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 Our newsletter features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. It is emailed in an HTML format from the galen@galen.org email address, via Constant Contact, and you may have to adjust your email settings and junk mailbox to ensure that you don’t miss an issue.Newsletters< Prev 1 2 3 4 5 6 Next >March, 20 2008
The True StoryA new survey that is highly critical of consumer-directed health care is getting attention in the media, and once again, we need to tell you what it really says. The Commonwealth Fund and the Employee Benefit Research Institute (EBRI) have produced the third in a series of studies that we can only believe reflects an agenda to show that CDHC is a failure. A new survey that is highly critical of consumer-directed health care is getting attention in the media, and once again, we need to tell you what it really says.The Commonwealth Fund and the Employee Benefit Research Institute (EBRI) have produced the third in a series of studies that we can only believe reflects an agenda to show that CDHC is a failure. The Commonwealth website, for example, highlights the clearly inaccurate claim that these plans are only for the healthy and wealthy. The joint news release says that enrollment in the plans remains low, that they do not help to reduce the number of uninsured, and that participants are less satisfied with their plans and have more missed care, just for example. The survey size this time is better than in the past: 4,217 people with private insurance participated in the on-line survey, and nearly half of them had high-deductible health plans, with or without spending accounts. While we don't have the tens of thousands of dollars to spend on a survey like this, we can mine the data to find out what we need to know about how the plans are working and where improvements are needed. Here are a few things from the survey that Commonwealth and EBRI didn't highlight:
So what is the bottom line, according to Commonwealth and EBRI? "In these deficit-strapped times, when the nation faces critical health system challenges, the question for policymakers is whether the tax advantages that the federal government provides the enrollees of these health plans over those in other types of plans are achieving the broader health system goals that they are aimed at." What? The headline of the study implies that CDHC is a flop, with only 2% of the population enrolled and only about half of them having tax-preferred health spending accounts. But the majority of the trends are moving in the right direction, to achieve the goals of providing new incentives for people to be more responsible users of health care and coverage. Lawmakers might want to look at what the survey really says rather than the biased press releases in making their decisions. ********* And we noticed a particularly encouraging commentary by 1972 Democratic presidential candidate, George McGovern. Entitled "Freedom Means Responsibility," the former senator now says that he has gained new respect for the value of liberty. Here are his words: "Under the guise of protecting us from ourselves, the right and the left are becoming ever more aggressive in regulating behavior… "Health-care paternalism creates [a] problem that's rarely mentioned: Many people can't afford the gold-plated health plans that are the only options available in their states. "Buying health insurance on the Internet and across state lines, where less expensive plans may be available, is prohibited by many state insurance commissions. Despite being able to buy car or home insurance with a mouse click, some state governments require their approved plans for purchase or none at all. It's as if states dictated that you had to buy a Mercedes or no car at all… "Why do we think we are helping adult consumers by taking away their options?… "The nature of freedom of choice is that some people will misuse their responsibility and hurt themselves in the process. We should do our best to educate them, but without diminishing choice for everyone else." If we are just patient and don't give up, people will see the essential value of liberty. ********* And we wish you all a Blessed Easter. Grace-Marie Turner  RECENT NEWS ARTICLES AND STUDIES:
The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Critics of the U.S. health care system frequently point to other countries with government-run, national health care systems as models for reform. However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care, writes Tanner. Overall trends from national health care systems around the world suggest the following:
Lawmakers Should Approach Wyden-Bennett Health Bill with Caution The Healthy Americans Act, sponsored by Sens. Ron Wyden and Bob Bennett, challenges the status quo on the federal tax treatment of health insurance and public health programs for the poor, writes Owcharenko. But the legislation needs significant changes if it is to be successful. The proposal's major problems are rooted in its sweeping and heavy-handed federal control over the insurance markets and its replacement of one tax inequity with another. Beyond these shortcomings are other unpleasant policy surprises such as the establishment of Medicare pricing over prescription drugs, permitting prescription drug reimportation, and even mandating that health insurers must cover abortion services. Instead of adopting features of the bill that turn to government regulation in an effort to squeeze out efficiencies in the system, lawmakers should look toward introducing more competition to achieve more affordable insurance. Measuring Disparities, Improving Health: Closing the Gap Our technical ability to measure apparent differences in mortality, health status, and access to health care services among various subpopulations and groups continues to expand much more rapidly than the identification and implementation of sustainable steps to reduce, let alone, eliminate them, writes AEI's Tom Miller, in a Health Affairs posting on health care disparities. Miller recommends rebalancing our health investments to focus more on the lives of children from disadvantaged environments. Quite simply, interventions to boost both health and skills development are more effective in early childhood than later in life, and building mutually reinforcing early advantages for targeted populations are much less costly than trying to correct deficits and their likely consequences much later, he writes. Additionally, it would be better to shape such early interventions more broadly, with greater emphasis on improving education quality and the development of fundamental skills, rather than delivery of enhanced health care services alone. He concludes by saying that although expensive health technology may at first be more available to those consumers with more education, or greater resources, its benefits eventually extend to everyone, even those more prone to experiencing health disparities. Clinton Role in Health Program Disputed Sen. Hillary Clinton, who has frequently described herself on the presidential campaign trail as having played a pivotal role in forging a children's health insurance plan, had little to do with crafting the landmark legislation or ushering it through Congress, according to several lawmakers, staffers, and healthcare advocates involved in the issue, reports The Boston Globe. Clinton has described the State Children's Health Insurance Program (SCHIP), as an initiative "I helped to start" and regularly cites the number of children in each state who are covered by the program. But the Clinton White House fought the first SCHIP effort, spearheaded by Senators Edward Kennedy and Orrin Hatch, because of fears that it would derail a bigger budget bill. And several current and former lawmakers and staff said Hillary Clinton had no role in helping to write the congressional legislation. "I do like her," Hatch said of Hillary Clinton. "We all care about children. But does she deserve credit for SCHIP? No -- Teddy does, but she doesn't." The Centers for Medicare and Medicaid Services has released 2007 SCHIP enrollment figures. Insurers, Doctors at Odds Over 'Concierge' Care Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies, reports the Houston Chronicle. United Healthcare confirmed it is dropping four local doctors from its network in April because the company disapproves of their so-called "concierge medicine" model. Cigna is also condemning the practice, in which physicians charge an annual retainer of $1,500 to $1,800 for patients who then receive more personal care. While some medical specialists have chosen to stop dealing with insurance companies entirely, others are trying to couple concierge care with insurance payments. United and Cigna say that's improper. Other major health insurers, including Aetna, Humana and Blue Cross Blue Shield of Texas, consider concierge care just fine so long as patients are clearly informed that the insurers will not reimburse any of the retainer. The Washington Post also writes about the