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Tag: Policy

HEALTH PLANS/POLICY: Lawmakers Should Not Reduce Funds for Medicare Advantage Program, apparently (with quick UPDATE)

• 11

Who says so? Well it’s the BCBSA CEO. Lucky that’s not self -serving or anything. Perhaps he’d like to explain how his members and the other health plans valiantly stayed in the Medicare market last time, took huge losses but stuck it out all the way to 2004 when rates were put back up. But this time they’ll quit instead. (BTW here’s the WSJ original to those of you with access)

After all, if we’re going to have revisionist history….

UPDATE: I was rushing to an interview (which you’ll hear tomorrow) so I didn’t get a chance to add one thing Mr Serota appears to have missed out in mentioning regarding the subject. Just like much of the American health care system Medicare Advantage is a good deal for its members, a great deal for its vendors (including but certainly not limited to the Blues) but not such a good deal (according to the CBO et al) for the poor saps who have to pay for it. And who would they be? Yup, it’s that taxpayer fellow again, and of course—due to the accounting and financing techniques of the con-artists who wrote the 2003 MMA, took us into Iraq et al—it’s also going to be paid for in the years to come by their children and grandchildren. But who cares about them when the Blues and other insurers are richer than they’ve ever been?

POLICY/POLITICS: Universal Health Insurance and the NY Times–all hail Jon Cohn (with brief UPDATE)

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In recent months, not content with letting Judy Miller transcribe enough Cheney press releases to sink us into a $1 trillion dollar/3,000 lives and counting quagmire in Iraq, whomever runs the New York Times’ health care coverage has essentially handed the keys to the liquor cabinet to a succession of idiots who wouldn’t know anything about health care if they were sober. It’s then printed a series of the most illogical, stupid and plain wrong articles about health care that’s so bad that I’ve run out of ways to describe how if the NY Times were a dog it could not leave its pustilent sore alone.

But Holy Cowdung Batman. Maybe there’s hope, as they’ve this weekend allowed Volvo-driving latte-quaffing liberal Jonathan Cohn—who actually knows something about the topic— to write a long article for the magazine. It’s called What’s the One Thing Big Business and the Left Have in Common? and the answer isn’t too surprising.

But now they’ve taken this timorous first step, what’s next for the NY Times— op-eds from Enthoven or Fuchs? Regular columns from Brian Klepper? Giving Ian Morrison or Robert Laszewski a chance to explain how health care really works? Cutting and pasting from THCB? I’m waiting!

UPDATE: I’ve added a permanent & free link to Jon’s piece so it’s not buried behind the NY Times firewall. He focuses on exactly the correct topic, which is "Do big business CEOs have the cojones to take on the health care industry," in other words to piss off all those drug and insurer CEOs they meet at their Wyoming hunting lodges. And of course can the ones who are losers in the current charade (Safeway, Costco, anyone with a union) persuade enough of their colleagues that they shouldn’t be competing over who can pay the lowest health care benefits–when WalMart seems to be winning that contest too. An excellent piece, so go over there, read it and ponder why the NY Times doesn’t print more like it as compared to the pustilent sore variety for which they seem to have such an appetite.

POLICY/HEALTH PLANS: Has George changed his tune?

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Found this Interview with KP CEO George Halvorson put out in January. Here he is talking about single payer

