Forbes has one of those “pics and words” articles about healthcare, with quotes from lots of smart and not-so-smart commenters. But I just thought it would be fun for you to read the quotes and then play the “who really said that” game. Here are some quotes I picked, not quite at random. After the jump, I reveal who said them with a little commentary
1) We want to get to 100% insurance coverage so the whole country is in the risk pool, which eliminates cherry picking.
2) The old managed competition idea from the Clinton years is still a pretty good one. The idea was to have some entity–employer, private or possibly a public sponsor–set up a menu of choices for people and give them a lot of information about each choice. Then give people a set of choices that range from basic coverage to highly generous, expensive coverage and let them decide how much money they want to spend. Subsidize lower-income people in some way, like refundable tax credits, to ensure people have money to buy good basic coverage, but then they’d have to add their own money if they wanted something more extravagant.
3) We have turned over $2.2 trillion of our money to those who manage our health care, without holding them accountable. Not surprisingly, these folks–hospitals, insurers, governments–used the money to benefit themselves
4) All of the incentives are pointed in the wrong direction.
5) The Medicare program needs to focus on being a more active purchaser. We need to consider an entire episode of care from start to finish to ensure a patient gets care in the most appropriate location … We don’t, at the moment, have a rational reimbursement structure for health care. You may pay more for a procedure at one location, and the quality of care may not be higher. Part of fixing that will take legislation.
6) Spend money on an information infrastructure. Then it would technically be quite possible to track what different hospitals actually spend on health care and what happens to these patients that get treated. Put that information on the web and let people see it to hold doctors and hospitals accountable for how they practice.
7) You need to have a private marketplace rather than have government control in the health care sector, and that means fixing the federal tax code.
You want to know who really said that? Read on:
1) We want to get to 100% insurance coverage so the whole country is in the risk pool, which eliminates cherry picking.
Said by Newt Gingrich—the man who took Pat Looney Rooney’s “advice”
and contributions to make underwriting and the HDHPs which destroy the
risk pool offcial Republican doctrine
2) The old managed competition idea from the Clinton years is
still a pretty good one. The idea was to have some entity–employer,
private or possibly a public sponsor–set up a menu of choices for
people and give them a lot of information about each choice. Then give
people a set of choices that range from basic coverage to highly
generous, expensive coverage and let them decide how much money they
want to spend. Subsidize lower-income people in some way, like
refundable tax credits, to ensure people have money to buy good basic
coverage, but then they’d have to add their own money if they wanted
something more extravagant.
Duke law professor Clark Havinghurst, last seen attacking my notion of social insurance in Cato’s discussion.
And I thought he was a let-them-eat-cake libertarian. But having gone back and read
his stuff—even though in his definition of managed competition there’s a
single risk pool or at least effective risk adjustment, I actually mostly agree with him.
3) We have turned over $2.2 trillion of our money to those who
manage our health care, without holding them accountable. Not
surprisingly, these folks–hospitals, insurers, governments–used the
money to benefit themselves
Brian Klepper? Alain Enthoven? Me? No. This is from Reggie
Herzlinger. At least we agree on the problem, even if she’s only now
after 15 years groping towards a comprehensive policy solution—even if
it’s one that won’t work.
4) All of the incentives are pointed in the wrong direction.
Brian Klepper? Alain Enthoven? Me? No. This is my favorite
lobbyist Karen Ignagni. She doesn’t seem so concerned when the
incentives are illogically pointed in the direction of her members.
5) The Medicare program needs to focus on being a more
active purchaser. We need to consider an entire episode of care from
start to finish to ensure a patient gets care in the most appropriate
location … We don’t, at the moment, have a rational reimbursement
structure for health care. You may pay more for a procedure at one
location, and the quality of care may not be higher. Part of fixing
that will take legislation.
Presumably said by someone far from the seat of power? Actually no—this is CMS’ Leslie Norwalk. She’s been there a while now. Perhaps she should try it. (OK, I’m being unfair!).
6) Spend money on an information infrastructure. Then
it would technically be quite possible to track what different
hospitals actually spend on health care and what happens to these
patients that get treated. Put that information on the web and let
people see it to hold doctors and hospitals accountable for how they
practice.
