The SCHIP debacle continues in Washington. There have been too many gullible Republicans who went along with this who apparently were frightened to death of the “sound bite” about them hating children.
Children would now be defined as people under age 25. That would happen in all states, and we know that many would continue the perversion of including adults as well. Remember that Wisconsin now spends 75% of its funding on adults, not children!
The income level provisions of this travesty have been increased to 400% of the federal poverty level, up from 200%. That is more than $80,000 for a family of four! Imagine just how many employers will appear on the next BadgerCare “embarrassment list” with that income benchmark in place.
SCHIP would become a permanent entitlement program whereas it has been forced through periodic re-authorization up until now. Imagine how this entitlement will spin out-of-control if the President would sign the bill.
Funding comes from a diverse group:
We all understand that the tax on tobacco products will increase in order to pay for this largesse. That goose will die off quickly enough, so many other sources will ultimately be tapped.
We didn’t know, however, that private insurance policies would be taxed as well. This “fair share” tax would begin at $375 million in year one, but we all know that number will pale in comparison to what we’ll see in five years and beyond. This on top of the "crowding out" of private insurance plans every time a person elects to be part of their state's SCHIP. Seems that "big insurance" was squarely in the cross hairs as the Democrats sought to incrementally increase the numbers of people on "government run health programs".
And, Congress "bravely" takes on the senior lobby by taking money away from the successful Medicare Advantage program that is now used by some 8 million seniors in lieu of regular Medicare plans. The CBO analysis indicates that as many as 3 million of the current users will be forced out of the programs by the funding reductions. These programs were, of course, made possible by insurers coming to the table as the original program intended to secure better levels of coverage and coverage in outlying areas. "Big insurance" was again in the cross hairs without regard to the seniors who were enrolled in this better deal.
The private sector is about to take a big hit from the liberals.
It is imperative that we let President Bush know we want him to hold his position and veto this abomination when it finds its way to his desk. It appears that his veto has a good chance of standing given that the House passed its version by just 225 to 204. Many congressional representatives would have to reverse their positions in order to sustain a veto.
In the meantime, each of us must contact our elected representatives who voted for this travesty to advise that we are disgusted with their work product and to assure them that we’ll remember through multiple election cycles. And, we need to talk with those who voted the right way so they aren't frightened into changing their vote if the President vetoes the bill.
Thursday, August 9, 2007
Saturday, July 21, 2007
SCHIP Expansion is Wolf in Sheep's Clothing...
How does this continue to happen? How can people continue to have the wool (no pun intended) pulled over their eyes…other than by willful ignorance?
The threat of Presidential veto of the newly proposed SCHIP expansion has again met with the usual press reports. He is denying the poor children their rightful coverage, etc., etc. It is interesting that, even with the Bush-bashing that has gone on for years, the current Congress rates even lower amongst the general population.
This is not about the children! The truth of this matter is simply that this expansion of SCHIP (BadgerCare in Wisconsin) is a ploy to include more adults in the program rather than more children. The additional children we all want in this program can be afforded under the President’s proposed SCHIP increase. But, in order to pervert this well-performing program, those who would see government-run healthcare are using this program as their “Trojan Horse”.
They reason that by adding multiple billions of dollars, more and more states (like Wisconsin that already uses 75% of the current funding to bring adults into the program) can use the increased funding to apply to adults. This happens as the qualifying poverty-level income multiples are increased. This permits people earning far in excess of poverty-level incomes to participate in government-funded health care plans. As this group increases, the private sector health plans lose more and more people…exactly what those who seek a total single payer system desire.
This is back-door socialism. It appears there are enough ignorant Republicans who’ve signed on to support this travesty to at least have gotten this through the Senate. Among those Republicans is Sen. Hatch (R-Utah) who spoke at the Capital Conference hosted by the National Association of Health Underwriters early in 2007. He spoke eloquently as to how this perversion wouldn’t be permitted to happen. He must’ve found some politically-expedient reason for supporting it. This “go along to get along” mentality is a serious threat to us conservatives. And, any number of liberal Democrats and middle-of-the-road Republicans are happy.
As an aside, the tobacco tax increase that has been included as the funding mechanism will succeed in putting cigars out of the reach of mere mortals. With the tax increase going from the capped amount of $0.05 per cigar to a capped amount of $10.00 per cigar, only the “fat cats” will puff cigars. This staggering Federal increase coupled with the hefty cigarette/cigar tax increases added by many states, will effectively kill that industry. Tobacco is a legal product by the way. This reeks of hypocrisy…but why should any of us be surprised at that?
That “industry” is the goose laying all these golden eggs, and it will be killed by the “do-gooders”. We’ll then all awaken to find ourselves taxed to cover the certain budgetary shortfalls thus created by these mandated programs. Back-door socialism will have created government-run health care and we’ll be unable to do anything about it.
This must be headed off in the House of Representatives even with President Bush’s stated position of vetoing the bill in its present form.
The threat of Presidential veto of the newly proposed SCHIP expansion has again met with the usual press reports. He is denying the poor children their rightful coverage, etc., etc. It is interesting that, even with the Bush-bashing that has gone on for years, the current Congress rates even lower amongst the general population.
This is not about the children! The truth of this matter is simply that this expansion of SCHIP (BadgerCare in Wisconsin) is a ploy to include more adults in the program rather than more children. The additional children we all want in this program can be afforded under the President’s proposed SCHIP increase. But, in order to pervert this well-performing program, those who would see government-run healthcare are using this program as their “Trojan Horse”.
They reason that by adding multiple billions of dollars, more and more states (like Wisconsin that already uses 75% of the current funding to bring adults into the program) can use the increased funding to apply to adults. This happens as the qualifying poverty-level income multiples are increased. This permits people earning far in excess of poverty-level incomes to participate in government-funded health care plans. As this group increases, the private sector health plans lose more and more people…exactly what those who seek a total single payer system desire.
This is back-door socialism. It appears there are enough ignorant Republicans who’ve signed on to support this travesty to at least have gotten this through the Senate. Among those Republicans is Sen. Hatch (R-Utah) who spoke at the Capital Conference hosted by the National Association of Health Underwriters early in 2007. He spoke eloquently as to how this perversion wouldn’t be permitted to happen. He must’ve found some politically-expedient reason for supporting it. This “go along to get along” mentality is a serious threat to us conservatives. And, any number of liberal Democrats and middle-of-the-road Republicans are happy.
As an aside, the tobacco tax increase that has been included as the funding mechanism will succeed in putting cigars out of the reach of mere mortals. With the tax increase going from the capped amount of $0.05 per cigar to a capped amount of $10.00 per cigar, only the “fat cats” will puff cigars. This staggering Federal increase coupled with the hefty cigarette/cigar tax increases added by many states, will effectively kill that industry. Tobacco is a legal product by the way. This reeks of hypocrisy…but why should any of us be surprised at that?
That “industry” is the goose laying all these golden eggs, and it will be killed by the “do-gooders”. We’ll then all awaken to find ourselves taxed to cover the certain budgetary shortfalls thus created by these mandated programs. Back-door socialism will have created government-run health care and we’ll be unable to do anything about it.
This must be headed off in the House of Representatives even with President Bush’s stated position of vetoing the bill in its present form.
Monday, July 16, 2007
Health Care Reform or Insurance Reform - The Political Reality
A guest Blog posted on behalf of Terry Murphy:
Democrats in the Senate just recently announced their health care reform plan known as Healthy Wisconsin. In fact, just one day after providing the details of the plan, they put their idea into their version of the State Budget and passed the plan out of the Senate. Their reform plan is theoretically one step away from being sent to the Governor’s desk to be signed into law. This is the most sweeping and expensive legislation in our state’s history and the vast majority of Wisconsin citizens have no idea the plan even exists, let alone what the plan will do to them. How could this possibly happen? Well, that’s a discussion for another day. Instead, the question we ask today is why are all of the government reform plans reforming insurance rather than reforming health care?
Both the Centers for Medicaid and Medicare Services (CMS) and a study found in the New England Journal of Medicine show that just 12 cents out of every insurance dollar goes to the cost of insurance administration, leaving the vast majority of the insurance dollar (88 cents) going to the cost of health care. While we recognize health care costs include some administrative costs of their own, the fact remains that the vast majority of insurance premiums collected are spent on health care, not the cost of financing such care through insurance. Knowing this fact, why would anyone devote all of their time and effort in trying to reform how we finance our health care (through insurance), rather than trying to reform actual health care costs? Healthy Wisconsin, like nearly all of the other reform plans introduced in the last year, focuses on how we finance health care by replacing our current insurance system with a government run taxing system. Even if their taxing approach actually reduced some of the insurance administrative costs (the 12 cents), because their plan doesn’t address the cost of health care (the 88 cents), health care will still be unaffordable, making either the insurance or the taxes to pay for such care unaffordable.
Senate Democrats estimate an initial payroll tax of 16% in order to pay for their program. First, this estimate makes a bold assumption that all health care providers (doctors, hospitals, nursing homes, etc) will voluntarily reduce their costs by about 40%. Does anybody in Wisconsin believe this assumption is realistic? Therefore, like the Massachusetts reform plan, the 16% payroll tax estimate will likely be much higher. Secondly, since 2000, health care inflation averaged 12% per year, compared to increases in US Household Income at 3.7%. A provision of Healthy Wisconsin states that health care increases in Wisconsin should not exceed the national average. This means that if health care inflation remains at 12%, payroll taxes for Healthy Wisconsin are guaranteed to increase each year, far outpacing what Wisconsin residents can afford. By the second year of their plan, payroll taxes would have to increase to nearly 18%, and by the third year, the payroll tax would balloon to over 20%. Exactly how is this plan supposed to help Wisconsin citizens?
The problem with Healthy Wisconsin and all of the other government based reform plans is that none of them set out to reform health care costs. Why? Perhaps the answer is that reforming health care costs is not “politically” attainable. To reform, or control health care costs, government has but two options. The first option would require the government to get control of health care providers by either dictating what they can charge or using the more radical approach and taking over the health care providers like the Canadian system. Regardless of what public opinion says about wanting “universal” health care, politicians know that Wisconsin citizens do not want government involved in their health care. Therefore, this option is not one likely to be found in a health care reform plan. However, if any of the government based reform plans like Healthy Wisconsin ever became law, as health care costs continued to increase, thereby increasing taxes, this would be the only option left for government to control health care costs. A scary thought indeed.
The second option would be for Government to let the market work to control health care costs, through transparency and competition. Unfortunately, for many politicians, this option takes far too long to work, and mistakenly gives the appearance of not doing anything in the eyes of voters. Politicians believe voters are looking for a silver bullet and the fact is there are no silver bullets in health care reform. The other problem with this second option is that it cannot be put into a 30 second sound bite that politicians could campaign on. It is truly sad that we have politicized health care reform, and that the only option that will work is not even being considered by many politicians because it isn’t politically acceptable. This is wrong for Wisconsin and wrong for Wisconsin consumers.
A recent report showed that Wisconsin enjoys some of the highest quality health care in the nation. Most surveys find that the majority of citizens like the health insurance plan they have purchased. Wisconsin citizens are smarter than some politicians give them credit for. The government can play a large role in this second option, by working to help the private market work better in controlling health care costs. The Coalition for Sensible Health Care Solutions has provided a blueprint for health care reform in Wisconsin. It works to address health care costs, and yet still works to improve the efficiency of our insurance industry. It is this second option that should be considered by any legislator who doesn’t care about politics, but instead cares about making health care affordable for his or her constituents.
We have to stop wasting our time, effort and resources with attempts to exclusively reform insurance only because it is politically acceptable. Instead, we have to start trying to reform health care costs and work to improve the efficiency of insurance because it is the right thing to do. Each year, Wisconsin consumers face another double digit increase in health care costs because we have avoided the second option. We cannot afford to wait any longer.
Terry Murphy is the owner of East Towne Insurance Services, Inc. (an employee benefits brokerage firm in Milwaukee). Mr. Murphy is also the Legislative Committee Chairman of the Wisconsin Association of Health Underwriters (WAHU). WAHU is an association of insurance professionals who work directly with consumers in the financing of their health care. WAHU is a chapter of the National Association of Health Underwriters covering the insurance needs of over 100 Million Americans.
Democrats in the Senate just recently announced their health care reform plan known as Healthy Wisconsin. In fact, just one day after providing the details of the plan, they put their idea into their version of the State Budget and passed the plan out of the Senate. Their reform plan is theoretically one step away from being sent to the Governor’s desk to be signed into law. This is the most sweeping and expensive legislation in our state’s history and the vast majority of Wisconsin citizens have no idea the plan even exists, let alone what the plan will do to them. How could this possibly happen? Well, that’s a discussion for another day. Instead, the question we ask today is why are all of the government reform plans reforming insurance rather than reforming health care?
Both the Centers for Medicaid and Medicare Services (CMS) and a study found in the New England Journal of Medicine show that just 12 cents out of every insurance dollar goes to the cost of insurance administration, leaving the vast majority of the insurance dollar (88 cents) going to the cost of health care. While we recognize health care costs include some administrative costs of their own, the fact remains that the vast majority of insurance premiums collected are spent on health care, not the cost of financing such care through insurance. Knowing this fact, why would anyone devote all of their time and effort in trying to reform how we finance our health care (through insurance), rather than trying to reform actual health care costs? Healthy Wisconsin, like nearly all of the other reform plans introduced in the last year, focuses on how we finance health care by replacing our current insurance system with a government run taxing system. Even if their taxing approach actually reduced some of the insurance administrative costs (the 12 cents), because their plan doesn’t address the cost of health care (the 88 cents), health care will still be unaffordable, making either the insurance or the taxes to pay for such care unaffordable.
Senate Democrats estimate an initial payroll tax of 16% in order to pay for their program. First, this estimate makes a bold assumption that all health care providers (doctors, hospitals, nursing homes, etc) will voluntarily reduce their costs by about 40%. Does anybody in Wisconsin believe this assumption is realistic? Therefore, like the Massachusetts reform plan, the 16% payroll tax estimate will likely be much higher. Secondly, since 2000, health care inflation averaged 12% per year, compared to increases in US Household Income at 3.7%. A provision of Healthy Wisconsin states that health care increases in Wisconsin should not exceed the national average. This means that if health care inflation remains at 12%, payroll taxes for Healthy Wisconsin are guaranteed to increase each year, far outpacing what Wisconsin residents can afford. By the second year of their plan, payroll taxes would have to increase to nearly 18%, and by the third year, the payroll tax would balloon to over 20%. Exactly how is this plan supposed to help Wisconsin citizens?
