system to provide excellent care to all US citizens … you just have to reset priorities in order to get decent “bang for the buck”.

Mar 26, 2009

Expanding on what Actuary says I am one of those companies that make $20, I wish $30, per employee per month, I wish per member. The most efficient plans in the country and those with the highest satisfaction are self funded plans. They are also under attack by both states, because they reduce premium taxes, and the federal government because they want more control.
In all the discussion on reform we completely ignore the most successful delivery method we have. It’s also the most logical. Your claims payor, PPO, UR/UM, disease management, and other programs are all purchased separately if the plan desires. If one doesn’t do a good job, over charges, or is behind the times in technology they are gone. You can replace parts of a self funded plan like you change parts on your car. Single Payor and most progressive reforms want a single solution, take it or leave it with no options or flexibility. If something isn’t working you’re either stuck with it or you change the entire system. Self funding is more logical, if your brakes are bad you replace the brakes not the entire car.
One of the most important features is information, self funding is more transparent then any other system. Large employers don’t trust an insurance carrier to tell them what their cost or premium should be, they hire their own actuary to review the data.
In my extensive experience with hospitals, administered both CA Assoc Hospital Districts and NV Rural Hosp Districts, contracted with numerous Hospitals as a PPO, and worked with various other ones around the country I have never worked with a hospital that could survive on government reimbursement. Medicare and Medicaid rates applied system wide is not an option, no way it could work from an actuarial perspective.