Uncategorized

PODCAST: Getting to grips with Grace-Marie Turner; well not exactly!

I interviewed Grace-Marie Turner from Galen. Take a listen to the podcast (about 45 mins) (Unfortunately I’m very loud and she’s very quiet, so you’ll have to adjust the volume every time I come on! Also excuse the first few seconds of the call. She’d just met with Bush and was hoping to see herself on TV, and why not!)

By the end of the conversation I was way more confused about the CDHP movement than when I began. As far as I can tell she’s an advocate of managed care, disease management, and pre-paid care, and even perhaps even compulsory universal insurance. Or at least she appeared to be promoting the benefits of all those things.

It seems to me that just like Reggie, she grabbed any potential advance in health care and called it "consumerism", even if the organizations that do it best like Kaiser and the VA have no history  of HDHP and HDHP insurance products. In fact those products promote fee-for-service procedures beyond the deductible –exactly the opposite incentives that she suggested were necessary. I felt like I was listening to someone who’d read what was wrong in the Alain Enthoven manual and had no idea that the solutions she was proposing weren’t going to solve the problem.

I also spent a very long time trying to get her to explain if the healthy people are allowed to take their money out in the form of personal accounts where the extra money in the risk pool would come from to treat the sick people. (For more on this problem read down here). Unfortunately either I’m just too dumb to understand her explanation or there is no underwriting, no sick people, and no adverse selection in her world, or at least it’ll all washes out in time. And apparently no one would get a better deal in the individual market, if they could get a worse one via an association?

So I’m still awaiting the clear explanation I’ve been looking for about how this HDHP/CDHP movement is going to deal with the mathematical problems it causes and avoid destroying the risk pool. I read Cato’s book, the Hubbard one, now have talked to all kinds of HSA proponents, and not one has answered the question. I wonder why?

Still it was a fun conversation, even if I never got to the tough questions about where Galen’s money comes from  although Hillary Clinton knows!

Grace Marie will be out in SF at the CDHCC conference on May 8-10 in San Francisco

 

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: ,

newest oldest most voted
Matthew Holt
Guest
Matthew Holt

Moved this thread over to the comments about my piece on Greg’s comments

Tom Leith
Guest
Tom Leith

> Using an insuance mechanism to pay for routine care
> is hugely inefficient. It involves massive
> administrative costs from both the insurer and the
> provider.
Yes, and.
Using the insurance mechanism or something a lot like it is the only way I can think of to drive quality improvements and see the patterns that lead to the price-insensitive services under insurance.
I don’t know how to come down on this at all. I understand the economic argument — reduce friction and restore some price-sensitivity. But that friction has beneficial effects too.
t

Greg Scandlen
Guest

Matthew Holt would have a point about “draining the pool” if it were true that every dollar currently spent on health benefits was necessary and efficient. But our current system is awash with administrative costs and needless spending. Using an insuance mechanism to pay for routine care is hugely inefficient. It involves massive administrative costs from both the insurer and the provider. And first dollar coverage encourages needless spending. This needless spending can be curbed by rationaing, or by demand-side behaviors. We tried rationing with managed care, and it works pretty well to hold down costs, but it was pretty… Read more »

The Medical Blog Network
Guest

Bravo, Eric. This is what the REAL consumersim should be about. One more item is needed however: complete transparency of both price and quality.
Unfortunately, too many people are confusing the meaning of consumerism. But this does not diminish its potential.

Eric Novack
Guest

Oh so much flattery amongst friends!! Points of disagreement for discussion: 1. change law so that providers can choose to set prices at, below, or above Medicare rate for medicare services. Make that information available to the public. Competition and human nature would make it that perhaps some very good docs might set their prices higher and some bad ones lower. Also, new docs might start out lower to get more patients when starting up. that would be real consumerism 2. for the very low income people, healthcare services should be paid for in a tax credit for services provided.… Read more »