trend toward concierge medicine and notes that more than 1,000 doctors have switched to this mode of practice. Keeping a Health Policy After You Leave Your Job The Washington Post on Sunday published a series of articles about the market for individually-purchased health insurance and how it works for the 18 million Americans who buy it. The articles offer how-to guidance, even suggesting an HSA-compatible high-deductible policy. One article reports that people leaving a workplace group-insurance plan have some options that others in the individual market do not. "First, under COBRA, which applies to workers at companies with 20 or more employees, you have the right to continue on your employer's plan for up to 18 months, and in some cases longer. Continuing in a group plan, which you do under COBRA, also makes you 'HIPAA-eligible' when you enter the individual market. HIPAA requires states to have at least two policies available without pre-existing condition exclusions. If a state doesn't have those two policies available, then it must set up an assigned risk pool." Once Uninsured, She's Happy to be Consumer The Healthy Indiana Plan shows how consumer-driven coverage can help in the public sector, reports the Milwaukee Journal Sentinel. Shelley Ross was the first of about 28,000 lower-income people who have signed up so far for the Healthy Indiana Plan, meant to subsidize coverage for adults who have no insurance. She signed up in December, had a cataract excised soon after, had the mammogram she was putting off. Demand to enroll in the program has been three times what officials expected, says Mitch Roob, the state's secretary of social services. Medicaid covers catastrophic care when bills exceed $1,100 a year. For routine care under that, the patient pays out of an account funded jointly by the state and the policy holder. Anything left over in the account rolls over to next year. The price is right for Ross, who makes about $25,000 a year. At $91 a month, "I'm smiling when I write that check," she says. "It's not like I wanted a free ride." UPCOMING EVENTS: Creating a Health Care System That Works for Americans Grace-Marie Turner speaking on the Mornings with Lorri & Larry Show Another Warning for Medicare? Healthcare Cost of Quality: The Relationship between Performance Metrics and Financial Results Can We Repair What's Wrong with our Health Care System through Christian Principles? Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. March, 14 2008
Gold StandardA gold standard in health policy is finding ways to improve care, save money, and enlist patients in better managing their chronic conditions. And we have new evidence of the success of a program that is doing just that.A gold standard in health policy is finding ways to improve care, save money, and enlist patients in better managing their chronic conditions. And we have new evidence of the success of a program that is doing just that.The Asheville Project began several years ago, enlisting local pharmacists to monitor and help manage the health of diabetes patients and coach them about using their medicines properly. In exchange for these regular visits, patients' co-payments are waived for their diabetes medicines. The results have been impressive: Patients' health improved dramatically, and their employer -- the City of Asheville, North Carolina -- saved money. Direct medical costs fell up to $1,872 per patient per year, absences from sick time decreased, and productivity increased by up to $18,000 a year. The Asheville Project was expanded to help patients manage other chronic illnesses as well. The American Pharmacists Association Foundation, which sponsored the program with support from GlaxoSmithKline, took the show on the road and began a Diabetes Ten City Challenge, enlisting employers and community pharmacists in cities from Honolulu to Milwaukee and Tampa Bay to participate. The results are similar: The health of patients improved across all key diabetes indicators, controlling blood sugar, cholesterol and blood pressure. Overall, patients rating their diabetes care as very good to excellent increased from 39% to 87%. "This shows that when patients are supported and empowered to make the lifestyle changes necessary to manage a chronic disease, significant improvements are possible," according to Bill Ellis, CEO of the APhA Foundation. A report on cost savings will follow. Significant improvements in health and cost savings are possible by providing new resources and incentives to engage patients in managing their care. Something as simple as having a pharmacist talk to patients about their medicines, encouraging them to monitor their blood sugar regularly, and checking their feet for evidence of problems can keep patients out of the hospital and give them the tools they need to stay healthier longer. And, by the way, this is a private-sector initiative. No legislation required. *********** I attended this week a health care symposium in Leesburg, VA, sponsored by the Mayo Clinic's Health Policy Center and organized by Mayo's visionary President and CEO Dr. Denis Cortese and exceptional Health Policy Director Bob Smoldt. Hundreds of leading health policy thinkers from around the country and the world attended to try to advance the conversation over health reform. Mayo is a formidable force in setting the gold standard for delivery of quality health care, treating more than half a million patients a year. And it is the only major health organization I am aware of that is working to facilitate a policy conversation through this series of conferences designed to "put the patient first" on the policy agenda. One of the best attended sessions featured spokespeople for the three leading presidential candidates talking about their candidates' health proposals.
Stay tuned. Grace-Marie Turner RECENT NEWS ARTICLES AND STUDIES:
Should Congress Mandate Health Insurance for Individuals? Grace-Marie Turner of the Galen Institute and Len Nichols of the New America Foundation debate the merits of an individual mandate for health insurance, with Nichols arguing that individual requirements to purchase health insurance are necessary to make the private health insurance market both efficient and fair. But Grace-Marie counters that an individual mandate has far-reaching consequences for individuals, businesses, and the health insurance market. When political leaders require everyone to have health insurance, they must define what qualifies as acceptable coverage. The insurance market can quickly turn into a government-regulated utility as politicians, rather than the marketplace, determine the terms of the coverage and regulate how much people must pay for the policies. Further, an individual mandate almost immediately turns into an employer mandate as political leaders determine how much employers will be required to pay for their employees' coverage. Aetna Launches Health Info Search Site Aetna has launched a web-based search site that allows customers to generate information about disease risks, medical costs, and local doctors using their electronic health records, reports the Associated Press. Aetna's SmartSource crunches data such as gender, age, ZIP code, employer, health care plan and information from the customer's personal health records. The search engine generates information tailored to individuals about diseases and medical conditions, treatments, health care costs, and local health care providers. Aetna will make the search engine available as a pilot program this year to between 20 and 25 employers with up to 1.5 million employees, and make the service available to more customers next year. A Threat to Innovation The Patent Reform Act pending before Congress could radically reduce innovation in the medical sciences, writes Sally Pipes. For example, the legislation would require the online publication of all patent applications 18 months after they are filed -- even if no decision has been made on granting a patent. But it takes the Patent Office an average of 31 months to make a determination. That means that inventors big and small would see their precious creations exposed to the world, in all their scientific detail, with no certainty of ever gaining patent protection. And copycats around the world would have more than a year to duplicate the invention and even claim it as their own. The proposed Patent Reform Act would weaken a system that has sparked innovation for two centuries. And it would alter the future of medical science for the worse. AEI's Roger Bate writes that the high court in India is reviewing a case that could allow Indian drug companies to use "compulsory licensing" to break the patent held by two Western countries for two cancer drugs. If successful, the lawsuit could open a Pandora's Box that would allow countries to override patents for all sorts of chronic conditions, including diabetes, hypertension and heart disease. Nothing less than the sanctity of the global patent system -- and the future of drug innovation -- are at stake. The Cost's the Thing John McCain and