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?”
Friday, May 11, 2007
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?
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