The Money/Medicine Mix Mistake

The free market at "work" in health care = increased costs.

Says Kevin Schulman of Duke U:

“These costs keep growing despite the recession, and health care is going to
shoot up as a percentage of our GDP even more. It’s just spooky.”

From AHLA newsbriefs:

The Palm Beach Post reports that the "giant companies that dominate Florida's health insurance market are stifling competition and escalating premiums," a new report by Health Care for America Now argues. The report said health insurance "premiums in Florida rose 3.6-times faster than wages from 2000 to 2007"; and two companies, "Blue Cross and Blue Shield (BCBS) of Florida and Aetna Inc., control 45 percent of the health insurance industry in the state." ... But United Healthcare spokesperson Roger Rollman charged, "The idea that UnitedHealthcare market share is driving premium costs is nonsense." Rollman contends that "the growth in premiums is mostly driven by overall health costs."

Similarly, the Houston Chronicle (5/21, Ackerman) noted that Texas health insurance premiums rose "nearly six-times faster than wages between 2000 and 2007"; and the report showed that "BCBS and United Healthcare control 68 percent of the Texas market." ... Notably, the Justice Department "considers a market 'highly concentrated' if one company holds more than a 42-percent share."

The Chronicle quotes an HCAN researcher: insurance companies’ profits between 2000 and 2007 belie their arguments [that an ageing population is the reason for increased costs]. He noted that the net incomes of the 10 largest insurance companies grew from $2.44 billion in 2000 to $12.8 billion in 2007. The Chron continues, During that time, Texas premiums have increased 87 percent, according to the report — 5.8 times faster than wages. For family health coverage, the average annual combined premium for employers and employees rose from $6,635 to $12,403.

That's bulls**t.

Okay, rant time.

Do we care about money or people? The cost of health care, the cost of treatment, the cost of an ageing population, the cost of premiums, profits, profits, profits, the market, the cost of innovations, pharmaceuticals, insurance, HMOs. This is what you hear in the news when you hear about health care. The only time people come in to the equation is when you hear "46 million uninsured." But again, look at that statement--"46 million uninsured." Not 46 million without health care, not 46 million people who are unhealthy or don't have access to preventative medicine. And even less frequently do you hear about the "underinsured," who pay their hard earned money to be "covered" yet still face huge bills and forgo medical treatments. Why? Because no matter what they're under, at least they're INSURED.

And being insured means you get the care you need right?

Well...certainly not in countries with the wrong kind of insurance--public. People in those places face long waits, and certain technologies aren't as widely available, right?

And, well...not in a place that's mandated insurance coverage for everyone either--say, Massachusetts. How long is the wait there now for a visit to the doctor? Many offices have stopped taking new patients, and the wait for an appointment can be up to a year.

So the country's discourse--and whatever possible "solution" comes of it--is based on faulty logic. Having insurance DOES NOT EQUAL having care.

I can't say I have the answers, but I can say the question needs to be rephrased.

"Cadillac Insurance" Tax

During the presidential campaign, one of the legs on which McCain's health plan platform stood was an elimination of tax breaks for employer sponsored health benefits in exchange for creating a tax credit for individuals and families who then chose to purchase insurance on the Free Market instead. The plan was that encouraging people to obtain insurance on their own instead of through their employer would create a more competitive insurance market, though McCain acknowledged this plan was effectively a tax on the wealthy.

What are those tax breaks? Briefly, the money an employer spends that is received in health benefits are not taxed as income. Further, an employer is able to contribute to those benefits with pre-tax dollars. McCain wanted to say bye-bye to that. What did now-President Obama say? No way.

Fast forward to May 2009. The plan to remove the tax breaks is still on the table. Somewhere. Some members of Congress (read: Baucus) and unnamed members of BO's administration are supportive of elimination of the employer benefit tax breaks. What will the President say now?

The obvious move for employers if this were to occur, which was part of the McCain health plan ideology, is that without the breaks, employers will cease to offer benefits, or offer less attractive (expensive) packages. This affects many many Americans as approximately 2/3 of those under 65 who are insured receive benefits from their employers, according to NYT. Of course, NYT does not differentiate on how good those benefits those are, but I suppose that doesn't matter when (1) something changes and (2) suddenly you're paying more for the same thing. No one likes that, right?

There is no talk in the NYT article about "balancing the platform," as McCain was to do with his tax credit. Why? Because the balance would be people using the public option, and that's an article of a different color, for both the NYT and this blogger. More to come........

Sebelius--One step closer, despite her "lack of candor".

Republican Senators Roberts (KS) and O.Snowe (ME) joined the Dems this week on a Senate Finance Committee vote giving Gov. Sebelius the green light to a full Senate vote on her nomination for HHS Secretary.

It's high-time for some highlights on Sebelius. (It's not like I have to read an entire book or anything... )





Brief Bio:

• A political family: Father was John J. ("Jack") Gillian, a Democrat who served in WWII before becoming a member of the US Congress in the 60s as an anti-war Dem, Governor of OH in the 70s, and next head of the Agency for International Development under Carter.
• Sebelius served as Insurance Commissioner in KS from '94-'98, declining to take contributions from insurance companies. Her term culminated in blocking giant Blue Cross from merging with for-profit Anthem, a move many cite as a key indicator as to why she's a fantastic, or horrible, HHS Secretary candidate, depending on which camp you're in.
• Sebelius has served as President of the National Association of Insurance Commissioners, past chair of the Democratic Governor's Association, and past Chair of the Education Commission of the States.

