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POLICY: Edwards meets Schwarzeneger & uses T word– NFIB flips out

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I was at a conference on Saturday when the Asst Sec of HHS in California and the former sec of HHS in Massachusetts managed to twist their tongues around how they were getting to mandates, with shared responsibility, provider contributions, employers cost-sharing, blah blah blah—and never a mention of a thing starting with T and ending with an ax.

John Edwards has decided to be brave and say that he can insure the uninsured with just that—a tax raise. Brave man. Foolhardy, perhaps! Especially as there’s plenty of money in the system now to do it—with just a little bit of redistribution (which Schwarzenegger is also pointing out).

At any rate the vaunted National Federation of Independent Business is out with its head firmly stuck up its rear. So perhaps he’s doing something right.

The National Federation of Independent Business, a powerful lobby that represents small-business owners, said such mandates amounted to a job-killing tax on small companies. “Health care mandates are a nonstarter for our members,” said Stephanie Cathcart, a spokeswoman for the federation.

I’ve said in polite terms what I think about the NFIB’s logic over at Spot-on a while back. Basically their members just can’t add up.

So now it’s time to be a little more direct. The best way to do this is perhaps to let you in on a little email chat with one of their number who thought that I would support his quest to get the Shaddeg bill into law. Clearly not a man who knows his audience. Here goes:

From: Ragley, Jay [mailto:Ja********@**ib.org” data-original-string=”n9ACey30+cwsaSVom4imPw==57d5NUDHbVds7yZf8SpwaD8VcwlatrvJ5G5jye/vBA9oVm+Co8SVAmZfSekHILSPxgIh2xSrZVhFVCyxVtv5/grdgoliz4ubdwRNUqScwTbqE4bSZphAvUBGdqiKj3rMclT4+ArCduR3agkogLXBuKVdSSxtMI0HQqaodKhXOzqI7UfJrSOaSCiYVWfm0GbpHqDTyY/2aLuWh4G21GZ+Z2G+3Ov28v2us0mJciYv2pRjsPK4cjHYtpypYKzrFcp7PndXk+VPyPYhUX/NBNiJBgXsuPnQghkUcqCTJ5ZEL/IkD0=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wednesday, December 20, 2006 1:23 PMTo: ti**@***************og.comSubject: Small Business Health Insurance EditorialTo Whom It May Concern at The Health Care Blog:

I don’t know if you link to published editorials, but I would submit the following editorial on some ideas our organization and our members are beginning to suggest in South Carolina.  If you choose to link it, I appreciate it and if not, I appreciate your consideration.

(Link to pro-AHP/Shaddeg bill article, which I didn’t link to—surprise surprise—whatever Eric Novack would like me to do!)

Jay W. Ragley

State DirectorNFIB/South Carolina

So I wrote back:

From: Matthew Holt [mailto:ma*****@*********lt.net” data-original-string=”5AXdh+tZQjClGmrSp+1J1g==57dDLGENGfl/yTAIeD84gScM19aKsljSsZUJPLmhWvdfvXs8mi8OsPiG2rATtDQmokH+YEeQBQmQIweAfcEnY8aHD8mgCWo2RhWFRsjrF3dfzQuVkI0bggchnxmBKksi/tla5h97f9rgY/kgWmBDsmjVCzvmOVV4iVXMfDPxTyglyJo97kpBshIR/P1nCxC/49QzezDa45zY1qTHpAe+dVggv+GpVcPP9evh62grJ3KgoSyFwPEJxp0Wo5VSETdUZx2izxshKGLUAagaHmrDYoXGrrA2Scf7611lRDAlaoP9nY=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wed 12/20/2006 4:59 PM To: Ragley, Jay Cc: Subject: RE: Small Business Health Insurance Editorial

Jay

You’re kidding right? Have you ever read THCB? I think that the NFIB is so, so dumb about this issue that it’s unbelievable. NFIB members offering health insurance are the group that would benefit the MOST from a national health insurance single payer scheme, and yet you insist on getting behind ridiculous solutions that make matters worse and will continue the cost escalation with no controls that cause the problem.

I’ve written about this here http://www.spot-on.com/archives/holt/2006/05/small_businesses_that_cant_do.html#more and I’m not going to berate you further. but I do invite you to respond to my basic assessment of why your position is so wrong for your own members.

 

All the best
Matthew

To which he gamely responded.

