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HEALTH PLANS: Insurers getting lambasted

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First, 24 hours after being shamed in the LA Times, Wellpoint has backed down on getting docs to check up on whether their patients should have their insurance recisionned (is that a word?). It’s good to know that someone’s setting insurance policy in this country even if perhaps Lisa Girion wasn’t actually elected to the job!

Then it gets announced that the AG of New York state (traditionally a post filled by a  kick-ass hungry Democrat, these days Andrew Cuomo) is going after UnitedHealth sub Ingenix and a whole raft of insurers it works with on price fixing/reimbursement rate manipulation. What particular part of a health plan’s business practices Cuomo is going after it’s hard to tell. There’s usually plenty of choice!

But it is clear that if anything gets done about health care in the next cycle, insurers are front and center in the politicians sights.

And if you think this is just me talking, check out libertarian Arnold Kling, who for some strange reason manages to get his stuff on the op-ed pages of the WSJ. He basically agrees with me.

Let’s All Ask Secretary Leavitt To Explain HHS’ Schizophrenia On Medicare Physician Data – Brian Klepper

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Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.

Continue reading…

CDC Officials Blocked Public Health Report

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By MAGGIE MAHAR

The Center for Public Integrity, a public interest investigative journalism organization, has obtained copies of a Centers for Disease Control and Prevention (CDC) study of environmental and health data in eight Great Lakes states that was scheduled for publication in July 2007. The report, which pointed to elevated rates of lung, colon, and breast cancer; low birth weight; and infant mortality in several of the geographical areas of concern has not yet been made public.

A few days before the report was slated to be released, it was pulled. Meanwhile, at precisely the same time, its lead author, Christopher De Rosa, has been removed from the position he held since 1992.  The Center for Public Integrity is asking why.

The study, “Public Health Implications of Hazardous Substances in Twenty-Six U.S. Great Lakes Areas of Concern” was developed by the CDC’s Agency for Toxic Substances and Disease Registry (ATSDR) at the request of the International Joint Commission, an independent U.S-Canadian organization that monitors and advises both governments on the use and quality of boundary waters.

The CDC report brings together two sets of data: environmental data on known “areas of concern” — including superfund sites and hazardous waste dumps — and separate health data collected by county or, in some cases, smaller geographical regions.Continue reading…

HEALTH PLANS: Wellpoint can’t leave bad enough alone

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You’d think the folks at Blue Cross of California or in their parent corporation in Indianapolis would have heard of Lisa Girion of the LA Times by now. Do they really think that by compounding the PR disaster they had with the recission stories of last year their public image is going to be helped by sending their prospective members’ applications to doctors and asking them to check them?

Health plans already ask doctors for medical records of their patients. And that’s a big enough pain as it is. Now it’s apparent that they’re asking them to check the forms of new enrollees. Their explanation that it’s for the good of the medical groups taking capitation probably doesn’t wash, as it’s probably the patient’s previous medical group which has the relevant information. Here’s the through the looking glass story from Lisa Girion at the LA Times.

My only assumption is that Wellpoint has decided that it can get away with basically anything and is desperate to make hay while the sun shines. After all no corporation can get away which such silly behavior for ever.

Hating employer-based insurance, Chelsea Clinton-style by Michael Millenson

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Chelsea Clinton is complaining about her health insurance. As a self-employed consultant, I almost felt sympathetic, until I saw she works for an asset management firm, Avenue Capital Group, that manages just over $20 billion worldwide. They are able to accomplish this with just 350 employees spread out over (take a breath): New York, London, Beijing, Bangkok, Hong Kong, Jakarta, Luxembourg, Manila, Munich, New Delhi, Singapore, and Shanghai.

The company’s Web site says the core team has been together for many years, so I strongly suspect the pay and benefits are actually quite, quite nice. Chelsea told CNBC she is “not happy” with her health insurance, but she didn’t offer enough detail to determine why her health benefits are so markedly inferior to the ones her Mom enjoys as a senator and that she’d like all Americans to be able to access.

