Employers and Health Reform

Employers and Health Reform

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“Change, before you have to…” Jack Welch

We live in a society that loathes uncertainty – particularly the unintended consequences that sometimes result from a catastrophic event or in the case of PPACA, landmark legislation. Wall Street and the private sector crave predictability and find it difficult in uncertain times to coax capital off the sidelines when the overhang of legislation or geopolitical unrest creates the potential for greater risk. Despite our best energies around forecasting and planning, some consequences, particularly unintended ones – only reveal themselves in time.

In the last decade, employers have endured an inflationary period of rising healthcare costs brought on by a host of social, political, economic and organizational failures. There was and remains great anticipation and trepidation as Congress continues to contour the new rules of the road for this next generation’s healthcare system. Optimists believe that reform is both a way forward and a way out of a mounting public debt crisis and a bypass for an economy whose arteries are clogged by the high cost of medical waste, fraud and abuse.  Cynics argue reform is merely a Trojan Horse measure that offers an open invitation for employers to drop coverage and for commercial insurers to “hang themselves with their own rope” as costs continue to spiral out of control — leading to an inevitable government takeover of healthcare.

Meanwhile, leading economic indicators are flashing crimson warning signs as recent stop-gap stimulus wears off and long overdue private/public sector deleveraging results in reduced corporate hiring, lower consumer confidence and increased rates of savings.  The symptoms of a prolonged economic malaise can be felt in unemployment stubbornly lingering around 9.2% and a stagnating US economy that is struggling to come to grips with the rising cost of entitlement programs.  Across the Atlantic, the Euro-Zone is teetering as Italy and Spain (which represent more credit exposure than Greece, Portugal and Ireland combined) stumble toward default.  Despite these substantial head winds, US healthcare reform is forging ahead – – right into the teeth of the storm.

Closer to home, states have begun to debate and propose legislative amendments to their own versions of reform as they attempt to reconcile a declining tax base with the soaring obligations of Medicaid and collectively bargained pension and long term care.  Should Congress finally agree to allow an estimated 28% of fee reductions in Medicare provider reimbursement to become law, the private sector could see as much as a 400bps increase in core medical trends resulting from cost shifting – pushing trends back into the mid-teens. Hospital systems, providers and healthcare agencies are bracing for cuts and potentially looking to the private sector as a source for more dollars.  All of this is building at a time when certain industries are nearing a “point of failure” – – an inflection point where healthcare spend as a percentage of revenues and operating profit will either consume earnings or completely erode employee take home pay.

Many are looking ahead to 2012 as a “burning bush” year – a seminal presidential and Congressional election where political results will help clarify the direction of reform – pivoting toward the reinforcement of employer sponsored healthcare as catalyst for market based reforms or merely a cementing of the incentives that seem to encourage the deconstruction of employer based coverage.  With 33 Democratic Senate seats up for reelection and 10 GOP spots up for grabs, the entire composition of our government could change – or perhaps not.  In the interim, the fiscal year 2012 will continue to show 44 states projecting budget deficits totaling $ 112B.

A recent controversial McKinsey study forecasted that as many as 30% of employers or 54m individuals covered under private healthcare would be “dumped” into public exchanges as of 2014.  This number is in sharp contrast to the 12.6mm assumed by the CBO (approximately 7% of 180mm privately covered individuals.)  The influx of 41.4mm unbudgeted insureds – all eligible for federal subsidies of as much as $5,000 – would upend the initial CBO estimate of $ 140B deficit reduction over 10 years and result in an increase in public debt in just six short years.  The ensuing debt arising out of PPACA over the periods 2020 to 2030 could easily eclipse $ 1T of additional public debt.

Any economist can confirm that all unsustainable trends eventually end.  Rising premiums, public to private cost shifting, perverse and unaligned incentives for care, rationing and a host of other stop-gap issues are all doomed to be replaced by a system that either drives efficiency through market reform or through the single payer procurement of healthcare.  It will take at least five more years and three election cycles for this marine layer of debate to lift.  Unlike 1996, there is graveyard silence arising from the private sector.  Employers seem to be stuck in one of the several stages – – often attributable to the dead and dying.

Denial — “This can’t be happening, not to me.” One could argue that this generation of business leaders has drawn the short straw when confronting the decisions we will need to make to keep our businesses viable in a period of sustained high unemployment and economic stagnation.  Many larger employers are nervous regarding reform but somehow feel that reform is more likely to happen to other people – smaller employers and the individual marketplace.