Barack Obama are reflecting a growing consensus that the continued growth of health spending is unsustainable and that something must be done to bring costs under control. But that doesn't mean Obama and McCain agree on how to reduce costs. Sen. Obama's plan, with its heavy reliance on government, leads to the same problems that bedevil universal healthcare systems all over the world: limited patient choices and rationed care, Tanner writes. In contrast, he says Sen. McCain's proposal is much more consumer centered and taps into the best aspects of the free market. He would attempt to promote greater competition by allowing people to buy insurance plans across state lines. And he would shift toward a system where individuals purchase and own their own insurance plans using new refundable tax credits. Testimony in Opposition to LD 2247 - An Act to Continue Maine's Leadership in Covering the Uninsured Maine's effort to cover all of the uninsured in the state by 2009 through its Dirigo Health plan is a costly disappointment, Tarren Bragdon recently testified. "Simply put, Dirigo Health was started in 2003 with the goal of covering 128,000 uninsured Maine people in a self-supporting health insurance program which would need no further taxes or state funds after the first year. Today, the program covers only 4,466 Mainers who were previously uninsured, which is less than 4% of the 2003 goal, in a program that costs over $45 million a year," notes Bragdon. The insurance reforms proposed in this legislation, which would increase taxes for additional Dirigo Health funding, are costly, unproven and actuarially estimated to have a nominal impact on premiums. Maine's insurance laws should be reformed with proven patient-centered regulations shown to reduce costs, increase choices and expand competition. The Impact of Medicare's Anemia Drug Coverage Decision on Cancer Patients: Comparative Effectiveness vs. Patient Centered-Care In this detailed paper, CMPI's Bob Goldberg analyzes the decision by the Centers for Medicare and Medicaid Services (CMS) to limit the ability of doctors to prescribe anti-anemia drugs known as Erythropoiesis-Stimulating Agents (ESAs) to patients undergoing chemotherapy. The report finds that CMS ignored the benefits of these medicines and also ignored the risks of blood transfusions (a more aggressive anemia treatment). The study also reviewed a 1997 decision by CMS to limit payment for ESAs in the End Stage Renal Dialysis program. As a result of that decision, anemia levels soared and patients died. Only after CMS removed the cap did patient well-being improve. Additionally, the report found that many new cancer drugs and treatments shown to prolong life are dependent on the use of anemia drugs that permit patients to undergo arduous therapies. CMS failed to consider the impact of reducing access to anemia drugs on cancer survival as a result of treatment. The report recommends that CMS, private insurers, companies, and researchers develop more patient-centered approaches to determining what medicines and treatments to use. A Food and Drug Administration panel yesterday recommended that doctors continue to prescribe anemia drugs for patients with cancer, reports the Los Angeles Times. But the panel also suggested scaling back which patients should be treated based on their type of cancer and the severity of the disease. UPCOMING EVENTS: Health Policy "Checkup" with Sen. Ron Wyden The Explosion of Health Scares: Everything Is Dangerous! Supporting Rural Family Caregivers Ask the Experts: Tax Subsidies and Health Insurance Healthcare Cost of Quality: The Relationship between Performance Metrics and Financial Results Health Reform Forum: Are Individual Mandates the Answer? Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. March, 7 2008
What They Agree OnNow that it appears the Democratic presidential contest will keep going for some time, health care will continue to be a major topic of debate. While most of the disagreement between Sens. Hillary Clinton and Barack Obama has focused on universal coverage -- and particularly an individual mandate -- that dispute is actually overshadowing how many similarities there are between their two health policy proposals. Now that it appears the Democratic presidential contest will keep going for some time, health care will continue to be a major topic of debate. While most of the disagreement between Sens. Hillary Clinton and Barack Obama has focused on universal coverage -- and particularly an individual mandate -- that dispute is actually overshadowing how many similarities there are between their two health policy proposals.The sooner that voters focus on the larger picture, the better informed their decisions can be. There are a number of provisions in both of their plans which are not controversial, such as a greater emphasis on using health information technologies, offering a choice of health plans, better prevention and chronic care management, etc. But here is a partial list of what Sen. Clinton and Sen. Obama are proposing that reveals their visions of a much larger role for government in our health sector. They both would create new health care purchasing arrangements and propose:
This dispute is important, but it should not obscure the many, many other provisions in their plans over which there is little debate but which would inject a much larger role for the federal government in health care financing and delivery. Most of the Republican presidential candidates' plans were organized around the idea of moving more power and control over health insurance and health care decisions to patients, as I described in my recent Wall Street Journal article. Because there was little debate in the GOP contest over health care, the issue received little attention. But to prepare for the general election, Sen. McCain must do more work to refine and develop his plan. There will be much more time to analyze all of these provisions in the coming months, but it's important to see that there are two very different approaches here to health reform. The question for voters this fall will be whether they think that the government will be able to inject greater efficiency and choice into the health sector or whether we should have a new approach that puts doctors and patients in charge and provides new incentives for competing plans and providers to offer more affordable care and coverage. Grace-Marie Turner RECENT NEWS ARTICLES AND STUDIES:
2008 Study of Consumer-Directed Health Plans Enrollment in consumer-directed health plans (CDHPs) grew by 25% in 2007, from 10 million Americans to 12.5 million, according to a study commissioned by the PPO association. Other highlights from the study, which focused primarily on Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs):
Medicare Advantage: The Case for Protecting Patient Choice Medicare Advantage, the new system of competing private health plans created under the Medicare Modernization Act of 2003, is a success, writes Bob Moffit. More seniors are getting a wider variety of health plan options with better benefits, lower cost-sharing, and more affordable health care coverage, as well as access to specialized programs that provide care coordination and care management. Some congressional leaders say that Medicare is paying too much to Medicare Advantage plans, and they want to cut funding for this option and thus reduce the number of plans that serve Medicare beneficiaries. But individual freedom, including personal choice of different health plans and benefit options, is not negotiable, writes Moffit. Instead of cutting payments to Medicare Advantage, Congress should re-target larger Medicare subsidies to lower-income persons and smaller subsidies to upper-income families. The Urban Institute's Bob Berenson writes that, while the Medicare Advantage program's future remains contentious politically, the Medicare Payment Advisory Commission ignores local market dynamics in important ways in its recommendation of financial neutrality at the local level between private plans and traditional Medicare. He explores alternative ways of setting benchmarks. Telephone Medical Consults Answer the Call for Accessible, Affordable and Convenient Healthcare Telemedicine introduces opportunities for improved access to health care services for all Americans -- regardless of geography -- with lower costs and better outcomes, according to the Center for Health Transformation. TelaDoc Medical Services, which currently serves more than 1.2 million members, was used as a model for understanding the concept of telephonic medical consults. Key benefits of using telephone medical consults include: access, particularly for rural residents; quality; affordability; efficiency; convenience; patient satisfaction; productivity; and early intervention in the disease process -- reducing morbidity, mortality, and saving money. Currently, more than 1.5 million Americans have access to this option with significant growth projected as more employers, health plans and other benefits payers recognize the opportunity