The problem with Healthy Wisconsin and all of the other government based reform plans is that none of them set out to reform health care costs. Why? Perhaps the answer is that reforming health care costs is not “politically” attainable. To reform, or control health care costs, government has but two options. The first option would require the government to get control of health care providers by either dictating what they can charge or using the more radical approach and taking over the health care providers like the Canadian system. Regardless of what public opinion says about wanting “universal” health care, politicians know that Wisconsin citizens do not want government involved in their health care. Therefore, this option is not one likely to be found in a health care reform plan. However, if any of the government based reform plans like Healthy Wisconsin ever became law, as health care costs continued to increase, thereby increasing taxes, this would be the only option left for government to control health care costs. A scary thought indeed.
The second option would be for Government to let the market work to control health care costs, through transparency and competition. Unfortunately, for many politicians, this option takes far too long to work, and mistakenly gives the appearance of not doing anything in the eyes of voters. Politicians believe voters are looking for a silver bullet and the fact is there are no silver bullets in health care reform. The other problem with this second option is that it cannot be put into a 30 second sound bite that politicians could campaign on. It is truly sad that we have politicized health care reform, and that the only option that will work is not even being considered by many politicians because it isn’t politically acceptable. This is wrong for Wisconsin and wrong for Wisconsin consumers.
A recent report showed that Wisconsin enjoys some of the highest quality health care in the nation. Most surveys find that the majority of citizens like the health insurance plan they have purchased. Wisconsin citizens are smarter than some politicians give them credit for. The government can play a large role in this second option, by working to help the private market work better in controlling health care costs. The Coalition for Sensible Health Care Solutions has provided a blueprint for health care reform in Wisconsin. It works to address health care costs, and yet still works to improve the efficiency of our insurance industry. It is this second option that should be considered by any legislator who doesn’t care about politics, but instead cares about making health care affordable for his or her constituents.
We have to stop wasting our time, effort and resources with attempts to exclusively reform insurance only because it is politically acceptable. Instead, we have to start trying to reform health care costs and work to improve the efficiency of insurance because it is the right thing to do. Each year, Wisconsin consumers face another double digit increase in health care costs because we have avoided the second option. We cannot afford to wait any longer.
Terry Murphy is the owner of East Towne Insurance Services, Inc. (an employee benefits brokerage firm in Milwaukee). Mr. Murphy is also the Legislative Committee Chairman of the Wisconsin Association of Health Underwriters (WAHU). WAHU is an association of insurance professionals who work directly with consumers in the financing of their health care. WAHU is a chapter of the National Association of Health Underwriters covering the insurance needs of over 100 Million Americans.
Friday, June 29, 2007
Google Could Revolutionize Healthcare...
Google has been thought to be considering working on ways in which people could store their health records on Google and have them readily available for personal needs. It has been quite careful about letting outsiders in on its plans but has just taken action that could suggest this idea is gaining traction.
Google recently appointed its new Health Advisory Council and it is comprised of some 22 very heavy hitters:
Dean Ornish, Founder and President, Preventive Medicine Research Institute
Douglas Bell, Research Scientist, RAND Health, RAND Corporation
Delos M. Cosgrove, CEO, Cleveland Clinic
Molly Coye, CEO, HealthTech
Dan Crippen, Former Congressional Budget Office Director & Reagan White House Asst.
Linda M. Dillman, EVP, Risk Management, Benefits & Sustainability, Wal-Mart
John Halamka, CIO, Beth Israel Deaconess Medical Center & Harvard Medical School
Bernadine Healy, Former NIH Head, Health Editor & Columnist, U.S.News & World Report
Bernie Hengesbaugh, COO, American Medical Association
Douglas E. Henley, EVP, American Academy of Family Physicians
David Kessler, Former FDA Commissioner, Vice Chancellor-Medical Affairs & Dean, School of Medicine, UCSF
John Lumpkin, Sr. VP, Director of Health Care Group, Robert Wood Johnson Foundation
John Rother, Group Exec. Officer of Policy & Strategy, AARP
Anna-Lisa Silvestre, VP, Online Services, Kaiser Foundation Health Plan, Inc.
Greg Simon, President, FasterCures
Mark D. Smith, President & CEO, The California HealthCare Foundation
Paul Tang, Internist & VP, Chief Medical Officer, Palo Alto Medical Foundation & Chairman, Board of Directors, American Medical Informatics Association
Sharon Terry, President & CEO, Genetic Alliance
John Tooker, EVP & CEO, American College of Physicians
Doug Ulman, President, Lance Armstrong Foundation
Robert M. Wachter, Professor of Medicine, UCSF, Assoc. Chairman, UCSF Department of Medicine, Chief – Medical Service, UCSF Medical Center
Matthew Zachary, Founder & Executive Director, The I’m Too Young for This! Cancer Foundation for Young Adults
The private sector is stepping up its game!
Google is among the most innovative organizations in the world and should not be undersold as to the potential for success in this undertaking…if that’s what it is.
Google recently appointed its new Health Advisory Council and it is comprised of some 22 very heavy hitters:
Dean Ornish, Founder and President, Preventive Medicine Research Institute
Douglas Bell, Research Scientist, RAND Health, RAND Corporation
Delos M. Cosgrove, CEO, Cleveland Clinic
Molly Coye, CEO, HealthTech
Dan Crippen, Former Congressional Budget Office Director & Reagan White House Asst.
Linda M. Dillman, EVP, Risk Management, Benefits & Sustainability, Wal-Mart
John Halamka, CIO, Beth Israel Deaconess Medical Center & Harvard Medical School
Bernadine Healy, Former NIH Head, Health Editor & Columnist, U.S.News & World Report
Bernie Hengesbaugh, COO, American Medical Association
Douglas E. Henley, EVP, American Academy of Family Physicians
David Kessler, Former FDA Commissioner, Vice Chancellor-Medical Affairs & Dean, School of Medicine, UCSF
John Lumpkin, Sr. VP, Director of Health Care Group, Robert Wood Johnson Foundation
John Rother, Group Exec. Officer of Policy & Strategy, AARP
Anna-Lisa Silvestre, VP, Online Services, Kaiser Foundation Health Plan, Inc.
Greg Simon, President, FasterCures
Mark D. Smith, President & CEO, The California HealthCare Foundation
Paul Tang, Internist & VP, Chief Medical Officer, Palo Alto Medical Foundation & Chairman, Board of Directors, American Medical Informatics Association
Sharon Terry, President & CEO, Genetic Alliance
John Tooker, EVP & CEO, American College of Physicians
Doug Ulman, President, Lance Armstrong Foundation
Robert M. Wachter, Professor of Medicine, UCSF, Assoc. Chairman, UCSF Department of Medicine, Chief – Medical Service, UCSF Medical Center
Matthew Zachary, Founder & Executive Director, The I’m Too Young for This! Cancer Foundation for Young Adults
The private sector is stepping up its game!
Google is among the most innovative organizations in the world and should not be undersold as to the potential for success in this undertaking…if that’s what it is.
Wednesday, June 27, 2007
Americans Living in Canada Comment on Health Care...
A recent survey of some 310 Americans who have experienced use of health care services in both the U.S. and Canada produced expected results. The full survey results are available here.
The overall result had 74% rating the overall quality of U.S. health care as excellent or good, while 50% of the same group gave Canadian health care a similar rating.
The nod was given to U.S. health care in the areas of accessibility, timeliness, quality, and available technology. Canada scored higher in the areas of personal cost of both health care and pharmaceuticals. Obviously, the government pays the costs of permissible care in Canada, so it was expected that personal financial exposure would be limited.
Wait times in Canada were comparatively quite long with people citing too few specialists and too little government funding.
As government funding was exhausted in Canada, services were rationed by imposition of longer wait times and cancelled surgeries.
This group had experienced U.S. health care within two to five years of the time of the survey and had been covered by Canadian health care since the time of their arrival in that country. The respondents were scattered across the provinces with higher concentrations where the population was greater.
The overall result had 74% rating the overall quality of U.S. health care as excellent or good, while 50% of the same group gave Canadian health care a similar rating.
The nod was given to U.S. health care in the areas of accessibility, timeliness, quality, and available technology. Canada scored higher in the areas of personal cost of both health care and pharmaceuticals. Obviously, the government pays the costs of permissible care in Canada, so it was expected that personal financial exposure would be limited.
Wait times in Canada were comparatively quite long with people citing too few specialists and too little government funding.
As government funding was exhausted in Canada, services were rationed by imposition of longer wait times and cancelled surgeries.
This group had experienced U.S. health care within two to five years of the time of the survey and had been covered by Canadian health care since the time of their arrival in that country. The respondents were scattered across the provinces with higher concentrations where the population was greater.
Monday, June 25, 2007
Senate Dems Use Interesting Tactic to Mount Health Plan...
Senate Democrats used an embargo of the press as they pushed an 11th hour health plan proposal out front of every other proposal. They scheduled an informational hearing for 11:00AM today (Monday), but refused to release details of their health plan proposal until Monday morning.
That seems a very strange way to encourage true debate on this most critical subject. Why, if your health plan is a genuine proposal and worthy of debate, would you keep the information to yourselves. How can we even think of this plan as worthy given the manner in which it is being exposed to public scrutiny?
It appears to be an extension of the Wisconsin Employee Trust Fund package of health plans with provisions for taxes on both employers and employees to pay for the program. The tax rates proposed appear, at first glance, to be low considering that the coverage is quite extensive with minimal co-payments and small deductibles. The plan would be made mandatory for all citizens of Wisconsin except those who are covered under existing federal plans or BadgerCare.
We encourage debate on all proposals…but we need to know the details of each well before the debate begins. These same Senate Dems plan to vote on the Budget Bill on Tuesday, and this plan is now going to be part of that Budget Bill. It appears to be simply a ploy! They cannot be sincere in this effort using such tactics.
That seems a very strange way to encourage true debate on this most critical subject. Why, if your health plan is a genuine proposal and worthy of debate, would you keep the information to yourselves. How can we even think of this plan as worthy given the manner in which it is being exposed to public scrutiny?
It appears to be an extension of the Wisconsin Employee Trust Fund package of health plans with provisions for taxes on both employers and employees to pay for the program. The tax rates proposed appear, at first glance, to be low considering that the coverage is quite extensive with minimal co-payments and small deductibles. The plan would be made mandatory for all citizens of Wisconsin except those who are covered under existing federal plans or BadgerCare.
We encourage debate on all proposals…but we need to know the details of each well before the debate begins. These same Senate Dems plan to vote on the Budget Bill on Tuesday, and this plan is now going to be part of that Budget Bill. It appears to be simply a ploy! They cannot be sincere in this effort using such tactics.
Friday, June 22, 2007
BadgerCare Publishes List to Embarrass Employers...
Wisconsin offers its version of the SCHIP programs called BadgerCare as we’ve discussed previously. Wisconsin has received approval from the federal Department of Health and Human Services to offer BadgerCare to adults as well as to the children for which the program was originally intended.
As a matter of fact, The DHHS Secretary, Michael Leavitt, points out that 75% of the Wisconsin program’s funds are spent on adults. Another tidbit is that Wisconsin covers nearly twice as many adults as children. Not bad for a children’s health program, huh?
Since the state wants to embarrass employers with employees participating in BadgerCare, we’ll certainly assist by adding the link to the list at http://dhfs.wisconsin.gov/badgercare/pdfs/employers0307.pdf .
Obviously, since “everyone” hates Wal-Mart from what I read in the news, Wal-Mart is at the top of this nasty list with 897 employees. Never mind that Wal-Mart employs more than 27,800 people in Wisconsin, just ridicule them for this 3.2% that managed to obtain BadgerCare.
How could that happen? Well, BadgerCare has established some rules that may explain this “unintended consequence”. First, if an employer offers its employees health insurance coverage but doesn’t pay at least 80% of the premium cost, the employee may be eligible. If the employee is earning less than 185% of the federal poverty level, then that person and his or her dependents are eligible for BadgerCare.
How much is 185% of the federal poverty level? For a single person, it is $1,574 per month. For a husband and wife with two children, it is $3,183 per month. For a family of 8, it is $5,329 per month.
Could it be that BadgerCare is too permissive in its attempts to cover children (when nearly twice as many adults as kids are covered)? Could it be that the 80% level of premium contribution placed on employers is too high? Could it be that BadgerCare is intended to bring as much federal largess into our state as possible (ignoring that we over-taxed Badgers are also paying federal taxes)?
Oh, and another thing! Among the culprit employers are these:
The United States Postal Service
The YMCA
Goodwill Industries
The State of Wisconsin
As a matter of fact, The DHHS Secretary, Michael Leavitt, points out that 75% of the Wisconsin program’s funds are spent on adults. Another tidbit is that Wisconsin covers nearly twice as many adults as children. Not bad for a children’s health program, huh?
Since the state wants to embarrass employers with employees participating in BadgerCare, we’ll certainly assist by adding the link to the list at http://dhfs.wisconsin.gov/badgercare/pdfs/employers0307.pdf .
Obviously, since “everyone” hates Wal-Mart from what I read in the news, Wal-Mart is at the top of this nasty list with 897 employees. Never mind that Wal-Mart employs more than 27,800 people in Wisconsin, just ridicule them for this 3.2% that managed to obtain BadgerCare.
How could that happen? Well, BadgerCare has established some rules that may explain this “unintended consequence”. First, if an employer offers its employees health insurance coverage but doesn’t pay at least 80% of the premium cost, the employee may be eligible. If the employee is earning less than 185% of the federal poverty level, then that person and his or her dependents are eligible for BadgerCare.
How much is 185% of the federal poverty level? For a single person, it is $1,574 per month. For a husband and wife with two children, it is $3,183 per month. For a family of 8, it is $5,329 per month.