From: Ragley, Jay [mailto:Ja********@**ib.org” data-original-string=”l3Z/ThL4qhNnQvooKxM2SA==57dh55ie4EKFzEB0T8z/Y+mKW7kLi4LxMqJ/Mlye9KCmM7JqqtaDpJMDtIRF8JZAugBrIxxhuYG0y8DIMmQTwCT5gQE4JHbNj2YUe/1pmkyxSe6ZMs94PXW2tSaaLNR8RSPsb8NFa1eWuBE1FsFmszgH2WnFin7o/j7fPeJlMzoVR+TF4fbq0uIWkdAiAIFmM5FYYJxvf2GxQP3U/JdHfoz6+NN/66HW4SB2mWHT2cD5INO//fIihZhFg2PIBfOI47Tz1KJ5RQ90jndMUt+qgecTNHwfBbGJp81WxX984JMyCk=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wednesday, December 20, 2006 4:12 PMTo: ma*****@*********lt.netSubject: RE: Small Business Health Insurance Editorial

Matthew:

 

Thanks for your response.  I did read some of your blog but obviously not enough.  I’m new to NFIB and have been trying to work more with bloggers as most of the MSM don’t care about small business issues.  I’m not aware of any health insurance blogs in South Carolina (mostly political ones down here).

 

I did read the blog posting you sent me and I hope you understand how NFIB determines its public policy positions.  We send ballots to our members throughout the year on a variety of issues.  So, when NFIB supports repealing the death tax, it’s because a strong majority of our members (not a 51% majority) support that position.  So believe it or not, it is the small business membership of NFIB that determines our public policy positions.

 

But as far as a single-payer system, I will ask the same question I asked folks when I worked in DC.  As a supporter of single-payer system, can you claim with any degree of confidence that a government-run health insurance system will not bankrupt the government, the economy or both as we know it in the USA?  Whatever tax you choose to impose to pay for this system will, in all likelihood, lead to lower economic growth, which will lead to lower tax revenues and thus produce deficits, assuming that all other government spending is held constant (a big assumption given the recent spending increases in many government programs besides health care).  So the economy will sour to a degree, the treasury will collect less revenue and the government will have to a) borrow b) cut spending c) raise taxes again.  Seems to me the most likely scenario is raise taxes, which will only exacerbate the problem.  There is no free lunch.

 

So unless the single-payer crowd can find a way to not wreck the federal budget and the world’s most dynamic economy, my members will keep telling me to find free-market solutions.  They’re risk takers and would rather have the opportunity to grow at the best rate possible.I guess small business owners aren’t happy with a Japan-like growth rate; they want the opportunity to grow at any rate they desire and create for themselves, business, employees and family.

By now of course I’m getting a little feisty on that basic math question:

 

From: Matthew Holt [mailto:ma*****@*********lt.net” data-original-string=”JDjrALRS8PCagdRCqRa/KA==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” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wed 12/20/2006 6:34 PM To: Ragley, Jay  Subject:RE: Small Business Health Insurance Editorial

I understand that you represent your members and that their policies are what you follow. I would also humbly ask how many of your members know what share of GDP is spent on health care here versus Japan, Korea, Taiwan, Germany, France et al…you know the answer. Those countries spend virtually 50% the amount we do on health care. So you explain to me how spending 50% less on something bankrupts us faster than spending at our current rate (and our faster growth rates).

If government imposes a tax to pay for health care, but at the same time removes the cost of providing health care from business, how does that hurt business? It’s a revenue neutral move. And more importantly in the long run the example of all those other countries is that government (or some proxy for it) has a much better shot at controlling health care costs because the taxpayer realizes the correlation between increasing costs and their taxes going up. But in this country we don’t bother making that equation, and so we keep paying more and more for health care.

But I guess if you pay money to a private insurance company that incidentally keeps 15-25% of your money in its pocket for doing not much, then that’s not a tax–so it’s OK to spend money on health care that way. But I get very confused when you tell me other countries are "going bankrupt" when they are containing spending much better than us, because they are using the government rather than an ineffective insurance sector to control spending. Are you telling me that if they spent at our rates of GDP they would be better off?

And BTW whatever you believe about the Laffer curve, you may have noticed that taxes going down can also lead to huge government deficits. Or were you not paying attention for the last 5 years?
Matthew

To which, like a true booty-mercantilist, he resorted by appealing to my own best interests!