From JD Kleinke perhaps? Adam Bosworth? Some other
consumerist-free-marketeer, believer in the power of technology, who
thinks that government policy doesn’t matter? Uh-uh. This is from Uwe
Reinhardt
7) You need to have a private marketplace rather than
have government control in the health care sector, and that means
fixing the federal tax code.
This one at least must be from a raging Republican!?
Actually from Ron Wyden, Democratic Senator from Oregon who essentially
wants to marry the Clinton plan circa 1993 with the FEBHP. And not a
bad idea come to think of it.
So overall you’d think that there was some grounds for
wider consensus here. But as JD Kleinke said in his interview the other
day—you should judge people by what they do, not what they say. And of
course not by the extracts of some sniping blogger!
The full Forbes piece is called Innovative Health Care Solutions
Categories: Uncategorized
Well Barry I guess I have to ask, not a good fit for WHO in our society? insurance companies?, investors?, hospital CEOs?, doctors?, Wall Street?, drug companies? lobbyists?, politicians?, the rich and connected?.
Peter (and others interested in healthcare and health insurance reform),
Check out the September 9th post from A Healthy Blog. It shows the relative agreement or lack of agreement among 30 healthcare luminaries from around the country and across the political spectrum with respect to a number of potential healthcare and health insurance reform ideas and concepts. #12 is not consistent with Single Payer probably because the approach is not a good fit for our society and our culture. Read it here.
“The system has to be paid for, whether exclusively from a tax or a combination of taxes and copays.”
I guess cost control is not in the consideration? If a voucher system is designed to have insurance companies “compete” in order to lower costs then you also must want to rely on insurance companies to lower reimbursements to providers and reduce utilization by patients to control costs. Anti single pay commenters on this site have said insurance companies have no more business controling healthcare costs as car manufacturers have reducing fuel consumption. I think the insurance industry has proven it is NOT on the patient’s side or on the side of controlling costs.
Barry Carol,
To connect to our Website, click on “Truman”.
Yes, I am referring to the Emanuel/Fuchs Universal Healthcare Vouchers plan. To your points, under their proposal, those already in Medicare would have the option to stay with that program or convert to Vouchers; those turning 65, and already under the Voucher program, after enactment would simply continue with the Voucher program. There is nothing in the proposal that requires copays – that is something to be determined in the political process leading up to enactment. The system has to be paid for, whether exclusively from a tax or a combination of taxes and copays.
Speaking of taxes, my preference is to separate the debate on the program from the debate on how it is to be financed. There are compelling arguments in favor of a VAT, very popular in Europe but not at all popular in the US. However, that debate should not detract from the Voucher concept, which in my mind is so compelling that it would be a shame if it were bogged down over the mechanics of financing.
“Instead of superimposing good reform ideas on a broken system, we need to overhaul the system completely, starting with the insurance companies.”
I can’t agree more with this statement. All plans I have seen now simply do that – rearrange the financing system to suit the present delivery system. And let’s be clear about what this reform fight is all about for providers, it’s about their ability to keep present (future) cash flows and profits in place – and not about providing healthcare. It’s always about the money.
I agree that Wyden’s plan has a lot to recommend it. He seems to have bridged the gap between some Republican and Democratic proposals by making sure that employers and individuals both pay their fair share while maintaining a market-based approach to insurance and reforming the tax system. Also, requiring everyone to buy insurance through FEHBP-like regional cooperatives would solve the problem of cherrypicking. I also like his standard benefits package, the use of community rating, and the fact that his plan would subsidize insurance for those earning up to 400 percent of the poverty level. And it makes eminent sense to separate insurance from employment.
However, as I explain in my book Rx for Healthcare Reform (www.rx-healthreform.com), and as George Halvorson also says in his excellent new book, there’s no way to solve our health care woes through financing reform alone. Unless we make changes in how we deliver care, costs will bury us. Moreover, the administrative and marketing costs of myriad competing health plans–and the admin costs of physicians and hospitals who have to deal with them–are unnecessary, especially when the majority of providers are in every plan.
Instead of superimposing good reform ideas on a broken system, we need to overhaul the system completely, starting with the insurance companies.
