Tag: health care

Government Can’t Do Charity

Post author By David
Post date July 30, 2009
12 Comments on Government Can’t Do Charity

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Those pushing the need for health care reform spend a lot of time talking about the uninsured and the many unfortunate people who cannot or will not afford to pay for health care. (Mostly they talk about the “cannot pay” people except when they are proposing to have individual mandates, then they start talking about “freeloaders” who don’t get insurance even though they can afford it.) These people claim that health care is a right and (although they don’t use the word) they are proposing that the government can and should provide charity care for those in the “cannot pay” camp. The only problem is that government has been trying to do that for a long time through medicaid and medicare. The fact is that government cannot provide charity care – government can only take from those it chooses to burden and give to those it chooses to help. This warps the system even when it is meant to level the playing field.

Tags Elevated, government, health care, ideal, liberty, money, religion, thoughts

National

Honest Democrats in Congress

Post author By David
Post date July 24, 2009
1 Comment on Honest Democrats in Congress

If we are ever to achieve any health care reform that will actually have a positive impact on our society it will require that we have honest Democrats in Congress. Not just any honest Democrats, but enough of them and in the right places that they can use their honesty to guide the debate. The way that you will be able to recognize a Democrat with the honesty to help the process is that he will reject the assertion of President Obama that Republicans only want to maintain the status quo.

An honest Democrat would have to recognize and admit that Republicans have been publicly acknowledging for years that we need health care reform. An honest Democrat would work from a position that understands that believing that the proposals they currently don’t have time to read are actually worse than the status quo (as Republicans generally do) is not the same as believing that the status quo is acceptable (as Republicans generally don’t). Using the scare tactic that doing nothing will make the cost of health care double within ten years without acknowledging that a poor solution could be crafted in a way that makes the cost triple within nine years is not honest. Such honest Democrats would be willing and able to actually have a dialog with Republicans and see if they have anything of value to offer on this issue.

Tags Democrat, discourse, Elevated, health care, insights, issues, parties, questions, Republican

National

The Cost Issue is MIA

Matthew Piccolo has a good summary of some of the major issues that are attached to the current health care proposal. That seemed like a good complementary article to what I wanted to point out about the Health Care Reform Freight Train™ speeding through the halls of Congress – there is a major issue that has failed to be attached to the current discussion – cost reduction.

Back in ancient history (2007 through mid 2008), while the presidential election was in full swing but before the economy and the urgent need to bail out anyone with pockets deep enough to hold quantities of money starting with “$” and ending in “Billion”, health care was seen as the most important domestic issue on the campaign trail – does anyone remember that time? If you do you should remember that one of the few points of consensus on the issue between all parties was that health care was too expensive and that any attempt at a solution would have to include measures to cut the overall amount that we spend on health care. Here is a clip from Obama’s campaign website on the issue of healthcare:

we want to make health insurance work for people and businesses, not just insurance and drug companies.

Reform the health care system:
We will take steps to reform our system by expanding coverage, improving quality, lowering costs, honoring patient choice and holding insurance companies accountable.

Improve preventative care:
In order to keep our people healthy and provide more efficient treatment we need to promote smart preventative care, like cancer screenings and better nutrition, and make critical investments in electronic health records, technology that can reduce errors while ensuring privacy and saving lives.

(emphasis added)

Tags change congress, Elevated, health care, issues, liberty, money, Obama

culture National

An Affordable Health Care System

Post author By David
Post date July 8, 2009
7 Comments on An Affordable Health Care System

On Sunday, July 5, Paul Krugamn laid out his argument that affordable health care for everyone was an achievable goal.[quote] Many people would be surprised to learn that I agree with him on that. He correctly argues that we already cover the bulk of the most expensive health care patients by covering the elderly under Medicare. He also argues that the uninsured already receive much care that we are already paying for so we are already paying much of the costs for their care. Finally he argues (as a corollary to the first point) that many of the uninsured are generally young and healthy so that insuring them would cost less per person than our current per-person cost of public insurance (bringing down the average cost per person and increasing the overall cost only slightly).