for improving access to quality care and reducing expenditures. The Real Reformer Bob Goldberg explores Sen. John McCain's proposal to allow veterans to get care anywhere rather than just through the Veterans Health Administration (VA). In some VA hospitals, he says, veterans wait 18 months for surgeries -- a record worse than Canada's or England's national health care systems. McCain would increase the opportunities for individuals to choose the care that's best for them by giving patients and doctors the dollars, information, and freedom to make medical decisions instead of being forced to operate through a government agency. Obama's Health Plan -- A Preview Former Senate majority leader Tom Daschle's new book, "Critical: What We Can Do About the Health-Care Crisis," provides a more detailed blueprint of the Democratic approach to overhauling American health care than either Mr. Obama or Hillary Clinton has offered on the campaign trail, writes Scott Gottlieb. The most important proposal Daschle offers is the creation of a "Federal Health Board," whose duties would include "recommending coverage of those drugs and procedures backed by solid evidence." Daschle admits that the board is loosely based on the National Institute for Clinical Excellence in Britain and the Federal Joint Committee in Germany, both of which are charged with managing the public's access to higher-cost drugs, medical devices and procedures. But both are growing increasingly unpopular in their home countries -- precisely because they've become a triumph of cost-containment over patient access and choice. Gottlieb writes that one alternative to empowering government agencies would simply be to help individuals buy affordable private insurance. That effort might start by leveling the playing field between big purchasers, who get better rates for their employees, and individuals, who make up the bulk of the uninsured. Sen. Hillary Clinton’s opening gambit to Congress for health reform would be a proposal for genuine, mandated universal health insurance coverage, and she would ask for as much as $110 billion a year to make the mandate affordable to all Americans, writes Princeton University Professor Uwe Reinhardt. By contrast, the assumption of Sen. Barack Obama appears to be that Congress would never be so bold as to cram mandated health insurance down the public’s throat, nor would it appropriate a sum as large as $100 billion or more a year for the subsidies needed to make if affordable to all Americans. If history is any guide, writes Reinhardt, neither candidate is likely to get out of the U.S. Congress even the less ambitious plan proposed by Obama. Most likely, Americans will have to suffer far greater misery in health care before reaching the maturity to embrace the idea of truly universal health insurance. Patently Absurd As state and federal officials push for importation of American medicines from abroad to obtain cheaper drugs, they would do well to look at the experience of our nation's capital, writes Doug Bandow. The Washington D.C. City Council outlawed "excessive prices" for medicines in 2005, but shortly after its passage, a federal District Court of Appeals voided the law, concluding that it would undermine the federal government's authority to grant patents and allow inventors a fair return on their research. The city tried to appeal the decision, and lost again. Unfortunately, what makes price controls attractive politically is that the costs are invisible. People won't suffer the worst consequences of price controls for years, given the long lead time in drug development. And it is impossible to say what products won't be available since no one knows what cures otherwise would have been discovered. The trade-off is cheaper drugs for voters today versus unrecognized deaths and hardship for the unborn in the future. If public officials really want to help the sick, they will keep their hands off of drug production. UPCOMING EVENTS: 2008 National Symposium on Health Care New medicines and new technologies: A saving or a burden? A New Plan to Expand Primary Health Care Access Across America Responsible Health Reform: Competition, Innovation, and Individual Control Roosevelt Rx: National Student Health Policy Forum Oncology Drug Development: Rethinking FDA Oversight Health Policy "Checkup" with Sen. Ron Wyden The Explosion of Health Scares: Everything Is Dangerous! Supporting Rural Family Caregivers Healthcare Cost of Quality: The Relationship between Performance Metrics and Financial Results Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at http://www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. February, 29 2008
Massachusetts StrugglesMassachusetts Gov. Deval Patrick has been boasting that his state's health reform initiative has reduced the number of uninsured by half, with nearly 300,000 more people added to the health insurance rolls. What he doesn't say is that four out of five of them are relying heavily on taxpayer subsidies for their coverage. Massachusetts Gov. Deval Patrick has been boasting that his state's health reform initiative has reduced the number of uninsured by half, with nearly 300,000 more people added to the health insurance rolls. What he doesn't say is that four out of five of them are relying heavily on taxpayer subsidies for their coverage.Of the 293,000 people newly insured in Massachusetts:
Further, about 60,000 are being exempt from the mandate that all citizens must buy coverage, showing how elusive the goal of universal coverage will be, even for a state that had a relatively low uninsured population to begin with. And costs are still an issue:
Further, the state is trying to figure out what to do with those businesses that already are offering coverage but whose policies don't comply with the higher standards set by the government. Should they be exempted, forced to pay for more expensive coverage, or be fined? Gov. Patrick and other governors were in town this week pleading with Congress to reverse the administration's Medicaid and SCHIP reform policies, saying they would threaten their ability to expand or even sustain coverage. That's because Massachusetts and other states rely heavily on federal payments for their expansion plans. The president wants them to focus on covering poor children and needy citizens first. Since the Bay State's initiative is being seen by many as a model for the nation, it's important to pay attention. There is clearly no Massachusetts miracle here. Other states should certainly be cautious before proceeding. ************* And today a new poll on health care finds that "a majority of Americans are backing key elements in the health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama." When asked whether they would support an individual mandate for health insurance, 59% said yes, as long as employers were required to provide coverage or pay a fee, and as long as there were subsidies for those with low incomes and insurance companies were required to take anyone who applies. "But when the question was asked a different way -- without emphasizing government subsidies, employer mandates and requirements on insurance companies -- support dropped to 47 percent in favor and 44 percent against. That's an even split, given the poll's margin of error of plus or minus 3 percentage points. "The finding suggests that support for requiring everyone to buy insurance may be iffy," according to the release issued by the poll's sponsors, NPR, the Kaiser Family Foundation and the Harvard School of Public Health. ************* There are gremlins at TurboTax thwarting people trying to enter their tax deductible Health Savings Account contributions. A number of people have been frustrated in dealing with the software, including a top HHS official, who recounted this experience: In TurboTax's on-line tax form, "their system logic doesn't allow you to enter HSA contributions. With TurboTax, you go through items of income and then deductions, and it prompts you with every item on a 1040. But it does NOT prompt you to enter HSA contributions. "I had to call them, wait on hold for 15 minutes, and then talk to some person who didn't even know what an HSA was. Finally, he figured out how to do it, but you have to search for the form and fill it out which, in total, took nearly an additional 15 minutes. "In prior years, the system logic just defaulted me to the form where I have spent a grand total of 30 seconds entering my information. And when I asked him why they had changed their system logic, he told me that he didn't know. "When I pointed out that entering my contributions had saved me $900, but that there were likely taxpayers who didn't understand that they would need to look for the form and would wind up overpaying their taxes due to TurboTax's negligence, I was greeted with silence." Expect to hear more about this. In the meantime, here is the (equally bewildering) "Help" page on the TurboTax website. ************* And farewell to Bill Buckley, truly a Renaissance man and transformative person of our time. He graced everyone he knew with his elegant and warm spirit and inspired all of us with his love of ideas and his indefatigable passion for liberty. Grace-Marie Turner RECENT NEWS ARTICLES AND STUDIES:
WHO's Fooling Who? The World Health Organization's Problematic Ranking of Health Care Systems The World Health Organization rankings, widely cited by critics of the U.S. health system, are not an objective measure of the relative performance of national health care systems, writes Glen Whitman. Whitman writes that using the existing WHO rankings to justify more government involvement in health care is to engage in circular reasoning because the rankings are designed in a manner that favors greater government involvement. Additionally, the rankings are easily misinterpreted, or misrepresented, as simply measuring health outcomes irrespective of inputs. For example, when Costa Rica ranks higher than the U.S., that does not mean that Costa Ricans get better health care than Americans. Americans most likely get better health care -- just not as much better as could be expected given how much more America spends. Electronic Medical Records Really Do Work Electronic Medical Records (EMRs) can improve care, reduce costs, and improve survival, according to a nine-year study of dialysis patients. U.S. dialysis patient mortality has remained at approximately 23-24% annually for many years. Using the EMR, however, the study found mortality dropped by almost 40% (to 15% annually) and has remained low through today. The study of patients treated at The Rogosin Institute, a non-profit treatment and research institute in New York City, shows that its results are now better than 99% of U.S. dialysis units. Further, clinical staffing was 25% lower per 100 patients than the national average, thereby lowering costs. The New York Times reports that New York City is ready to equip doctors with computer software than can track patients' medical records in order to provide better preventive care. Any doctor who has a practice where 30 percent of the patients are either uninsured or on Medicaid is eligible for the assistance, but the city is also asking that they provide their own computers, and contribute $4,000 to the Fund for Public Health in New York for continuing technical support. The new system, a software package developed with $30 million from the city and roughly $30 million from the state and federal governments, would let doctors do much more than is possible with paper charts by integrating a patient's medical history, lab results and current medications into one electronic interface. Two hundred doctors with 200,000 patients have committed to use the system, and the city hopes to have 1,000 doctors with one million patients using it by the end of the year. Robert Wood Johnson Foundation Launches Commission to Look Beyond Medical Care System to Improve the Health of All Americans The Brookings Institution's Mark McClellan, former FDA commissioner and CMS administrator, and Alice Rivlin, former OMB director, will co-chair a new two-year Commission to Build a Healthier America. The national, independent and nonpartisan health commission will focus on factors outside the health care system and identify non-medical, evidence-based strategies -- both short- and long-term -- to improve the health of all Americans. The group will investigate how factors, such as education, environment, income and housing, shape and affect personal behavioral choices through an extensive inquiry that will include regional field hearings. "For reasons that don't appear to have much to do with health care, there is a big gap between how healthy we are and how healthy we could be," said McClellan. "The commission will investigate practical strategies being developed and implemented around the country, in the public and private sectors, to strengthen our health and close the gap." Running for the Exits Health care consumers -- not their employers -- should choose their insurance plans, writes Professor Herzlinger. The good news is that all the major presidential candidates that remain in the race -- Senators Obama, Clinton, and McCain -- are offering alternatives to our current employer-provided health-insurance system. But the structure of the Democrats' proposals ensures that they will evolve into a government-provided, single-payer scheme, she writes. Although less detailed than the plans of his Democratic rivals, Senator McCain's plan has the best long-term potential. His is the only one that would end the employer deduction entirely and give all individuals a $2,500 tax credit ($5,000 for families) to purchase health insurance. He would also allow consumers to shop out-of-state for affordable policies and require hospitals and physicians to publish information on treatment outcomes and cost of services, encouraging patients to become informed health-care shoppers. In short, he envisions a health-care market that closely resembles other sectors of the economy. The Need to Aggregate: What Should Come Next for Medicare Physician Payment? Congress urgently needs to decide on the basic direction of a future Medicare reimbursement system for physicians, writes Dr. Wilensky. Developing a more aggressive payment strategy for physicians is the key to resolving both the frustrations and the perverse incentives associated with the current disaggregated system and its more than 6,000 codes. Developing a program that encourages the provision of high-quality, efficiently produced care and that rewards clinicians who can produce such care remain important goals of the Medicare program and need to be reflected in the physician reimbursement system. A Helping Hand for Vets Satel writes about the serious consequences that can accompany a rush to judgment about a veteran's rehabilitative potential. Under the current system, veterans can go straight to a claims examiner and be granted psychiatric benefits without ever being treated for their mental illness. But new legislation would induce new veterans to embark upon a path to recovery. Any veteran diagnosed with major depression, post-traumatic stress disorder or other anxiety disorder stemming from military activity would be eligible for a new program that provides a financial incentive of $11,000 distributed over the course of a year in exchange for two commitments: the veteran must adhere to an individualized course of treatment; and he or she must agree to a pause in claims action for at least a year or until completion of treatment, whichever comes first. The great virtue of this legislation is that it offers an opportunity to receive payment as a condition of trying to get better. Imagine giving young men and women permission to surrender to their psychological wounds without first urging them to pursue recovery. For many young veterans, a "treatment first" approach could be their road to recovery and a rich civilian life. Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare Health care spending is expected to double by 2017, reaching $4.3 trillion and consuming nearly one-fifth of the economy, according to federal analysts from the Centers for Medicare and Medicaid Services. Health care spending is expected to hit $2.2 trillion in 2007, growing on average 6.7% through 2017 and outpacing economic growth by about 1.9% each year. Although the outlook for national health spending growth calls for continued stability for the next ten years, the authors note that they expect the leading edge of the baby-boom generation to begin to affect the Medicare program. By 2017, Medicare spending is expected to account for $884 billion, or just over one-fifth of all national health spending. Medicaid spending is also expected to continue to rise at a faster rate than overall health spending in the coming decade, reaching $717.3 billion. The report also examines spending trends for hospitals, physicians, prescription drugs, and long-term care, as well as projected trends for various payers including consumer out-of-pocket payments and private health insurance. UPCOMING EVENTS: New Center Poll Highlights Importance of Acting Now to Protect the Public's Health and Safety Market Reforms and Reelection: Are They Compatible? 2008 Women Business Leaders Summit Pulling the Trigger: How the Funding Warning Could Shape Medicare's Future The Shortcomings of Government-Managed Health Care Life in Health Policy with Diane Rowland Oncology Drug Development: Rethinking FDA Oversight Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at htt;?www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. February, 22 2008
What Do Consumers Want?A new study out by Deloitte's Center for Health Solutions is a must read. The big consulting firm has produced the most comprehensive profile so far of the American health care consumer, under the direction of the center's executive director, Paul Keckley, Ph.D. The 2008 Survey of Health Care Consumers found unequivocally that Americans are not passive patients willing to let others make decisions for them but are active consumers who want to be engaged in decisions.