These firms do not want to believe that the myriad unintended consequences associated with reform could impact their bottom line. Denial has been a principle ingredient and willing accomplice to healthcare cost inflation in the last decade.  For many employers, the inability to confront the fact that many of their own business practices – insistence on open access PPO plans, less medical oversight and utilization review, limited appetite for employee disruption, inability to dedicate the time or resources to assess the health risks embedded within their own population of employees – – has them resigned them to a cycle where premiums are increasing faster than wages and corporate earnings. While costs continue to rise, many employers have simply focused on stop-gap year over year cost shifting.  Others prefer to abdicate to commercial insurers who have failed to drive affordability and improved access. It comes down to believing you can make a difference and a willingness to confront the hard choices – choices that could fundamentally drive market-based reforms.

Anger — Many find themselves simmering with resentment, hunting for villains whose feet they would seek to lay all blame: “It’s those damn insurance companies!” “It’s that Socialist in the White House!”” It’s the failure of regulators to do their job in managing the complexities of the healthcare delivery system. “It’s the big hospitals!” “It’s the drug companies!” It’s the rich and their lack of empathy” “It’s the poor and their lack of personal responsibility” The list of culprits could fill a thousand postal office walls.

A polarized Congress, pariah hungry media and a workforce unwilling to understand that access does not equal quality means that change cannot happen without some noses getting out of joint.  Yet, we understand clearly that if we want to reduce our exposure to the coming storm of public to private cost shifting, we must engage and move on from our own anger.  As 35m additional Baby Boomers increase the double the ranks of Medicare to 70mm by 2030, total health spending will near 30% of the GDP and Medicare costs are expected to eclipse $ 32,000 per enrollee up from $12,000 in 2010.  Facing the magnitude of these suffocating entitlement costs, we will either embrace private sector, market-based reforms that fundamentally realign the current delivery system or we will default into a more regulated, lowest common denominator system that will rely on rationed access and reimbursement as a means of controlling cost.

Bargaining —”I’ll do anything for a few more years.” The third stage involves the hope for postponement.   The lion’s share of stakeholders in healthcare can be found milling in this no man’s land of indecision.  While hope is not a strategy, a surprising number of firms are clinging to the dream of “repeal and replace” legislation. Others are merely expecting Washington to do what it does best – prolong debate and delay implementation long enough to afford them enough altitude to pass the problem on to someone else. The tea leaves do not look promising for fundamental legislative intervention that would disrupt the momentum of reform.  Repeal is unlikely. Employers must understand that 2014 will require certain decisions.  Fundamentally employers will have one of four choices:

Take the Money And Run – Do I drop coverage, pay the penalties associated with moving employees into the public exchange and pocket the difference?

Drop Them But Ensure A Safe Landing – Do I drop coverage, grossing all employees up to my current level of subsidization so all might afford coverage in the public exchanges?

Create a Consumer Plan of Your Own – Do I move to a private exchange or defined contribution approach to financing my medical benefits to cap expenditures but remain involved as a sponsor of my benefit programs?

Control Your Own Destiny – Do I continue to offer group based private insurance believing that employer sponsored health coverage is more likely to experience lower trends if properly managed and that medical coverage remains a fundamental part of my company’s ability to attract and retain employees.

Depression — “What’s the point?” The problems we face as a nation and in business can feel overwhelming.  We have the misfortune of having to confront $38T in underfunded Medicare liabilities, $ 14T in public debt, and a potential double dip economic recession arising out of any number of black swan events – – credit defaults abroad, domestic hyper-inflation or a slowing of Chinese GDP.  It seems inevitable that we must head into a period of profound austerity.  Facing the potential of sustained uncertainty can burden any decision maker to the point of inaction.  While some period of reflection is healthy to any organization, people must take a position, plan around the certainty of change, grieve over the passing of an epoch and move forward with a renewed conviction to address the challenges that lay ahead.

Corporate depression may manifest itself in a lack of willingness to engage in the discussions or conduct financial modeling required to understand what scenarios will best benefit your organization.  It is a strange period where we express grief knowing that the traditional employer/employee social contract has changed forever in a hot, crowded, global marketplace.

The sense of urgency to explore alternatives to traditional employer sponsored coverage will led by retail, agriculture and hospitality while professional services, technology and collectively bargained public sector plans may feel more obligated to remain on a course of employer sponsored coverage.  Planning prior to 2014 is essential to be position a firm to react to opportunities that may present themselves.  Should a key industry competitor choose to discontinue coverage and use operating overhead reductions to drive down prices, what will you do?  Many have promised to not be first but not be third in line to change.

