The Health Care Blog – Page 873 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What Obama Must Demand from Congress on Health Care

Sep 8, 2009• 23

By ROBERT M. REICH

Congress returns this week to one of the fiercest and most important debates in recent memory — whether and to what extent the nation will provide health care to all Americans, and how we will reign in the soaring costs of health care overall. But do not expect unusual courage from this Congress in standing up to demagogic lies and money-toting lobbyists. An unusually large portion is facing close races in 2010, both in primaries and in the general election. Republicans have many primary challenges from the right. A record number of Democrats, who took over Congress in 2006, hail from traditionally Republican or swing states and districts.

In order to get anything meaningful through this session of Congress, then, the President will have to give congressional Democrats far more leadership and more cover. Doing so is harder now than before the recess, when he was still basking in the afterglow of a honeymoon and 60 percent favorabilities.Yet it’s not too late. Addressing a joint session of Congress next Wednesday is a good idea but Obama can’t rely solely on his exceptional rhetorical skills. He’ll need to twist arms, cajole, force recalcitrant members to join him, threaten retribution if they don’t come along.

Most importantly, he’ll need to be specific about what he wants — especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business.

No Alternative: An Analysis of the GOP Plan

Sep 8, 2009• 38

By HARRIS MEYER

Congressional Republicans have been blasting away all summer at the Democrats’ health reform legislation. But they might face heavy blowback if more Americans took a close look at two ambitious health reform bills sponsored by GOP lawmakers.

While the GOP plans include some worthy ideas, they have fatal policy flaws at their heart, largely related to insurance risk selection. Plus, they’re vulnerable to many of the same big-government political attacks leveled against the Democratic proposals. That may be the reason Republican lawmakers aren’t talking up their plans at the stormy health care town hall meetings they’re hosting across the country.

The two bills – the Patients’ Choice Act (PCA), sponsored by Oklahoma Sen. Tom Coburn and several House Republicans, and the Health Care Freedom Act of 2009 (HCFA), sponsored by South Carolina Sen. Jim DeMint – have a fair amount in common, though DeMint’s bill is the more conservative and deregulatory of the two.

More surprisingly, each bill shares some features with the Democratic proposals – including health insurance exchanges, subsidies for the uninsured to buy coverage, insurance market reforms, accountable health organizations, and a national rulemaking commission. The sad part of the nasty, mendacious political debate this summer is how little Republicans and Democrats have focused on those big areas of agreement.

Happy Trails, Trigger

Sep 8, 2009• 3

By ROGER COLLIER

Okay, my apologies to Roy Rogers, but I was pleased to see in the New York Times that the idea of a public plan trigger is finally getting serious consideration by the White House and by Senate Finance Committee members.

I proposed the trigger concept in a piece that ran in THCB back in March. It was clear then that a nationwide public plan faced very considerable political obstacles, and I suggested that a more acceptable approach might be to establish a public plan option that would be implemented only where and when private plans failed to meet predetermined cost control targets.

Senator Olympia Snowe proposed the trigger approach to fellow members of Senate Finance some weeks ago, and the NYT reports that the White House—desperate for at least one Republican vote in the Senate—is now analyzing its political feasibility and practicality.

Senator Snowe’s approach, reflecting the situation in her home state of Maine, where the market is dominated by a single insurer, would tie the trigger to affordability, rather than to cost control. This approach has political advantages, but could be labeled as unfair, since it includes a factor that private plans cannot control—individual incomes—in the trigger comparison. It also has the disadvantage of focusing on individuals who are just above the Medicaid income threshold. To achieve affordability for this lower-income group could mean a public plan network virtually identical to that of Medicaid, raising the question: why not just allow this group to buy-in to Medicaid?

Healthcare Reform: Strangled In Its Bed

Sep 8, 2009• 3

By JOE FLOWER

Follow the bouncing ball here: Health care was a mess, cost way too much, sick people getting dropped by insurance companies and left to die and bankrupted and all that. The obvious solution: Go to a single-payer system, or at least to a universal, subsidized, heavily-regulated private system, like all those other countries who pay half as much or less for better results.

But that would never fly, because the health plans are way too big and employ a lot of people, including a zillion lobbyists, so politically, forget it. We’ll back off and cut a deal.