*********** A new study out by Deloitte's Center for Health Solutions is a must read. The big consulting firm has produced the most comprehensive profile so far of the American health care consumer, under the direction of the center's executive director, Paul Keckley, Ph.D. The 2008 Survey of Health Care Consumers found unequivocally that Americans are not passive patients willing to let others make decisions for them but are active consumers who want to be engaged in decisions. They are hungry for information and want e-mail and web-based connections to their doctors, and given the chance, they would be value-shoppers, willing to make trade-offs, like accepting smaller networks of doctors to save money on insurance premiums. At the same time, they are worried about future health care costs and are searching for alternative medicines and services that can save them money and offer convenience. The survey, conducted last fall with a scientific online poll of more than 3,000 Americans, found many gaps between what consumers want, especially in timely and useful information and control over their health care decisions, and what's available to them today. A few examples:
And about health insurance: When given a choice between getting health insurance through an employer or on their own, 54% would prefer the employer. But almost as many -- 46% -- would prefer to get insurance on their own. This is great progress in a health sector where people have been brainwashed to think that the only place to get health insurance is through their jobs. They understand intuitively that portability is crucial. And what is the first thing they ask for in a health plan? Prescription drug coverage was at the top of the list, with 76% saying it was their most important consideration for health insurance, followed by 74% who say the monthly premium is most important. These issues were much more important than coverage for dependents (48%) or whether a plan covers mental health costs (33%). The survey also shows that it would be a mistake to think of American health care consumers as a homogenous group. There are many different personality types with different levels of interest in navigating the health care system. Some are content and compliant, but the majority is interested in change, including innovative approaches to care and coverage and in having much more access to personalized, online information. This barely skims the surface of this in-depth survey. It's worth a read by anyone, including political leaders, interested in finding out what services health care consumers want and will need in the future. Market opportunities abound if politicians don't throw up roadblocks to progress. *********** The number of uninsured people in the U.S. grew by 3.4 million between 2004 and 2006, a time of robust economic growth, largely due to a continued decline in employment-based health insurance. This is the key finding in the latest study by John Holahan of the Urban Institute entitled, "The U.S. Economy and Changes in Health Insurance Coverage, 2000-2006." Not surprisingly, the declines were greatest among those with lower incomes. It is worth remembering that every time the cost of health insurance rises by 1%, the number of people with health insurance declines by 200,000 to 300,000 people. During 2004-2006, employer health benefit costs rose by nearly 20%. It is not surprising that those at the lower end of the income scale, whose wages are most sensitive to benefit cost pressures, are most likely to be impacted. Is the answer going to be trying to force employers to provide health insurance, as both Sens. Clinton and Obama would do? Especially when the mandated coverage is going to be at least as rich as that provided to members of Congress? Providing lower-income workers with meaningful subsidies to buy more affordable, portable coverage would seem a much more sound prescription for realistic reform. To paraphrase the classic campaign line, "It's the costs, stupid." *********** We learned late last night that Rep. John Shadegg of Arizona has decided to run again for Congress after announcing last week that he planned to retire. He is one of our heroes in the Congress on health reform, and he received letters from 146 of his colleagues in the House, from the heads of 33 conservative organizations (including us), and from thousands of constituents asking him to reconsider. His letter to constituents is moving and classy. "I expected my decision would elicit little reaction here in Arizona, and less in Washington," he wrote. "The events of the last week have, to say the least, stunned and deeply humbled me." This statement from his letter rang particularly true: "The letter signed by my colleagues in the U.S. House emphasized my hard work and expertise in health care reform. I have fought for patient-centered health care reform since my arrival in Congress. I fear we may be on the brink of dramatically damaging the delivery of health care in America -- making it worse, not better. We all recognize the current system doesn't work well for millions of Americans. Health care decisions are being made by third parties, such as insurance adjustors, employer personnel departments, and health care plans, not patients and their families. Many of the changes being promoted by some would make a bad situation even worse. They would move further away from patient choice, personal responsibility, and individual control and toward government run, bureaucrat-controlled health care." We need Gen. Shadegg in this fight, and he is back to lead the battle! Grace-Marie Turner RECENT NEWS ARTICLES AND STUDIES:
State Legislative Health Care and Insurance Issues: 2007 Survey of Plans State lawmakers explored a number of strategies in 2007 to expand access to health coverage, including efforts to increase public program eligibility and assist low-income populations in purchasing private insurance, according to this BCBSA study. A dozen states introduced bills requiring individuals to purchase state-approved health benefit plans, and 13 states introduced some type of employer "play or pay" proposal. All of these measures failed because of their controversial nature and the difficulty of finding adequate funding sources. Ten states created or expanded programs to subsidize private insurance coverage for low-income workers and/or children. And ten states approved bills to promote greater provider transparency, including requiring hospitals to disclose medical adverse events and hospital-acquired infection rates. Aneurysm Lands Man in Health-Care Nightmare A shortage of specialized services in Ontario hospitals has forced 164 patients with broken necks, burst aneurysms and other types of brain bleeding to hospitals in Michigan and New York State since April 2006, reports Toronto's Globe and Mail. Although Ontario has the worst problem by far, it is not alone. British Columbia sent four patients with spinal-cord injuries to Washington State hospitals for care from May to September 2007. And Saskatchewan sent patients to neighboring provinces, including Alberta, for specialized neurosurgical services. In Ontario, patients face barriers to receiving care at every turn, the Globe reports. There is limited access to teleradiology and operating-room time. There are too few intensive-care beds, a short supply of neurosurgically trained intensive-care nurses to staff them, and too few neurosurgeons. The Toronto Star reports that Claude Castonguay, the architect of Quebec's now-overburdened public health-care system, is proposing a strong and controversial remedy that includes further privatization and user fees of up to $100 for people to see their family doctor. The report concludes that Quebec can no longer sustain the annual growth in health-care costs. On Patent Reform, Don't Be Evil The Patent Reform Act, while purporting to bring efficiency and flexibility to the patent system, would actually water down existing patent protections, Pipes writes. While this may be good for a few large technology firms, it will inflict serious harm on small entrepreneurs and research-based health sciences firms, whose livelihoods depend on marketing just a handful of lifesaving inventions. And the costs to biotech and pharmaceutical companies are far greater than any efficiencies created by leaner patent litigation. Patent protection provides the security that