Acceptance — “I can’t fight it, so I better prepare for the inevitable.”  2014 will mark the beginning of a movement toward or away from employer-sponsored healthcare.  It is more likely that most will be carefully weighing election results, the first two years of public exchange performance and the actions of their competitors to determine a course forward.

2014 is forcing discussions over the will of the private sector to drive market-based reforms, and the review of decades-old beliefs regarding direct and indirect compensation plans.  Employers that have navigated these phases of change and are now aggressively accepting the new normal of healthcare and will most likely end up as self insured, in touch and aware of their own population risks, directing patients to primary care based system that reward providers based on quality and efficiency and are committed to driving healthier behaviors and personal compliance with to reduce chronic illness.  Employers will realize returns on these efforts as aggressively managed plans will likely experience lower single digit medical trends.  These firms will be reticent to abdicate management of healthcare costs to a public exchange but instead focus on educating and activating their workforce to the personal and corporate dividends of change.

Some employers may convert to defined contribution plan designs such as cafeteria plans to allow for a more diversified workforce to allocate finite dollars to purchase coverage that make most sense for their unique needs.  Health benefits may become part of an overall defined contribution approach to retirement and benefit planning – affording each employee to allocate their dollars to their circumstances and in doing so, accept their circumstances more freely because they have choice in where they spend their dollars.

Reform is a process and like many of the vagaries in life, every person and each business will react differently to the stimulus of change.  Every problem is a disguised opportunity and with it, comes the added dividend of using change as a catalyst for reassessing your strategies to attract and retain employees. It’s about making decisions by commission rather than omission.  And, the sooner an employer navigates these stages of change, the more likely it is that healthcare reform will happen for them – instead of happening to them.

Michael Turpin is frequent speaker, writer and practicing benefits consultant across a 27 year career that spanned assignments in the US and in Europe. He served as the northeast regional CEO for United Healthcare and Oxford Health from 2005-2008 and is currently Executive Vice President for Benefits for the New York based broker, USI insurance Services. He writes at Usturpin’s Blog.

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70 Comments on "Employers and Health Reform"


Guest
Sallyy
Jan 30, 2013

Very interesting article

Guest
Barry Carol
Jul 21, 2011

Margalit and Nate –

Germany is the country that lets the wealthy opt out of the public system and roughly 10% or a bit less of the population chooses to do so.

I would love to be able to buy a $10,000 or even a $20,000 deductible policy despite my cardiac issues as long as I thought that the price was sufficiently lower than a more traditional policy to make it worth my while to assume the additional financial risk. I would also expect to be eligible to pay the insurer’s contract reimbursement rate for any services, tests or procedures that fell within the deductible. That said, from a societal point of view, I think it would be reasonable to require me to demonstrate that I have sufficient financial resources to assume that risk just as I would need to demonstrate a certain (high) level of net worth before being allowed to invest in a hedge fund.

At the other end of the spectrum, I think many, if not most, advocates for the poor think they should have no deductibles and no co-pays for any services they might need because they’re too poor to afford the co-pay and might be inclined to avoid necessary care as well as unnecessary care. At the same time, a recent letter to the editor of the NY Times from a pediatric ER doc with inner city hospital experience said she saw many instances where poor people thought nothing of calling an ambulance for a diaper rash. Also, 30% of the time they don’t show up for appointments which then makes scheduling difficult. While I can empathize with the poor and the often stressful and chaotic lives they lead, I think many of them could make more of an effort to uphold their end of the social contract than they do.

Guest
Nate Ogden
Jul 21, 2011

I have numerous professionals asking for higher dollar HSAs and in most parts of the country you can’t buy anything over $5000, soon to be $2500. If a lawyer for example wants to buy a $10,000 deductible policy why should we stop them?

Guest
Jul 21, 2011

You should not. I don’t remember which European country it is (Barry should know), but I believe they let rich people opt out of the national program (upside down means testing of sorts).

