Tag: Policy/Politics

So will the public option hurt hospitals? Not in the Ozarks

I've had this sitting in my inbox a while, but I thought that with the Senate bill out it was time to have a bit of weekend fun with it. The topic is the fear that a public option/government-run health plan/Hitler-ization of America (delete where applicable) will of necessity put all those worthy private health plans out of business. And worse because it will impose government's lower pay rates on providers, it'll also put them out of business, or at least into a position equivalent to that of Ukrainian peasants working on a collectivized farm.

Everywhere you go in the hospital world you hear complaints that Medicare pays less than private payers, and that the private insurance business is the only thing keeping providers alive.

Everywhere but Orark mountains of southwest Missouri and Northeast Arkansas.

Paul Taylor is the CEO of a tiny hospital system there called Ozarks Community Hospital. It's basically a safety net hospital and it only gets about 5% of its business from the leading commercial insurer, Blues of Missouri–part of Wellpoint. And does Wellpoint pay more for its patients than Medicare?



In fact this chart shows that it pays less than half in many cases. I thoroughly recommend you read Pauls blog piece on the topic from which I lifted that chart. It's an entertaining, detailed and sensible read.

But what he's saying is that a public option will be better for hospitals serving lower-income populations than a simple expansion of private insurance.

Modest step in the reform journey shows the idiocy of our political system

It does seem to take a health care bill to remind us all how incredibly screwed up the political process is in these here United States. The Medicare Modernization Act was railroaded through by Tom Delay and friends using all their charm and finesse. And last night the House passed its version of the health reform bill. It includes employer mandates, exchanges, subsidies, public option and taxes on those earning more than $500,000 to close the cost gap. And CBO in its wisdom says that it doesn’t increase the deficit.But it didn’t pass by much. 40 Democrats opposed it. These were the Blue Doggers who needed some political cover to be able to say in 2010 that they were against the bill before they were for it. Their expected course of action is that a less liberal bill comes back from final conference with the Senate which they can support. Apparently out there in purple state land uninsurance and egregious health plan behavior are not a problem—at least not compared to the desire of the people to protect the incomes of those earning over $500,000 a year.

But in order to stop even more Democrats opposing it at the last moment Pelosi had to let some previously unheard of Congressman called Stupak become the mouthpiece of the Catholic Bishops who decided that they needed to impose their views about reproductive medical care into the debate. Cynics like me may wonder about the validity of views on that issue from a bunch of old men who’ve allegedly never been married or had sex with a woman, and whose main contribution to child welfare over the past few decades has been to ignore and assist in flagrant abuses of it by their colleagues. But no matter, over recent days they started putting pressure on various Democrats to tighten restriction on Federal funding of abortion.Continue reading…

Good Intentions Aren’t Enough with Health Care Reform

Sarah-palinFormer Alaska Governor Sarah Palin’s widely publicized comments on death panels and  rationing this August were among the opening shots of an unprecedented national fight over health care reform. At the time, few sober analysts would have predicted that Palin’s criticisms would gain traction. Yet, they found a receptive audience among conservative opponents of the Obama administration’s health care reform plans, triggering an ugly battle between supporters of reform and right wing opponents.This weekend, Gov. Palin returned to the healthcare debate with another post to her official Facebook page that touches on the talking points you’re likely to hear in the months to come from Republican critics of the Obama administration’s health care reform efforts.  In the spirit of debate we are republishing the post in its entirety. — John Irvine

Now that the Senate Finance Committee has approved its health care bill, it’s a good time to step back and  take a look at the long term consequences should its provisions be enacted into law.

The bill prohibits insurance companies from refusing coverage to people with pre-existing conditions and from charging sick people higher premiums. [1] It attempts to offset the costs this will impose on insurance companies by requiring everyone to purchase coverage, which in theory would expand the pool of paying policy holders.Continue reading…

Silly Season: Monty Python Policy Making

Editor’s Note: Ian Morrison today makes his first contribution to THCB. Ian was President of Institute for the Future where I learned my health care consulting trade in the 1990s. A more amusing boss one couldn’t have hoped to have and he never minded me (or half of health care) shamelessly stealing his jokes–although his Scottish brogue always gave them a zing none of us can quite match. Ian’s now a full time speaker/writer/futurist and he gave THCB his view of the health care debate, interpreted logically through the lens of Monty Python’s Flying Circus–Matthew Holt

Now we are down to the really fun part of healthcare reform, when they actually write the final bill and figure out ways to pay for it.  And to honor the 40th Anniversary of Monty Python’s Flying Circus’s debut, Congress and the Administration have entered the silly season where final policy is turned into law.

I love the American healthcare system, not because it is the best in the world, but it is the funniest. The laughs keep coming.  Here are a couple of my latest favorites.

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Why AHIP needs the public option

It’s been a fun week. After years of THCB explaining that neither could AHIP do genuine research nor could its venerable President open her mouth without lying, the rest of the world has caught on. I won’t rehash the blow by blow here—Jonathan Cohn is among many who’s done that already—but essentially AHIP commissioned PWC to include the half of the analysis about the Baucus bill that was favorable to them and leave the rest out. And the fall from grace has been particularly fun to watch. Even the whores from PWC who wrote the report criticizing the bill have been backing away from it. And some astute commentators think that the debacle has helped the likelihood of a more liberal bill’s passage.

