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HEALTH PLANS/POLICY: A health plan CEO who genuinely believes in universal coverage

Health Plan CEO Georganne Chapin believes managed care can evolve with universal coverage! I thought her money quote was pretty amusing.

So then, if Americans are interested in universal coverage, the industry supports it, and the money is already in the system, when will it happen? “In 1996, I said it would come in 10 years,” Chapin says. “We still have four more months.”

Of course she runs a non-profit Medicaid HMO, so her attitudes may not represent those of a typical AHIP member CEO!

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RickWilliam Jeffersonjason djdJack E. Lohman Recent comment authors
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Jack E. Lohman
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Barry, it is impossible to tell the difference between a stress test that was done because of legal concerns versus one that is done because it is profitable as hell. Even IF it were done to protect your hindside, it certainly doesn’t hurt that it is profitable as hell. There will never be a prosecution here because of overuse, because malpractice concerns will always be used as an excuse. >> “Besides, since cardiac procedures are among the most well compensated under Medicare, CMS has not been able to control utilization very well among the Medicare population either.” Medicare is not… Read more »

Barry Carol
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Barry Carol

I think there is a big difference between performing totally unnecessary surgery and, say, being too quick to order a stress test based on a defensive medicine mentality. The former should be treated as a crime and prosecuted to the full extent of the law. Besides, since cardiac procedures are among the most well compensated under Medicare, CMS has not been able to control utilization very well among the Medicare population either. I think this is an area where improving information technology can be very helpful in flagging individual doctors and group practices that are ordering or performing significantly more… Read more »

Jack E. Lohman
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I looked back on the Redding Medical Center comment, Barry, and if the doctors on this thread are willing to comment you will learn that it was NOT a rare event and indeed it occurs all too frequently. We had one cardiologist in our town that was investigated by the FBI after complaints from other physicians about his excesses and over-utilization, and why he did not end up behind bars is beyond me.

Jack E. Lohman
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I haven’t read it yet Barry, but have it on order. I appreciate your comments and will look at it carefully.
I will probably view it differently, I suspect, because of my 35 years in the industry and first-hand knowledge of the shenanigans and abuses that I’ve witnessed. But I’ll report back after I’ve had a chance to read it. It has had good reviews elsewhere.

Barry Carol
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Barry Carol

Jack,
I read her book a couple of months ago and am unpersuaded. The Redding Medical Center episode was an extreme, rare and newsworthy event but hardly typical or representative of the system.
The more I learn about this industry, the more convinced I am that the power of information from price and quality transparency to electronic medical records to home monitoring can lead to material improvements in care quality while controlling costs.

Jack E. Lohman
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From a book review of:  Maggie Mahar’s Money-Driven Medicine Excerpts: …. Her book offers a guided tour to the medical landscape few patients like to envision—the one where profit, not health, guides the actors. Money-Driven Medicine is really an investigation into the ways the quest for cash infects and distorts every level of the health-care system. …. And did you know that your hospital is likely a private institution, dedicated to improving its bottom line by lowering labor costs, which means dangerously overstretching your anesthesiologists and surgeons? Or that senior administrators in the FDA consider the pharmaceutical industry, rather than… Read more »

Barry Carol
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Barry Carol

Jack, It always amazes me how people who disagree on an issue can view the same set of facts so differently. Simple semantics also can get people arguing past each other. With respect to the Massachusetts plan, what you see as nibbling around the edges, the powers that be in Massachusetts view it as a significant effort that can make a considerable difference in sharply reducing the number of people in the state without health insurance, and, at the same time, cutting the number of free riders that drive up costs for everyone else and pay for it by more… Read more »

Jack E. Lohman
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Barry, Massachusetts is an example of trying to trim around the edges without cutting into the meat. Here’s a piece on it by Robert Kuttner. In time it may become workable but will it be better than Medicare-for-all (which, contrary to Glasscock’s view, already has lots of physician and hospital choices). That’s the kind of choices the public wants, not the mish-mash of plans we have today and most certainly not the 45 Medicare drug plans. Ask Glasscock’s public what they want and give them a choice of Medicare for all and they’ll jump at the option. But I can… Read more »

Barry Carol
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Barry Carol

Jack, At a healthcare sector investor conference I attended over the last two days, the luncheon keynoter today was Governor Romney who gave a very polished and articulate presentation about the Massachusetts healthcare reform plan. One interesting point that he made is that once the plan is implemented on October 1st, we will probably find that we made some mistakes that we will address and fix as best we can. He also commented that neither he nor his legislature got everything they wanted even though the combined vote in the Massachusetts House and Senate was 198-2! How’s that for bipartisanship?… Read more »

Jack E. Lohman
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It makes no sense for us to get pissed at each other, but we must also realize that we are not going to solve this here. It’s a good debate, and without disagreement we have no debate anyway; just a discussion. As a member of the Wisconsin Health Coalition my efforts are being put into getting something pushed through at the state level. The stakes are lower (only $1.4 million in industry campaign contributions to battle).

John Fembup
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John Fembup

Jack, I’m glad Dr. Jekyll is back, I like him much better. “you wouldn’t like working for me and I wouldn’t like working for you.” Maybe, but don’t be too quick to conclude that we couldn’t work together. (BTW, I have held more senior positions than you may think – I got into benefits management at the end of my career, after two prior retirements, because I had the opportunity at a huge non-profit organization in New York whose name you would instantly recognize. I was a consultant before that – surely a thinker’s role not a doer’s role.) Here… Read more »

Jack E. Lohman
Guest

John, we may see in our lifetime a heath care system that works for the public. It may be your way with less government or my way with more government. I don’t trust for-profit CEOs and you seem to. But I am mad as hell and don’t want to wait the 20 years I think it is going to take if we do it your way. Sometimes I jump when taking it slowly is wiser, but I usually get there, and get there faster than others. Clearly I am a doer and you are a thinker. You don’t like my… Read more »

Jack E. Lohman
Guest

Thank you John.

John Fembup
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John Fembup

So Jack, your true nature emerges. Doctor Jekyll vanished like – what is the phrase? – a fart in the wind. Welcome, Mr. Hyde. I did not realize that radical change to 17% of the U.S. economy is the equivalent of starting some private small business somewhere. I did not realize, as a big-time CEO of course would, that having the big idea is sufficient and planning is not required from the guy who has the big idea. My apologies to you sir. You probably taught the management courses I had to study for. But I do not mock you… Read more »

Jack E. Lohman
Guest

Gee, John, no mention that my sarcasm was right out of your post to me on Sep 6, 2006 7:03:26 PM? What a shame. You did that one so well. But your stonewalling is not productive. You sound like the kind of guy that needs to create a committee to move the water cooler. It is silly to continue discussion with someone intent on delaying the successful overturn of a flawed system. What in the hell makes you think Americans are so different than Canadians? If I started my company 28 years ago with your posture of investigating every nook… Read more »