Guest
Dr. Mike
Jul 21, 2011

Come on Nate, if you take away their talking points they won’t have any thing to talk about any more! It’s a condition/response thing – when you hear ____ you need to say ____. HSA is one of the trigger words – it doesn’t matter what you say after uttering those three letters, the liberal brain goes into talking point mode and meaningful discussion ceases.
It is not possible to have an intelligent discussion with someone who believes in fairness of outcome. They believe with all their heart that it is possible to have a good and fair outcome for everyone. It doesn’t faze them to point out that every time this has been tried it has resulted in a mediocre to poor outcome for all instead. If you say, “Government healthcare necessarily results in rationing” they will reply, “But our current system results in rationing also.” They cannot accept a system in which the poor have government rationing, while the wealthy have rationing based only on their ability to pay. They believe that what is accessible to the rich should be available to the poor and so they design a system they believe will give great care to all but that instead results in government rationing for all (i.e. the end result if Obamacare is allowed to stand). Revamping medicaid to allow for co-pays and deductibles would have been much more affordable (or do they really not believe that government overhead is less – they must not as they want taxpayers to subsidize the purchase of private insurance instead). And true insurance reform – why is it I can buy a fairly affordable individual policy, but when I try to get insurance for my small business, suddenly my individual premiums go through the roof. Obamacare might seem like a blessing to a small business like mine, but I am certain I will be forced to purchase an insurance policy that is more expensive than what I want or need. What I want is an HSA, and I want to help fund one for my employees, but that is currently very difficult to set up, and only gets more difficult after 2014.

Guest
Barry Carol
Jul 21, 2011

“If the “collective”, as you put it, in a democracy decides that the level of funding is inadequate then they can vote to spend more, and vote for higher taxes as well, or as is sometimes the case, more debt.”

Peter –

While I can’t speak for other countries, in the U.S. there is a severe disconnect between the cost of services people want and expect from government and the taxes they are willing to pay to fund them. By people, I mean primarily the broad middle class.

The UK periodically claims to put more money into its healthcare system but not a lot. Canadians are willing to wait longer than we are for imaging or elective surgery. Japanese are willing to wait several hours in the waiting room of the more popular doctors for a visit that lasts no more than five minutes. As I read more and more comments from doctors, I conclude that patient expectations in the U.S. are the most unreasonable in the world by far. It’s not just defensive medicine that drives three times more imaging per 100,000 people in the U.S. vs. Western Europe. Many patients want and even demand these tests and they’re not happy if they don’t get them.

Guest
Nate Ogden
Jul 21, 2011

Whats an unreasonable expectation? To not want to wait hours or months would seem fair and reasonable. Not wanting to wait and not wanting to pay for the capacity now would be unreasonable. I think our private insured population pays more then enough for our expectations. I would question our Medicare and Medicaid beneficiares and rather their expectartions are reasonable for what they contributed. Obviously I don’t think they are.

Guest
Jul 21, 2011

Nate, taking my own medicine as directed, here is my reply.

The argument for and against HSA is based on that 75% you quote. On the liberal side, there is a concern that the 25% for whom these plans are not suitable, is the same sicker and poorer 25% that we are trying to help. Furthermore, whether one falls in the 75% or 25% can be dependent on sheer luck, which means that HSAs require that the individual assume some level of risk. You may be OK with that. Generally speaking poor and sick people are not well suited to take financial risk.

Most people, including myself and including you, sometimes make false statements due to either lack of knowledge or misunderstanding. This is a very complex subject. Instead of assuming that folks just lie, which is rather simplistic, why not explain things again dispensing with the preamble? You will advance your opinions much better this way. I usually disregard your jabs and concentrate on the content and several times have learned new things and even changed my opinion. Most people are thin skinned and cannot get past the abrasive introduction.

There will always be people trying to advance politics. The best way to counteract that is to steer away from the politics and bring the debate back to solutions. However, you need to understand that we all come from different starting points. Holding certain views about the world (i.e. liberal, conservative) does not necessarily correlate with party politics. It does correlate with defining goals and constraining solutions. I personally love the fact that we disagree and that you bring to table a perspective that I tend to ignore or at least disregard with the obvious result of making my views less rational. I hope you can find similar utility in my arguments.

Guest
Nate Ogden
Jul 21, 2011

“On the liberal side, there is a concern that the 25% for whom these plans are not suitable, is the same sicker and poorer 25% that we are trying to help.”

Honest question but this was discussed in the past, the sickest and poorest people have the most to gain from HSAs, the much lower out of pocket means they are incurring substantially less cost under an HSA then they would under a normal plan.

“which means that HSAs require that the individual assume some level of risk.”