From: Ragley, Jay [mailto:Ja********@**ib.org” data-original-string=”+St87IHqm29dHYTKk5gJhg==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” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wednesday, December 20, 2006 4:51 PMTo: ma*****@*********lt.netSubject: RE: Small Business Health Insurance Editorial

Matthew:
 
Lots to digest here but not enough time tonight for a response.  Will get back to you.  Although I have to wonder, wouldn’t your consultant company go out of business with a government health insurance system?  I mean, you would have to get a job with the government I guess.
 
JWR

And I’m afraid I went for the non-technical KO:

From: Matthew Holt [mailto:ma*****@*********lt.net” data-original-string=”QkdSZ1v9InUYoZhZO2JTfQ==57d6pqDE5kIS7S4HMMhIKmt7TY0OwzT2y3+KzYlZT18GoPKHrpOIbGX9bZnnJhQWNM7VwgjTgZUQXNWTsX8jc6EvxsbeOF8A+ktjKBOedBNWAjjWfSykB8i4IlwtmGCoZj2Sf0lxcNWpTwIho20pkpOPQ==” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.] Sent: Wednesday, December 20, 2006 4:55 PMTo: ‘Ragley, Jay’Subject: RE: Small Business Health Insurance EditorialSo is it about doing the right thing, or hanging on to my business at any cost? Sounds like a paper-pushing unionized bureaucrat’s view to me!

And don’t worry–there are LOTS of people for whom a single payer system WOULD be very bad news (Insurers, drug cos, many doctors, many hospitals, etc) I just don’t think that small businesses can be counted amongst them!

Matthew

PBMs: Not responsible for anything much at all?

I have purloined this and reprinted almost in full from AISHealth.com’s Government News of the Week.

Caremark Rx, Inc. did not breach its fiduciary duties when negotiating drug prices and managing the formulary for a multi-employer health fund because it was not acting as a fiduciary, a federal appeals court ruled last month. The pharmacy benefit management (PBM) industry hailed the opinion, saying it sets a precedent for other lawsuits and state initiatives that claim PBMs have fiduciary responsibilities. In a Jan. 19 ruling (No. 05-3476), the U.S. Court of Appeals for the Seventh Circuit upheld a lower court ruling that found Caremark was not an Employee Retirement Income Securities Act (ERISA) fiduciary for the Chicago District Council of Carpenters Welfare Fund (Carpenters). The fund had sued Caremark, claiming it breached fiduciary duties under three multiyear contracts to provide Rx benefits to union members.The parties disagree about the nature of Caremark’s obligations under the contracts, according to the ruling. Carpenters portrays Caremark as its fiduciary, responsible for, among other things, negotiating prices with retail pharmacies and drug manufacturers on behalf of Carpenters. Caremark claims only to have agreed to provide the stated benefits at prices determined via "arm’s-length negotiations between Caremark and Carpenters," the ruling says.In fact, each contract provided that Caremark "was not a fiduciary as that term is defined by ERISA, and that Carpenters possessed the sole authority to control and administer the plan," according to the ruling. "Nonetheless, Carpenters alleges that, under the three contracts, Caremark has discretionary authority over the management and administration of Carpenters’ drug benefit plan and also exercises discretion and control over Carpenters’ assets," according to the appeals court. The fund contends this "discretionary authority" gives rise to fiduciary duties under ERISA, the ruling adds.Specifically, the union alleges Caremark has discretion (and therefore fiduciary duties) in four specific areas: (1) negotiations with drug retailers over drug prices; (2) negotiations with drug manufacturers over rebates and other discounts; (3) the management of the formulary program; and (4) the management of the drug switching program. Among other things, Carpenters contends that Caremark breached its fiduciary duties by charging the fund a higher price than Caremark negotiated with retail pharmacies, and by choosing drugs for the formulary that were more expensive so that Caremark could pocket extra rebates it obtained from drug makers, according to the ruling. The district court, however, found nothing in the contracts that required Caremark to pass through cost savings to Carpenters, according to the appeals court.Stephanie Kanwit, special counsel at PBM trade group Pharmaceutical Care Management Association (PCMA), described the appeals court decision as an "important ruling" that will set a precedent for other cases. <SNIP>. At least 20 states rejected PBM fiduciary and/or disclosure bills in the first half of last year, according to PCMA. The latest appeals court ruling makes clear from one of the most economically sophisticated courts in the country that these are matters of contracts, Kanwit contends. "It doesn’t do any good and, in fact, harms the interest of customers like this union to start claiming breach of fiduciary duty. That’s a red herring."Kanwit says PBM customers generally don’t want their PBMs to be fiduciaries. "Customers want the PBM to do what the Carpenters did here, enter into a contract," she says. "You do not want them to be in charge of what this court calls ‘discretion.’ There is no discretion about it. In a contract, here it is, here is the price. It’s spelled out."Others say the ruling on the federal ERISA law will have a limited effect on state efforts to impose PBM fiduciary duties. Some states have adopted or are considering legislation that says fiduciary duties exist between a PBM and any company or health plan that hires a PBM to negotiate rebates and other discounts from a drug company, says Sharon Treat, executive director of the National Legislative Association on Prescription Drug Prices, which has worked with states to develop PBM fiduciary laws."That legislation really isn’t affected by a decision that interprets ERISA, because these laws aren’t intended to interpret ERISA," she says. The legislation, rather, defines the relationship between contracting parties as a "fiduciary relationship under state law," Treat says, adding that states have had the right to regulate contracts since time immemorial. "How courts rule on ERISA is, in some cases, beside the point," she adds.

