Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com

Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com:

"“Frankly, it’s very hard for the average consumer, or frankly the average governor, to understand how some of these companies can have the margins they do and the annual increases in premiums that they do,” Mr. Patrick said in an interview. “At some level, you’ve just got to say, ‘Look, that’s just not acceptable, and more to the point, it’s not sustainable.’ ”

"The threat seems to have been heard. Insurers seeking to participate in the state’s subsidized insurance program, Commonwealth Care, recently submitted bids so low that officials announced last week that they would keep premiums flat in the coming year. That may provide cover for the program as the state seeks ways to fill a nearly $4 billion gap in its 2010 budget."

Sphere: Related Content

The Concerns of "Harry and Louise" circa 1994

YouTube Link to videos here.

Because my daughter is working on her undergraduate thesis on comparing the health care reform policy environment in 1994 and now, we were looking at the old Harry and Louise videos.

It is funny, because there are two issues raised in the commercials. In the first, set "Sometime in the Future,"the concern is about having to choose among "insurance plans designed by government bureaucrats" and the lack of choice among doctors, hospitals, etc., should this happen. And the cute little line about, "Remember our old plan? That was a good one."

Well, of course, those ships have all sailed. Our insurers now dictate our provider choices ever more restrictively. If you've ever changed your insurer, you probably have come to terms with looking through the provider book and figuring out which PCP practice to switch to, whether to go "out-of-network" to keep your old specialists, and whether to drive to a new hospital in your network. Unless, of course, you are in a federal plan, designed by bureaucrats, which generally will provide you with substantially more choice than your private plan.

It's also worth saying that in most markets, insurance consolidation has resulted in ever dwindling choice in private insurers. So, the choice thing? Not so much.

The second commercial talks about the dangers of "community rating" to the premiums of the younger and healthier. This is exactly right, and Uwe Reinhardt has been warning about this lately. If not forced to buy insurance, those who are at lower risk of needing health insurance will opt out, driving up the premiums for those buying insurance, particularly small employers who can't spread the risk out. A genuinely fair concern that is still in the mix of issues that need to be dealt with today.

So, how to deal with it? Everyone must be in. We must accept the societal bargain that when we are healthy, we subsidize those who are not. When our kids are healthy, we subsidize our neighbors' kids with diabetes and autism and cancer. When our parents have chronic illnesses, we spread the risk amongst us all.

Sphere: Related Content

Dr. Oliver Fein reports on the White House health summit - PNHP’s official Blog

Dr. Oliver Fein reports on the White House health summit - PNHP’s official Blog

An excerpt:

What was my role in all of this? Despite my best efforts, I was unable to make a public statement at the meeting, although thanks to the PNHP staff in Chicago we were able distribute my prepared remarks to the media while the summit was under way. Our staff member in Washington, Danielle Alexander, also handed out hard copies to summit participants as they left the White House.

I took the opportunity to talk one-on-one with six senators and seven representatives and suggested that if their committees held hearings on health
reform, at least one or two single-payer advocates should be included on the
hearing panel. I also said that single-payer bills like H.R. 676 should be
compared with all other proposals for health care reform by the Congressional
Budget Office. There was considerable receptivity to these ideas among some of
the Congress members. We will pursue these leads.

The media took great interest in the successful battle by Rep. Conyers and myself to get into the summit, with stories in the Congressional Quarterly, The Wall Street Journal, and The New York Times, among other places. We have also been able get the single-payer message out on radio, with myself and Drs. Walter Tsou, Steffie
Woolhandler, David Himmelstein and Quentin Young, among others, being invited to
appear on the air, often on programs with national reach. This was a plus.

In sum, I came out of the White House Health Care Summit with conviction that
single payer – that is, publicly funded, privately delivered health care, which
removes the wasteful for-profit, private health insurance companies as middlemen, remains the only solution that can guarantee access to comprehensive, quality health care with choice of doctor and hospital, and reduce overall cost. Single-payer, an improved and expanded Medicare-for-All, is the gold standard against which all other proposals for health care reform should be measured.