Could it be that BadgerCare is too permissive in its attempts to cover children (when nearly twice as many adults as kids are covered)? Could it be that the 80% level of premium contribution placed on employers is too high? Could it be that BadgerCare is intended to bring as much federal largess into our state as possible (ignoring that we over-taxed Badgers are also paying federal taxes)?
Oh, and another thing! Among the culprit employers are these:
The United States Postal Service
The YMCA
Goodwill Industries
The State of Wisconsin
Thursday, June 21, 2007
Uninsured In America...
Stuart Browning has produced at least three pieces depicting issues within the health care debate.
The piece titled Uninsured in America is found here .
I hope you'll agree that this needs to be shared with as many people as you can get it to as quickly as you can.
We'll look at two more over the next few days.
The piece titled Uninsured in America is found here .
I hope you'll agree that this needs to be shared with as many people as you can get it to as quickly as you can.
We'll look at two more over the next few days.
Thursday, June 14, 2007
Consumers Demand Transparency...
A recent survey (completed in February 2007) conducted for the PNC Financial Services Group by the Boston-based research firm of Chadwick Martin Bailey found that consumers (especially those with high deductible health plans) want more transparency in health care administration.
The survey was based on telephone calls conducted with 150 executives from U.S. hospitals or health systems, 50 executives from insurance organizations and an online survey of 1,000 U.S. consumers.
Six of ten people who have high deductible health plans strongly agree that their families have become more conscious of health care costs, and some 22% said they compared doctors and hospitals to find the best value for their money.
This finding supports the changing environment that is being brought about by consumer directed health care. As consumers are reintroduced to the process of buying their health care, they are quickly becoming more aware of costs and outcomes. As the consumer directed movement continues to expand, it is becoming clear that the marketplace is responding with pricing transparency, better knowledge of outcomes and generally more informed patients.
Hospitals are working diligently to improve their overall ranking in terms of outcomes. Physician groups are focusing on patient communication. Entrepreneurial companies are developing point-of-sale claims pricing systems to enable patients to learn true costs and to pay for services with debit cards.
Employers are very conscious of wellness programs as a part of the solution to bring health care costs down, thus reducing the cost of insurance benefit plans while gaining a healthier and more productive workforce.
Employers are learning if they don’t already know it, that they must share the premium savings with their employees through funding of Health Savings Accounts and Health Reimbursement Accounts. Those who used the high deductible health plans primarily as vehicles to shift costs are coming to understand that this was a short-sighted approach.
Consumer directed health care is maturing and expanding. That frightens some in government and industry. Some in government don’t relish the idea of empowering the individual since people begin to understand that they don’t need big government to take care of them.
Some in industry and labor circles are similarly wary of these programs. Again, control of members can be threatened when the individuals begin to make their own decisions.
Some in the health care industries are not anxious to see patient independence since they are comfortable with the status quo. However, those same health care providers are being forced to change. They will either adapt to this new era, or risk being relegated to the junk heap as another entity that failed to take the necessary action.
There is a growing tide sweeping over the health care landscape and it is called consumerism.
The survey was based on telephone calls conducted with 150 executives from U.S. hospitals or health systems, 50 executives from insurance organizations and an online survey of 1,000 U.S. consumers.
Six of ten people who have high deductible health plans strongly agree that their families have become more conscious of health care costs, and some 22% said they compared doctors and hospitals to find the best value for their money.
This finding supports the changing environment that is being brought about by consumer directed health care. As consumers are reintroduced to the process of buying their health care, they are quickly becoming more aware of costs and outcomes. As the consumer directed movement continues to expand, it is becoming clear that the marketplace is responding with pricing transparency, better knowledge of outcomes and generally more informed patients.
Hospitals are working diligently to improve their overall ranking in terms of outcomes. Physician groups are focusing on patient communication. Entrepreneurial companies are developing point-of-sale claims pricing systems to enable patients to learn true costs and to pay for services with debit cards.
Employers are very conscious of wellness programs as a part of the solution to bring health care costs down, thus reducing the cost of insurance benefit plans while gaining a healthier and more productive workforce.
Employers are learning if they don’t already know it, that they must share the premium savings with their employees through funding of Health Savings Accounts and Health Reimbursement Accounts. Those who used the high deductible health plans primarily as vehicles to shift costs are coming to understand that this was a short-sighted approach.
Consumer directed health care is maturing and expanding. That frightens some in government and industry. Some in government don’t relish the idea of empowering the individual since people begin to understand that they don’t need big government to take care of them.
Some in industry and labor circles are similarly wary of these programs. Again, control of members can be threatened when the individuals begin to make their own decisions.
Some in the health care industries are not anxious to see patient independence since they are comfortable with the status quo. However, those same health care providers are being forced to change. They will either adapt to this new era, or risk being relegated to the junk heap as another entity that failed to take the necessary action.
There is a growing tide sweeping over the health care landscape and it is called consumerism.
Tuesday, June 12, 2007
Wisconsin Health Plan Follow-up...Chapter Two
Another interesting tidbit that was included in the Lewin Study but wasn’t highlighted is this:
Of the some 2.958 million persons currently receiving health insurance benefits through an employer in Wisconsin, the cost for the Wisconsin Health Plan (WHP) will be less than the current costs for only 736,000 persons.
That means that the WHP, a lesser plan, will cost more for the other 2.222 million persons.
Is that not significant enough to warrant mention rather than to be buried on page 49?
How many other nasty surprises are yet to be found?
Is this really what Wisconsin citizens desire?
Of the some 2.958 million persons currently receiving health insurance benefits through an employer in Wisconsin, the cost for the Wisconsin Health Plan (WHP) will be less than the current costs for only 736,000 persons.
That means that the WHP, a lesser plan, will cost more for the other 2.222 million persons.
Is that not significant enough to warrant mention rather than to be buried on page 49?
How many other nasty surprises are yet to be found?
Is this really what Wisconsin citizens desire?
Monday, June 11, 2007
Wisconsin Health Plan Follow-up...Chapter One
Further exploration of the issues surrounding the Wisconsin Health Plan has turned up some very interesting items.
It seems that the Lewin Study discusses an Option 1 that was really the original Plan up until March, 2007. This “option” is actually the original legislation introduced as AB 1140 and is the plan that was the subject of the Legislative Fiscal Bureau analysis. This “option” was presented to everyone as the health care solution that would be fully funded by an assessment of from 3% to 12% of payroll to be paid by employers, and an accompanying assessment of 2% on employee wages.
An independent analysis by the Wisconsin Hospital Association at the time concluded that this plan was under funded by anywhere from $3 billion to $5 billion. This was met by strong disagreement from the author of the WHP.
Buried in the Lewin Study is the fact that the original Plan was indeed under funded by $3.6 billion. It seems strange that this has not been published. If one didn’t know better, it could almost appear as if the author of the Plan was being a bit disingenuous simply to assure that his Plan would continue moving forward. Apparently the end does sometimes justify the means. When you know best what is right for the 5 million citizens of the state, it simply would not do to have facts derail the proposal.
In fact, the March 2nd version of the report pointed out the fatal flaws of the original Plan, and yet that information has not seen the light of day other than in wonk circles.
Stay tuned…more to come!
It seems that the Lewin Study discusses an Option 1 that was really the original Plan up until March, 2007. This “option” is actually the original legislation introduced as AB 1140 and is the plan that was the subject of the Legislative Fiscal Bureau analysis. This “option” was presented to everyone as the health care solution that would be fully funded by an assessment of from 3% to 12% of payroll to be paid by employers, and an accompanying assessment of 2% on employee wages.
An independent analysis by the Wisconsin Hospital Association at the time concluded that this plan was under funded by anywhere from $3 billion to $5 billion. This was met by strong disagreement from the author of the WHP.
Buried in the Lewin Study is the fact that the original Plan was indeed under funded by $3.6 billion. It seems strange that this has not been published. If one didn’t know better, it could almost appear as if the author of the Plan was being a bit disingenuous simply to assure that his Plan would continue moving forward. Apparently the end does sometimes justify the means. When you know best what is right for the 5 million citizens of the state, it simply would not do to have facts derail the proposal.
In fact, the March 2nd version of the report pointed out the fatal flaws of the original Plan, and yet that information has not seen the light of day other than in wonk circles.
Stay tuned…more to come!
Friday, June 8, 2007
Wisconsin Health Plan Study Raises Questions...
There are many questions about the Lewin Study and the Wisconsin Health Plan.
So far, we have heard, through the press, that the Study affirms this is a great idea, will save money for everyone and answers the health care needs of all but 17,000 people in Wisconsin.
All this begs details to support these conclusions that appear to have been drawn by the WHP creators. Rep. Jon Richards (D-Milwaukee) is trying to “fast track” his WHP but is trying to do so without sharing all the facts.
What we haven’t seen or heard is what questions were asked of the Lewin Group? Were those questions agreed to by all member organizations referenced in the press releases? Have there been changes made to the original Plan? Have there been critical questions asked but not answered? If so, what were those questions? Posed by whom? Etc., etc. etc.
Stay tuned. We’ll continue to dig for answers.
So far, we have heard, through the press, that the Study affirms this is a great idea, will save money for everyone and answers the health care needs of all but 17,000 people in Wisconsin.
All this begs details to support these conclusions that appear to have been drawn by the WHP creators. Rep. Jon Richards (D-Milwaukee) is trying to “fast track” his WHP but is trying to do so without sharing all the facts.
What we haven’t seen or heard is what questions were asked of the Lewin Group? Were those questions agreed to by all member organizations referenced in the press releases? Have there been changes made to the original Plan? Have there been critical questions asked but not answered? If so, what were those questions? Posed by whom? Etc., etc. etc.
Stay tuned. We’ll continue to dig for answers.
Monday, June 4, 2007
National Association of Health Underwriters Offers SCHIP Position...
Congress is currently in the midst of reauthorizing the State Children's Health Insurance Program (SCHIP), the state/federal block grant program that funds health insurance coverage for low-income children. It is this program that funds Wisconsin's BadgerCare plan for children. The National Association of Health Underwriters (NAHU) feels that during the reauthorization process, Congress has a great opportunity to make it simpler for states to voluntarily use SCHIP dollars to subsidize private group coverage for eligible children who have access to such private coverage through their parent's employer.
Doing so would have the following benefits:
More families would accept employer-sponsored coverage for their children, lowering the number of uninsured children.
The administrative burden on low-income families would be lessened, as families could be covered together on the same health insurance plan.
It would reduce the “crowd-out” of the private market that occurs when parents decline employer-sponsored coverage in favor of SCHIP coverage for their dependents.
It would lower costs by taking advantage of any premium dollars employers are willing to contribute toward their eligible employee dependent premiums—money that is now often “left on the table.”
It would also reduce SCHIP costs because the risk associated with covering the children with employer-sponsored coverage would be borne by the private market plan rather than the public program.
Licensed health insurance producers, who are already helping millions of business owners purchase health insurance coverage for their employees nationally, could provide outreach and enrollment assistance at virtually no cost to the SCHIP program.
We believe this is a wise approach and urge that our state Senators and Representatives give careful consideration to these points.
Tuesday, May 29, 2007
Canadian-style Health Care Decried by Canadian...
Brett Skinner, Director of Health, Pharmaceutical and Insurance Policy Research for the Fraser Institute, Canada’s leading think tank is urging that California and other states so inclined avoid the Canadian approach to health care.
“Canada is currently witnessing the failure of its own single-payer health insurance system. Faced with this example, why would Americans want to adopt such a system for themselves? The fact is that the Canadian model is an example of what not to do in health care,” said Mr. Skinner.
He went on to say:
“Canada’s public health insurance monopoly is failing and millions of Canadian patients wait so long for treatment that they are no better off than uninsured Americans.”
The article states that the current average wait time from one seeing his or her family physician to being able to see a specialist is 18 weeks. Statistics show that of the patients who received health-care services in 2005, 11 percent waited longer than three months to see a specialist, 17% waited longer than three months to get necessary non-emergency surgery; and 12 percent waited longer than three months to get necessary diagnostic tests.
While Canadians are forced to wait for treatment, the system legally prevents them from seeking treatment elsewhere and paying for it from their own pocket unless they choose to leave the country.
Most important for any state in the U.S. is that the report produced by the Fraser Institute shows that the Canadian system is not financially sustainable in the long run.
Wisconsin would do well to take Mr. Skinner’s words to heart.
“Canada is currently witnessing the failure of its own single-payer health insurance system. Faced with this example, why would Americans want to adopt such a system for themselves? The fact is that the Canadian model is an example of what not to do in health care,” said Mr. Skinner.
He went on to say:
“Canada’s public health insurance monopoly is failing and millions of Canadian patients wait so long for treatment that they are no better off than uninsured Americans.”
The article states that the current average wait time from one seeing his or her family physician to being able to see a specialist is 18 weeks. Statistics show that of the patients who received health-care services in 2005, 11 percent waited longer than three months to see a specialist, 17% waited longer than three months to get necessary non-emergency surgery; and 12 percent waited longer than three months to get necessary diagnostic tests.
While Canadians are forced to wait for treatment, the system legally prevents them from seeking treatment elsewhere and paying for it from their own pocket unless they choose to leave the country.
Most important for any state in the U.S. is that the report produced by the Fraser Institute shows that the Canadian system is not financially sustainable in the long run.
Wisconsin would do well to take Mr. Skinner’s words to heart.
Friday, May 25, 2007
Jack Lohman's Capital Times Opinion Piece...
Mr. Lohman has used an interesting technique to continue his quest for a government-run statewide equivalent of Medicare.
First, because our political system permits contributions to politicians, and because some of those contributions originate with health care or insurance entities, political corruption is part of the “health care crisis”.
If it is, why do we not tackle political corruption as a separate issue and not throw it into the same basket with health care? Health care in and of itself is far and away a tough enough situation to resolve properly without the added impediment of political corruption tossed into the mix.
Next, he restates his premise that a single payer system of health care would be a windfall for business, the economy of Wisconsin and the citizens who would be the consumers of health care in this brave new world.