Matthew Holt
Guest
Matthew Holt

Hey, THCB is a safe place for name calling among friends. Eric is a smart intelligent guy, and he can happily call my ideas crap if he wants to (and vice versa). I know his heart is in the right place The major problem I have with Eric (and many of those who disagree with me) is that when we get in conversation, we agree too much and dont get to focus on where we disagree. That was a major frustration that I had with Grace-Marie. She continually ascribed lots of good things (disease management, consumer involvement in their own… Read more »

Eric Novack
Guest

I apologize for strident… just think name calling is bad for the debate…
I agree with you that doctors need to do better.
That does not mean that it is impossible to be informed.
I maintain that instead of trying to create a master list of best treatments for every condition at every time, we should decide what is definitely wrong for certain conditions and make sure doctors understand.
This is much more achievable and would be more likely to improve people’s health.

elliottg
Guest
elliottg

that should be “doctors can not”

elliottg
Guest
elliottg

Eric, your comments are becoming more strident than I recall previously. The concept of informed consumers is a myth since not even doctors can identify and prescribe the most cost effective care on a consistent basis. Explain this result if you want to be taken seriously about personal responsibility.
http://www.arthritis-pain-cure.com/article_info.php/articles_id/208

Eric Novack
Guest

Commonwealth fund study= study deisgned with bias toward results. You skipped out on all of my questions? I actually do not think that ‘personal responsibility’ is crap and neither do you. Who is responsible for making my kids understand the importance of learning? for their understanding right and wrong? for their values? It is the parent’s responsibiltiy. (not the government) Who is responisble for not drinking and driving, putting yourself, others and your family at risk? you. Who is responsible for showing up at work on time? getting deadlines met? paying your bills on time? you. Who is responsible for… Read more »

Barry Carol
Guest
Barry Carol

Matt, I’m very interested in learning as much as I can about this issue, and I appreciate your responsiveness. I agree that the insurance pool would be deprived of money from young healthy people under your $10 per year for a $100,000 deductible scenario. However, I think even young healthy people would prefer the peace of mind that comes with health insurance that protects against high cost catastrophic events. Afterall, life is unpredictable and the financial consequences of being wrong (catastrophic event occurs and you don’t have insurance) are severe, at least once you have some assets to protect and… Read more »

Matthew Holt
Guest
Matthew Holt

Eric, cmon man. You’ve never heard of social insurance? Invented by Bismarck? in the 1870s? Ever heard of Social Security, Medicare? And you think that getting along in Washingon in today’s climate is an indication of being something special? Hey–lets go to Iran with the rest of the PNAC loonies–they run the show now. They must be brilliant…just your and my kids will be paying for their lunacy for years to come. And I call Grace, Reggie, etc the way I see them. I don’t care if they ever speak to me, I’d rather be known for telling the truth…and… Read more »

Eric Novack
Guest

Matthew- quick hint from an interviewer— do not report to the public that “your guests cannot string a logical sequence of thoughts together”. Makes it unlikely you will ever get them or anyone they know to speak to you again. Avoid ad hominem attacks as they weaken your cause. Ms. Turner, who I spoke to last year, has impressively risen the ranks of influence, given her role on the medicaid reform committee and her meeting with the President. The rules for those people are somewhat different (on both sides of the aisle) as the career and political aspirations can be… Read more »

Matthew Holt
Guest
Matthew Holt

Barry. That only works if you view the 100,000 young healthy’s as a separate pool. But you need their money to pay for the sickies. If they paid $10 a year for a $100K deductible, you could get it to be actuarily neutral, but you end up with anyone who needed care paying for it out of pocket, or as would actually be the case, not paying for it. That’s why it’s called social insurance! Go back to the post I link to and answer the question, and forget that you ever heard the words premium, actuarial, and expected cost.… Read more »

Matthew Holt
Guest
Matthew Holt

Trap. Your intellectual champions (Reggie, Grace-Marie)cannot string a logical sequence of thoughts together, and claim that any advance in health care is a product of consumerism, or will be turbocharged by it when the financial arrangements they advocate, even when those advances (like DM) have nothing to do with HDHPs and will be destroyed by it.
Did you get to the part yet where she told me that my buying a cheaper underwritten plan was illogical behavior and that consumers would rather buy a more expensive group policy, and that there was no adverse selection. I was ROTFLMAO.