PwC: Are there other practices you see overseas that you think are importable?George Halvorson: One of the nice things about almost every other country, particularly the ones with single-payer systems, is that they focus very heavily on primary care. Most health-care costs come from a very small number of people: 1% of the population represent 40% of the costs; 10% of the people represent 80% of the costs, etc. So the largest potential you have for changing the total cost of health care is to focus on that small group of people and take care of them appropriately. And the only really effective way to focus on those people is with primary care. You need to intervene medically with those people before diseases progress to the point where they’re extremely expensive. And that requires a primary-care model.Countries with single-payer systems all have put in place extensive primary care, and employ much less expensive specialty, secondary and tertiary care. That’s actually not a bad model, because what you end up with is fewer people needing a heart transplant. If you need a heart transplant, you may be less likely to get it in those other countries. But if you have really good primary care, you’re much less likely to actually need the heart treatment.PwC: Does that mean there are trade-offs regarding care?George Halvorson: Only if you have to decide where you’re going to invest. If you decide to invest in the primary care part of the equation, then you eliminate the need for some of those very expensive treatments. On the other hand, if you don’t invest in the prevention part of the agenda, then you have to invest much more heavily on the tertiary side of the equation. It’s a cost trade-off for the system. For the patient, think of the quality-of-life perspective: Would you rather have a massive heart attack, or would you rather be treated by a primary care doctor? It makes more sense to focus on early prevention and not on the tertiary care rescue model.

It’s a sensible and pretty accurate description. But that’s not exactly the terms he was using about single payer more recently at the Commonwealth Club when his description of single payer used the terms “rationing”, “Canadians coming to the US” and he alluded to single payer being like the prison health care system. I wonder what changed his tune? Was his body invaded a la Harry Potter movies by Sally Pipes?

HEALTH PLANS/POLICY: Individual association problems

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Nothing really new here, but a nice piece from Lisa Girion in the LA Times about how because of the haste of insurers to avoid association groups and insure the young healthies, said groups are going into death spirals. And of course being kicked out by their plans if they can possibly figure out a reason in the fine print to do so. Today’s bete noir is Blue Shield of California which is kicking out the Association of Realtors on a technicality, but they’re obviously all at it.

Which of course means that if you’re in one of those association groups and yours get terminated and you’re sick, you’re screwed. I thank my lucky stars that when this happened to me, I was able to fool one plan into thinking that I’m healthy enough to be worth having. So far, one year later I have no claims, so they’re up!

POLICY/POLITICS: Up at The Grauniad

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My father would rolling in his grave if he wasn’t still alive. I, yup the guy who voted for Thatcher twice, have been given a column on the venerable web site of The Guardian–the paper of the wet liberal lefty chattering classes in the UK. I’m up explaining the Democratic Presidential candidate’s health plans or lack of them.

This past week saw the first debate among the Democratic candidates
for president about what has become the most important domestic issue
in American politics: the country’s failed healthcare system.
To serious students of policy, America’s healthcare is the most obvious
feature of its society and economy that needs correction. However, to
serious students of American politics, reforms to the
healthcare system are the most difficult problems. Case in point: the
Democrats lost control of Congress in 1994 in large part because of
opposition to the Clinton healthcare plan.

The problem is that healthcare system reform will necessitate
controlling the system’s huge and growing costs – currently 17% of GDP
in the US against less than 10% in most of Europe. But those reforms
will need to cover the 45 million people who now lack insurance, as
well as reassure middle America that they will keep their coverage, and
not upset upper-income Americans and the senior lobby who are generally
happy with their doctors. And of course then there is the problem of
dealing with a powerful $2,000bn industry which has little interest in
seeing its bumper profits diverted.

POLICY/INTERNATIONAL: More boring pointless mush from the AEI

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So the WSJ gives another know-nothing big oil-sponsored hack from AEI another forum to use the same tired defense of the US system in the Elizabeth Edwards case. Oh look! Cancer outcomes are worse here than in Europe therefore their health care systems must be worse. With the unspoken implication that if her husband’s plans get enacted she’d be dead.

Just for a minute ignore all the other issues about costs, the 18,000 people whom the IOM says die each year here earlier than they would in those European countries because they’re uninsured, medical bankruptcies up the wazoo, etc, etc, and feast your eyes instead on this little nugget from a much longer article at the Annals of Internal Medicine.

Contrary to popular belief, the health care here isn’t always the best. Many other industrialized countries provide health care that is just as good and sometimes better. For instance, 30-day acute myocardial infarction case-fatality rates are below 7% in Denmark, Iceland, and Switzerland, compared with almost 15% in the United States. Incidence of major amputations among diabetic patients in Finland, Australia, and Canada is less than 10 per 10,000 compared with 56 per 10,000in the United States. And Australia, Canada, England, and New Zealand all have a better 5-year kidney transplantation survival rate than the United States.