Medicare relies upon the private sector insurance companies and health care administrators to pay all its claims. Those costs have been shown to be about 12% of the total claims paid, not 31%. The government cost of operating the system is some 2% to 3% of the total cost. That total administrative cost is about the same as the cost of private sector plans in the state under our free market approach.
“A small payroll tax” of 10% to 15% would be levied on the state’s employers instead of the money currently being spent for the free market version of health care. That would impact the roughly 50% of Wisconsin’s smaller employers that do not currently offer health insurance to employees. A new tax of “just” 10% to 15% would virtually guarantee that those employers would cease operation or move from Wisconsin where that was possible.
The reference to Medicare costing more per capita then would the program Lohman espouses is concerning. He maintains that the state-run program would actually save money over Medicare in that all citizens would be rolled into the pool thus spreading the risk. He ignores the fact that Medicare reimbursements are barely more than $0.50 on each billed dollar. The amount unpaid by Medicare is transferred to the free market programs through increased retail fees at the point-of-care. That alone is a big part of the health care crisis which is largely a health care cost crisis as we’ve argued before.
An alternative would be for those same health care providers to decide whether or not they could continue in business if all reimbursements were now at or below the level of Medicare reimbursements. Another alternative would be for the state to hire the providers of care to take all the egregious “profit” out of the equation. Yet another alternative is for rationing of the then available health care services by the state agency charged with running the health system. Each of those alternatives certainly has a nice ring to them; it’ll be really difficult to decide which to use. Maybe we can have some of each.
And then there is another “small tax” to take away all co-pays, deductibles, dental and vision expense. That would complete the loop. The entitlement mentality that is a large part of the current problem would have become the mentality of us all, and we would’ve driven more jobs out of Wisconsin.
But, we would’ve completely eliminated the insurance industry, all the agents, etc. And that seems a primary goal for effective health care reform from Mr. Lohman’s perspective.
Finally, the argument returns to that of “Business Ethics 101”.
We are finally in agreement: all sides of this debate must be completely honest and ethical because this is far too important a debate to permit it be limited or twisted.
First, because our political system permits contributions to politicians, and because some of those contributions originate with health care or insurance entities, political corruption is part of the “health care crisis”.
If it is, why do we not tackle political corruption as a separate issue and not throw it into the same basket with health care? Health care in and of itself is far and away a tough enough situation to resolve properly without the added impediment of political corruption tossed into the mix.
Next, he restates his premise that a single payer system of health care would be a windfall for business, the economy of Wisconsin and the citizens who would be the consumers of health care in this brave new world.
Medicare relies upon the private sector insurance companies and health care administrators to pay all its claims. Those costs have been shown to be about 12% of the total claims paid, not 31%. The government cost of operating the system is some 2% to 3% of the total cost. That total administrative cost is about the same as the cost of private sector plans in the state under our free market approach.
“A small payroll tax” of 10% to 15% would be levied on the state’s employers instead of the money currently being spent for the free market version of health care. That would impact the roughly 50% of Wisconsin’s smaller employers that do not currently offer health insurance to employees. A new tax of “just” 10% to 15% would virtually guarantee that those employers would cease operation or move from Wisconsin where that was possible.
The reference to Medicare costing more per capita then would the program Lohman espouses is concerning. He maintains that the state-run program would actually save money over Medicare in that all citizens would be rolled into the pool thus spreading the risk. He ignores the fact that Medicare reimbursements are barely more than $0.50 on each billed dollar. The amount unpaid by Medicare is transferred to the free market programs through increased retail fees at the point-of-care. That alone is a big part of the health care crisis which is largely a health care cost crisis as we’ve argued before.
An alternative would be for those same health care providers to decide whether or not they could continue in business if all reimbursements were now at or below the level of Medicare reimbursements. Another alternative would be for the state to hire the providers of care to take all the egregious “profit” out of the equation. Yet another alternative is for rationing of the then available health care services by the state agency charged with running the health system. Each of those alternatives certainly has a nice ring to them; it’ll be really difficult to decide which to use. Maybe we can have some of each.
And then there is another “small tax” to take away all co-pays, deductibles, dental and vision expense. That would complete the loop. The entitlement mentality that is a large part of the current problem would have become the mentality of us all, and we would’ve driven more jobs out of Wisconsin.
But, we would’ve completely eliminated the insurance industry, all the agents, etc. And that seems a primary goal for effective health care reform from Mr. Lohman’s perspective.
Finally, the argument returns to that of “Business Ethics 101”.
We are finally in agreement: all sides of this debate must be completely honest and ethical because this is far too important a debate to permit it be limited or twisted.
Thursday, May 24, 2007
Fixing an Ailing State Health Program...
Maine created Dirigo as the panacea to solve the uninsured problem of its citizens. Dirigo has been, by most counts, a failure having attracted only 13,000 participants.
For the second year in a row, a new bill is coursing its way through the political process that would put another twist on this failed program.
Dirigo would become self-funded and apparently Maine would be its own reinsurer. This is intended to permit the replacement of Anthem that had the audacity to earn a profit of some $3.6 Million from its work on Dirigo.
States have every right to experiment with what their citizens believe ought to work, but they really should be more careful than is the case with some.
Maine will find itself in the health care authorization business. Rationing is the term that comes to mind. Political forces will be pushed and pulled by the heartbreak that illnesses and need for treatment bring. Politicians seem to believe that the supply of money is endless, and will be hard-pressed to save themselves from approving new coverage to gain votes.
Inevitably, there will be budget pressures and those will lead to increased cost-sharing with those covered, or increased taxes, or more stringent rationing…and likely a combination of the three.
Wisconsin needs to take note as it debates the issues involved with health care.
For the second year in a row, a new bill is coursing its way through the political process that would put another twist on this failed program.
Dirigo would become self-funded and apparently Maine would be its own reinsurer. This is intended to permit the replacement of Anthem that had the audacity to earn a profit of some $3.6 Million from its work on Dirigo.
States have every right to experiment with what their citizens believe ought to work, but they really should be more careful than is the case with some.
Maine will find itself in the health care authorization business. Rationing is the term that comes to mind. Political forces will be pushed and pulled by the heartbreak that illnesses and need for treatment bring. Politicians seem to believe that the supply of money is endless, and will be hard-pressed to save themselves from approving new coverage to gain votes.
Inevitably, there will be budget pressures and those will lead to increased cost-sharing with those covered, or increased taxes, or more stringent rationing…and likely a combination of the three.
Wisconsin needs to take note as it debates the issues involved with health care.
Wednesday, May 23, 2007
Canadians don't care for Sicko...
…so read the headline for an article written by Peter Howell for the Toronto Star on May 20, 2007.
He stated that Michael Moore took quite a verbal beating during an interview at the Cannes Film Festival where Moore has been touting his latest “documentary”. I quote from his article:
“We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.”
“…Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo.”
“Other Canadian journalists spoke of the long wait times Canadians face for health care, much longer than the few minutes Moore suggests in Sicko.”
“Sicko, to be released in North America on June 29, is by turns enlightening and manipulative, humorous and maudlin. It makes many valid and urgent points about the crisis of U.S. health care, but they are blunted by Moore’s habit of playing fast and loose with the facts. Whether it’s a case of the end justifying the means will ultimately be for individual viewers to decide.”
The U.S. health care industry knows this is coming and feels alternately threatened, angered, frightened and somewhat helpless. What can be done to blunt this latest of Moore’s film adventures?
Those who care must become much more knowledgeable about Canadian, British, French and Cuban health care issues and how those systems compare to that of our country. Moore has changed his original tactics and now attempts to cajole, instead of club, folks to get them to see his point of view.
His tactics require that spokespeople for the industry assure that they too change their tactics. They can no longer simply criticize the messenger; they must become sufficiently knowledgeable as to be able to refute the wild claims one-by-one.
We are disadvantaged by the fact that his public relations machine is running at full speed and has been for awhile. We have yet to see the film in its entirety and do not yet understand the nature of his various claims and/or charges. We must begin to act now in order to counter the various “issues” soon after the initial screenings in this country.
Agents certainly understand many of the faults of the current U.S. health care system. They must not be seen as defensive, however, when it is they who have been preaching to the choir for the past decade or better.
Agents simply need to occupy the high ground of truth and reason. The Coalition for Sensible Health Care Solutions is a solid platform on which to build consensus.
He stated that Michael Moore took quite a verbal beating during an interview at the Cannes Film Festival where Moore has been touting his latest “documentary”. I quote from his article:
“We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.”
“…Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo.”
“Other Canadian journalists spoke of the long wait times Canadians face for health care, much longer than the few minutes Moore suggests in Sicko.”
“Sicko, to be released in North America on June 29, is by turns enlightening and manipulative, humorous and maudlin. It makes many valid and urgent points about the crisis of U.S. health care, but they are blunted by Moore’s habit of playing fast and loose with the facts. Whether it’s a case of the end justifying the means will ultimately be for individual viewers to decide.”
The U.S. health care industry knows this is coming and feels alternately threatened, angered, frightened and somewhat helpless. What can be done to blunt this latest of Moore’s film adventures?
Those who care must become much more knowledgeable about Canadian, British, French and Cuban health care issues and how those systems compare to that of our country. Moore has changed his original tactics and now attempts to cajole, instead of club, folks to get them to see his point of view.
His tactics require that spokespeople for the industry assure that they too change their tactics. They can no longer simply criticize the messenger; they must become sufficiently knowledgeable as to be able to refute the wild claims one-by-one.
We are disadvantaged by the fact that his public relations machine is running at full speed and has been for awhile. We have yet to see the film in its entirety and do not yet understand the nature of his various claims and/or charges. We must begin to act now in order to counter the various “issues” soon after the initial screenings in this country.
Agents certainly understand many of the faults of the current U.S. health care system. They must not be seen as defensive, however, when it is they who have been preaching to the choir for the past decade or better.
Agents simply need to occupy the high ground of truth and reason. The Coalition for Sensible Health Care Solutions is a solid platform on which to build consensus.
Monday, May 21, 2007
Hospitals Threatened by Gov. Doyle...
Governor Doyle has threatened the hospitals in Wisconsin by stating they would receive no Medicaid rate increase unless they accepted his 1% of gross revenue hospital tax proposal.
The Wisconsin Hospital Association is opposed to the tax with a chief reason being their fear that the additional Federal money that would flow into the state as the result of this “tax” would not go entirely to the hospitals. They also stated that the acceptance of the Governor’s proposal in this instance would cause such an approach to become the approach of choice for years to come.
The assessment would generate some $202.5 million in 2008 with only $136.9 million going back to the hospitals, and would generate some $212.7 million in 2009 with $147.3 going back to hospitals.
It seems obvious that the hospitals have every right to be concerned even in the face of the Governor’s threat.
By the way, does anyone have any idea where all this newfound money will come from? Of course. We all pay our taxes to the U.S. and the state; and any hospital shortfalls will be collected from those who use those facilities.
We citizens just seem to have really deep pockets…at least to the Governor!
The Wisconsin Hospital Association is opposed to the tax with a chief reason being their fear that the additional Federal money that would flow into the state as the result of this “tax” would not go entirely to the hospitals. They also stated that the acceptance of the Governor’s proposal in this instance would cause such an approach to become the approach of choice for years to come.
The assessment would generate some $202.5 million in 2008 with only $136.9 million going back to the hospitals, and would generate some $212.7 million in 2009 with $147.3 going back to hospitals.
It seems obvious that the hospitals have every right to be concerned even in the face of the Governor’s threat.
By the way, does anyone have any idea where all this newfound money will come from? Of course. We all pay our taxes to the U.S. and the state; and any hospital shortfalls will be collected from those who use those facilities.
We citizens just seem to have really deep pockets…at least to the Governor!
Wednesday, May 16, 2007
Self-Fullfilling Prophesy?
An Associated Press report titled “Health System Deemed a ‘Mess’” appeared in the Journal-Sentinel in Milwaukee today. It obviously has appeared across the country.
The first two paragraphs read as follow:
“The U.S. health care system is ‘a dysfunctional mess’ and politicians who insist otherwise look ignorant, according to a medical journal essay by a prominent ethicist at the National Institutes of Health.
‘If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative,’ Ezekiel Emanuel wrote in today’s Journal of the American Medical Association."
Mr. Emanuel went on to decry our health care results, to express dismay at what is spent per person in the U.S., to advise that our average life expectancy ranks 45th in the world behind both Bosnia and Jordan. He also noted, for good measure apparently, that the U.S. infant death rate is 6.37 per 1,000 live births, higher than that of most developed nations.
First, the AMA was in the company of the AARP and Families USA when, on January 18, 2007 they issued a joint press release announcing the “unprecedented alliance” of themselves and some 13 other organizations which had come together to solve the health care crisis.
A careful reading of that unprecedented agreement suggests that some of what had been more reasonable organizations rolled over and became part of the liberal solution. The solution used several federal programs to expand coverage, increased participation of the uninsured, encouraged state experimentation, etc., etc. There is nothing wrong with any of that, except it is apparent to me that the “solutions” lay on the left side of center. Isn’t that always the case when the left-leaning organizations announce some great new coalition?
Next, Emanuel plays loose with his numbers by not taking into account the variations that exist. We spend more per person and we get more. Countries that spend less ration care to their citizens. Our birth rate adjusted to the manner of accounting employed in other countries would show better survival than the rest since we permit low weight, premature and disadvantaged babies to be born into the world, and then we fight to keep them alive. By the way, we count every live birth. We do not extract from the total those that are unlikely to survive for the first year as is common in many other higher ranking countries.
Is the Journal of the AMA publishing this misinformation simply to try to justify its own beliefs, or did it simply take for granted the veracity of the author? I’ll bet that it didn’t simply print without an editorial vetting.
The first two paragraphs read as follow:
“The U.S. health care system is ‘a dysfunctional mess’ and politicians who insist otherwise look ignorant, according to a medical journal essay by a prominent ethicist at the National Institutes of Health.
‘If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative,’ Ezekiel Emanuel wrote in today’s Journal of the American Medical Association."
Mr. Emanuel went on to decry our health care results, to express dismay at what is spent per person in the U.S., to advise that our average life expectancy ranks 45th in the world behind both Bosnia and Jordan. He also noted, for good measure apparently, that the U.S. infant death rate is 6.37 per 1,000 live births, higher than that of most developed nations.