His conclusion is that “extending coverage to most or all of the 45 million people in America without health insurance — should, in the end, add only a few percent to our overall national health bill.” He would be right at the beginning but eventually the nightmare spiral of skyrocketing costs would take over because the fundamental problem in our health care system would not be addressed – overuse and the disconnect between the source of payment and the subject of care.

Tags Elevated, government, health care, money, New York Times, Paul Krugman

National

The Healthcare Issue Simplified

Post author By David
Post date June 19, 2009
4 Comments on The Healthcare Issue Simplified

DownsizeDC has a post entitled Complexity, Simplified that promises to make our national issue with health care reform understandable. And they deliver on that promise. They say more than this, but it all boils down to these few statements:

But we think the complexity can be simplified to two simple questions:

For whom does your doctor work?

Do you pay for your health insurance directly?

If your doctor tailors his or her care to the policies of your insurance company, or some government program, then you don’t really have a doctor who works for you, and health care hasn’t really been reformed.

You’ll know health care has really been reformed when the following things are true…

You and your doctor deal with your health insurance provider as rarely as you currently do with your car insurance company

Doctors post their prices, and compete with each other based on price and quality

It’s really that simple. As long as insurance policies and/or government programs fund most of your health care, doctors will work for them and not for you.

The same holds true for health insurance. As long as our health care coverage comes mostly from employer controlled insurance or the government, we won’t have a competitive health insurance market, and the cost of both insurance and health care will grow constantly.

When Americans care about the impact that their use of health care has on their insurance premiums in the same way that they care about the impact that speeding tickets and minor scrapes have on their car insurance, you’ll know that our health care system has really been reformed.

There – in two questions to ask, two systemic changes to watch for, and two paragraphs decribing what real reform would look like – is the entire health care issue.

Tags change, Downsize DC, health care, issues

culture

Hillarycare and the Media

Post author By David
Post date January 23, 2009
No Comments on Hillarycare and the Media

This post is not intended to mock or even evaluate the positions espoused by Hillary Clinton now or in the past. I chose the title to be short and to grab attention. The purpose of this post is to summarize and evaluate how the news media covered the issue of health care reform during the presidency of Bill Clinton. I think that the fact that the proposal is now known as Hillarycare is as telling about the media coverage as anything else I will say here.

James Fallows calls the health care debate of the mid 1990’s “The Press’s Vietnam War.” The image being that there could be no winners in the debate, only combatants. I will follow the format of his coverage – as a seven act drama – to show how the media coverage of the day served to hinder the average citizen from ever getting a clear view of what what being discussed and what might be best for the country.

Emerging Issue

Health Care as a political issue began to be noticed during the Democratic primary. Rather than evaluate the proposals by Bill Clinton and Robert Kerrey (the candidates most closely tied to that issue) the media coverage focused on how the differences in their proposals (whether to try a single-payer approach or not) would play in the primary race. People could gain no understanding of the issue from the coverage, all they could learn (if anything) was the potential political fallout. Once Kerrey dropped out the coverage ended because there was no political confrontation involved anymore.

Crafting the Bill

The Clinton team had been studying the issue of health care reform long before the presidential election and when Bill became president they intended to hit the ground running – and they did. In doing so the press later complained that they were operating in the dark because they spent their time communicating with congressional leaders etc. rather than running their work past the press for public vetting of their ideas.

Scandal Reigns

When the plan was first unveiled the uniform reaction was positive but positive does not make for exciting press coverage. Fate stepped in to make the lives of reportes more exciting. Just when President Clinton was starting a tour to promote the Health Care Bill a crisis erupted in Somalia which diverted his attention and gave the press more exciting things to cover. At the same time this provided an opportunity for opponents of the bill (notably the insurance industry) to stage a counter-attack. By the time the news coverage focused on health care again the president was plagued with more energized opposition and a number of scandals.