And on to the nomination-related news:

• Sebelius joins the ranks of many-a-member of the BO administration, by having mistakenly failed to pay taxes. The Gov payed over $7,000 in back taxes owed for '05-'07. A paltry sum compared to her peers, but her "unintentional error" is noteworthy nonetheless.



• Sebelius is the Moderate Pro-Choice candidate? Bob Novak, no stranger to controversial reporting, has called the Gov a "national pro-choice poster girl," and states there is "substantial evidence she has been involved in what pro-life advocates term "laundering" abortion industry money for distribution to Kansas Democrats." An interesting op-ed links the Gov's political activity to the "apex of a complicated Kansas financing system involving the famous abortion provider George Tiller of Wichita," Planned Parenthood, and the court system--more involved than I would like to get on this blog right now, but click the link. During her first confirmation hearing in front of the SFC she said she will remain "staunchly pro-life, and will advocate for the lives of the unborn."



• And speaking of the famous doctor, Sen. Grassley is concerned about Sebelius' "lack of candor" with respect to her "inadvertent omission" of campaign contributions from late-term abortion doc Tiller (who has been spied partying at the Gov's Mansion). The Gov had to amend her statement to the SFC after stating she and her PAC received $12,450 from the doc in '94-'01, when the total was really more like $40,000.

• Despite her record of vetoing and speaking out against various abortion laws, at the end of March (right before her confirmation hearings) Sebelius signed a law that gives women the option to view a sonogram before an abortion. The Gov had previously vetoed legislation including such a provision, though the language in the vetoed legislation included mandates, not options, and also reporting requirements.

• Sebelius supports BO's reform plans, including a public insurance option. In April, the Gov signed a law to use federal stimulus money to subsidize health insurance for those who have lost their jobs.

Sebelius had originally taken her name out of consideration for cabinet positions, citing a need to focus on her responsibilities to Kansans in tough economic times.

That's what I've been saying!

Howard Dean is back on the scene. After being passed over for HHS consideration, he keeps on trucking. His newest health care campaign: Stand with Dr. Dean.



Now, call me naive, but this is what I've been saying when I talk to my pals about health care reform. (though I hope I didn't speak like I've never read cue cards before.) Makes total sense.

In America, you can go to public school, you can pay more for private, or you can home school. You can get on public transit (for a small fee) or you can buy a car. You can use the USPS or you can ship FedEx. You can call the police when you hear a noise and you can buy your own alarm system. Why why why is health care different? As "Governor Howard Dean, Dr. Howard Dean," says, this is the system already set up in health care if you qualify for Medicare/caid (read: you're poor, disabled, over 65). Why stop there? (*cough* insurance lobbyists *cough* AMA *cough*...)

Care costs $... bigger entity, more moolah.

Catching up, at home and in MA.

Been away a while while graduating/taking the bar/subletting my apartment & moving. Now I'm trying to sort through old news & catch up with the new. Onward!


On March 15, 2009, NYT published an article on the costs of care in MA & how the Commonwealth is trying to deal. Costs were high in the projected plan, and have soared even higher.

Alan Sager, a professor of health policy at Boston University, has calculated that health spending per person in Massachusetts increased faster than the national average in seven of the last eight years. Furthermore, he said, the gap has grown exponentially, with Massachusetts now spending about a third more per person, up from 23 percent in 1980.

All of that, and still 2.6% of residents, 167,300 people, are not covered. Now, while that's comparatively nothing to sneeze at, we still have to contemplate just how much money is being spent, and that the return is not universal.

Why do we care about health care in MA? Well, beyond the general desire to watch an experiment at work, the Obama administration has certainly taken a liking to it, and even without Daschle, the Plan is peppered all over policy talk from the White House.


The article offered a very nice nutshell of Phase I of the MA plan, which was simply getting it enacted, including the sell of Mandatory Coverage. Phase 2 of health care reform in MA involves an ambitious restructuring of payment schedules.

They want a new payment method that rewards prevention and the effective control of chronic disease, instead of the current system, which pays according to the quantity of care provided. ... If Massachusetts becomes the first state to make this conversion, health policy experts argue that it would be as audacious an achievement as universal coverage.

Again, significant on a Federal level. Paying for quality instead of quantity is already creeping in to the Federal system (for example, Medicare's new non-reimbursement rule for certain complications after patient admission), and managed care organizations have also experimented with/enacted various quality-based payment systems very similar to what MA may be proposing. This proposition is not without logic since chronic disease is a huge chunk of health care spending, and can either be prevented or effectively managed by patients and doctors for lower costs overall.

Of course the problem of determining sufficiency of quality is common to pretty much every health care delivery quandary: WHO decides? But that's a post for another day.


The article goes on:

Those who led the 2006 effort said it would not have been feasible to enact
universal coverage if the legislation had required heavy cost controls. The very
stakeholders who were coaxed into the tent — doctors, hospitals, insurers and
consumer groups — would probably have been driven into opposition by efforts to
reduce their revenues and constrain their medical practices, they said. Now
those stakeholders and the state government have a huge investment to protect.

Well wasn't that a slick move.

congressional health care caucus

live streaming now.