First, the AMA was in the company of the AARP and Families USA when, on January 18, 2007 they issued a joint press release announcing the “unprecedented alliance” of themselves and some 13 other organizations which had come together to solve the health care crisis.
A careful reading of that unprecedented agreement suggests that some of what had been more reasonable organizations rolled over and became part of the liberal solution. The solution used several federal programs to expand coverage, increased participation of the uninsured, encouraged state experimentation, etc., etc. There is nothing wrong with any of that, except it is apparent to me that the “solutions” lay on the left side of center. Isn’t that always the case when the left-leaning organizations announce some great new coalition?
Next, Emanuel plays loose with his numbers by not taking into account the variations that exist. We spend more per person and we get more. Countries that spend less ration care to their citizens. Our birth rate adjusted to the manner of accounting employed in other countries would show better survival than the rest since we permit low weight, premature and disadvantaged babies to be born into the world, and then we fight to keep them alive. By the way, we count every live birth. We do not extract from the total those that are unlikely to survive for the first year as is common in many other higher ranking countries.
Is the Journal of the AMA publishing this misinformation simply to try to justify its own beliefs, or did it simply take for granted the veracity of the author? I’ll bet that it didn’t simply print without an editorial vetting.
Sunday, May 13, 2007
Why Do Our Rulers Not Hear Us?
Wisconsinites are in the midst of the single biggest money grab by any political party in my memory…and that covers some ground.
The combinations of all proposed (some accepted already) new or increased fees and taxes will equal nearly $3 Billion in additional payments to the state. There are some 5.5 Million of us in Wisconsin.
Our rulers are expecting an average of an additional $545 from every person in the state. If you and your wife constitute your household, then you can expect to pony up another $1,091 for the state. If you and your wife have two children at home, then your equivalent share will be $2,182, and so on. These are averages, and the people who pay the majority of taxes (those earning $50,000 and more) will be hit several times harder.
This does not begin to take into account the additions that will be required of communities, and of our school districts, and of our county, and on and on. This does not take into account Governor Doyle’s latest, the promise of a college education in a Wisconsin institution of higher learning for every current eighth grader and all future students who maintain “B” averages, stay out of trouble and sign a contract. So far, many of the 75,000 eligible this year have signed this document even before the program has been approved. By the way, we aren’t even being told the ultimate cost of this boondoggle.
This does not take into account that the state will have managed to move up a slot or two or three on the “Highest Taxed States in the Nation” list that our current rulers seem to think is an honor.
This does not address the negative impact on our business environment, and on the purchase of new vehicles, and on the sales tax collection fall-offs, or our children leaving the state and it does not address another thing…
When, if ever, will enough be enough for Governor Doyle and the Democrats, our rulers?
We are now going through the charade of state budget “debate”. It is during this time that the Joint Finance Committee, comprised of eight Democrats and eight Republicans meet regularly to make changes to the budget submitted by the Governor. One small problem exists, however, in that the Democrat members of this Committee have almost consistently chosen to vote against any changes in the budget as they march to the beat of the Governor's drum.
When this Committee deadlocks at eight to eight, as it usually does, the Governor’s proposed budget remains in place. And, our Governor has chosen to load his budget with nearly every conceivable spending and gifting proposal coupled with increases in everything that already exists. (I use the word “nearly” since his creativity has outstripped my imagination. There are probably more yet to come.)
It would be interesting to see the list of taxes and fees that are not being increased. Certainly it would be easier to list those than all that are going to be, or already have been, increased.
And, what’s worse is that elected Republican officials can do virtually nothing about this except to hold news conferences to try to get the word out. That, too, is made difficult since the mainstream media appears to be enjoying this renaissance with its newly promised government largess.
They can't find time to have a vote on their Sick Leave largess, but raising taxes is good at any time!
These rulers do not represent me. I presume they also do not represent many others! Will our memories last long enough to get us to the polls and to remember that changes are necessary?
It was widely rumored that this was Governor Doyle’s last race for public office. If so, it seems he has decided to get everything on his list accomplished during this last term.
We can only hope for two things: that this is his last term, and that we’ll be able to put food on our tables after he’s gone.
The combinations of all proposed (some accepted already) new or increased fees and taxes will equal nearly $3 Billion in additional payments to the state. There are some 5.5 Million of us in Wisconsin.
Our rulers are expecting an average of an additional $545 from every person in the state. If you and your wife constitute your household, then you can expect to pony up another $1,091 for the state. If you and your wife have two children at home, then your equivalent share will be $2,182, and so on. These are averages, and the people who pay the majority of taxes (those earning $50,000 and more) will be hit several times harder.
This does not begin to take into account the additions that will be required of communities, and of our school districts, and of our county, and on and on. This does not take into account Governor Doyle’s latest, the promise of a college education in a Wisconsin institution of higher learning for every current eighth grader and all future students who maintain “B” averages, stay out of trouble and sign a contract. So far, many of the 75,000 eligible this year have signed this document even before the program has been approved. By the way, we aren’t even being told the ultimate cost of this boondoggle.
This does not take into account that the state will have managed to move up a slot or two or three on the “Highest Taxed States in the Nation” list that our current rulers seem to think is an honor.
This does not address the negative impact on our business environment, and on the purchase of new vehicles, and on the sales tax collection fall-offs, or our children leaving the state and it does not address another thing…
When, if ever, will enough be enough for Governor Doyle and the Democrats, our rulers?
We are now going through the charade of state budget “debate”. It is during this time that the Joint Finance Committee, comprised of eight Democrats and eight Republicans meet regularly to make changes to the budget submitted by the Governor. One small problem exists, however, in that the Democrat members of this Committee have almost consistently chosen to vote against any changes in the budget as they march to the beat of the Governor's drum.
When this Committee deadlocks at eight to eight, as it usually does, the Governor’s proposed budget remains in place. And, our Governor has chosen to load his budget with nearly every conceivable spending and gifting proposal coupled with increases in everything that already exists. (I use the word “nearly” since his creativity has outstripped my imagination. There are probably more yet to come.)
It would be interesting to see the list of taxes and fees that are not being increased. Certainly it would be easier to list those than all that are going to be, or already have been, increased.
And, what’s worse is that elected Republican officials can do virtually nothing about this except to hold news conferences to try to get the word out. That, too, is made difficult since the mainstream media appears to be enjoying this renaissance with its newly promised government largess.
They can't find time to have a vote on their Sick Leave largess, but raising taxes is good at any time!
These rulers do not represent me. I presume they also do not represent many others! Will our memories last long enough to get us to the polls and to remember that changes are necessary?
It was widely rumored that this was Governor Doyle’s last race for public office. If so, it seems he has decided to get everything on his list accomplished during this last term.
We can only hope for two things: that this is his last term, and that we’ll be able to put food on our tables after he’s gone.
Friday, May 11, 2007
Enroll in SCHIP and Drop Private Coverage?
The Associated press has just reported on a Congressional Budget Office report that said for every 100 children who enroll in SCHIP (State Children’s Health Insurance Program), there is a corresponding reduction in private coverage of between 25 and 50 children.
CBO officials also pointed out that when SCHIP was created, it had been estimated that about 40% of the participants would previously have had private insurance. If those parents were actually at or beneath the federal poverty level, I have no problem with this. Those families could certainly have found an excellent use for the freed money.
If, however, these were children whose parents only became eligible because they lived in a state that raised the income by doubling or tripling the federal poverty level to attract entrants, I don’t think that was ever intended.
Sen. Grassley, R-Iowa was reported to have said, “This report tells us that Congress needs to make sure that whatever it does, it should actually result in more kids having health insurance, rather than simply shifting children from private to public health insurance.”
And, we Wisconsinites have more adults in the SCHIP program than children. If that were the intent, wouldn’t it be better called SAHIP…the State Adult Health Insurance Program?
Yet another perversion of a well-intended program that leads one to ask…”This makes us want government run health care why?”
CBO officials also pointed out that when SCHIP was created, it had been estimated that about 40% of the participants would previously have had private insurance. If those parents were actually at or beneath the federal poverty level, I have no problem with this. Those families could certainly have found an excellent use for the freed money.
If, however, these were children whose parents only became eligible because they lived in a state that raised the income by doubling or tripling the federal poverty level to attract entrants, I don’t think that was ever intended.
Sen. Grassley, R-Iowa was reported to have said, “This report tells us that Congress needs to make sure that whatever it does, it should actually result in more kids having health insurance, rather than simply shifting children from private to public health insurance.”
And, we Wisconsinites have more adults in the SCHIP program than children. If that were the intent, wouldn’t it be better called SAHIP…the State Adult Health Insurance Program?
Yet another perversion of a well-intended program that leads one to ask…”This makes us want government run health care why?”
Thursday, May 10, 2007
Public Policy Forum Discusses Health Reform…
The Public Policy Forum held a panel discussion in Milwaukee on Wednesday, May 9th to discuss health reform in Wisconsin. Three proposals were discussed:
Wisconsin Health Care Partnership Plan which is the single payer plan developed by the Wisconsin AFL-CIO. It would be financed by a flat tax that this group estimates to be $340 per month per employee. Seems like that is a number we heard in the Massachusetts “Connector” plan debate…that has increased several times over the past months. It claims that it will reduce the 27% of every premium dollar going to administer health care insurance today. We seem to have a disagreement on that number, as well; since our information suggests the real cost is closer to 12% as borne out by federal studies.
Fortunately, this plan appears to be DOA from all indications.
The Wisconsin Health Plan which has been developed largely by David Riemer. It tends to use the state employee program model and would be funded by a tax on all employers. Last I heard, the proponents of this plan were talking about maybe a 12% tax, but only when pushed to give an estimate. Our information suggests that this tax would be much closer to 17% at the outset. The plans would be limited to those selected by “a commission” and each person would be required to select coverage from that list. This smacks of too much government control for my tastes. It also will drive businesses out of business and that certainly won’t be good for heath care or anything else.
BadgerCare Plus is the plan espoused by Governor Doyle. It would supposedly expand health insurance coverage to 98% of our state citizens. First, that still leaves 2% that are uninsured and that isn’t a real good solution since it would retain cost-shifting to the insured. We need to be sure everyone is covered. This plan piggybacks on federally-funded programs that are intended for children, would subsidize families with incomes beneath a certain point, etc. Our state already has more adults covered in the children’s health plan than it does children. The poverty level that determines subsidization is already set at twice the federal program’s original intent and there are those who would increase it again. There are as many as 200,000 people in our state that qualify for the various government programs who simply do not enroll. Why will this be different? And, what happens when federal funding begins to be restricted due to the increasing costs of Medicare, Medicaid and Social Security? Will providers’ reimbursements, already too low in this program, be reduced further?
Any successful reform plan must involve the effort of the private market and of government. Government’s role should be that of support, working with the private sector to get control of costs, and using its influence to assure transparency in those costs, transparency in the quality of care and transparency in the outcomes of the providers of that care. The consumer will take care of the rest.
Basic health care plans must be made available. Tax-advantaged programs must be featured. New tax-advantaged programs such as a Health Coverage Account should be made available to help low income people to be able to afford the basic health plans.
That sounds like a sensible solution.
Wisconsin Health Care Partnership Plan which is the single payer plan developed by the Wisconsin AFL-CIO. It would be financed by a flat tax that this group estimates to be $340 per month per employee. Seems like that is a number we heard in the Massachusetts “Connector” plan debate…that has increased several times over the past months. It claims that it will reduce the 27% of every premium dollar going to administer health care insurance today. We seem to have a disagreement on that number, as well; since our information suggests the real cost is closer to 12% as borne out by federal studies.
Fortunately, this plan appears to be DOA from all indications.
The Wisconsin Health Plan which has been developed largely by David Riemer. It tends to use the state employee program model and would be funded by a tax on all employers. Last I heard, the proponents of this plan were talking about maybe a 12% tax, but only when pushed to give an estimate. Our information suggests that this tax would be much closer to 17% at the outset. The plans would be limited to those selected by “a commission” and each person would be required to select coverage from that list. This smacks of too much government control for my tastes. It also will drive businesses out of business and that certainly won’t be good for heath care or anything else.
BadgerCare Plus is the plan espoused by Governor Doyle. It would supposedly expand health insurance coverage to 98% of our state citizens. First, that still leaves 2% that are uninsured and that isn’t a real good solution since it would retain cost-shifting to the insured. We need to be sure everyone is covered. This plan piggybacks on federally-funded programs that are intended for children, would subsidize families with incomes beneath a certain point, etc. Our state already has more adults covered in the children’s health plan than it does children. The poverty level that determines subsidization is already set at twice the federal program’s original intent and there are those who would increase it again. There are as many as 200,000 people in our state that qualify for the various government programs who simply do not enroll. Why will this be different? And, what happens when federal funding begins to be restricted due to the increasing costs of Medicare, Medicaid and Social Security? Will providers’ reimbursements, already too low in this program, be reduced further?
Any successful reform plan must involve the effort of the private market and of government. Government’s role should be that of support, working with the private sector to get control of costs, and using its influence to assure transparency in those costs, transparency in the quality of care and transparency in the outcomes of the providers of that care. The consumer will take care of the rest.
Basic health care plans must be made available. Tax-advantaged programs must be featured. New tax-advantaged programs such as a Health Coverage Account should be made available to help low income people to be able to afford the basic health plans.
That sounds like a sensible solution.
Wednesday, May 9, 2007
Common Sense in Health Care Debate...at least do no harm!
As the debate over health care and the changes needing to be enacted in Wisconsin continues, we need to be ever mindful that wise people in other states have already made their share of mistakes.
Maine thought that "Dirigo" would cover 130,000 citizens in the first year. That was nearly three years ago. There are some 18,000 citizens covered. Dirigo was to be the vehicle that assured universal coverage.
Connecticut's governor proposed a magic cure-all program. The program wasn't proposed with any cost numbers, but those were developed later. It seems that the Connecticut program might accomplish its goal...but the cost would be triple that of Connecticut's state budget annually.