What is the risk they are assuming, if they are really sick they pay less, if they are really healthy they have money in the bank at the end for future cost. Only people that don’t come out ahead are the small bank of people that have moderate claims that fall under the deductible year after year. This would be someone that has lets say $3000 of claims every year. They would pay $2500 every year. Under a $500 80/20 plan they would be paying $1000 a year. We are talking $1500 annual difference for a small group of people, its not exactly a large risk.

Boy this is going to come back to bite me…..

“including you, sometimes make false statements due to either lack of knowledge or misunderstanding.”

I make very few of these, if I lack the knowledge I don’t comment or find the facts then comment, somerthing many people would be well advised to learn to do. With the internet there is no excuse for the majority of false statements made. 2-3 seconds people could have the correct information. Which goes back to something I use to say, if someone doesn’t care enough about their comment to spend 3 seconds getting it right why should we?

I love arguing with you, I even love Maggie’s post becuase it motivates me to research and prove how full of it she is. Its very easy to get lazy in our beliefs, like you say if they aren’t challenged we never evaluate them and reconsider them. Be it factual or partisian, for example the more i discuss politics the more I can’t stand republicans.

Don’t know about you but this was very refreshing, it would get old if it was every day but its cleansing to blow things up now and then

pcp’s dig at my editing on the other hand was just hurtful and mean spirited

Guest
Barry Carol
Jul 21, 2011

Margalit –

My knowledge of the Swiss healthcare system is limited and incomplete to put it mildly. Most of what I know came from an article published in Health Affairs last summer.

Regarding rationing, I don’t know what the wait times are for elective procedures and imaging as compared to the U.S. I’m also not sure how they determine what services to cover and not cover. I’m pretty sure that they don’t use QALY metrics but I don’t know how drug prices are determined or whether or not a particular drug will be on the formulary and to what extent, if any, formularies vary among insurers.

I do know that there is no public option or health plan in Switzerland, even for the elderly. I know that they have less obesity and less poverty than the U.S. does. I know that they pay considerably less for drugs and, probably, per procedure than we do in the U.S. but I don’t know why. I suspect but don’t know for sure that defensive medicine is less of an issue in Switzerland and I suspect, but don’t know for sure, that they deal with end of life care more sensibly than we do.

From my trip there last summer, I can tell you that it’s a very expensive country for just about everything including meals in ordinary restaurants and items sold in supermarkets. Gasoline is far more expensive than in the U.S. Housing is expensive as well. For some reason, though, healthcare is cheaper but their fully private system is the 2nd most expensive in the world as a percentage of GDP after the U.S. Since last year, the Swiss franc appreciated more than 20% against the dollar so now it’s an even more expensive country, at least for Americans to visit or do business there.

Guest
Peter
Jul 21, 2011

“So, the collective wisdom might decide that the people in a particular country should not spend more than, say, 9% to 11% of GDP for healthcare. That number has nothing to do with the actual health needs or wants of the population.”

Barry, I guess the U.S. 17.9%(2009) would then cover the actual needs or wants of the population, since you say government systems chock utilization and regulate prices while private systems provide to all that want it? I’ll argue government systems (not U.S.) are actually more efficient (they have to be) since they have less capacity to hide inefficiencies in billings and un/under insurance. If the “collective”, as you put it, in a democracy decides that the level of funding is inadequate then they can vote to spend more, and vote for higher taxes as well, or as is sometimes the case, more debt. But we seem to have the worst of every system, high prices, less than universal access and high debt – welcome to the better system?

Guest
Nate Ogden
Jul 21, 2011

“I’ll argue government systems (not U.S.) are actually more efficient”

How are you measuring efficency? Is it like Price is right your not allowed to go over? Most government systems under deliver, see NHS for all its examples. if they deliver 30% less care that is needed and the US delivers 30% more care then needed is one more efficent then the other?

Guest
Jul 21, 2011

“That being said how do you counter politically partisan attacks without also resorting to political partisian attacks? And whats wrong with paritisan attacks, are you saying there is never a place for them?”

You counter them with respectful, well thought out and well explained logic and facts.
There is never a place for blind, rabid partisan attacks. They contribute nothing to the conversation and even less to finding a solution.

Guest
Nate Ogden
Jul 21, 2011

then what purpose does clearly inaccurate and misleading arguments lend to this solution finding?

If we are having a discussion about healthplans and someone for months or even years continues to repeat the claim that HSAs are terrible health plans becuase all they do is shift cost to the employee and everytime people thoughtfully reply no HSAs actually reduce liability for 75% of people is the person repeating this incorrect argument not just as bad?

