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Tag: Policy

HEALTH PLANS/POLICY: eHealthinsurance still skipping stats 101

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eHealthinsurance is out with its annual report of what premiums are in different cities and they’re still comparing the price of rotten month old apples with sweet juicy, juicy mangoes. And amazingly enough they’re different. Basically some states ban underwriting and therefore have insurance which is more expensive. So what I said last year when they said that prices were going down still applies—

On further review there are more questions than answers. Who got insurance? Was this group more underwritten (i.e. healthier) than the previous year? And what benefits were they getting compared to last year?  And were there changes in deductibles, co-pays and out of pocket maximums?

Just saying that the premium went down is a bit like saying the average price of a BMW 3 series is less this year on average because more people are buying them without the fully loaded options. And if it’s really true that apples for apples the premiums went down why didn’t eHealthinsurance.com put that information in the report?

Although last year apparently “prices went down” and this year they didn’t say that, so it’s pretty damn likely that if you compared apples to apples of the stripped-down underwritten plans they’re looking at, prices went up.

Of course in practical terms this report is useless. I’m a great example in that I applied for two identical policies from different carriers on eHealthinsurance—both quotes about $100 a month for a $2500 deductible plan. But when the underwriting was done, one was still $100 a month and the other wouldn’t take me at all and suggested I went in the guaranteed issue pool at $400 a month for a $4000 deductible. So quoting price without knowing what the individuals concerned need to go through to get the insurance and therefore knowing the actual price is useless.

I do note one little thing in their report. They say that St Louis Missouri has the cheapest children’s insurance premiums ($29 a month) and yet there are 119,000 uninsured kids in Missouri. In other words very cheap—or even free given the numbers who don’t sign up for the SCHIP programs—isn’t cheap enough to get kids (and adults) insured. eHealthinsurance seems to be surprised about this.

The only logical conclusion is that health insurance needs to be compulsory and automatic (although not of course free to those who can afford it). And in fact even eHealthinsurance could do OK in such a system, although the logical ramifications of it would be horrendous for many of the plans they broker for.

POLITICS/POLICY/HEALTH PLANS: On the Blues’ political giving & CDHP complexity

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Says here that Blues Plans Favor Republicans With Their 2006 Campaign Contributions. But I think what it means is that they’re favoring incumbents. Having said that and reading the polls and the tea leaves, I think the Blues might think about evening up those contributions given that the Congress is as likely to flip over his year as any since 1994, and that the Blue Dog Democrats are the crowd most traditionally aligned with their interests.

Meanwhile, Joe Paduda is showing that the CDHP is even more confusing to consumers than ordinary health plans. Well, when United bought the shysters at Golden Rule, you didn’t actually think that they were going to reform them, did you?

 

POLICY/THE INDUSTRY: Nice work if you can get it

So for rewriting Alain Enthoven’s lectures from the late 1980s and missing the main points, apparently Michael Porter is being paid $50,000 a day, and that is a discount from his apparently usual fee of $100,000! Damn, that’s nice work and yes I am very jealous. Hopefully I’ll soon have his co-author Elizabeth Teisberg on THCB to explain what I don’t understand about their book which I’m chunking through at the moment.

When I said he was sinking in the health care quagmire, I should have said that he would be rolling in it.

HOSPITALS/POLICY: Unhealthy & unhappy Returns from BillMon

I missed this but last week my favorite writer on the entire Internet, Billmon at the Whiskey Bar, wrote about health care. 99% of his posts are about foreign policy, from an extremely cynical point of view. But this time he looked at the capital problems facing hospitals and his extrapolating guess is that to maintain the profitability of hospitals we will soon be allowing emergency rooms to turf people out to die in the streets. His piece on the future of EMTALA (not that he uses the term, but he clearly understands it) is called Unhealthy Returns.

PHARMA/POLICY: Medicaid gets screwed over on best price, Ignagni fibbing again.

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A little while ago I sat through a webcast starring my favorite factually challenged health plan lobbyist. Karen Ignagni said this about the costs of pharmaceuticals for Medicaid that are now bought instead by the private plans working under Part D:

"I’m hearing shock from (state) Medicaid directors that we’re getting better prices than they are"

At the time I postulated this

Ignagni is either lying here
(or massively overstating the truth from a few anecdotes), or going to
find a few men in sharp suits from the rich part of K street funded by
big Pharma coming down to see her carrying baseball bats.