Sphere: Related Content

Rep. Roy Blunt on Healthcare reform - RNC Weekly Address

Republican • National • Committee:

A snippet from Roy Blunt's response to the Obama weekly address, on Health Care Reform:

“Just imagine a health care system that looks like a government run operation most of us are all too familiar with - the local DMV. Lines, paper work, taking a number. Or how about another government agency - the IRS."

Now, Mr. Blunt gets his health care through his job, I imagine, which puts him in the federal program, and most of my patients get their health care courtesy of Medicare, and I don't hear much complaining from them, while I hear LOTS of complaining from those who have private health insurance. All the time.

Sphere: Related Content

Eight principles of Health Care Reform - from Obama Budget

• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.

• Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.

• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.

• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

• Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

Nothing over the top in here. The principles, I think, are not very assailable.

The Politico offers their "translation" and I think zeroes in on what may become the critical throw down issue: Will we have a public insurance option to compete with private insurers in a system where all are required to have insurance?

Henry Waxman told AMA members in DC that a public option was in his plans, and Obama and Sen. Baucus have also indicated support for a public option.

Here is a link to the AMA National Advocacy Council news site. I have to say, the list of speakers is impressive. No Cato, Fraser, Heritage to be found (at least on the fist day - Tuesday) speaker list. Mostly progressive speakers.

Sphere: Related Content

The White House - Press Office - White House Forum on Health Reform Attendees and Breakout Session Participants

The White House - Press Office - White House Forum on Health Reform Attendees and Breakout Session Participants

I was curious who was invited, so click on the link to see the complete list.

The physicians groups that I saw are below.

American College of Physicians, Jeff Harris, President
American Academy of Pediatrics, David Tayloe, President
American College of Cardiology, W. Douglas Weaver, President
American Academy of Family Physicians, Ted Epperly, President
American Medical Association, Nancy Nielsen, President
National Medical Association, Mohammad Akhter, Executive Director
Physicians for a National Health Plan, Dr. Oliver Fein, Director
University of Chicago Medical School, Eric Whitaker, Executive Vice President For Strategic Affiliations

And only one nurses group?

American Nurses Association, Rebecca Patton, President

Sphere: Related Content

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries -- American College of Physicians, -- Annals of Internal Medicine

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries -- American College of Physicians,:

When we were talking last week about the lack of single payer advocates at last week's summit, I didn't realize that ACP was there. The President of the ACP was there, though I don't know his persoanl feelings about reform, I did go back and look at the recommendations published by ACP last year.


"Paying for Health Care

"Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

"1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals' freedom to make their own health care choices. [CMHMD Note: I guess it shows how complicated this all is. ACP considers Japan single payer and France a hybrid sytem, but most consider both single payer. In any case, neither have significant problems with waiting times.]

"2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. (See the ACP's proposal for expanding access to health insurance as an example of how a pluralistic system can achieve universal coverage [69].)

"Recommendation 1b: Provide everyone access to affordable coverage—whether provided through a single-payer or pluralistic financing model—that includes coverage for a core package of benefits, including preventive services, primary care services—including but not limited to chronic illness management—and protection from catastrophic health care expenses.

"Recommendation 1c: Until there is political consensus for achieving universal coverage at a federal level, Congress should encourage state innovation by providing dedicated federal funds to support state-based programs with an explicit goal of covering all uninsured persons within the state. (See the ACP position paper, "State Experimentation with Reforms to Expand Access to Health Care" [70].)

"[ACP]Comment: Universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality. The federal government should assure that all persons within the borders of the United States also have access to health care services without undue financial barriers and that health care services provided are adequately reimbursed. The ACP recommends 2 alternatives: a system funded solely or principally by government (federal and state), commonly known as a single-payer system, or a pluralistic system that incorporates existing public and private programs with additional guarantees of coverage and with sufficient subsidies and other protections to assure that coverage is available and affordable for all. The ACP has proposed a step-by-step plan that would achieve universal coverage while maintaining a pluralistic system of mixed public and private sector funding."

^{------------------------------------------}

^{SO, ACP advocates either a single payer model, or a social health insurance model (i.e., a hybrid system) as the path to paying for universal health care. This is where I come down as well. I think it would be very useful if we could get a majority of physicians to accept this either/or approach with the caveat that we vigorously campaign to allow NOTHING LESS than this to be our line in the sand.}

Sphere: Related Content