Fear-Mongering

I was excited to read about the work of Robert Pear who carefully delved into issues and provided in depth reporting. What interested me however was the effect of his work. Neither Mr. Pear, nor anyone else in journalism took the time to consider the whole health care proposal. Mr. Pear focused on one item, one leak at a time and evaluated it. Each time he would show who stood to lose over that particular aspect of the plan. The result was something like the reverse of Hitler’s ethnic cleansing in Germany – instead of one ruling group peeling off layers of “undesirable” elements of society each aspect of the plan reported by Pear drew the attention of a small group who stood to lose on that particular facet of the bill. As the groups combined, each focused on their pet issue, they grew to the point that they stopped the final bill. It may be that none of them realized or considered the potential positive effects of the whole bill.

Focus on Conflict

Kathleen Hall Jamieson, the dean of the Annenberg School for Communication relates an interesting experience of attending a presentation by Hillary Clinton on the health care reform bill.

She went into the substance of the plan, and took on virtually every argument that had been raised against it. . . When she was talking about her plan, the reporters had clearly heard all of this before and found it completely uninteresting. They talked to each other passing notes around.

But as soon as she made a brief attack on the Republicans, there was a physiological reaction, this surge of adrenaline, all around me. The pens moved. The reporters arched forward. They wrote everything down rapidly. As soon as this part was over, they clearly weren’t paying attention anymore. They were writing on their laptops as they began constructing the story of how the First Lady had attacked her opponents.

(emphasis added)

The press would always prefer to talk about alternate bills and problems with the current idea than actually talk about the whole issue and have people work towards a solution. Solutions make for a day of coverage while problems can be exploited day after day.

Misinformation

Eventually there was someone who read the whole bill and attempted to put it into perspective. Her name was Elizabeth McCaughey (pronounced “McCoy”). When she did so, whether she intended to or not, she included some crucial pieces of misinformation that made the bill sound draconian. The difference between her evaluation of the bill and the actual text of the bill is similar to the difference between what the people behind fightfoca.com say about the Freedom of Choice Act (FOCA) and what the actual bill says. (I discussed this difference last week.) No journalist ever explored the accuracy of her statements.

Out of Sight, Out of Mind

When the health care bill died the news coverage of the health care issue died as well until about 2006 when it was again a central issue for a presidential campaign season. During all that time the issue of affordable heath care has been at least as important as it was when it first started garnering media attention during the Democratic primaries for 1992.

Tags health care, issues, media

National State

“Free Market” Health Care

The call for Lawyers to join health-reform efforts was a not so subtle reminder to me about how "free" our health care market is currently. We can’t really pretend that the cost of services or the services rendered are determined by patients and providers. In fact, they are not even determined by a combination of patients, providers, and insurance interests.

Malpractice lawsuits, whether as threat or reality, skew a provider’s treatment decisions to the legal safe side, members of the Legislature’s Health Care System Reform Task Force were told Tuesday. That approach, in turn, adds to the amount of redundant testing and is a significant but so far unaddressed factor in the reform process.

The cost of malpractice-insurance premiums for providers also is rising rapidly, Rep. Gregory Bell, R-Fruit Heights, and an attorney, told fellow task force members.

We have developed a pricing and practice environment based on a staggering concoction of laws, medical knowledge, middlemen, and advertising. Patients may demand unnecessary services or medications based on what they hear from advertisements. They may also have unreasonable expectations regarding how flawless our medical system is or should be – in other words, they may feel entitled to compensation for unavoidable tragedies. Governments step in to define what "unavoidable" means by specifying standards of practice which may bear little connection to medical necessity. Insurance companies can, by choice or accident, inflate the costs by demanding standards of practice and levels of compensation that can’t possibly take into account all the factors that should define the practice of health care and the commensurate compensation for care.