There are so many better things to be arguing about.

But if the AEI and the fake free-marketeers want to play that game, why is the American health care system killing people with heart attacks, or chopping the legs off diabetics at more than double the rate of foreigners? Does the AEI really want to go down that path–particularly as there are way more Americans  with heart disease and diabetes than with cancer.

HEALTH PLANS/CONSUMERS/POLICY: Administrative costs–bad and will get worse with CDHPs

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PNC Bank has a new survey out saying that 30% of all health care costs are to do with administration—actually it may be more than that if you believe the study in Health Affairs that said it was 20-22% of all provider costs, when the public provider payer segment is keeping an additional 3–20% of all the dollars too. I think that PNC is trying to promote HSAs et al, and perhaps wants to suggest that this will solve the administration problem. As I’ve been saying for a while, the current set up of CHDPs just means that instead of chasing down health plans for the money, providers will be turned into consumer collection agencies.

And PNCs own survey shows that most providers agree with me:

Nearly three-quarters of hospital executives surveyed (72 percent) expect high deductible health plans, which require consumers to pay more upfront costs for care out of their own pockets, to add another layer of complexity to the claims, billing and payment process.

POLICY/HEALTH PLANS: Clowns to the left of us, jokers to the right…..

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Yet another study showing that even if you’re insured, because of the structure of our insurance system even the insured have trouble paying bills.  Now I know I should leave this well alone. It’s ground that I’ve trampled to death before, such as this story about the insured parents of the sick kid who’ve declared bankruptcy. But when the magic four letter acronym of certain industry trade group pops up (even without a certain lobbyist’s name mentioned) I just can’t help myself.

Along with deductibles and co-payments, The Access Project found other factors associated with medical debt were annual or lifetime "caps" on benefits; extra charges for "out of network" care, even when admitted to in-network hospitals; and complex billing systems by insurers and hospitals that left patients confused about what they owed.

Mohit Ghose, spokesman for the industry trade group, America’s Health Insurance Plans, says the study unfairly blames insurers for rising costs. He says there are many reasons spending on health is going up, including new treatments and drugs, rising demand as the population ages and "defensive medicine" by providers worried that they will be sued if they don’t run every test or offer every alternative to patients. "For too long, people have found it convenient to put any and all problems with the health sector at the doorstep of health insurance plans," says Ghose.

Not actually a direct lie this time, you’ll note. But excuse me again, but if it’s not to sort out that stuff—the over use, the defensive medicine, assess the correct use of technology—then what do AHIPs members do for their customers other than slap on 20% and send them the bill? Not much is the answer.

But I guess AHIP is doing its job. They’ve been getting idiot libertarians from no-name universities to write ridiculous op-eds about the value private insurers bring to the system and than has succeeded in getting them placed in that bastion of Marxism The New York freaking Times!! I’ll spare you the whole thing (although this post at Economist’s View  explains largely what a pile of crock Cowen writes. But this choice piece of outright idiocy has to make an appearance at THCB:

It is precisely because competing insurance companies spend money evaluating the appropriateness of claims that they are willing to pay for so many heart bypasses, extra tests, private hospital rooms and CT scans.

Given what Ghose says in the line above about how insurers aren’t able to do that stuff because it’s just too hard for them, someone at AHIP has clearly not been communicating well with their pet blogger, or at least Cowen has no idea what a health insurer does. Perhaps he should try to get a job at HBS? He’d fit in well there

And given that Cowen is an out-there libertarian nut with no basic chops in health care, and for whom this is his second recent appearance in the Times, it’s worth asking how many op-eds has the Times featured from Alain Enthoven, Vic Fuchs, or anyone else with half a brain on the topic this year? You know my guess as to the answer.

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