Illinois's governor has proposed a plan. It threatens to tax employers out of business. Even the Reverend Jesse Jackson has seen the light and stated that health care coverage at the cost of employment is not at all a good trade for the citizens of Illinois.
All this reminds me of what I'd always thought was a part of the physician's oath. There is an erroneous attribution to Hippocrates having to do with the phrase, "first, do no harm." He did author a similar plea, but did so in his Epidemics, Bk. I, Sect. XI. One translation reads: "Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to help, or at least to do no harm." (Emphasis added)
It is imperative that we do no harm as we settle on the set of initiatives required to set our Wisconsin health care community on the right path for the future as we see that today. Let us incorporate the wisdom of Hippocrates in the process.
Maine thought that "Dirigo" would cover 130,000 citizens in the first year. That was nearly three years ago. There are some 18,000 citizens covered. Dirigo was to be the vehicle that assured universal coverage.
Connecticut's governor proposed a magic cure-all program. The program wasn't proposed with any cost numbers, but those were developed later. It seems that the Connecticut program might accomplish its goal...but the cost would be triple that of Connecticut's state budget annually.
Illinois's governor has proposed a plan. It threatens to tax employers out of business. Even the Reverend Jesse Jackson has seen the light and stated that health care coverage at the cost of employment is not at all a good trade for the citizens of Illinois.
All this reminds me of what I'd always thought was a part of the physician's oath. There is an erroneous attribution to Hippocrates having to do with the phrase, "first, do no harm." He did author a similar plea, but did so in his Epidemics, Bk. I, Sect. XI. One translation reads: "Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to help, or at least to do no harm." (Emphasis added)
It is imperative that we do no harm as we settle on the set of initiatives required to set our Wisconsin health care community on the right path for the future as we see that today. Let us incorporate the wisdom of Hippocrates in the process.
Sunday, May 6, 2007
Mandated Health Care
Wisconsin has added certain required coverage for health insurance policies over the course of many years. There are more than twenty such requirements or “mandates” as they’re known in Wisconsin. There are even more such mandates across all fifty states.
Mandates have the effect of adding to the overall cost of health care. In some cases this happens because such services were not covered earlier or only partially covered. Mandates can and do make access to such care easier without significant personal cost. Health care costs drive health insurance costs, not the other way around as much of our media would have us believe. Mandates increase our health care costs. And that adds to our crisis in health care.
Mandates viewed individually appear to be good things. The following list shows those that are required in Wisconsin (Fact Sheet on Mandated Benefits in Health Insurance Policies, Office of the Commissioner of Insurance, PI-019 [R 01/2007]):
Optometric Service Access, Chiropractic Service Access,
Nurse Practitioner Access, Dental Service Access,
Adopted Child Coverage, Handicapped Child Coverage,
Home Health Care Access, Skilled Nursing Care,
Kidney Disease Coverage, Mammography Examinations,
Newborn Infant Coverage, Grandchild Coverage,
Diabetes Equipment & Supplies, Genetic Testing Restrictions,
HIV Treatment Drug Access Lead Screening (for children under 6),
TMJ Disorders, Breast Reconstruction,
Child Immunizations, Certain Clinical Cancer Trial Costs,
Maternity Coverage (if provided for any insured, it must be available to all),
Nervous and Mental Disorders, Alcoholism, and other Drug Abuse,
Hospital/Ambulatory Surgery Charges & Anesthetics for Certain Dental Care
(Self-funded [ERISA] plans by a city, village, county, or school district plans may be included in these regulations.)
Reviewing these individual mandates, we begin to get a better idea of how they might increase costs. Chiropractic-type services, for example, were covered originally only if delivered by a medical doctor. If we wanted to see a chiropractor, we did and we paid for it from our pockets. Chiropractors lobbied to gain the right to engage in the delivery of these services through health insurance policies and ultimately won that right. Unit costs were reduced somewhat with the new competition, but increased access to these services, coupled with advertising by the newly approved providers, likely more than offset whatever unit cost savings resulted.
The federal law that enabled health maintenance organizations also added the requirements for some of the now-mandated items in the interests of promoting preventative care (such as vision examinations). Labor-management bargaining contributed to the addition of benefits over the years and that led to certain of the mandates. Insurers were complicit since they added more such benefits in the attempt to differentiate themselves. Health care provider-to-consumer advertising also had a significant impact on health care mandates and increased costs.
Some states have begun to permit health policies referred to as “mandate-light” policies to be sold within their borders. These policies contain fewer mandates, or completely eliminate mandates, thus reducing the cost of those policies, and thereby making health insurance more affordable. The total cost for mandates in Wisconsin is estimated at from 20% of premiums to as much as 32% of premiums.
A valid question is: Should Wisconsin permit mandate-light policies to be sold? If that answer is yes, then the question becomes, which mandates should be excluded? The job of deciding which are in and which are out would be difficult. [Almost as difficult as a government run program deciding what to cover and what not to cover.] Self-insured plans in the private sector could provide some benchmarks for what is provided to employees by a majority of the self insured companies.
If mandate-light plans were permitted, would insurers still be willing and able to offer full mandate policies? Would they be able to price those to anticipate the increased costs of claims being spread across a smaller segment of society [adverse selection]? Would the state promulgate new laws requiring both types of policies? If both types were required, the premium cost would almost certainly be higher in the full mandate policies since only those using the services would be likely to enroll in these plans.
Would this adversely affect many patients or few patients? Is the primary impact more likely to be limited to the provider groups due to decreased volume? Would decreased volume lead to higher unit costs by those same providers? Would the elimination of mandates spawn new policies from some of the more specialized insurers (a talking duck comes to mind)?
As with all questions relating to health care, these are difficult to answer. The free market has historically responded to these needs. Critical illness policies, which have been available for years, were introduced before such coverage was popular in the mainstream, and continue to be purchased by those who believe them to be of benefit.
It has been established that fewer small employers believe they can afford to provide health insurance benefits for their employees each year. The latest reports indicate that something in the range of 60% to 62% of small employers now provide access to health insurance benefits.
Would mandate-light health insurance be better than nothing? Would mandate-light be better than a single payer system operated by a government agency or quasi-public entity? Would mandate-light actually be a step toward relying upon insurance for what it was originally intended…catastrophic unforeseeable health care needs?
We have come to expect fully prepaid health care with but small office visit co-pays, at best. Our “entitlement mentality” has caught up with us and we’re all guilty of permitting that to occur. It has also caught up with our employers and with our country. We are only a few years away from the day when health care costs will consume 20% of our gross domestic product.
We need candid, honest debate and we need it now. That will be difficult in the highly charged environment of today, but it is essential. Can we indeed find our way “back to the future” or are we destined to repeat the failures of so many of our world neighbors?
Mandates have the effect of adding to the overall cost of health care. In some cases this happens because such services were not covered earlier or only partially covered. Mandates can and do make access to such care easier without significant personal cost. Health care costs drive health insurance costs, not the other way around as much of our media would have us believe. Mandates increase our health care costs. And that adds to our crisis in health care.
Mandates viewed individually appear to be good things. The following list shows those that are required in Wisconsin (Fact Sheet on Mandated Benefits in Health Insurance Policies, Office of the Commissioner of Insurance, PI-019 [R 01/2007]):
Optometric Service Access, Chiropractic Service Access,
Nurse Practitioner Access, Dental Service Access,
Adopted Child Coverage, Handicapped Child Coverage,
Home Health Care Access, Skilled Nursing Care,
Kidney Disease Coverage, Mammography Examinations,
Newborn Infant Coverage, Grandchild Coverage,
Diabetes Equipment & Supplies, Genetic Testing Restrictions,
HIV Treatment Drug Access Lead Screening (for children under 6),
TMJ Disorders, Breast Reconstruction,
Child Immunizations, Certain Clinical Cancer Trial Costs,
Maternity Coverage (if provided for any insured, it must be available to all),
Nervous and Mental Disorders, Alcoholism, and other Drug Abuse,
Hospital/Ambulatory Surgery Charges & Anesthetics for Certain Dental Care
(Self-funded [ERISA] plans by a city, village, county, or school district plans may be included in these regulations.)
Reviewing these individual mandates, we begin to get a better idea of how they might increase costs. Chiropractic-type services, for example, were covered originally only if delivered by a medical doctor. If we wanted to see a chiropractor, we did and we paid for it from our pockets. Chiropractors lobbied to gain the right to engage in the delivery of these services through health insurance policies and ultimately won that right. Unit costs were reduced somewhat with the new competition, but increased access to these services, coupled with advertising by the newly approved providers, likely more than offset whatever unit cost savings resulted.
The federal law that enabled health maintenance organizations also added the requirements for some of the now-mandated items in the interests of promoting preventative care (such as vision examinations). Labor-management bargaining contributed to the addition of benefits over the years and that led to certain of the mandates. Insurers were complicit since they added more such benefits in the attempt to differentiate themselves. Health care provider-to-consumer advertising also had a significant impact on health care mandates and increased costs.
Some states have begun to permit health policies referred to as “mandate-light” policies to be sold within their borders. These policies contain fewer mandates, or completely eliminate mandates, thus reducing the cost of those policies, and thereby making health insurance more affordable. The total cost for mandates in Wisconsin is estimated at from 20% of premiums to as much as 32% of premiums.
A valid question is: Should Wisconsin permit mandate-light policies to be sold? If that answer is yes, then the question becomes, which mandates should be excluded? The job of deciding which are in and which are out would be difficult. [Almost as difficult as a government run program deciding what to cover and what not to cover.] Self-insured plans in the private sector could provide some benchmarks for what is provided to employees by a majority of the self insured companies.
If mandate-light plans were permitted, would insurers still be willing and able to offer full mandate policies? Would they be able to price those to anticipate the increased costs of claims being spread across a smaller segment of society [adverse selection]? Would the state promulgate new laws requiring both types of policies? If both types were required, the premium cost would almost certainly be higher in the full mandate policies since only those using the services would be likely to enroll in these plans.
Would this adversely affect many patients or few patients? Is the primary impact more likely to be limited to the provider groups due to decreased volume? Would decreased volume lead to higher unit costs by those same providers? Would the elimination of mandates spawn new policies from some of the more specialized insurers (a talking duck comes to mind)?
As with all questions relating to health care, these are difficult to answer. The free market has historically responded to these needs. Critical illness policies, which have been available for years, were introduced before such coverage was popular in the mainstream, and continue to be purchased by those who believe them to be of benefit.
It has been established that fewer small employers believe they can afford to provide health insurance benefits for their employees each year. The latest reports indicate that something in the range of 60% to 62% of small employers now provide access to health insurance benefits.
Would mandate-light health insurance be better than nothing? Would mandate-light be better than a single payer system operated by a government agency or quasi-public entity? Would mandate-light actually be a step toward relying upon insurance for what it was originally intended…catastrophic unforeseeable health care needs?
We have come to expect fully prepaid health care with but small office visit co-pays, at best. Our “entitlement mentality” has caught up with us and we’re all guilty of permitting that to occur. It has also caught up with our employers and with our country. We are only a few years away from the day when health care costs will consume 20% of our gross domestic product.
We need candid, honest debate and we need it now. That will be difficult in the highly charged environment of today, but it is essential. Can we indeed find our way “back to the future” or are we destined to repeat the failures of so many of our world neighbors?
Monday, April 30, 2007
Advanced Healthcare, Aurora & the Future...
I am the patient of an Advanced Healthcare doctor. My first reaction to the early news that Advanced Healthcare and Aurora were negotiating a joint relationship was one of wait and see.
Now, some weeks later, there is the outward indication of a significant change in relationship…a formal announcement by the two parties has been issued.
My initial reaction to the announcement over the week-end that this likelihood seemed nearly a fait accompli was one of concern. I was concerned for me as a patient, for my doctor as a participant, for Community Memorial Hospital as a threatened institution and for the whole healthcare topography in S.E. Wisconsin.
I had an unexpected opportunity over the week-end to experience healthcare first-hand. As the result, I also had the opportunity to talk with a couple of physicians…one a member of Advanced Healthcare and the other a member of another group [but who would be impacted by any issues ultimately surrounding the viability of Community Memorial]. I also had the opportunity to interact with employees of Community Memorial Hospital, although I chose to not engage any of them in this discussion.
The Advanced Healthcare doctor told me that he had mixed emotions as did many of his peers. He also stated an interesting statistic as follows: a handful of years ago, Advanced Healthcare was one of a couple of hundred similarly-sized group practices in the U.S. but today it is the sole group practice of its size left in the U.S. Each of the others has been acquired, has merged or has somehow been absorbed by another entity. He reminded me that even though each physician sees his patients as a sacred trust, the corporate folks understand that healthcare is a business. And businesses must remain competitive in order to survive. If one group of physicians lost its edge, many of its patients would quickly migrate to another practice that had the edge. We patients expect our physicians to be “loyal” to us, but we can move without those same feelings flowing in the other direction.
The non-Advanced Healthcare doctor told me that there were mixed emotions of a very strong nature inside and outside the systems involved. He said little else, I presume because of the highly-charged situation of which he is a part.
I saw no sign that staff members had changed in any way as the result of this news. Some probably had no idea that such news had been issued while others felt they would be okay no matter what. It is, after all, difficult to imagine that a hospital of the size and reputation of Community Memorial with its partnering relationship with Froedert could not survive very ably in almost any situation.
Maybe the other suitor earlier reported will step up to the plate with an offer to Advanced Healthcare that transcends the deal in the current discussion. If so, it could be that my concerns would be for naught; or it could be that I’ll have a whole new set of concerns.
If we simply take a look around us, we’ll see that there has been consolidation of insurers and consolidation of hospital groups. If the physician groups do not scale up in size, they will have lost much of their negotiating leverage with both the insurers and the hospitals. We cannot foretell what such consolidation will mean to the cost of healthcare; it is easy, however, to postulate increased costs given fewer alternatives and more buildings and more expensive equipment and less competition [in the form of fewer competing entities].
Physicians generate the bulk of patient flow for hospitals by their admitting profiles. So these physicians have significant leverage at the moment.
Could our local hospital emerge strong as ever? Certainly it could.
Could it emerge as a weaker entity? Certainly it could.