Care must cost more when malpractice insurance rates rise. Prices will increase when the salaries and profits of insurance companies must also be covered in the process of receiving health care. Checks against unnecessary care will disappear when those receiving care are not sensitive to the costs of individual procedures. Medical decisions will be skewed when manufacturers provide kickbacks to doctors and advertise their wares directly to customers who have no medical background.

While we use the Brass Serpent (the Nehushtan) as the symbol for the field of medicine we might find it convenient to use the Hydra as a symbol of the cost of health care.

The Hydra - photo by Craig Stephen
Hydra – photo by Craig Stephen

Somehow we need to slay this monster but while the sword of government may have a place in the battle it is not sufficient to complete the task – by itself the sword of government makes the monster more dangerous.

Tags Deseret News, economics, free markets, government, health care, issues, laws

life National State

The Costs of Health Insurance

Post author By David
Post date October 29, 2008
7 Comments on The Costs of Health Insurance

Maybe this is related to being under a dentists drill this morning, but today’s topic is the cost of health care. A story over at The Health Insurance Myth detailing how much more a visit to the eye doctor costs for insurance companies was very revealing. Add to that the fact that we are entering the Open Enrollment period at Intermountain Healthcare where I get to reassess my health insurance situation and make any changes necessary and you can see why I would be thinking about this today.

I’ve never done this before since I’ve never had a year where I was not in a new job, had just enrolled immediately prior to the Open Enrollment period, or had the company completely changing their benefits package. This year we get a mild rate increase over last year and there are a couple of new benefits available, but nothing truly drastic. Open Enrollment doesn’t mean too much to me since I don’t foresee making any significant changes, but I was pleasantly surprised to see Intermountain subtly encouraging employees to choose their High Deductible plan. There was nothing really overt about it, but while rates are increasing for all the plans they still pay the entire premium for full time employees on the HD plan and on top of that they reduced the annual out of pocket maximum by almost half so those using these plans have lower financial risk than before.

To give some perspective – their no-deductible plan costs more in premiums than the deductible of the high deductible plan – that’s before you set aside any money in a Flexible Spending Account (FSA) to cover for the copays (money that disappears if you don’t use it). The lower deductible plans cost less than the deductible on th HD plan until you factor in their deductibles and copays. For anyone who expects to pay the full deductible they can contribute their premium and FSA money to a Health Savings Account (HSA) and easily cover the out of pocket maximum. Any money they don’t spend in the HSA rolls over to the next year and earns interest. For those of us who don’t expect to even meet the full deductible we can build up an HSA that earns interest and is almost perpetually funded very quickly so that we can devote the extra cash to other needs.

All of this deals with the insurance/health care issue at a personal level, but it should illustrate the need to step outside the mindset of traditional health insurance as we try to tackle this public challenge – the last thing we need to do with this monster is limit our options at the outset. (Unfortunately Medicaid, CHIP, and UPP serve as good examples of programs where we artificially limit our options.)

Tags government, health care, HSA, insurance

National

Delving Into “Six Steps”

Joe Jarvis is a doctor and a candidate for the Utah legislature. I was very interested in exploring the six steps to bring about true health-care reform in Utah that he outlined in the Salt Lake Tribune. He has been kind enough to answer some of my questions and I want to share what I have learned from him and from digging into his sources.

Health underwriting

Every critically ill or injured person will be treated in our health system whether they have health insurance or not.

The realization that doctors and hospitals are obligated under the law to treat people in need should really change the way we look at the issue of universal coverage and the underwriting process. It deserves to be one of the areas we look at to make fundamental change to improve our health care system.

Unsafe hospital practices

Another cause of inefficiency in the system. Dr. Jarvis pointed me to studies by the Institute of Medicine demonstrating the statistical results of accidents and poor industry practices. (I say statistical to make it clear that the above link does not lead to grotesque images of hospital injuries.)