Truman,
You didn’t provide a link to your website. Are you referring to the Universal Healthcare Vouchers proposal by Emmanuel and Fuchs described here? If so, I liked most of what I read. I do have several reservations, however. First, I think it might be easier, at least at first, to leave the Medicare system intact for the 65 and older population. Second, vouchers as proposed may not work well for the poor because they won’t be able to afford the copays. Perhaps it would be better to leave Medicaid intact but to make it a completely federal program with one set of rules. State aid in other areas such as road construction and education could be cut back or eliminated, in effect, reallocating federal and state responsibilities.
My biggest reservation relates to the financing. The authors contend that their approach could be financed with a 10%-12% dedicated value added tax, rising to 15% as the Medicare program is phased out. At the same time, the benefit package is very generous and has no deductibles and unspecified, but presumably low, copays. Even if we could pass a value added tax here, it would probably have plenty of exemptions (or at least lower rates) for necessities like food and housing. If it were as broad based as most of those in Europe (applicable to about 40% of GDP), a 12% VAT would raise revenue equal to about 5% of GDP (about $700 billion) or well short of what would be needed to cover the under 65 population even with significant savings in administrative costs. Growth in VAT revenue would also probably not keep pace with medical cost growth. I think a more realistic financing scheme would consist of a 15%-16% payroll tax on Social Security applicable wages ($97,700 in 2007) to cover the employed population plus a dedicated VAT of 3% or so to cover the currently uninsured. We could replace the current income tax structure with a 28% flat tax on all income (including dividends and capital gains) and give a full dollar for dollar credit for all FICA and health insurance payroll taxes paid by wage earners (but not those paid by employers). The Earned Income Tax Credit (EITC) could probably also be tinkered with to take care of the working poor.
The Healthy Americans Act is well-intentioned but unnecessarily complicated pretty much assuring that it will never receive the kind of public support necessary to move Congress to action.
There is a better plan out there that to date has attracted attention among policy wonkers but has made virtually no headway in the public dialogue – HealthCare Vouchers. Under this plan (read more about it on our Website), everyone receives a healthcare voucher from the Federal government redeemable for a standard health plan that meets government-established minimum requirements (FEHBP at a minimum). Health plans can be offered by insurance companies, HMO’s or other health organizations, thus keeping delivery in the private sector, but overseen by a public entity. No one can be refused entry to a health plan for any reason. The voucher plan also calls for a proactive government role in encouraging quality improvement and cost containment.
Employers would no longer have a role in health care. Means testing would be a thing of the past. Individuals would be free to purchase additional coverage, to an already rich set of benefits, but would receive no tax incentives to do so. The plan provides for state funded universal coverage delivered by a more competitive private sector in the public interest.
The big losers in the Wyden plan are Health and Human Services (means testing goes through the IRS instead of through HHSC, and Medicaid is dissolved, so they’re doing a lot less), small health plans who aren’t awarded major contracts, underwriters (much less need for it), drug companies and device makers, and anyone who profited off the administrative nightmare that is our current health care system, like my company, which provides Medicaid eligibility services.
In his plan, private companies don’t really save big in the short term, because they’re supposed to pass the savings of not having to buy insurance on to their employees through higher salaries. Long-term, everyone saves big because his plan is a vehicle through which sensible reimbursement and reduced administrative overhead could be created.
Paul MM,
“Self-regulating big business is the public’s trusty friend” is not the theme of a single one of the quotes listed, with the possible exception of #7. But #7 is from Wyden, who wants a variant on Medicare-for-all.
In other words, you got it exactly backwards. While nobody quoted is calling for the utter removal of business, neither is anyone calling for self-regulation or a smaller government role than currently exists.
For me, an overarching theme here is how, since the Reagan administration, big business and the people they put in office have somehow managed to convince large numbers of Americans that government is the enemy – and self-regulating big business is the public’s trusty friend!
I’ve looked at the Wyden Plan on his web site and the message and the numbers don’t add up. From his examples private companies save big and citizens save big and if big insurance is happy, who do they get the difference from?
I agree. Wyden’s plan is still by far the best one to come out and yet it seems to have zero traction. It has something for everyone: Subsidized universal health care while also dissolving Medicaid and divorcing health insurance from employment. Small government people are happy, universal health care people are happy, big insurance is happy. And most importantly it’s a vehicle through which we might be able to devise a sensible reimbursement model.
Awesome post. We are living in strange times. Why isn’t Wyden’s plan getting more play, particularly among the D presidential hopefuls? He’s done all the work for them.