Here’s what the new deal was supposed to be: We’re not going to wipe out the insurance companies. What we’ll do is offer people an alternative insurance plan, a “public option.” It will be cheaper because it will only pay 5% over Medicare rates, but doctors and hospitals will be mandated to take it. And it will also be cheaper because it’s a government offering, so it takes out no profit, and it won’t have to compete with other insurance companies to pay out as little as possible.

Individuals will have to buy insurance, or they will pay a big fine to the IRS. But there will be these “insurance exchanges,” offering lots of plans that will actually compete for the public’s business (instead of the one or two now available in most markets), plus the “public option.” Employers will have to offer plans with “essential benefits,” meaning good coverage of hospitalization, drugs, outpatient care, mental health care, and so forth. Small employers will have to chip in, too, but they get help with the cost. If the employer doesn’t offer a good plan with “essential benefits,” the employee will be able to take the money the employer is chipping in, and buy a good health plan on the “exchange.”

Sounds like a plan. Health plans couldn’t turn anyone down for “pre-existing conditions,” they would have to take everybody. On the other hand, everybody would have to take them, unless the “public option” turns out to be both way cheaper and more reliable.

Of course, along the way, everybody else gets what they want, too, out of this deal. The drug companies, for instance, get told that, no, the government will not negotiate with them for lower prices; any government plan will just pay market prices. And we’ll make it harder, not easier, for generics to compete with brand-name drugs. And no organization, company, or government will be able to re-import drugs from overseas, where they cost much less.

Oh, and of course there will be nothing in the bill to make health plans actually honor their contracts, stop refusing to pay for stuff they agreed to pay for, or stop tossing out people who get really sick and spend too much.

Then the details start getting sliced up, and things start turning weird. The Blue Dogs in the House get the Commerce Committee to turn out a bill that says, well, actually, hospitals and doctors should not have to take the public option. It should be voluntary, and they should be paid market rates, that is, what they are paid now. So the savings go out the window. The public option, in this version, is not particularly cheaper than the private plans. And anyway, employers with a less than a $500,000 payroll (which is 87% of all the employers in the nation) would be exempt. They wouldn’t have to provide any health care insurance at all. The employees would still have to buy it for themselves, though, or pay a big fine. Of course, they could buy the no-longer-particularly-cheap public option.

Over in the Senate, the key Finance Committee lets it leak that it’s probably dropping not only the public option altogether, but employer mandates, too. Employers won’t have to offer health plans at all, but the employees have to buy them, whether anyone’s offering them a decent plan or not.

Democrat Kent Conrad, on the committee, says nobody will go for a public option plan; instead we’ll try co-ops. This idea would consist of trying to start new not-for-profit insurance companies in every market in the country. Doctors and hospitals would not have to sign up with them. The coops would not have their rates tied to Medicare; they would have to pay market rates. Actually, they would have to pay more than market rates, because the doctors and hospitals in those markets are already signed up with the existing insurers and have plenty of business already, thank you very much. So the new coops would have to bid premium rates to get providers to sign up, or they would have to “rent” them (again at a premium) from their competitors. No big deal, though: If it’s voluntary and paying market rates, the “public option” would have the same problem – high prices, not many providers, so not many customers.

And then Ted Kennedy’s committee turns out a bill that says, well, actually, employers are not really obliged to offer a minimum level of health care insurance – yet the bill keeps the requirement that employees must accept and pay for whatever health care plan their employer offers them, whether it seems an acceptable level of care at an acceptable price or not. So again, savings for the individual go out the window, and now choice of health plans does, too.

If a so-called “reform” bill comes up with these elements – no employer mandate, strong individual mandate, market rates for everything, no real insurance reform – there is no reason to vote for it. It is worse than no bill at all.

That is about what we are facing now.

With nearly 30 years’ experience, Joe Flower has emerged as a premier observer and thought leader on the deep forces changing healthcare in the United States and around the world. As a healthcare speaker, writer, and consultant, he has explored the future of healthcare with clients ranging from the World Health Organization, the Global Business Network, and the U.K. National Health Service, to the majority of state hospital associations in the U.S. He has written for a number of healthcare publications including, the Healthcare Forum Journal, Physician Executive, and Wired Magazine. You can find more of Joe’s work at his website, www.imaginewhatif.com, where this post first appeared.