Inappropriate care

Inappropriate care seems to be the symbol of all that is wrong with our system. It appears to be a direct result of a medical industry that is being controlled by the insurance industry which is more interested in avoiding legal repercussions than in keeping people healthy

Perverse incentives

Dr. Jarvis quoted an article from the Wall Street Journal on April 5. I was unable to find that article to confirm the numbers he quoted (“if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve.”) I did find an article from April 7th in the Wall Street Journal, More Choices Drive Cost of Health Care, that appeared to be the same except that it had different numbers ($50 billion saved over 5 years). (Follow the link here to see more than the free preview.) While I could not verify the numbers he quoted, the concept that we must eliminate the perverse incentives that drive the health care system is sound.

Market-based health policy

Dr. Jarvis argues that “health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.” While I would agree with him in the case of an appendectomy there are services (lasik, orthodontics, or well child checkups for example) where demand will rise as prices fall. Besides that, the WSJ article cited above indicates that many people, fueled by a “more is better” attitude, will indulge in available health services that are unnecessary. This would probably not be the case if they had to pay more than a token amount for those extra procedures. Also, at times when the patient is not the driving force behind extra procedures the findings are that

More office visits, hospital stays and diagnostic procedures likely indicate poor coordination among doctors and facilities that can lead to worse care and outcomes.

So far I am not convinced that real market forces do not have a significant role to play in radically improving our health care system.

Benefit denial

I had never previously considered the cost associated with claim denials, but Dr. Jarvis provided some eye opening data. In his article he stated that “Claims costs are at least 10 percent higher in Utah than would be optimally efficient.” He was gracious enough to allow me to look through the data he used to arrive at that figure and answer my questions to help me understand what I was seeing.

Here’s what I learned; the claims cost is the percentage of the insurance company’s revenue that is spent in evaluating and denying claims – it does not count the cost of claims paid, just the cost of processing the claims. The 10% figure is a bit misleading. Let me try to clarify the numbers. The most efficient insurance provider in Utah is apparently the Public Employees Health Plan (PEHP) which spends nearly 4% of revenue in processing claims. The data from the other major health insurance providers (IHC, Blue Cross, Altius, and UHC) shows that they spend between 12% and 19% of revenue on the processing of claims. To put that in perspective, PEHP spends 1 of every 25 dollars in claims processing while the other providers spend between 1 in 8 and 1 in 5 dollars. That is 3 to 5 times higher than optimal. It is a difference of 10% of their revenue but it is not evidence that they spend 1.1 times the optimal amount on claims processing.

Conclusion

Even where I do not fully agree with the details of Dr. Jarvis’ claims about these six steps I do agree that all six of these steps are important issues to address if we are to come up with a decent approach to improving health care in our state. I also agree wholeheartedly with Dr. Jarvis that the system requires a major overhaul, not just some tinkering if we are to avoid the looming crisis in the health care system.

Tags connections, free markets, health care, Utah

National

Willing Suspension of Disbelief

Post author By David
Post date May 3, 2008
2 Comments on Willing Suspension of Disbelief

Reports from the CBO that a Universal Health Coverage Bill would be budget neutral are obviously based on the third kind of lie (namely statistics). Commonhealth sums up the effects of the bill like so:

The legislation:

gets rid of employer based insurance (employers that contribute to coverage would give employees that money at first, and eventually shift to a federal health coverage tax)

requires all Americans to have health insurance

offers subsidized coverage up to 400% FPL (Mass is up to 300%)

sets up purchasing pools (like the Connector)

Could someone please point out to me where this plan gives health care providers an incentive to provide efficient, high-quality care? It seems to me that insuring all our uninsured citizens will never pay for itself in a system that thrives on inefficiency – as the current system does. Adding inefficiency couldn’t possibly pay for itself.

Ending employer based insurance is potentially a good thing. Requiring everyone to buy insurance looks like an incentive for more inefficiency and even price gouging. And one of my senators is sponsoring this. I think he should have his head examined.

Tags economics, health care, issues, statistics