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.
Friday, May 25, 2007
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?
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