More by the same author:

Fear and Loathing over the Stimulus Bill
Healthcare as a Complex Adaptive System

Interview: TR Reid on healthcare reform around the world

Sep 8, 2009• 12

By Matthew Holt

TR Reid is a former foreign correspondent with the Washington Post. He spent two years (partly funded by the Kaiser Family Foundation) looking at health care systems across the world and has been featured heavily in many media venues lately asking the simple question, if everywhere else can cover everyone at half the cost, how do they do it? I had a great and not too long interview with him last week.

His book is called The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and here's an interview he did as part of Frontline's Sick Around The World.

Funnily enough I'm posting this from Barcelona, Spain where hopefully I won't have to use the healthcare system unless I get carried away with the late night Sangria…

Transcript of Obama’s Health Care Speech (and the GOP response)

Sep 7, 2009• 3

Transcript of the GOP Response to Obama’s Speech

The full text of President Obama’s address on health care to the Joint Session of Congress:

———

Madame Speaker, Vice President Biden, Members of Congress, and the American people:

When I spoke here last winter, this nation was facing the worst
economic crisis since the Great Depression. We were losing an average
of 700,000 jobs per month. Credit was frozen. And our financial system
was on the verge of collapse.

As any American who is still looking for work or a way to pay their
bills will tell you, we are by no means out of the woods. A full and
vibrant recovery is many months away. And I will not let up until those
Americans who seek jobs can find them; until those businesses that seek
capital and credit can thrive; until all responsible homeowners can
stay in their homes. That is our ultimate goal. But thanks to the bold
and decisive action we have taken since January, I can stand here with
confidence and say that we have pulled this economy back from the
brink.

Winners and Losers – Strategy in a Post-Reform World

Sep 4, 2009• 29

By BILL KRAMER

Kramer

Most health policy experts are focusing
on the daily ups and downs in the political battles over health reform.
Within the health care industry, however, there is a
buzz about who will be
the winners and losers after health reform passes. A.M. Best’s U.S. Health and HMO Insurance Index has been
volatile since last November, reflecting high uncertainty about the
effect of health reform. Earlier this summer, there was some speculative
analysis about the potential impact
of reform on health care stocks. Will health insurers come out as winners?
What about hospitals, doctors, drug manufacturers, and insurance agents?

It’s good to look ahead, but I think
most people are asking the wrong question. Each of these health
industry sectors – in aggregate — will probably do just fine in the
post-reform world, as Bob Laszewski points out in his recent blog post. The more important question is: who
will be the winners and losers within each sector?

Getting Rid of “Friction” in Health Care

Sep 4, 2009• 10

By FLETCHER LANCE

Main Friction occurs when an object moving through space encounters resistance, slows down and has its forward energy diverted. In the world of health care, friction is a term that has become synonymous with paperwork.Today, the U.S. spends $2.3 trillion on health care, and the U.S. Health Care Efficiency Index estimates that we could reduce this cost by $30 billion if we could eliminate the friction of phone-based and paper-based systems.¹ This is a significant savings, and the American Recovery and Reinvestment Act is an attempt to realize that savings with a very targeted focus on Electronic Medical Records (EMRs). If all of the physicians in the country used EMRs, the argument goes, we would dramatically improve the efficiency of our health care system. The only problem is that only 17 percent of physicians are using EMRs today, so we’re talking about converting 83 percent of physicians to a computerized system for maintaining patient records, and while we absolutely must move in that direction, it is going to be a long and time-consuming process.²

“Low-hanging Fruit” Meanwhile, there’s a much quicker fix that is not getting much attention in the current debate, and that is the savings that could be realized by full conversion to electronic health care claims. Unlike EMRs, electronic claims aren’t slowed down by privacy issues and other barriers that arise with business-to-human transactions. They offer billions of dollars of savings. According to the Center for Health Transformation, 90 percent of claim payments are still made in the form of a paper check. By eliminating these paper-based checks, the U.S. could reduce the overall cost of health care by $11 billion.³ Every paper check that is eliminated and replaced with a wire transfer saves the payer $.78, according to a study by Yoo and Harner.⁴ And given the fact that a few large payers – United, Aetna, Cigna and BlueCross BlueShield – are responsible for a majority of claims checks written in this country, making the switch to electronic health care claims may be easier than you think. Continue reading…

Our President is on the Ropes

Sep 3, 2009• 39

By DR. STEPHEN KARDOS

Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.

There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.Continue reading…