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Health Care Reform: What Do Americans Want? (Or Think They Want?)

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By MAGGIE MAHAR

On the surface, it seems that American voters have made their will clear. Poll after poll shows that they are calling for a major overhaul of our health care system. But when you look closer, their responses bristle with contradictions and discrepancies that I think the reform-minded presidential candidates will have to consider when deciding how to approach health care reform.

In a poll reported in Health Affairs at the end of last year, sixty-nine percent of respondents rated the US system as “fair” or “poor.” Yet in the same survey, when asked about their own experience with receiving medical services or with their own physician, 80 percent who had received care in the last year ranked their care as “excellent” or ”good.”

Other polls reveal the same pattern.

According to a survey released by Greenberg Quinlan Rosner in July, voters express doubts about the quality of the American health care system (with 49 percent dissatisfied), while 74 percent were dissatisfied with the cost. Yet, “at another, more personal level,” the pollsters note, “a slightly different picture emerges. Fully eight in ten (82 percent) describe themselves as satisfied with the quality of the health care they receive personally. This number jumps to 90 percent among seniors (64 percent very satisfied), but includes impressive majorities of nearly all groups…”

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POLICY: Me and the Republicans on NPR (no, not really)

So you can listen to my NPR appearance in Los Angeles on Air Talk hosted by Larry Mantle here (works better in Real Player). The other guest was veteran UCLA Professor Rick Brown, who was playing the lefty here–while I was doing my best to play the straight man and give a vaguely direct explanation of what I thought the Republicans were up to. If you’re as confused by Romney as I am, here’s the weekend headline about wanting coverage for all in 4 years that I’m referring to. That puts him to the left of Obama!

BTW I did this call on a cell phone from a hallway in San Francisco’s most expensive hospital (no prizes for guess which one) so my voice quality is a little spottier even than usual. Still it’s a short and relatively interesting piece.

An EHR We Can All Agree On, by Eric Novack

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NovackI have written about this previously directly and tangentially, but given that this is ‘open enrollment
’ period (for those who still have more than one choice), it is worth repeating.

I report this as a part owner of a small business whose costs are increasing every year while revenues are decreasing.

Therefore, I present to you all the new, improved EHR: Effective Hourly Rate.

The EHR should be given to all employees of all companies.

What it will consist of is simple: all of the total compensation divided into what that rate would be on an hourly basis. Let’s give an example:

Current situation:

Employee paid $18.00 per hour

Employee gets 3 weeks paid vacation (or 120 hours of ‘paid time off’) and does not miss other days (we will assume no overtime payments)

Assuming that this covers a full 52 weeks at 40 hours per week that equals 2080 hours in a year.

A bit more math: $18 x 2080 = $37,440.00

And that is all an employee sees.

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POLICY: The Times’ editorial leaves me baffled

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I for one remained baffled about what’s happening within the gizzards of the Grey Lady. On Sunday the NY Times published presented a long editorial about American health care and its high costs.

After the dog sore licking episodes of last year, (hinted at in the "does this matter?" section of this editorial when they dare to say "By some measures, Americans are getting good value.") this year the NY Times has had some sensible columns and has highlighted Wennberg’s work.

The editorial is a hodge podge of mostly correct analysis without any real "editorial" as to what to do. I’m baffled. Most of us would largely agree with their diagnosis but I’m confused as to what they’re suggesting here. The final paragraph bears repeating for being total woffle

By now it should be clear that there is no silver bullet to restrain soaring health care costs. A wide range of contributing factors needs to be tackled simultaneously, with no guarantee they will have a substantial impact any time soon. In many cases we do not have enough solid information to know how to cut costs without impairing quality. So we need to get cracking on a range of solutions.

I long for the halcyon days of 1992 when the NY Times more or less supported managed competition. There are plenty of things we could do (managed competition properly implemented is one, single payer is another, extending the VA to all Americans is a third). All of those policies would do something to contain costs. Now I’m a realist and I know we’re not going to do any of those–but this piece is supposed to be an editorial, fer chrissakes! Can’t they support something?

This editorial was clearly written by a committee that either didn’t understand the solutions or doesn’t agree about them.

POLICY: Someone else beats up on Herzlinger

Here’s Maggie’s takedown of Herzlinger’s WSJ column, with a heavy dose of Uwe included. And as far as I can see the most important thing about any regulated individual insurance system is consistency of benefits across plans—which means the plans then have to concentrate on improving care rather  than gaming risk selection. And then there’s risk adjustment between them. (At least that’s the original Enthoven model).