At what point is a liar a liar and called as such?

Making astuff up is not contributing to a solution or conversation it is degrading to them. Lets take this comment of yours;

“I can assure you Nate that an universal system will not be paying for massage therapy, so let’s just stay with the subject.

How can you assure us universal coverage wont cover massage therapy when a handful of states already require such coverage. If Universal coverage was enacted via state enchanges then it would already require such coverage.

Obviously you can’t assure us of this and most likly were not aware that states already mandate this coverage. What benefit did your obviously false statement lend to finding a solution? Finding a solution should probably start with why massage therapy is a mandated benefit, far from fostering this movement to a solution you try to kill it;

“so let’s just stay with the subject.”

I was trying to ask if I may create my own fantasy future, since you seem to assert the right to do so.”

These comments seem neither respectful, to the benefit of solution finding, or well thought out since they were clearly wrong.

Which none of that is a big deal until the hypocrisy starts. Maggie calling everyone on the right fear mongers, sexist, racist, and everything else isn’t a problem until she want’s to start censoring people for doing the same thing. You don’t care about factual debate and furthering the discovery of a solution, you and Peter throw out some of the craziest BS on THCB.

If you want productive conversation the first step would be to stop the private sector demigoding, start discussing real numebrs and fact not DNC talking points.

Think how many bytes have been spent on;
Insurance companies make 30% profits

50% of all bankrupties are from medical bills

Medicare has 3% admin compared to 30% for private insurance so moving everyone to medicare would save money

only 42% of doctors are sued so medical malpractice is no big deal

PPACA will save money

You can keep your insurance

The entire debate has never been about solutions, its always been about politics. Since Medicare the politics have always trumped the solution and thus nothing has been solved. You claim you want solutions but offer nothing but politics…..

Guest
Jul 21, 2011

“It can take the form of extended wait times for non-life threatening elective procedures or QALY metrics to determine what will be covered and paid for or explicit age based rationing or some combination of all of those.”

Is this the case in Switzerland, Barry?

Guest
Barry Carol
Jul 21, 2011

Peter –

First, for the record, I have long advocated taxing the value of employer provided health insurance as ordinary income though I would reduce marginal income tax rates and increase the standard deduction to ensure that the government does not collect any more net revenue than it does now.

Second, in Switzerland, insurers, all of which are non-profit, negotiate with providers as a group in each canton so that every insurer pays the same price for a given service, test or procedure in that canton.

It may surprise you to learn that I do think that a public monopoly over health insurance may result in a less expensive healthcare system but not because the public sector is more efficient than the private sector or better negotiators with providers. It would achieve lower cost through the use of dictated prices and a collective political decision with respect to how much the society is prepared spend for healthcare. So, the collective wisdom might decide that the people in a particular country should not spend more than, say, 9% to 11% of GDP for healthcare. That number has nothing to do with the actual health needs or wants of the population. Since healthcare needs and wants are likely to cost more than the political process will allow, they devise a system that imposes rationing. It can take the form of extended wait times for non-life threatening elective procedures or QALY metrics to determine what will be covered and paid for or explicit age based rationing or some combination of all of those. In the end, though, since the quality of healthcare that one has access to is a relatively small factor in determining life expectancy, the approach is acceptable to many. Personal behavior, genetics, socioeconomic status and environmental factors are all more important than access to quality healthcare when it comes to life expectancy.

While I think there is plenty that we in the U.S. can do to reduce healthcare costs from tort reform to price and quality transparency to tiered insurance networks, moving away from fee for service payment in favor of capitation, bundled pricing for surgical procedures, shared risk and shared savings, and a more sensible approach to end of life care, I believe the U.S. healthcare system will always be the world’s most expensive because of our culture and our values.

Guest
Peter
Jul 21, 2011

“HSAs are different coverage and majority of the time they are more coverage.”

HSAs as constructed use HDHPs, high(er) deductibles are less coverage, or “different” in your sales pitch and benefit higher income insured who have a better capacity to weather a high deductible event.

