Matthew Holt

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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joanGregory WilliamsHughwonderingTom Leith Recent comment authors
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joan
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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.

http://www.onlineuniversalwork.com

Gregory Williams
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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.

http://www.onlineuniversalwork.com

Hugh
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Hugh

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”… Read more »

wondering
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wondering

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… Read more »

Tom Leith
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Tom Leith

> 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… Read more »

Nate
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Nate

“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?

Peter
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Peter

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… Read more »

Nate
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Nate

Peter, 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… Read more »

Peter
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Peter

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… Read more »

rbar
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rbar

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,… Read more »

Nate
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Nate

Another interesting example of how government fights to keep insurance and healthcare expensive; http://mjperry.blogspot.com/2009/03/bureaucrats-force-low-cost-doc-to-raise.html “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… Read more »

Barry Carol
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Barry Carol

rbar,
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.

Nate
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Nate

rbar, 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… Read more »

rbar
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rbar

Nate, 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… Read more »

Nate
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Nate

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… Read more »