I haven’t felt the need to torture myself enough to read the latest Herzlinger book—given that I suffered through the previous two, I awarded myself time off for good behavior. However, she appears to want to allow plans to offer personalized benefits “for consumer choice” and then somehow do back end-risk adjustment between them later. Funnily enough that’s roughly what Wellpoint’s California lobbyist said when I asked how they justified selling Tonik et al. At the least it sounds very complex (after all, risk-adjustment between plans with identical benefits is hard enough), and in reality it’s probably just more destruction of the risk pool.

So in other words the part of Switzerland that does work (the uniform benefits) is the part that Reggie wants to destroy. No doubt Maggie will be looking forward to lots of incoherent comments and accusations of plagiarism and poor research skills on her blog.

POLICY: Low prices ain’t cheap enough

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Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans.

Fewer small employers offered health insurance this year, despite
the widespread availability of new, lower-cost high-deductible
insurance plans, a survey released today by benefit firm Mercer shows.
Advocates of the high-deductible plans touted them as one solution to
the growing number of uninsured, expecting the plans to appeal to small
employers, who would continue to offer health insurance as a result.
"That’s not happening," says Blaine Bos, a Mercer partner and one of
the study authors. "In fact, the reverse is happening."The
study of nearly 3,000 employers found that the percentage of employers
with 200 workers or fewer offering any kind of health insurance fell to
61% this year from 63% in 2006.That drop came even as the cost
of high-deductible plans with tax-free savings accounts averaged $5,970
per worker per year. That was $700 less than a comparable plan without
a savings account and far lower than the $7,120 for the average HMO,
the study says.

HSA/HRA type plans are growing in the market, but not as fast as employers are dropping coverage.

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POLICY: The NY Times Remembers the War on Drugs, but has learned none of its lessons

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No one bothers to care much about the war on (some) drugs these days. Sure it’s an $80 billion a year boondoggle for law enforcement and criminals, paid for by the taxpayer at an untold cost in lost civil liberties. But that pales in comparison to the $200 billion a year boondoggle otherwise known as the War in Iraq—a trough in which there are even more snouts. And of course one which has created even more problems than the war on drugs, which may even have a larger effect and last as long. But out of nowhere, the NY Times Editorial page has remembered.

Sadly remembering and understanding are two very different things.

Mexican criminals make money off the criminilization of personal behavior in the US. That money, in the form of cash and guns, flows south. And there’s a terrible inevitability about it, as the Times says, Yet so long as there is demand, the narcotics will always find a route, through Mexico or some other way.

So what, after 90 years of failed prohibition, is the NY Times’ radical answer? Send more money to the Mexicans from the US taxpayer so that the police there can buy more guns.

Did Judy Miller get moved to the editorial department? The NY Times editorial is drinking the kool-aid straight from the futile but endless fundable idiocies of the drug warriors at the DEA. Can it not do better?

 

POLICY: Taking Out The Trash-Talk

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I’m up at Spot-on talking about a particularly crappy study that snuck into a WSJ editorial. I made some snarky remarks about the math skills of economists at the Manhattan Institute in the process. Of course after the editing process a Spot-on it all got a little smoother, shall we say

I’m not too worried that a Republican will actually win the White House in 2008. But I am worried that efforts by what I confidently believe will be a Democratically controlled White House to reform the U.S. health care system will founder on the free-marketeers devotion to faulty statistics, unsound analysis and, well, lying.It’s not a new problem. But it’s one that’s increasingly difficult to combat.

Read the rest and of course come back here to comment if you like.

CONSUMERS: icyou goes to the Consumer Congress

Our friends at icyou (who by the way are doing a fabulous job with the forthcoming Health 2.0 DVD) are at the 3rd Annual Consumer-Centric Healthcare Congress this week. They have a raft of interviews with some of the smartest people in the pro-consumer care crowd (Michael Cannon and John Goodman), some people from technology (Sheila Mehan from WebMD) some from the old world of health care (Neal Miller from Kaiser talking about how to bribe people to go to the gym ($150 for going 90 times a year! and Bridget Duffy from Cleveland Clinic on patient advocates— Health navigation they call it )—all talking about consumer driven health care.

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