“Hispanic and African American Adults Are Uninsured at Rates One-and-a Half to Three Times Higher Than White Adults”

Gee Nate, why would they cost us more, we insure them less.

http://www.commonwealthfund.org/Content/News/News-Releases/2006/Aug/Hispanic-and-African-American-Adults-Are-Uninsured-at-Rates-One-and-a-Half-to-Three-Times-Higher-Tha.aspx

“Dying For Basic Care
For Blacks, Poor Health Care Access Cost 900,000 Lives”

“http://www.washingtonpost.com/wp-dyn/articles/A13690-2004Dec20.html”

Guest
Nate Ogden
Jul 21, 2011

“HSAs as constructed use HDHPs, high(er) deductibles are less coverage”

Ok Peter then what is lower out of pocket? If a $250 deductible plan has $5000 OOP max and a $2500 HSA has $2500 OOP max your claiming that is less coverage?

Guest
Nate Ogden
Jul 21, 2011

I get it Peter your a flaming liberal that cherry picks facts and misuses data to make up arguments.

Why don’t we give everyone a zero dollar deductible plan, it will have 80% co-insurance and no limit on out of pocket but according to Peter’s logic would be the best healthplan possible. co-pays, co-insurance none of that matters the lower the deductible the better.

We need a special plan for special people like peter no deductible and 100% member co-insurance, watching his head spin as he tries to figure out why he owes so much will be priceless.

Guest
Jul 21, 2011

Nate:

Do you realize you’re the mirror image of Ms. Mahar, i.e., a complete inability to edit a post combined with a love of politically partisan ad hominem attacks?

Guest
Nate Ogden
Jul 21, 2011

I also don’t get the benefit of comment editing and protection from the higher powers. That being said how do you counter politically partisan attacks without also resorting to political partisian attacks? And whats wrong with paritisan attacks, are you saying there is never a place for them?

To make the argument clear lets take this overseas to Europe and assume I was making such attacks on communism. Most people agree communism is a failed ideology that has killed millions. How do you discredit and destroy communism without being partisian?

Bring that back here, how do you show Liberalism is a failure of an idelogy and should be discredited without attacking liberalism? Any effort to diminish it is obviosuly partisan.

No in regards to the ad hominem attacks issue. I don’t see this. First where is the personal attack? I have never meet a liberal that took it as an insult to be loabeled a flaming liberal. Next part of an ad hominem attack is to discredit something he said, Peter did take a fraction of a benefit plan, the deductible, and ignore the rest, the co-insurance, to make an argument. How is this an ad hominem attack?

If I had said you can’t trust Peter he’s a commi that would be an ad hominem attack.

What’s wrong with my editing i missed one capital letter for co-pay and a semi colon between pocket and but. By internet standards thats a solid A-

Guest
Nate Ogden
Jul 21, 2011

at least give me a much yonger mirror image.

Guest
Nate Ogden
Jul 21, 2011

Tell me about african american culture Nate.

http://minorityhealth.hhs.gov/templates/content.aspx?ID=3723

Except for African Americans 20-24 years old, African American women are more likely than White women to get breast cancer before age 40.

African American women are more likely than White women to die from breast cancer.

New cases of certain cancers occur more often in African American women, including colorectal cancer, pancreatic cancer, and lung cancer.

The death rate from colorectal cancer and pancreatic cancer is higher among African American women than other racial groups.

In 2001, African American women were 2.6 times as likely to have been diagnosed with stomach cancer, and they were 2.3 times as likely to die from stomach cancer, compared to non-Hispanic white women.

African Americans are 29 percent more likely to die from heart disease than non-Hispanic whites. This occurs despite the fact that 9.6 percent of African Americans have heart disease vs. 12.2 percent of whites. Some 26.7 percent of African Americans have hypertension compared to 20.1 percent of whites.

3.2 million, or 13.3 percent of all non-Hispanic blacks aged 20 years or older have diabetes. After adjusting for population age differences, non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic whites.

Although African Americans make up only 13 percent of the total U.S. population, they accounted for 50 percent of HIV/AIDS cases in 2003.

African American females had more than 25 times the AIDS rate of non-Hispanic white females.

In 2002, African Americans aged 65 and older were 30 percent less likely to have received the influenza (flu) shot in the past 12 months, compared to non-Hispanic whites of the same age group.

In 2002, African American adults aged 65 and older were 40 percent less likely to have ever received the pneumonia shot, compared to non-Hispanic white adults of the same age group.

Although African American children aged 19 to 35 months had comparable rates of immunization for hepatitis, influenza, measles, mumps, rubella ( MMR ) , and polio, they were slightly less likely to be fully immunized, when compared to non-Hispanic white children.