This may sound like complex legal stuff. And it is. I don’t know whether its reasonable or useful to call a PBM a fiduciary with the obligations that go along with it. But one hopes that, whether or not it is legally obligated to serve its clients’ interests, at least the PBM sincerely believes that its interests and those of its clients are the same. But I’ll leave you to be the judge of whether it really does.

TECH/PODCAST: interview with Rahul Singal, CEO of WorldDoc

Worlddoc3_1
WorldDoc is a company that sells an interesting mix of a consumer web tools based on PHRs, care management software and transparent PBM services. Its current customers are employers and regional TPAs & HMOs. I spoke with CEO Rahul Singal about the company, their business, and what he thought about the future of consumer services in health care. And to find out, you can listen to this podcast.

POLICY/INTERNATIONAL: A split in the libertarian right? (albeit a Canadian one)

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Buried at the end of a rant about the evils of the Canadian system from our northern brethren’s version of Cato/PRI—the Fraser Institute—is their solution for what to do about it all.

Canada should adopt a system like Switzerland’s that offers universal compulsory private health insurance that includes drug coverage. That way we could have both the benefits of cost-efficiency and the broadest possible access to advanced medicines and medical care," Skinner concludes.

Err.. so some libertarians do think that we should have compulsory health insurance including drug coverage? That’s not very free market of them. No wonder David Gratzer and John Graham had to run away! After all, I need here to quote what Cato’s Michael Cannon wants, or at least doesn’t want, from comments he’s written just last month on THCB.

You’ve been kind enough to put me in the "sensible libertarian" category in the past, so on behalf of all of us: yes, abolish mandates, abolish community rating, and let people group and pool voluntarily. Per Pauly and Herring, you might be surprised how much pooling you get. But if you’re still unsatisfied, this Guide to Subsidies can help:

Voluntary subsidies via insurance: good.Involuntary subsidies via insurance: bad.Involuntary subsidies via cash: less bad.

Michael and I will agree to disagree on the merits of mandated/involuntary subsidies (or community rating)/taxes et al—and for that matter on the validity of Mark Pauly’s body of work. But I’m surprised to see that the Fraser guys are coming down on my side of the line.

HOSPITALS: How much is too much?

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The only major hospital CEO to also be a blogger, Paul Levy at Beth Israel Deaconess, is wondering whether his salary of $1m is too much. My flip answer is, well of course it is, but would you turn it down?

Much of the issue is that salaries for high end positions are set “competitively.” In other words the compensation board of for-profit and non-profit institutions and wants to reward their CEO better than his peers. Like in Lake Woebeggon, every board in Boston and way beyond thinks it has the best CEO, so they deserve more than average—so the spiral increases. And the bigger the non-profit gets the bigger the salaries. Someone sent me a form last year with salaries for the top brass of Kaiser Permanente. I didn’t bother verifying it but I recall that it claimed that more than a dozen senior execs had total comp of over $1m.

I wrote a long article about this last year, called Overpaid Facility Managers?, looking at the salary of a decent sized community hospital in the SF Bay Area with some $300m in revenues—as opposed to Beth Israel Deaconess’ $1 billion. That CEO too was on close to $1m total comp.

The problem is that there are almost 2,000 hospitals of that size or larger. If all their CEOs get that amount, or even $500,000 a year, then the whole comparison inflation cycle goes on. And really how hard is it to run a $300 million business, where most of the income walks in the door because of location, referrals of agents (physicians) and government subsidies? I don’t know.