chemists and other scientists need to undertake the labor -- and time intensive -- research at the core of drug production. All innovators could benefit if Congress considered meaningful reforms which strengthen, not weaken, patent protection. A strong patent system enables the research and creativity that have produced everything from the paper clip to asthma medication. The Associated Press reports that Google will begin storing the medical records of a few thousand people as it tests its long-awaited service to provide secure, on-line electronic medical records. Medicare Funding Warning Response Act of 2007 Secretary Leavitt sent a proposal to Congress this week asking legislators to make changes to Medicare that will begin to slow the flood of red ink the program is facing. The Medicare Trustees have determined that, for two consecutive years, more than 45% of total Medicare spending will be derived from general revenues within the current or following six years. Key components of the HHS proposal include: providing the Secretary of Health and Human Services the authority and responsibility to introduce principles of values-based health care in the Medicare program, including a payment system that pays for quality; reducing the excessive burden that the liability system places on the health care delivery system; and income-relating the Medicare prescription drug benefit premium. Geographic Variation in Health Care Spending The CBO examines the geographic variation in health spending, the reasons for that variation, and its implications for evaluating the efficiency of the health care system. Per capita spending on health care varies widely, from about $4,000 in Utah to $6,700 in Massachusetts, the CBO reports. And variations can be even greater within regions. In California, for example, Medicare spending per patient in the last two years of life ranged from less than $20,000 in some areas to more than $90,000 in others. The CBO wrestles with the reasons for these variations, from higher prices for services, severity of illness, income and preferences of patients for specific types of care, and differences in medical practice styles. The CBO offers several suggestions for change: Use bundled payments to "curb incentives to provide increasingly intensive services that produce only modest or no improvement in health," enhance incentives to follow accepted care guidelines, and generate more information about variations in practice patterns to "reorient inefficient practice patterns toward greater efficiency." Health Questions for the Candidates Betsy McCaughey offered a list of health policy questions for Sens. Clinton and Obama: She suggests that Sen. Clinton should be asked about the effect her individual mandate would have on young adults and if her plan would provide health care coverage for legal and illegal immigrants. Sen. Obama should be questioned about how he plans to enforce his requirement that all parents have health insurance for their children and if he would allow people to shop for cheaper insurance outside of their own state. McCaughey notes that both Clinton and Obama call for limits on the profit margins of insurance companies. Attacking the most unpopular industry in America may sound politically attractive, but if profit margins are legally capped, investors will flee to other industries and private insurance could become a thing of the past. That would leave only a government-run health-care system. UPCOMING EVENTS: Economic Lessons from Indiana: A Speech by Indiana Governor Mitch Daniels Health on the Home Front: Focusing on Veterans' Needs Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good Health Information Technology and Privacy: Is There a Path to Consensus? New Center Poll Highlights Importance of Acting Now to Protect the Public's Health and Safety Market Reforms and Reelection: Are They Compatible? 2008 Women Business Leaders Summit Pulling the Trigger: How the Funding Warning Could Shape Medicare's Future Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. February, 20 2008
Very Strange BedfellowsThe National Federation of Independent Business has been one of the stalwart defenders of health freedom. But its recent association with two activist liberal groups is raising eyebrows around town. The National Federation of Independent Business has been one of the stalwart defenders of health freedom. But its recent association with two activist liberal groups is raising eyebrows around town.The NFIB was a leader in the 1990s in explaining to the American people the restrictions and complexities of the Clinton health reform initiative and the loss of freedom to Americans and especially small businesses. But something has changed 15 years later. The NFIB now has joined with the AARP and the Service Employees International Union (SEIU), as well as the Business Roundtable, in a campaign called "Divided We Fail." The NFIB says the campaign provides a national platform to talk about why small business is so important to America and why rising health costs continue to be the number one concern of small businesses. The Business Roundtable sees it as a way to "catalyze new thinking" about high health costs. The goals of the joint campaign sound innocuous enough. But it's important to look at the other agendas of these strange bedfellows, especially the SEIU. The union that represents one million service workers, primarily in hospitals and hotels, is working to build a number of coalitions to advance its agenda. And what is that agenda? The SEIU's "Vision for Reform" calls for "a universal health care system" with "guaranteed affordable health coverage for all Americans" and a "core health care benefit similar to the one that is available to federal employees." The union wants all of the presidential candidates to have "a detailed, comprehensive health care plan that meets those principles." The SEIU says that "All of the major Democratic presidential candidates have met that challenge, unlike their Republican counterparts -- an essential difference that SEIU members will highlight as they work to elect the next president," according to a February 4, 2008, SEIU news release. The union plans to spend $75 million this year on its grassroots advocacy campaign, including paid advertising and a nationwide tour, to "make health care the central issue in the election…draw sharp distinctions between the Republican and Democratic presidential nominees' approach to health care…and to help elect a president committed to real solutions." These business groups may have their own vision that incorporates more free-market principles. But are they prepared to spend $75 million to promote them? If not, they risk getting used in this effort. The NFIB and Business Roundtable are not alone in their involvement in this strained coalition-building: Wal-Mart, Intel, General Mills, and AT&T, among others, announced last year they are working with SEIU to "overhaul the country's broken health care system…When this many different perspectives unite around a common goal, it makes very clear that health care reform is achievable," the May 8, 2007, release announces. Maybe. Maybe not. I absolutely believe in coalitions and am a facilitator and supporter of many conversations among people who come from different ideological perspectives seeking consensus around core ideas. But there must be some common philosophical ground for a conversation or you wind up with an unworkable mismatch of policy. It is crucial that principle and policy not be lost in a misguided attempt at reaching an artificial agreement that can't possibly hold up when writing new laws. The 2008 election will provide a clear contrast between two different philosophies of health reform, as I described in my recent Wall Street Journal piece. It deceives voters to pretend that here is a middle ground between a much expanded role for government in our health sector and a properly functioning, patient-centered free market. NFIB surveyed its members, and it found that more than half of them support an individual mandate -- requiring individuals to purchase health coverage. Therein lies their support for universal coverage. But do they understand that an individual mandate immediately morphs into an employer mandate, which NFIB adamantly opposes, because employers will be required to pay a government-determined share of the premiums? Is