In the United States, prematurity/low birthweight is the second leading cause of all infant deaths (during the first year of life).

During 2000-2002 (average) in the United States, preterm birth rates were highest for black infants (17.6 percent), followed by Native Americans American Indians (12.9 percent), Hispanics (11.4 percent), whites (10.7 percent) and Asians (10.2 percent).

In 2002, African Americans had 2.4 times the infant mortality rate of non-Hispanic whites.

African American infants were over 4 times as likely to die from causes related to low birthweight, compared to non-Hispanic white infants.

Lupus is more common in African American women and other minorities than in White women.

The Centers for Disease Control and Prevention (CDC) reports that between 1979 and 1998, 70 percent more African American women (between 45 and 65 years old) died from systemic lupus erythematosus (SLE).

Being overweight or obese increases your risk of heart disease, type 2 diabetes, high blood pressure, stroke, breathing problems, arthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), osteoarthritis and some cancers. Fifty percent of adult African American women are obese.

African American women were 1.6 times as likely as non-Hispanic white women to be obese.

Would you like more Peter?

Guest
Peter
Jul 21, 2011

“Why would we pay taxes on a healthplan?”

Why would you pay taxes for a company supplied vehicle you use for personal use? Why would you pay taxes on a company bonus? If you want tax free employer healthcare then let all of us deduct healthcare from our taxes – not just the actual amount spent for care that’s above the wage threshold.

“Your argument for public control is education?”

Show me privately run education with a better track record and less cost in inner city (poor) schools. Show me a charter school that does better teaching inner city kids with the same burden as public schools; take all comers (not just cherry pick or lottery), large student/teacher ratio, unmotivated parents, dysfunctional families, learning disabilities, dilapidated facilities, hunger, (african americans?) etc. What does your little mouse tell you about “adjusting for hundreds of variables” in education?

HSAs are less coverage. Anyone can cut patient benefits to achieve less cost.

“So your a fan of shutting down public schools and going 100% voucher?”

Only you Nate would extrapolate that conclusion from my post.

“Why don’t you introduce a 17% african american culture into the swizz system and see how that changes things.”

Tell me about african american culture Nate.

Guest
Nate Ogden
Jul 21, 2011

“HSAs are less coverage. Anyone can cut patient benefits to achieve less cost.”

No Ezra, or Peter, or whichever illiterate liberal is repeating this BS lie. HSAs are different coverage and majority of the time they are more coverage. First off, while the deductible might be higher, 90% of the time the maximum out of pocket is much lower. They are providing greater coverage then the plan they replaced. Up until PPACA they also covered wellness at a higher rate and greater dollar amount then non HSA plans.

Why can’t you liberals pick up a policy and learn the facts before you go running your mouths? You can find thousands of them online, are you really incapable of reading to yourself?

Guest
Nate Ogden
Jul 21, 2011

“the Swiss pay quite a bit less than we do, but more than virtually everybody else. And that’s despite the fact that everybody else has lower, rather than higher, out-of-pocket payments. This seems to be evidence that substantially public systems hold down costs much better than substantially private systems, like the Swiss system, or more starkly, the American system.” Ezra Klein.”

The mouse outside my office says swizz cheese is more expensive then american so obviously America must be more efficent. Granted the mouse is 100 times smarter then Ezra Klien, the same “expert” who called HSAs sexist, but he is still a mouse, why would you listen to him? Ezra doesn’t have the data, experience or inteligence to even start comparing the two systems. Why don’t you introduce a 17% african american culture into the swizz system and see how that changes things. Or better yet 20 million illiegal south americans.

You can’t compare the cost of our system to others without adjusting for hundreds of variables you lazy liberals have never bothered to adjust for. Until you do the math right your just blowing hot air….and insutling HSAs as sexist, whats with you people and your cheap attacks?

“tax free to you”

Why would we pay taxes on a healthplan? I now need to pay your liberal government for the right to be healthy? Anything you liberals wont tax?

“but if like education, you view healthcare as a basic necessity that is key to an even chance at success, then private sector control of healthcare should be as little as possible.”

Your argument for public control is education? The massivly failed educztion system, thats your best argument? Most inner city schools don’t even graduate 50% of their students, thats the success we should model our healthcare after?

“I would agree with government hands off of healthcare if, as with most other products and services, you could access and choose less expensive options (no Nate, not less coverage) that could get you to the same place and participate evenly in the economy.”

So your a fan of shutting down public schools and going 100% voucher?