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Tag: Policy

Expect to hear a whole lot about this…

Seniors care about death panels (apparently) but they usually really care about drug prices and costs. Part of the political rationale for the Republicans passing Medicare drug coverage in 2003 was to deny the Democrats the ability to bundle seniors’ desire for drug coverage with a universal coverage bill. So far the Republicans have to say the least muddied the waters as to whether universal coverage is a good thing for Medicare recipients—or at least the ones that don’t care about their kids or grand-kids.

But there’s one minor trick. The deal with big Pharma that’s part of HR 3200 cuts the donut hole in half. That’s real money for seniors.

And when the cuts to Medicare Advantage become apparent, that donut hole is going to affect many more seniors who now are getting good benefits from Medicare Advantage and are pretty unaware about what’s about to happen to those benefits, according to this recent Silverlink/Suffolk University poll. (Hint, many Advantage plans will get much less generous).

In that case, knowing that there is something in the bill that helps them might change some seniors’ minds. Right now the Silverlink/Suffolk poll does not make happy reading for the Administration:

The survey also polled Medicare recipients on healthcare reform. Despite high levels of satisfaction and relatively strong amounts of optimism, nearly half of Medicare recipients polled (48%) say they do not believe the Obama administration is looking out for their best interests when it comes to healthcare reform. The remaining are split, with 28% believing the administration is looking out for them and 24% unsure.

We’ll be back here in 2016, unless

I’ve been meaning for a while to put up a common sense post that points out that if we don’t do reform now, we’ll end up with cost at close to $30K per family as opposed to the $15K as they are now, and in turn that will mean 80–100 million uninsured as opposed to 50–60 million we have now, and of course the end result will be a health care industry that looks like General Motors.

But luckily Joe Paduda just wrote the post for me and added a date—go read at Managed Care Matters.

Which just leads to one conclusion. The health care industry had better buckle down with the Blue Dogs, put more on the table, and get something passed that they can live with now. AND in addition, they need to figure out some way to stop the loony fringe at the town halls and listening to Rush Limbaugh from making the next best alternative be doing nothing—which is what they want.

Otherwise the conversation they’ll be having with the President and the Chinese central bank in 2016 will be very, very unpleasant.

Neither Quick Nor Easy

Thomas Greaney

The idea of establishing regional cooperatives, advanced as an alternative to President Obama’s public plan option, has attracted attention as a means of assuring that health reform legislation contains some means to improve competition among health plans around the nation. But the proposal, which may have superficial appeal as a “middle ground” between a public plan option and an unchecked private market, is ill-equipped to fix the key problems a public plan would address. In addition, recent experience teaches that timely and effective entry by such plans is unlikely.

The first issue is whether a cooperative, organized by consumers or other groups, can effectively deal with the shortcomings of the existing delivery system and insurance market. Thus far, the proposal advanced by Senator Conrad is pretty sketchy, but are grounds for skepticism. A central reason for having government sponsored plans is to allow the efficiencies of Medicare’s well-established administrative structure and innovative payment experiments to carry over to the private sector. Coops provide no such advantage. A second advantage of public plans is that they would likely achieve some bargaining leverage by virtue of their probable role as insurer for people representing higher risks whom private insurers find some methods to avoid. Hospitals and physicians will be hard pressed to bypass such a significant presence in the market and the public plan can thereby exert market-wide pressure to keep provider and pharmaceutical costs down. Whether co-ops will be willing to undertake the role of covering such individuals or able to sponsor innovative delivery systems to treat them is far from certain.

In any event, it is hard to envision numerous regional coops gathering the necessary data, experience and reputation to serve as a benchmark or counterweight to dominant hospitals and provider groups across the country. Further, there is a serious question regarding the independence and mission of coops. It is a mistake to assume that nonprofit entities will necessarily work to the advantage of the public. Unfortunately, our experience with nonprofit hospitals and HMOs suggest that they can easily be persuaded to play along with other providers and may not always vigorously pursue their charitable mission. Keeping cooperatives’ eye on the ball would require close attention to the control and governance of such entities.

The second objection is based on timing and practical considerations. There is ample evidence from our experience with health insurance markets that developing effective coop-sponsored plans will not come easily or quickly. It is clear that new entrants into health insurance markets face a host of obstacles. The prevalence and magnitude of entry barriers is evidenced by the dominance and profitability of existing insurance plans. One or a handful of companies dominate most health insurance markets around the country and these firms have enjoyed consistent and robust profits. Economic theory would suggest that such profit opportunities should have invited entry by rivals eager to capture some of the profits available in those markets.

Additional proof of the obstacles to entry are found in the investigations by insurance commissioners into proposed mergers in their states. In Pennsylvania for example, the proposed merger of Highmark and Independence Blue Cross would have combined the dominant insurers in two large distinct geographic regions of the state. Evidence provided to the State indicated that numerous attempts by regional and national firms such as Aetna and Coventry to enter both markets had proved unsuccessful over the years. Expert studies suggested that a variety of factors including brand loyalty, difficulties in securing physician and hospital network contracts, regulatory and information gathering costs, and obstacles created by the contracting practices of incumbent providers, thwarted entry. Newly formed coops needing to acquire expertise and develop networks will surely face enormous difficulties penetrating markets.

Professor Greaney’s is a nationally recognized expert on health care law and the Chester A. Myers Professor of Law and the Director, Center for Health Law Studies, St. Louis University School of Law.  Thomas Greaney has spent the last two decades examining the evolution of the health care industry. He is also a frequent contributor at Health Reform Watch where this post first appeared.  His recent testimony to the Senate on “Competition in the Health Care Marketplace” may be found here.