Could it simply go away as we know it today? If Aurora were to acquire or merge with Advanced Healthcare and then build a northern tier hospital as has been discussed; and, if Medical Associates were to conclude negotiations with ProHealth located in Waukesha and began referring patients in that direction…certainly it could.
Whatever your thoughts, this is an exciting and/or troubling time for we consumers of healthcare in this area.
Now, some weeks later, there is the outward indication of a significant change in relationship…a formal announcement by the two parties has been issued.
My initial reaction to the announcement over the week-end that this likelihood seemed nearly a fait accompli was one of concern. I was concerned for me as a patient, for my doctor as a participant, for Community Memorial Hospital as a threatened institution and for the whole healthcare topography in S.E. Wisconsin.
I had an unexpected opportunity over the week-end to experience healthcare first-hand. As the result, I also had the opportunity to talk with a couple of physicians…one a member of Advanced Healthcare and the other a member of another group [but who would be impacted by any issues ultimately surrounding the viability of Community Memorial]. I also had the opportunity to interact with employees of Community Memorial Hospital, although I chose to not engage any of them in this discussion.
The Advanced Healthcare doctor told me that he had mixed emotions as did many of his peers. He also stated an interesting statistic as follows: a handful of years ago, Advanced Healthcare was one of a couple of hundred similarly-sized group practices in the U.S. but today it is the sole group practice of its size left in the U.S. Each of the others has been acquired, has merged or has somehow been absorbed by another entity. He reminded me that even though each physician sees his patients as a sacred trust, the corporate folks understand that healthcare is a business. And businesses must remain competitive in order to survive. If one group of physicians lost its edge, many of its patients would quickly migrate to another practice that had the edge. We patients expect our physicians to be “loyal” to us, but we can move without those same feelings flowing in the other direction.
The non-Advanced Healthcare doctor told me that there were mixed emotions of a very strong nature inside and outside the systems involved. He said little else, I presume because of the highly-charged situation of which he is a part.
I saw no sign that staff members had changed in any way as the result of this news. Some probably had no idea that such news had been issued while others felt they would be okay no matter what. It is, after all, difficult to imagine that a hospital of the size and reputation of Community Memorial with its partnering relationship with Froedert could not survive very ably in almost any situation.
Maybe the other suitor earlier reported will step up to the plate with an offer to Advanced Healthcare that transcends the deal in the current discussion. If so, it could be that my concerns would be for naught; or it could be that I’ll have a whole new set of concerns.
If we simply take a look around us, we’ll see that there has been consolidation of insurers and consolidation of hospital groups. If the physician groups do not scale up in size, they will have lost much of their negotiating leverage with both the insurers and the hospitals. We cannot foretell what such consolidation will mean to the cost of healthcare; it is easy, however, to postulate increased costs given fewer alternatives and more buildings and more expensive equipment and less competition [in the form of fewer competing entities].
Physicians generate the bulk of patient flow for hospitals by their admitting profiles. So these physicians have significant leverage at the moment.
Could our local hospital emerge strong as ever? Certainly it could.
Could it emerge as a weaker entity? Certainly it could.
Could it simply go away as we know it today? If Aurora were to acquire or merge with Advanced Healthcare and then build a northern tier hospital as has been discussed; and, if Medical Associates were to conclude negotiations with ProHealth located in Waukesha and began referring patients in that direction…certainly it could.
Whatever your thoughts, this is an exciting and/or troubling time for we consumers of healthcare in this area.
Saturday, April 28, 2007
Health Care & Unintended Consequences...or, How We Got Where We Are
Back in the 1970s, our elected officials enacted new legislation to permit an entity called a Health Maintenance Organization to be organized under federal regulations. That same law provided for grants to be used to create these new entities. People streamed to the federal trough and hundreds of health maintenance Organizations were created.
The intended results were the broadening of health care available to the members of these new organizations. The law required the use of a tool called community rating. This tool was intended to make premium rates fair across the total spectrum: young and old, male and female, and healthy and ill.
In addition, the entities could now either employ the health care providers directly, or those health care providers could organize for purposes of negotiating master agreements under which they'd provide required services for advanced payments. This was thought to be a good way to control the use of limited health care services while helping the new organizations remain financially stable.
It was believed that keeping people healthy was better and less expensive than the treatment of acute issues that had lain untreated for a period of time.
There seemed nothing wrong with the hypothesis, however time began to show the deficiencies.
Community rating caused the rates of the healthy and younger to rise since they had to offset the added costs of the ill and older members. The prepayments to the Health Maintenance Organizations were subject to shortfalls if over utilization occurred. We had just created an official way to ration health care. Services were delayed until the next month, and that solved the over utilization problem for the moment.
To this point, the free market had taken care of this issue; if you didn't have the money to pay for the service, you waited until you had the money.
This method of compensating providers came to be known as prepaid health care and began the process of removing the health care consumer from the equation. We consumers began to observe that our only out-of-pocket cost for this new kind of plan was our co-payment. Back then, co-payments were in the range of $5 to $10 per visit. We began to lose track of the real total cost of the health care we consumed. If we had a sniffle, why not see the doctor; after all, it only cost $5 or $10. We gave no real thought to where the rest of money was coming from, because it didn't appear to come from our pockets. That wasn't and isn't true, but it seems so on the surface.
It is important to understand that the Health Maintenance Organizations were not villains; they were simply following the federal edict. HMOs as we began to call them managed to eliminate much of the waste that had existed. They negotiated tough reimbursement agreements with hospitals. Hospitals that had had occupancy rates of 50% to 60% were now forced to close off wings, or to be creative and find other uses for the empty facilities. One of those uses was the birthing center with soft lighting, etc. Even though the mother was only given 48 hours in the hospital, they were going to be softly lit hours!
As HMOs took ever larger share of the market from traditional insurers, the insurance companies reacted and created their own provider networks and negotiated discounted prices from the usual fee for service pricing. As doctors were forced to take less money for each procedure, they could only exist by performing more procedures.
This story could go on for many more paragraphs. Suffice to say, there were many unintended consequences that continue to cause problems to this day:
The intended results were the broadening of health care available to the members of these new organizations. The law required the use of a tool called community rating. This tool was intended to make premium rates fair across the total spectrum: young and old, male and female, and healthy and ill.
In addition, the entities could now either employ the health care providers directly, or those health care providers could organize for purposes of negotiating master agreements under which they'd provide required services for advanced payments. This was thought to be a good way to control the use of limited health care services while helping the new organizations remain financially stable.
It was believed that keeping people healthy was better and less expensive than the treatment of acute issues that had lain untreated for a period of time.
There seemed nothing wrong with the hypothesis, however time began to show the deficiencies.
Community rating caused the rates of the healthy and younger to rise since they had to offset the added costs of the ill and older members. The prepayments to the Health Maintenance Organizations were subject to shortfalls if over utilization occurred. We had just created an official way to ration health care. Services were delayed until the next month, and that solved the over utilization problem for the moment.
To this point, the free market had taken care of this issue; if you didn't have the money to pay for the service, you waited until you had the money.
This method of compensating providers came to be known as prepaid health care and began the process of removing the health care consumer from the equation. We consumers began to observe that our only out-of-pocket cost for this new kind of plan was our co-payment. Back then, co-payments were in the range of $5 to $10 per visit. We began to lose track of the real total cost of the health care we consumed. If we had a sniffle, why not see the doctor; after all, it only cost $5 or $10. We gave no real thought to where the rest of money was coming from, because it didn't appear to come from our pockets. That wasn't and isn't true, but it seems so on the surface.
It is important to understand that the Health Maintenance Organizations were not villains; they were simply following the federal edict. HMOs as we began to call them managed to eliminate much of the waste that had existed. They negotiated tough reimbursement agreements with hospitals. Hospitals that had had occupancy rates of 50% to 60% were now forced to close off wings, or to be creative and find other uses for the empty facilities. One of those uses was the birthing center with soft lighting, etc. Even though the mother was only given 48 hours in the hospital, they were going to be softly lit hours!
As HMOs took ever larger share of the market from traditional insurers, the insurance companies reacted and created their own provider networks and negotiated discounted prices from the usual fee for service pricing. As doctors were forced to take less money for each procedure, they could only exist by performing more procedures.
This story could go on for many more paragraphs. Suffice to say, there were many unintended consequences that continue to cause problems to this day:
- consumers have no concept of the real cost of the services they consume
- health care providers continue to provide more services since that is how they get paid
- health care costs spiral upward at multiples of the cost of other goods and services
- small employers have gotten to the point of ending health care plans to avoid going out of business
- health care now consumes nearly 16% of every dollar generated by our national economy and is headed up
We must restore the consumer to his and her rightful place in the equation. One of the ways to do that is to cause the consumer to want to know the real costs, and to think seriously about seeing the doctor before deciding to do so on a whim. We cause that by having the consumer again be responsible for a larger part of what he or she consumes.
In order for this to happen, we must have truly transparent cost information available. We must have truly transparent quality information available. And, we must have truly transparent outcomes information available. These are roles in which government can legitimately play a part.
We must reward health care providers for being good at what they do. Providers with better outcomes and better pricing should be rewarded with more business. Those not measuring up to their peers should pay the price of full disclosure causing them to clean up their acts. These are roles in which government can legitimately play a part.
Government does not belong in the health care business. There are numerous examples all across the world that vividly point this out. The governments with single payer plans are in trouble. They are running out of money, have alienated their customers [who are also the taxpayers that refuse to pay any more for inferior services], and look longingly to the United States and what they see as the best health care system in the world.
It seems that we're the only people who don't recognize what we have and how we can make it even better.
Friday, April 27, 2007
State Children's Health Insurance Programs: Follow Up
The earlier Blog covering this subject discussed the incremental approach to government run health care and cited the use of the Children's program to cover adults.
Sen. Olympia Snow of Maine (supposedly a Republican but actually a RINO) introduced legislation Thursday to double the funding of this program over the next five years. This flies in the face of the real Republicans who wanted the funding levels reduced to end the improper use of the program using the purse strings.
She was joined in sponsoring this legislation by Sens. Jay Rockefeller (D-W.Va.) and Teddy Kennedy (D-Mass.)
While they were at it, they seized on this opportunity to also increase the coverage afforded under the SCHIP program to include mental and dental health care. This is such a good example of incrementalism, I couldn't help but post an update.
Sen. Olympia Snow of Maine (supposedly a Republican but actually a RINO) introduced legislation Thursday to double the funding of this program over the next five years. This flies in the face of the real Republicans who wanted the funding levels reduced to end the improper use of the program using the purse strings.
She was joined in sponsoring this legislation by Sens. Jay Rockefeller (D-W.Va.) and Teddy Kennedy (D-Mass.)
While they were at it, they seized on this opportunity to also increase the coverage afforded under the SCHIP program to include mental and dental health care. This is such a good example of incrementalism, I couldn't help but post an update.
If There Is Any Doubt About Government-run Healthcare...
We need simply look at the gyrations occurring in Congress as the “great debate” over SCHIP and Medicare Advantage takes place to see exactly where we’ll be if Healthy Wisconsin were to become the law in Badgerland.
SCHIP is being re-engineered to bring in more and more adults and to permit families of four earning over $80,000 per year to join. This is a very obvious expansion of government-run healthcare.
Medicare Advantage funding is being threatened because it represents an incursion of the private sector into the world of government-run healthcare (Medicare) that is a threat to all those whose goal is just that…government-run healthcare.
Doctors in Medicare would be favored by some of money freed up by the reductions in Medicare Advantage while SCHIP would get the rest because there simply isn’t enough money to go around even with huge increases in tobacco taxes. Medicare Advantage could disappear as the direct result of this move. In this instance, oldsters who had selected Medicare Advantage will be forced back into Medicare parts A & B with lesser benefits available to them at higher costs. This subtle form of rationing should give us all pause. Future forms of rationing promise to be far less subtle.
Politicians running healthcare is oxymoronic. They will be unable to resist the temptations of all that power…and you and I will suffer…just as those on Medicare Advantage programs are about to suffer. What will it be next? Will it be mandatory health prevention as suggested by one presidential aspirant? What will happen with all that data that is collected? And then where will it go? Will we ultimately see consciously controlled death rates since death is less expensive than living with and treating a disease? That happens in single payer countries around the world today. What makes us think that it wouldn’t happen here as well?
SCHIP is being re-engineered to bring in more and more adults and to permit families of four earning over $80,000 per year to join. This is a very obvious expansion of government-run healthcare.
Medicare Advantage funding is being threatened because it represents an incursion of the private sector into the world of government-run healthcare (Medicare) that is a threat to all those whose goal is just that…government-run healthcare.
Doctors in Medicare would be favored by some of money freed up by the reductions in Medicare Advantage while SCHIP would get the rest because there simply isn’t enough money to go around even with huge increases in tobacco taxes. Medicare Advantage could disappear as the direct result of this move. In this instance, oldsters who had selected Medicare Advantage will be forced back into Medicare parts A & B with lesser benefits available to them at higher costs. This subtle form of rationing should give us all pause. Future forms of rationing promise to be far less subtle.
Politicians running healthcare is oxymoronic. They will be unable to resist the temptations of all that power…and you and I will suffer…just as those on Medicare Advantage programs are about to suffer. What will it be next? Will it be mandatory health prevention as suggested by one presidential aspirant? What will happen with all that data that is collected? And then where will it go? Will we ultimately see consciously controlled death rates since death is less expensive than living with and treating a disease? That happens in single payer countries around the world today. What makes us think that it wouldn’t happen here as well?
Wednesday, April 25, 2007
Health Care - The Uninsured: Part Two
The group of uninsured people in the U.S. is dynamic, as mentioned in my earlier blog; Wisconsin has an estimated 546,870 people, or about 9.9% of our population, who are uninsured at any one point in time. These numbers rely upon the use of Census information, analysis by the Blue Cross Blue Shield Association and estimates by the Congressional Budget Office.
We established the four major groups:
*people who are eligible for existing government programs but who have failed to enroll
*middle class people who earn $50,000 or more per year and who believe they cannot afford or choose not to buy insurance
*people who are classified as the short-term uninsured [up to two years uninsured, recent college graduates, seasonal workers and those who feel no need for insurance [or “the invincible” as I intimated in my last blog]
*the long-term uninsured who simply have fallen through the cracks and remain uninsured for a time span beyond two years
What is the number of Wisconsin citizens that fall into each category?