You see, Medicaid plans get from pharma manufacturers
what’s known as “best price”. In other words if they give a better
price to another customer, they also have to give that price to
Medicaid. Medicaid is still of course buying its drugs for its
non-Medicare dual eligible population. The drug companies know this, so
I doubt that what she’s saying is true. But if it is true that
Ignagni’s health plan members are getting a better price than the
states are, then the states can go back to the pharma manufacturers to
get a better rebate — oh, and also prosecute Pharma companies for fraud
over not giving them best price, as has happened many times.

And today writing in the New York Times Milt Freudenheim has picked on the issue, which he calls  a Windfall From Shifts to Medicare. So was Ignagni telling the truth? Were the prices that Medicaid is now paying for its drugs via Part D lower than they were paying under the best price regime? Well take a wild guess.

Under that program, as it turns out, the prices paid by insurers, and eventually the taxpayer, for the medications given to those transferred are likely to be higher than what was paid under the federal-state Medicaid programs for the poor.

McLellan is also quoting the line that Part D is getting better prices, but the article has a raft of evidence suggesting that the drug companies think they’re doing better, and the states are being asked to return more under the "clawbacks"–the amount they are being billed as they no longer have to provide drugs for the dual eligibles–than if they’d maintained their own programs. Several states are suing the Feds about that.

Meanwhile, I still think that they ought to be able to go to the drug companies and get "best price" for the rest of their Medicaid drugs (unless someone can tell me they have an exemption under the law). Which I guess in the end may make this a wash, if the drug companies have to provide even cheaper Medicaid drugs.

But for now it’s just more evidence that Part D is a windfall for drug companies and health plans, and that AHIP’s President has been caught being extremely economical with the truth. Not exactly news, I know.

TECH/POLICY/RANDOM: Monday update

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Apologies for the quiet start today. A few things to keep you going with while I work on some other stuff off-line

MyMedwork is a MySpace/Linked in for physicians which has funding from a business accelerator started by bunch of big name mid-west medical orgs (including the Cleveland Clinic). Hey I (re-)met my fiancee on Linked-In so there must be something to this social networking stuff?

The first rumblings in the real business of health care—how much Medicare pays for what—are starting up. CMS is rattling the saber, and somehow managing to divert the attention onto 3M which is attempting to redesign DRGs and getting it in the neck for its troubles, apparently. Of course this is the beginning, not the end of a very long and ongoing process. The same thing is going on on the physician side around changes in the RVS system. The health plans have been muddying this water for some time, as I noted in my article about the punking of Milt Freudenheim back in June.

I’ve been having some fun backchat with Michael Cannon at Cato (the thinking man’s libertarian think-tank) over his riposte to my piece about Medicare HSAs. Well worth reading his response. More on that when I get my act together to edit our emails…Meanwhile over at Cato’s blog you should read anything Radley Balko’s written. He’s doing the best job in America about tracking the western liberal Democracies’ almost imperceptibly slow movement towards becoming authoritarian states. Did you know that “swearing” in public in the UK can now warrant a $130 on the spot fine at the sole discretion of the police?

Finally, working on some stuff on the new San Francisco health plan, which will emerge at Spot-on soon—now that I’m banned from writing about soccer for quite some time!

 

 

POLICY/POLITICS/HEALTH PLANS: HSAs for Medicare? Crazy but apparently true

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So the HSA ideology has wormed its way into CMS, and now Medicare is seeking proposals for its Consumer-Directed Health Plan demonstration. Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no-one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.

But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending. Perhaps we’ll get to see if the private plans really can stand on their care management merits—and there’s so much fat in Medicare that they ought to be able to, easily.  Although they failed to do so in the late 1990s.

However, it’s just bizarre to increase the costs of a tax payer funded universal risk pool by allowing people who are not paying into it to withdraw cash from it. So the only real explanation is that CMS and its political masters in the White House are eventually intending to put the entire system into a high-deductible plan and not fund the amount below the deductible.  Just the same as most employers are doing (as I explained in this Spot-on piece about Intel).  That of course makes perfect sense for the government and the taxpayer. Until, that is, the seniors find out! I wouldn’t want to be in charge of Medicare when that happens, remember what those seniors did to Rostenkowski!

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