Enthoven’s ABCDs and why that socialist Gingrich is wrong on standardized benefits

Here's Alain Enthoven's four part plan for fixing healthcare. As THCB regulars might guess, it's familiar and very sensible stuff. (Here’s the PDF)

A. Create an exchange with standardized plans, make individuals buy through the exchange and limit outside subsidies to the value of the lowest cost plan.

B. Tax health benefits (starting with those over the value of the cheapest plan)

C. Phase in the same system for Medicare

D. Phase out employer based insurance, giving everyone a voucher for the lowest cost plan based on a dedicated tax like a VAT.

Meanwhile in the LA Times, Newt Gingrich, who continues to smell blood in the Palin-infested waters, spouts BS that would destroy any sensible Enthoven-style reform. Apparently in Newt-world a regulated insurance package of standardized benefits is government bureaucracy run amok.

Continue reading…

Voices from the deserving mob

From the (UK) Independent. Real quotes from real people attending the free care in LA this week:

“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”

***

She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”

***

“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”

And that last one is the money quote.

Continue reading…

Shaking my fist at Jon Cohn

Today Stephen Hawking gets the Presidential Medal of Freedom. Not bad for a guy the British NHS had its “death panel” kill off in the 1960s.  Meanwhile the real star of the day is not the guy who was on Canadian TV yesterday, but instead it’s The New Republic health care guru (and blogger at The Treatment) Jon Cohn who was just great on the Colbert —even revealing to Colbert that his insurance policy included death panels too. Colbert of course thought that this meant he could have his staff put to death.

The Colbert Report Mon – Thurs 11:30pm / 10:30c
Jonathan Cohn
www.colbertnation.com

Fame! (In Canada only)

TV is fascinated by my views on American health reform. Well not American TV (you have to be called Michael Cannon to get on American TV).

Following my record-setting appearance on France 24 TV (record was fewest every viewers for a news show), today I’m going to be on CBC News. That’s CBC as in Canada. I think you can find it here and I should be on at 11.15 PST or 2.15 EST

Kids Can’t Vote but Health Reformers Should Still Listen

Alan_L._Goldbloom

Depending on who you listen to, health care reform in Washington is either closer to reality than it has ever been, or it’s on life support.   Competing ideas are all over the map in terms of how health care should be delivered in America, and how we should pay the tab.  About the only thing everyone seems to agree on is that the current system doesn’t work, and that we need to get something – anything – done.

But with all the energy and effort going into reform, getting “anything done” isn’t good enough.  This is a chance to change the core values of our health care system to deliver access to high quality, low cost care.  It’s time to “invest” in the health of our nation.  We can’t settle for anything less.

As president and CEO of Children’s Hospitals and Clinics of Minnesota, my number one concern is the health of children, and I feel a responsibility to be a voice for children in this debate.  The simple fact is, children don’t vote.  They don’t have political action committees and they don’t make campaign contributions.  But the decisions that elected officials will make about health care will have a huge impact on the health and well being of our children.

If we want to provide the best quality care for children, a few key principals must guide any and all health care reform decisions.

First, we need to address issues around Medicaid reimbursement.  Medicaid is the single largest insurer of children in the country. In Minnesota Medicaid reimburses only around 80 percent of the cost of care, and in many other states, it’s less.  In fact, for all the talk about poor Medicare reimbursement levels, Medicaid pays providers at rates 20 to 30 percent lower than Medicare.  That’s why more and more doctors and clinics are declining to treat Medicaid patients, leaving families without access to proper care.

The current House bill recognizes this inequity and proposes to increase primary care physician payments under Medicaid to 100 percent of Medicare by 2012.  However, it does not address inequities for other key providers such as pediatric hospitals and specialists.

At Children’s of Minnesota, we served more than 42 thousand children on Medicaid in 2008.  We treat all children regardless of insurance status, but Medicaid reimbursement rates do threaten our ability to provide the kind of high quality, specialized services we believe children in our community deserve.

The second key element to reform involves a simple philosophy: we need to reward quality rather than quantity.   My state, Minnesota, has a well-deserved reputation for delivering high quality, low cost health care. Because of this, our reimbursement rates are among the lowest in the country.

We are very concerned about any reform proposals that would apply across-the-board cuts to existing reimbursement rates, without taking into account the value of care already being delivered.

We need reform that provides incentives to caregivers to be innovative around efficiency.  We should be rewarding providers who develop unique care models that eliminate waste while delivering excellent results.  Only then will we see the cost savings that health care reform advocates are promoting.

Finally, we need to change the way we think about health care for children.  Providing health coverage for all children should not be a luxury in this country.  We have already acknowledged that every child has a right to an education, and as a society, we pay for it.  Children’s health care deserves the same support.  After all, the money we spend on children’s health is an investment that pays off for 70 or 80 years, not only in productive lives, but in avoidance of long term health costs. No other health care expenditure has that kind of return on investment.  The needs of children must be front and center in this debate.

There are no easy answers for health care reform.  Honest and thoughtful people can disagree on how we should go about changing the system.  But by sticking to these core principals around Medicaid reimbursement, encouraging efficiency, and investing in children, we will have a good foundation to build on.

Alan L. Goldbloom, MD, is president and CEO of Children’s Hospitals and Clinics of Minnesota, the 7th largest pediatric health system in the United States.  Previously, Dr. Goldbloom was executive vice president and chief operating officer at The Hospital for Sick Children in Toronto, Canada’s largest children’s hospital.  After graduating in medicine at McMaster University in Hamilton, Canada, and training in pediatrics at Boston Children’s Hospital, Dr. Goldbloom practiced General Pediatrics and served as Director of Residency Training at both Dalhousie University in Halifax and at the University of Toronto, before becoming involved in hospital management.

And the real reason health reform matters

And in case you’d forgotten what the health care reform battle is really about, here’s video from Reuters about an open air clinic for the uninsured in Virginia…