First, the group that already qualifies for government programs but has failed to enroll represents an estimated 204,529 people.
Second, the group classified as middle class who either cannot afford to or have chosen not to buy insurance is estimated at 174,998 people.
Third, the short-term uninsured is estimated to contain 68,359 people.
Based on these estimates, then, the long-term uninsured group is comprised of an estimated 98,984 people or about 1.8% of Wisconsin’s population.
Does this mean we still have a serious problem as far as the number of uninsured in Wisconsin and the country? Absolutely we do. Does it mean that we have to turn the present system on its head and move to “universal health care” (the euphemism for Single-Payer coverage)? Absolutely not.
It does mean that we need to bring all those who do not have insurance into the insurance system. It means that costs incurred by those providers who are not paid for services rendered are being shifted to the third party reimbursement system. That simply magnifies the increases in health care costs and, thus, insurance premiums year over year.
It also points up the truth that many do not want to accept: our problem is a health care cost problem and not a health insurance cost problem. Health insurance increases mirror the increased costs of health care, not the other way around.
Insurance by its nature was always intended to help each of us defray the unexpected catastrophic expenses that might befall us. We have come to expect that health insurance will cover everything. Prepaid health care has removed consumers from the equation...to the detriment of the whole system!
It’s as if our auto insurance covered the cost of gasoline and oil changes in addition to collision and comprehensive damage expense. It’s as if our homeowners’ coverage covered the cost of a new garage door opener when it quit working or a new coat of paint every few years.
Reform of our health care delivery system is too important to permit ourselves to be confused by “sleight of hand”. We have to get it right for we’ll most likely not have another opportunity to do so!
We established the four major groups:
*people who are eligible for existing government programs but who have failed to enroll
*middle class people who earn $50,000 or more per year and who believe they cannot afford or choose not to buy insurance
*people who are classified as the short-term uninsured [up to two years uninsured, recent college graduates, seasonal workers and those who feel no need for insurance [or “the invincible” as I intimated in my last blog]
*the long-term uninsured who simply have fallen through the cracks and remain uninsured for a time span beyond two years
What is the number of Wisconsin citizens that fall into each category?
First, the group that already qualifies for government programs but has failed to enroll represents an estimated 204,529 people.
Second, the group classified as middle class who either cannot afford to or have chosen not to buy insurance is estimated at 174,998 people.
Third, the short-term uninsured is estimated to contain 68,359 people.
Based on these estimates, then, the long-term uninsured group is comprised of an estimated 98,984 people or about 1.8% of Wisconsin’s population.
Does this mean we still have a serious problem as far as the number of uninsured in Wisconsin and the country? Absolutely we do. Does it mean that we have to turn the present system on its head and move to “universal health care” (the euphemism for Single-Payer coverage)? Absolutely not.
It does mean that we need to bring all those who do not have insurance into the insurance system. It means that costs incurred by those providers who are not paid for services rendered are being shifted to the third party reimbursement system. That simply magnifies the increases in health care costs and, thus, insurance premiums year over year.
It also points up the truth that many do not want to accept: our problem is a health care cost problem and not a health insurance cost problem. Health insurance increases mirror the increased costs of health care, not the other way around.
Insurance by its nature was always intended to help each of us defray the unexpected catastrophic expenses that might befall us. We have come to expect that health insurance will cover everything. Prepaid health care has removed consumers from the equation...to the detriment of the whole system!
It’s as if our auto insurance covered the cost of gasoline and oil changes in addition to collision and comprehensive damage expense. It’s as if our homeowners’ coverage covered the cost of a new garage door opener when it quit working or a new coat of paint every few years.
Reform of our health care delivery system is too important to permit ourselves to be confused by “sleight of hand”. We have to get it right for we’ll most likely not have another opportunity to do so!
Health Care - The Uninsured
Part of virtually every discussion concerning the state of health care in the U.S. is a reference to the uninsured. Given that, we assume that the group of uninsured must be a very important part of the problem. We need to better understand just what is meant by the ubiquitous “uninsured”. We’ll likely all agree that it is a very serious part of the problem confronting us as a nation.
We hear of the ever-increasing number of uninsured. The former top number for the United States was 46 million…until it became 47 Million. That seemed to occur overnight. I don’t know who is responsible for keeping track of that number, but they sure seem on top of their game! If only our census were as accurate as the press and “special interest groups” [remember the earlier blog about special interest groups?] would have us believe is the estimate of uninsured.
Let’s take a look at what comprises the “uninsured”. First…this is not a static group of people; instead, the number of “uninsured” is an estimate…a snapshot…of the number of folks thought to be without health insurance on any given day of the year.
Please also note that I used the phrase, “without health insurance”. That is a much different phrase than had I said “without access to health care”. Every person in the United States has access to health care…by virtue of Federal law. It is true however that much of that health care is received in Emergency Rooms, and that is a significant part of our nation’s problem. The care is received too late in the wrong setting to be of lasting value to the individual. The care is also delivered in the most expensive possible setting and much of that cost is unreimbursed and therefore is “shifted” to the insurance premiums paid by individuals and employers.
The current number de jour for the uninsured in Wisconsin is 546,870. That number has increased each year but has remained fairly constant so far as it’s comparison to the total population of the state. Using the most recent census numbers for Wisconsin, coupled with an analysis by the Blue Cross Blue Shield Association and the Congressional Budget Office estimates of the make-up of the group called “uninsured”, we see an emerging picture made up of these parts:
*people who are eligible for existing government programs but who have failed to enroll
*middle class people who earn more than $50,000 per year and who believe they cannot afford or choose not to buy insurance
*people who are classified as the short-term uninsured [up to two years without insurance, recent college graduates, seasonal workers and those who are young and therefore invincible]
*the long-term uninsured who simply have fallen between the cracks and remain uninsured for a long time
In Part Two of this blog, we’ll look at the distribution of Wisconsin’s 546,870 uninsured based upon the segments identified above. I think you’ll be surprised; I know I was. And I’ve been more intimately involved in the insurance and health care industries than many.
We hear of the ever-increasing number of uninsured. The former top number for the United States was 46 million…until it became 47 Million. That seemed to occur overnight. I don’t know who is responsible for keeping track of that number, but they sure seem on top of their game! If only our census were as accurate as the press and “special interest groups” [remember the earlier blog about special interest groups?] would have us believe is the estimate of uninsured.
Let’s take a look at what comprises the “uninsured”. First…this is not a static group of people; instead, the number of “uninsured” is an estimate…a snapshot…of the number of folks thought to be without health insurance on any given day of the year.
Please also note that I used the phrase, “without health insurance”. That is a much different phrase than had I said “without access to health care”. Every person in the United States has access to health care…by virtue of Federal law. It is true however that much of that health care is received in Emergency Rooms, and that is a significant part of our nation’s problem. The care is received too late in the wrong setting to be of lasting value to the individual. The care is also delivered in the most expensive possible setting and much of that cost is unreimbursed and therefore is “shifted” to the insurance premiums paid by individuals and employers.
The current number de jour for the uninsured in Wisconsin is 546,870. That number has increased each year but has remained fairly constant so far as it’s comparison to the total population of the state. Using the most recent census numbers for Wisconsin, coupled with an analysis by the Blue Cross Blue Shield Association and the Congressional Budget Office estimates of the make-up of the group called “uninsured”, we see an emerging picture made up of these parts:
*people who are eligible for existing government programs but who have failed to enroll
*middle class people who earn more than $50,000 per year and who believe they cannot afford or choose not to buy insurance
*people who are classified as the short-term uninsured [up to two years without insurance, recent college graduates, seasonal workers and those who are young and therefore invincible]
*the long-term uninsured who simply have fallen between the cracks and remain uninsured for a long time
In Part Two of this blog, we’ll look at the distribution of Wisconsin’s 546,870 uninsured based upon the segments identified above. I think you’ll be surprised; I know I was. And I’ve been more intimately involved in the insurance and health care industries than many.
Health Care & Special Interest Groups
We often hear about “special interest groups” trying to influence decisions especially during the debate on the health care “crisis”. Special interest groups have gotten the reputation of being somehow improper or part of something almost subversive in nature. Somehow many of us have been conditioned to shudder whenever we hear the term “special interest group”.
There are some special interest groups with which I take exception and there are other special interest groups with whose positions I concur. I am an intentional member of some of these groups. I am also a member of other special interest groups without even being aware of the fact.
Let’s take a look at some of these special interest groups. The list is almost endless, but here are a few examples. If you are a union member, you are part of one or more special interest groups. If you are a member of a local organization such as a Chamber of Commerce, you are a member of one or more special interest groups. Nurses, insurance agents, church members, AARP members, auto club members, teachers, and parents belonging to a parent/teacher organization are part of a special interest group.
My point is this: each of us, whether we know it or not, is likely part of at least one special interest group. Some of us are members of such groups because we chose to be and, as mentioned before, others of us are members of such groups unknowingly.
When you hear a news commentator or a radio talk show host talk about special interest groups, remember that you’re probably part of such a group whether or not that is a specific group or family of groups.
What does all this have to do with the health care debate? It means that just about every position that is advanced will favor one group over others. It means that the members of a particular group are trying to protect their interests. This often also means that the interests of other special interest groups will be subverted. It means that politicians who have accepted donations from one or another of these groups may have more at stake then you or I understand.
When more than 15% of our country’s gross national product is in play, there will be some very tough fighting going on behind the scenes. This is really brought to light by the recent combination of several special interest groups that have heretofore been the enemies of each of the others with which they’ve now chosen to align. These groups include an insurance company group, a labor union group, and a “family values” group. Each of these groups appeared to be on opposing sides of the “health care crisis” issue until a few days ago. What are we to make of this alliance?
For one thing, we can safely conclude that not only does politics make for strange bedfellows, money does as well!
There are some special interest groups with which I take exception and there are other special interest groups with whose positions I concur. I am an intentional member of some of these groups. I am also a member of other special interest groups without even being aware of the fact.
Let’s take a look at some of these special interest groups. The list is almost endless, but here are a few examples. If you are a union member, you are part of one or more special interest groups. If you are a member of a local organization such as a Chamber of Commerce, you are a member of one or more special interest groups. Nurses, insurance agents, church members, AARP members, auto club members, teachers, and parents belonging to a parent/teacher organization are part of a special interest group.
My point is this: each of us, whether we know it or not, is likely part of at least one special interest group. Some of us are members of such groups because we chose to be and, as mentioned before, others of us are members of such groups unknowingly.
When you hear a news commentator or a radio talk show host talk about special interest groups, remember that you’re probably part of such a group whether or not that is a specific group or family of groups.
What does all this have to do with the health care debate? It means that just about every position that is advanced will favor one group over others. It means that the members of a particular group are trying to protect their interests. This often also means that the interests of other special interest groups will be subverted. It means that politicians who have accepted donations from one or another of these groups may have more at stake then you or I understand.
When more than 15% of our country’s gross national product is in play, there will be some very tough fighting going on behind the scenes. This is really brought to light by the recent combination of several special interest groups that have heretofore been the enemies of each of the others with which they’ve now chosen to align. These groups include an insurance company group, a labor union group, and a “family values” group. Each of these groups appeared to be on opposing sides of the “health care crisis” issue until a few days ago. What are we to make of this alliance?
For one thing, we can safely conclude that not only does politics make for strange bedfellows, money does as well!
Tuesday, April 24, 2007
State Children's Health Insurance Programs
State children's health insurance programs have been around under a federal mandate for some 10 years. The mandate needs to be re-visited and that has been going on in earnest in Washington, D.C. since the beginning of this year.
These programs were originally intended to help the states provide health insurance to needy children whose parents weren't poor enough to qualify for Medicaid. As is too often the case when federal money is available, some states have been very creative with these "children's" programs. One lament over these programs was the fact that so many children remained uncovered. These states have decided that they'd be able to attract more children if they could permit people with incomes of two to three times the poverty level to enroll their children.
There were, according to the powers that be, still too many uncovered children. So, it was decided that the parents needed to be brought into the "children's" program since they would enroll for the coverage...and would enroll their children for coverage, too. The SCHIP costs grew accordingly.
During the ongoing debate over future funding of these programs, several states have been complaining that they're out of money and need stopgap funding in order to avoid disrupting these programs.
Among these states are Arizona, Michigan, Minnesota and Wisconsin. These four states cover more adults than children! According to a Wall Street Journal editorial on April 24th, Minnesota spent 92% of its grant insuring adults. Arizona spent two-thirds of its grant the same way.
We are witnessing the incremental creation of government-run health care without the pain and suffering of voting on the issues. These deals were concocted in the halls of Congress and no one appears to have understood the concept of unintended consequences. Or...they did understand and knowingly circumvented the will of the people to achieve what they weren't able to otherwise accomplish with HillaryCare.
These programs were originally intended to help the states provide health insurance to needy children whose parents weren't poor enough to qualify for Medicaid. As is too often the case when federal money is available, some states have been very creative with these "children's" programs. One lament over these programs was the fact that so many children remained uncovered. These states have decided that they'd be able to attract more children if they could permit people with incomes of two to three times the poverty level to enroll their children.
There were, according to the powers that be, still too many uncovered children. So, it was decided that the parents needed to be brought into the "children's" program since they would enroll for the coverage...and would enroll their children for coverage, too. The SCHIP costs grew accordingly.
During the ongoing debate over future funding of these programs, several states have been complaining that they're out of money and need stopgap funding in order to avoid disrupting these programs.
Among these states are Arizona, Michigan, Minnesota and Wisconsin. These four states cover more adults than children! According to a Wall Street Journal editorial on April 24th, Minnesota spent 92% of its grant insuring adults. Arizona spent two-thirds of its grant the same way.
We are witnessing the incremental creation of government-run health care without the pain and suffering of voting on the issues. These deals were concocted in the halls of Congress and no one appears to have understood the concept of unintended consequences. Or...they did understand and knowingly circumvented the will of the people to achieve what they weren't able to otherwise accomplish with HillaryCare.
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