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POLICY: Can You Really Mandate People To Buy Health Insurance? by Robert Laszewski

Jan 10, 2008• 13

Robertlaszewski This evening THCB welcomes our newest contributor. Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog. Can you really mandate people to buy health insurance? That’s not so much a policy question as a practical question and it is what Hillary Clinton seems to be saying
is the big difference between her health care reform plan and the health reform plan of Barack Obama. That’s why a news story this week out of Massachusetts caught my eye.

It seems that the Mass Department of Revenue is in the process of drafting new regulations to up the penalty for people who do not buy health insurance. If they are approved, the maximum penalty for those who do not buy health insurance would jump from $219 per year to a maximum of $912 in 2008. The penalty is estimated to be half the per person cost of the lowest priced health plan available.

Penalties would vary by age and the time a person was without health insurance.
A 26 year-old would have a penalty of $672 per year and those over 26
would pay $912. So, a family of two adults over 26 would pay about
$1,800 in penalties if they didn’t buy health insurance (a reader has correctly pointed out children are not covered by the mandate).

Health Wonk Review Is Up! – Brian Klepper

Jan 10, 2008

Our good friend Bob Laszewski is host of this edition of Health Wonk Review, which consistently displays a collection of the best, most insightful health care writing around the Web. Maggie Mahar and yours truly are represented from THCB. Drop by Health Policy and Marketplace Review for Bob’s thumbnail sketches of each column. Indulge yourself for a half hour and read them all. It reminds you how dedicated and superbly thoughtful our colleagues are.

Leveraging The Doctor As A Trusted Authority – Brian Klepper

Jan 10, 2008• 3

I was on the phone with my good friend Bill
Bestermann MD yesterday. Dr. B, a preventive cardiologist who is
passionate about the underlying mechanics of cardiovascular disease and
the horrific toll the American diet and lack of exercise is taking on
everyday people, lives in spectacularly beautiful, rural Kingsport TN.
He told me he was driving through town, channel surfing on his radio,
and he happened upon the station that broadcasts information for the
local schools. They were announcing the menu in the school cafeterias.
He said it was appalling. "Honeybuns and processed foods. It was all
the stuff I tell my patients to avoid."

POLICY: Self-employed, and going it alone

Jan 10, 2008• 9

If you want to understand why an individual mandate in a community rated state won’t work without both significant reforms to the insurance systems and a whole new range of taxes and subsidies, read this experience of a healthy mid-20s writer in New Jersey who’s self-employed, and going it alone. Of course if she was living in California, she’d be able to buy a much cheaper policy–but then no sick person in California can get individual insurance.

Perhaps enough of this and it will dawn on people that we need a single pool funded by ability to pay….

On a side-note, any idiot can see that a single pool guaranteed universal system would help solo freelancers and small business people. And of course the NFIB leads the charge against it.

POLITICS: Just Saying No to crass politicization

Jan 9, 2008• 3

Yeah, I know it’s not likely that anyone will pay attention given the season, but I do feel that there are enough cases with which to bash insurers which are legitimate that John Edwards didn’t have to start politicizing one in which not only was the insurer’s argument pretty good, but about which a government-sponsored universal system would also have to make the same choices. So I’m up over at Spot-on about Just Saying No.

To separate himself from the Democratic front-runners former Sen. John Edwards has spent the last few days laying into insurance company, Cigna, for its failure to immediately approve a liver transplant for California teenager, Nataline Sarkisyan. That action, says Edwards, in concession speech after concession speech, is emblematic not just of the health care system’s break-down but of a failure of the current American political system.

Edwards like most Democrats wants a single payer health system and his plan is the closest of the three front-runners to providing one. But his advocacy of Natalie Sarkisyan’s case raise a question no one else seems to be asking.

Here’s the rest

On Practical Reforms – Brian Klepper

Jan 9, 2008• 11

Now that health care reform is once again an active, visible issue in state governments and the presidential campaigns, the ideas are flying fast and furious. Predictably, some ideas are better than others.

Over at Health Care Policy and Marketplace Review, Bob Laszewski asks an important, practical but vexing question for universal coverage advocates: Can you really mandate people to buy health insurance?

POLICY: Ian Morrison–to be thrown out by the Paisley Fabianists club

Jan 8, 2008• 7

In a great article called The Fallacy of Excellence my old boss and friend Ian Morrison explains what we intuitively know. people don’t understand that more care is not better care. This is going to lead to lots of political problems as we get to righting the Wennberg-illuminated wrongs.

On the other hand, Ian’s lifetime membership in the Paisley Fabian Society will probably be revoked when they find out he’s been watching the Republican candidates debate…..

INTERNATIONAL: Those damn froggies beat us again

Jan 8, 2008• 1

Here’s one international comparison I’d missed when it originally. The US has fallen to last place amongst 24 developed nations in an index of preventable death–one presumably cooked up by a Marxist cell masquerading behind a front organization called the London School of Hygiene and Tropical Medicine and funded by that cabal of Trotskyites known as the Commonwealth Fund. We’ve fallen four places since last time and are now even behind the Brits & the Irish—who I’ve always thought encouraged preventable death.

What’s happened is that every other nation showed significantly better measures relatively quickly (over a 5 year period to the early 2000s) and the US didn’t improve much at all.Who came top? Yes, those darn French again.

And their President is shagging a super-model. It makes me long for the days of JFK and Marilyn Monroe.

POLICY: It’s official–2 Trillion Dollars

Jan 8, 2008• 2

For everyone who’s been going on about our (adopt Dr Evil voice) 2 Trillion Dollar health care industry, it’s now official. The 2006 data is out and we’re at 16% of GDP, $2.1 trillion and $7,000 and change per head. Growth, somewhere at the bottom of the trough, is around 6.5%. That’s nominal not real of course, but it’s still way over the economy’s growth rate, and that gap will grow if/when a recession hits.

The major change of course was the introduction in 2006 of Medicare Part D which mean that drug spending increased at over 8.5%. But then again, they’re telling us that Part D was less than originally projected. Although I bet you no one in CMS (or now out of it) will tell you what really was originally projected, and in fact which of the many revised projections the $41 Billion costs of Part D was really below!

And of course assuming that cost increases were stable in 2007, we’re actually already at 2.1 trillion + 6%, or 22.35 trillion!

PODCAST: Interview with Michael O’Neil GetWellNetwork

Jan 8, 2008

This podcast I did with Michael O’Neil who is the founder of GetWellNetwork. Michael had an episode of cancer relatively early in his adult life and although he was the recipient of great medical care from one of our nation’s leading academic medical centers, he was also very upset about the quality of the in-room patient experience. The result is a new system of using the TV to improve patient care in hospitals. You can hear much more in the interview.

On a technical note: this interview was conducted in the middle of a significant California winter storm, so there will be occasional tricky patch. Thanks for your patience and thanks to Michael too for his.