Avenue Capital is more colloquially described as a hedge fund specializing in the debt and equity of “distressed companies.” I thought only Republicans did that kind of work, but it turns out her boss is a big Democratic donor. Poor Chelsea — first Stanford, then Oxford, then McKinsey & Co., and now this, stuck with “job lock” in a career that pays an ambitious 27-year-old just a few hundred thousand dollars or so annually on her way to a dreary low-seven-figure compensation. Who knows what hardship her health plan forces her to endure?

Call me cynical, but for that kind of money, you don’t need to buy into your senator’s health plan — you can buy the whole senator!

Editors Note: It’s worth mentioning that although Michael is a general purpose cynic he’s also a declared supporter of Obama for President.

PHYSICIANS: Your data is wrong!

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Read this article from the Dallas Morning News called Insurers’ ratings often aren’t accurate, doctors complain. It’s very very important, in that it explains both what’s wrong with using claims data to do analytics without working a little harder than most insurers want to, and also how the AMA is gearing up to beat back P4P, physician segmentation, Consumers checkbook and everything else in one simple phrase.

"Your data is wrong and I’m a good doctor"

TECH: Beating up on Maggie’sFarm Blog

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Maggie Mahar’s blog HealthBeat is so good that I’ve been itching to find something wrong over there to criticize! (That’s a British trait of criticizing your heroes; sorry!). And finally I have. Her co-conspirator Niko Karvounis wrote a piece on eVisits that’s so off the mark I had to go off in the comments over there. 

The rest of you go there and take a look at what Niko said about The Downsides of Virtual Medicine and at my comment. And of course pay more attention to the fantastic stuff Maggie (and usually but not in this case, Niko) writes there—as well as here….

HEALTH PLANS: Who said this….?

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In one of the many newsletters I diligently peruse so that you don’t have to be contaminated directly I read this. Astonishing, even considering the source.

I had a terrific opportunity to speak to 700 health insurance agents and brokers on Tuesday morning, here for the Capitol Conference of the National Association of Health Underwriters, most ably led by CEO Janet Trautwein. These people are entrepreneurs who are on the front lines of saving the private market for health insurance in this country, and they are my heroes.

So who is it who thinks that this country’s health care heroes are the insurance brokers and underwriters who are in fact just waste motion making money off our dysfunctional insurance system? Answers/guesses in the comments please…..

CODA: I was actually speaking at a PRI event last year and met an insurance broker who explained to me that he was giving wonderful service to his clients. I with a hint of cynicism asked him what he meant and he said that he was helping them navigate the health care system, finding them the right doctors and negotiating with hospitals for them. I pointed out that those were the functions of a health advocate not a traditional insurance broker. He agreed. Hmmm…I said so you want to move your business from commission based insurance sales to fee-based consumer advocacy, and he told me that he had even been discussing this with Sheila Kheul (the main proponent of single payer in California) as a potential role for brokers in a single payer world.  How many health advocates like you do you think we need in California, I said. About 2-3,00 he said. How many health insurance brokers and underwriters are there in California I asked. About 50,000 he said.

That leads to me thinking that this bunch isn’t going quietly into the night….but then again they’re "heroes"

POLICY: Has the dog’s sore not completely healed?

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The NY Times has been getting much better in its reporting on health care policy. After all David Leonhardt had Shannon Brownlee’s book as economics book of the  year! And they’ve been getting Jack Wennberg in frequently.

But every now and again something crops up that worries me about it’s desire to go straight adn reminds me of that dog with the licking problem. Today it’s the idea that concerns about health care costs are global, which I guess is true, and that the rest of the world–where employers often don’t pay for health care–is becoming more like the  US where employers do. The short piece is called Going Global With Concerns on Health Costs and the casual reader might think that systems are converging around the idea that employers should pay for health care because governments can’t afford to.

Leaving aside the basic point that the route by which money is raised to pay for health care is not very relevant compared to how it’s spent and the system by which people get coverage, the article makes two tiny confusions.

First, as it says, it’s supplemental health care costs that employers are paying for in most countries–and in many countries like the UK they’ve done that for decades. Here employers pay for everything. that’s a massive difference.

Second, the increase in percentage paid by employers is only big enough to grow really fast in 4 countries. Those are India, China, Venezuela and Russia. Not exactly health care systems that compare to the US. Our health care system is bigger than those economies!

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