Paul compares himself to a sports star. But the sports stars make so much because they fill hours of TV cheaply which generates lots of advertising revenue. Would we watch the same teams with less good stars? I doubt it, and it’s for sure that the owners are not willing to risk finding out. Which is why the big stars who are measurably better in both statistics and winning percentage get so much more money than those not quite as good.  There are only so many Kobe Bryants, Ronaldinhos, Derek Jeters et al.

The question Paul needs to ask himself is not whether he works hard and does a good job relative to other big AMC CEOs. Of course he does. The real question is are there more than  couple of hundred people who could do his job roughly as well. In other words if the board changed out a .300 hitter for a .265 hitter, would the effect on Beth Israel Deaconess be noticeable the way it would be for the Lakers if Kobe was traded for a journeyman shooting guard.

My guess is that the cult of the CEO is well overblown. And that while Paul is by no means a big offender in creating it (and may be helping to knock it down), we are stuck in a cycle where no one dares take the risk the way the Oakland A’s do in baseball—get unrecognized young talent in, pay less for it and get just as good results. But it’s unlikely to change for some time.

TECH: Cisco Innovations in Healthcare IT Discussion Forum

Logo
I am the host for a Q&A forum hosted by Cisco. It’s a follow up to this video discussion about the use of IT in health care. Like most tech companies, Cisco is increasingly targeting health care as an industry where its networking technology can make a real difference—and of course where it can sell more of it! As you know I’m in general an advocate of more IT use in health care, and I think that they’re showcasing some interesting innovations.

So please come over to the discussion forum to join in the conversation. I’ll be referencing some of the more interesting things that I saw at Cisco there and here next week.

The BerkeleyMBA Business of Healthcare Conference

The BerkeleyMBA Business of Healthcare Conference is tomorrow. It has a good line up and those of you desperate to see me in the flesh can find me on the IT panel in the morning. Also on that panel will be people from Intuit, RelayHealth, iMetrikus, and Healthline. Other interesting speakers include MaryAnn Thode, the soon to be ex-head of Kaiser Hospitals, N. Cal; Kevin Young from Gilead sciences, and J. Carl Craft, from Medicines for Malaria venture. There are several other breakout panels, including one with Arnie Milstein from Mercer on it. I believe admission is only $80.

Of course if it was the Stanford Business School Conference it would be much better, I’m sure! But when I was at Stanford our football team was better than Cal’s—times appear to have changed.

PHARMA/BLOGS: Jim Edwards torpedoes own career!

Some of the best reporting on the pharma business in the last few years has come not from the mainstream press but from Jim Edwards, a reporter buried in the marketing industry trade press at Brandweek. Given the fact that certain Manhattan-based major press publications could use to improve their pharma and health care journalism (and I’m not talking about the WSJ, think more of dogs and sores!), I was hoping and expecting to get an email one day from Jim telling me of his new gig.

But instead, he’s decided to not only stay at BrandWeek but also to commit journalistic suicide and become one of us. His new blog is called BrandweekNRX. Pity. But I look forward to reading it!

PHYSICIANS/INTERNATIONAL: GPs making hay in the UK

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My dad told me never to become a doctor. As I failed physics "O" Level and wandered off into social sciences that was probably sound counsel for me, but in general his advice may not have been correct. With the bonus payments and a bunch of other incentives, it looks like British GPs are really making out these days. Apparently average income is now north of 100K GBP, which is far in excess of income for primary care docs over here (if you take it at the $2 to 1GBP exchange rate).

And they are pretty happy about it, or as we Chelsea fans say "top of the league and having a laugh"

TECH: Health plan uses novel security solution

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A smaller Pennsylvania Blues seems to think that it’s going to be providing access to their data to its members everywhere. It’s using some interesting security tools to do it.

Diversinet Corp. (OTCBB: DVNTF), a leading provider of mobile authentication security and access solutions, today introduced MobiSecure™ Wallet and Vault, new solutions that give users secure and immediate access to a host of personal, financial, and insurance identity information, as well as other critical, privileged data. Offering both convenience and security, the new MobiSecure products give banks and other financial institutions, insurance companies, and health care providers a unique and easy-to-use solution they can use to provide individuals with fast, convenient and secure access to new applications and services via mobile phone, PDA or PC browser. Diversinet also announced today it has signed a licensing agreement with Blue Cross of Northeastern Pennsylvania (BCNEPA) for the MobiSecure Wallet and Vault.

assetto corsa mods