Now to be fair (or overly fair as they’d never concede this to the other side), the insurers have a point. They loaded Baucus up with lots of cash and put a former Wellpoint exec in as his chief of staff. They romanced the White House and kept quiet when Pelosi and the rabble criticized them. The deal they thought they’d cut was that they would give up the way they currently make money by underwriting and risk skimming in individual-small group and being overpaid for Medicare Advantage, and in return they’d get 45 million more customers, all forced to buy insurance and subsidized by the government to do so.

But somehow along the way the Democrats, despite lots of tough talk about “bending the curve,” lost the cojones to find even a mere $100 billion a year to redistribute from the probably $1 trillion waste in our $2.5 trillion health care system.

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Health Care Reform Lite

J.D. Kleinke


“The only constant in health care is change.”  It’s one of those shop-worn things you hear too often on health care’s rubber-chicken circuit; and not only is it not true, but it is exactly untrue.

Of course, there is one thing different in 2009: everybody gets to whine about it on Facebook.

So too health care reform.  When the “journalists” at Fox News, the red-faced demagogues in Congress, and the alarmists in your organization are done ranting about “ObamaCare” and the sky falling, understand that the essence of the health care bill moving forward today is one very simple thing: a violent endorsement of the status quo, paid for with an artfully diffused redistribution estimated to cost, on an annualized basis, less than 4 percent of the system’s annual $2.2 trillion haul.

Under the plan that looks most likely to pass after some classic Capitol Hill 3 a.m. horse-trading – this time between the grumpy far left and poll-sitting centrists on both sides of the aisle – health care “reform” will involve little of substance beyond (1) the long overdue jamming of 46 million people currently outside the system into that system, and (2) an equally long overdue prohibition against health insurers kicking them back out.  For the middle-class taxpaying swing voter in denial of what could happen in 90 horrifically unlucky days at their job and within their bone marrow, i.e., the average voter with coverage they might not be able to afford after simultaneously being fired and getting leukemia, #2 is worth the entire effort – and the reason any politician of calculation if not conscience should vote for the plan.Continue reading…

Medicare and Health Reform: Part II



In his closing remarks to the Senate Finance Committee last week, Senator Baucus pointed with special pride to the effect the Committee’s reform bill will have on shaping the health care system in the longer run:

One point I want to make… is about delivery system reform.  We are starting here in this bill to finally reform our delivery system so it’s based much more on quality and patient focus, moving ever so slowly, but inexorably, from fee for service….which causes a lot of the waste in our system. We’re not going to see savings, the benefits, to the system for a while… but after four, five, six years from now, we’re going to see the real benefits of reform.Continue reading…

Let’s Not Lose Sight of the Goals

Picture 4

I love Daniel Schorr.  I’ve never met him in person, but I love his voice and his insights about politics on NPR’s Weekend Edition.  But this morning I was disappointed.  After listening to his comments on the Olympics and Iran, I looked forward with anticipation to his thoughts about the Senate Finance Committee’s accomplishments earlier this week on health reform legislation.  When asked whether a “real health care bill” is likely to pass later this year, he said, “Well, it begins to look more [likely] . . . that there will be a bill.  The question is not whether there will be a bill . . . but what will be left in the bill, because so many things have been taken out.”  I could almost hear him sigh.  He went on to talk about the fact that the public option is not a part of the Senate Finance bill, although it might be restored in full or part (through a trigger mechanism or health cooperatives) as the bill moves through Congress. Let’s step back for a minute.  (This is what I usually rely on Schorr to do for us.)  Where were we a year ago?  Although advocates of health reform were encouraged that the health care crisis was getting a lot of attention in the Presidential election campaign, the outlook was not rosy. Obama and McCain were neck and neck, and McCain’s reform proposal was so weak as to be laughable.  The pundits and pollsters were predicting that the Democrats would get about 56 seats in the Senate – not enough to overcome a filibuster.  And there was serious concern that even if Obama were elected, health reform would be crowded out by other major crises – the threat of a serious economic depression, the banking collapse, Iraq/Afghanistan/Iran, energy and global climate change, and who knows what else.  In October 2008, the likelihood of serious comprehensive health reform was probably about 25%.

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Olberman, hysterical hypocrisy expose

A really fun piece from Keith Olbermann as he shows how the entire Gang of Six and more voted for fully socialized flood insurance and yet seem to have a problem with an independent government run public option.  

Of course, now that a bill has finally left Baucus committee, our meandering towards a relatively inconsequential tinkering at the edges of the health insurance market is a little further down the path. But can we somehow arrange it that the bozos at the NY Times (yes I’m talking about Robert Pear and David Herzenhorn) please stop saying things this dumb:

the Democrats are trying to restructure one-sixth of the economy, writing a bill that will affect almost every American, every business and every doctor and hospital in the country.

The level of exaggeration in that statement is simply unworthy of the paper of record. Would that it were true.

Money-Driven Medicine film now downloadable

If you want to watch the documentary Money Driven Medicine based on Maggie Mahar’s book, it’s now available for free download at (the DVD is also available for purchase). The free download is part of an ongoing “Watch-In! For America’s Health” — a national viewing party organized in conjunction with the Consumers Union.


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