this the compromise that NFIB is prepared to make? If businesses think an individual mandate is going to make their health care problems go away, they should think again. Even Hillary Clinton criticized an individual mandate in 1994, saying, "The individual mandate...makes it very difficult to determine and monitor who is in the system and who is out. It would require tracking individuals as they move in and out of jobs, as they move in and out of the insurance market. It would require, in our view, the IRS to engage in an enormous administrative oversight of our health care system." And the NFIB's solution to control costs? "Laws, regulations and insurance arrangements should direct health care spending to those goods and services that will maximize health." What? Is that really the NFIB calling for more laws and regulations over health care? The affiliation with the SEIU should be causing heartburn for NFIB and Business Roundtable members. The SEIU boasts of its work in helping to pass the Massachusetts and Maine health care reengineering efforts and of the union's work in crafting and helping to pass the Wal-Mart bill in Maryland. The bill targeted Wal-Mart in requiring it to spend at least 8% of its payroll on health insurance. The bill was overturned by a U.S. District Judge as violating ERISA. Now that is certainly a business-friendly record for the NFIB and the Business Roundtable (which has been less involved in the health debate in the past) to associate themselves with! I do know that businesses want urgent action on health issues, but the agenda of the SEIU and the AARP, which has been lobbying for more government control over health care and pharmaceutical pricing, is very much out of sync with freedom in the choice of private health insurance and competitive market forces to bring down costs. That is the conversation we need to be having. Principles matter. This coalition compromises the ability to educate the electorate about free-market solutions in health care. Let's hope that other organizations don't follow suit. Otherwise, they will be compromised in their ability to move forward with policies that would create a truly competitive health sector and allow the U.S. to create a uniquely American solution to the challenges of a 21st century health sector. Grace-Marie Turner RECENT NEWS ARTICLES AND STUDIES:
Require Freedom, Not Health Benefits Across the country, every state requires insurers to cover certain medical services and providers, including essential services like emergency room care and lesser ones like acupuncture, massage therapy, and pastoral counseling. Mandates, which vary from a low of 14 in Idaho to a whopping 63 in Minnesota, can drive up insurance costs by as much as 50%, according to Grace-Marie Turner. One way to escape expensive health insurance mandates and regulations would be for Americans to be allowed to purchase health insurance policies from insurers in states that have more sensible health policy regulations. When looking for solutions to the rising number of uninsured in their states, lawmakers might first consider undoing the damage they have done with mandates and regulations that have made health insurance so expensive in the first place. CDHC Prognosis Consumer-driven health care can help foster a stronger doctor-patient relationship, according to Grace-Marie Turner. But the crucial relationship between the doctor and patient has been disconnected by the third-party payment system. "There are too many people with decision-making power that gets between the patient and the doctor," she says. With a middleman saying yes or no, what doctors and patients have is "Mother May I medicine," Turner says. "It's so demoralizing to physicians not to be able to do what they were trained to do. They wind up having health plans that are directing their practices and keeping them from spending the time they want, and need, to take care of patients." She finds, "Patients are sick of it, too. They want to be able to deal directly with their doctor to get good advice and care," she says. "When consumers have more access to healthcare information, doctors can do a better job of explaining things. That is especially important in helping people with chronic illnesses become partners in their care," Turner says. Democrats' Health Plan Not So Harmless Single-payer "universal" coverage is the enemy of health care, and it's the inevitable outcome of the Democratic proposals, writes Ben Zycher. Ostensibly, the Democratic candidates recognize the importance of private insurance options, and the proposals add a Medicare-like government insurance option to provide enhanced competition driven by supposedly lower administrative costs. But the government option would crush competition and render meaningless the Democratic promise to preserve choice. The inevitable result is waiting lists, denial of coverage, underinvestment in medical technologies and the long-run degradation of health care quality observed under all single-payer systems. And so the Democratic promise that those who prefer private coverage will be able to keep it, and that the health-insurance market would continue to enjoy the broader economic advantages offered by a private system, borders on the naïve or the cynical. ERISA Pre-Emption: Implications for Health Reform and Coverage EBRI provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and state and local attempts at comprehensive health insurance reform. It reviews the statute and its history, major case law relating to the interaction of ERISA and state law, and the implications of ERISA's pre-emption of state laws governing health insurance. It also presents the latest data on the number of health plan participants in both insured and self-insured ERISA-governed plans, and the trends related to self-insurance. The President's Proposals for Medicaid and SCHIP: One Step Forward, One Step Back The Bush Administration's budget proposal for increased spending on SCHIP is a major departure from its previous position and a serious concern, writes Nina Owcharenko. Flooding the program with new money and focusing on expanding enrollment would defeat the fiscal rationale of a block grant. More important, it would undermine efforts to expand access to private health insurance by implying that a government-run health program is the preferred way to cover uninsured children in low-income families. Congress would be wise to reject the proposed increase in SCHIP funding and instead focus on enacting policies, such as health care tax credits, to make private health care coverage more affordable for low-income families, thus reducing the dependence on SCHIP and Medicaid. The Manhattan Institute's Dr. David Gratzer argues that states badly need to experiment with their Medicaid and SCHIP programs. A few states are already rethinking their programs, and these experiments are the most exciting developments in health care. Twelve years ago, a bipartisan majority in Congress ended welfare as we knew it, sending poverty rates falling to the lowest levels in decades. The basic principle of that effort - state innovation - worked for welfare. It is also the key to health-care reform. Senior Benefit Costs Up 24% The cost of government benefits for seniors soared to a record $27,289 per senior in 2007, according to a USA Today analysis. That's a 24% increase above the inflation rate since 2000, and medical costs are the biggest reason. Last year, for the first time, health care and nursing homes cost the government more than Social Security payments for seniors age 65 and older. The average Social Security benefit per senior in 2007 was $13,184. The analysis finds that Medicare experienced the most explosive growth from 2000 to 2007. The Medicare prescription drug benefit, started in 2006, accounts for about a quarter of the increase in Medicare. Long-term care costs per senior have declined slightly in the past three years because of a move away from nursing homes to less expensive home care. UPCOMING EVENTS: Grace-Marie Turner speaking on Health Beat of America Looking Back to Look Ahead: Lessons for Today from the New Frontier and the Great Society Grace-Marie Turner speaking on Let's Talk Human Organs for Sale? Health on the Home Front: Focusing on Veterans' Needs Third National Pay for Performance Summit Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good | |