Consumer Health Updates
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February 26, 2008 - Click here to discuss this topic
Consumers for Health Care Choices Second Annual Awards Banquet featured four fascination presentations from some of the most innovative thinkers in American health care. These talks are now available on-line. They include:
Regina Herzlinger -- Pioneer in Health Economics.
Introduced by Dr. Stormy Johnson, CHCC Board Chair.
Professor Herzlinger of the Harvard Business School is the thought leader on consumer driven health care in the United States. She is the author or editor of three books that laid out the intellectual foundation for the consumer empowerment movement: Market-Driven Health Care (1996); Consumer-Driven Health Care (2004); and Who Killed Health Care? (2007). She is a frequent and popular lecturer on all aspects of health care reform, and serves on the Boards of some of the most innovative health care companies in America.
Professor Herzlinger's talk (audio only).
William Boyles -- Pioneer in Communications.
Introduced by Tom Noland of Humana.
Mr. Boyles is the editor and publisher of the Consumer Driven Market Report and the Health Market Survey. He has been covering and reporting on Congress since 1976 and has published numerous newsletters following the evolution of the benefits markets. He was the first journalist to identify the profound change represented by consumer driven health care. He does not merely report on events but has been involved in organizing conferences both here and abroad and is a featured speaker at dozens of events every year.
Mr. Boyles' talk
Garrison Bliss, MD -- Pioneer in Medical Practice.
Introduced by Dr. Tom Lagrelius, CHCC Director.
Dr. Bliss is a board certified physician with 30 years of practice in primary care. His Seattle Medical Associates was the second practice in America to test a monthly fee "concierge medicine" approach to primary care. His new company, Qliance, is bringing the same principles to working people, including those who are uninsured. He is a past president and chairman of the Society for Innovative Medical Practice Design, and widely considered the leading voice for patient-financed medicine in the United States.
Dr. Bliss's talk.
Tony Miller, Pioneer in Benefit Design.
Introduced by Greg Scandlen, CHCC President.
Tony Miller co-founded Lemhi Ventures in 2006 to build the capital base and value added approach of forming and helping companies continue to advance the marketization of the healthcare industry. Additionally, Mr. Miller is part of the leadership team at Carol Corporation, a Lemhi Ventures Portfolio company. Mr. Miller serves on the Boards of VisionShare, and Carol Corporation. Prior to founding Lemhi Ventures, Mr. Miller was a co-founder and CEO of Definity Health, a national market leader in consumer-driven health benefit programs, which was sold to UnitedHealth Group in 2004.
Mr. Miller's talk.
December 06, 2007 - Click here to discuss this topic
Picture Gallery from the Second Annual Awards Banquet
Diners Seated for the Festivities
CHCC Board Chair Stormy Johnson, MD, Welcomes Guests
More Diners
CHCC President Greg Scandlen Introduces Tony Miller
Tony Miller, Pioneer in Benefit Design
Humana's Tom Noland Introduces Bill Boyles
Bill Boyles, Pioneer in Communications
Bill Boyles Receives an Ovation
CHCC Board Member Tom Lagrelius, MD, Presents Award to Garrison Bliss, MD
Garrison Bliss, MD, Pioneer in Medical Practice
Garrison Bliss Receives an Ovation
Two Diners Enjoy the Festivities
Doctors Johnson and Lagrelius Looking Dashing
Ready for Dessert
November 13, 2007 - Click here to discuss this topic
CHCC's Second Annual Awards Banquet
December 2, Hyatt Regency, Crystal City
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-- Regina Herzlinger -- Pioneer in Health Economics
-- William Boyles -- Pioneer in Communications
-- Garrison Bliss, MD -- Pioneer in Medical Practice
-- Tony Miller, Pioneer in Benefit Design
-- Travel, Hotel, Conference Discounts
Come join us for a celebration of a new era in health care at our Second Annual Awards Banquet! It will begin with an opening reception from 6:30 to 7:30 pm on Sunday, December 2, 2007, followed by a scrumptious meal complete with wine and dessert.
Hear presentations from three of the most creative innovators in health care -- Regina Herzlinger, William Boyles, and Garrison Bliss, MD
Get caught up with all your friends in the Consumer Choice movement and get to know some new ones.
Tickets are $185 for CHCC sustaining members and $245 for all others. Payment must be made in advance by sending your check to CHCC Banquet, PO Box 4955, Hagerstown, MD 21742.
Regina Herzlinger -- Pioneer in Health Economics
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Professor Herzlinger of the Harvard Business School is the thought leader on consumer driven health care in the United States. She is the author or editor of three books that laid out the intellectual foundation for the consumer empowerment movement: Market-Driven Health Care (1996); Consumer-Driven Health Care (2004); and Who Killed Health Care? (2007). She is a frequent and popular lecturer on all aspects of health care reform, and serves on the Boards of some of the most innovative health care companies in America.
William Boyles -- Pioneer in Communications
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mr. Boyles is the editor and publisher of the Consumer Driven Market Report and the Health Market Survey. He has been covering and reporting on Congress since 1976 and has published numerous newsletters following the evolution of the benefits markets. He was the first journalist to identify the profound change represented by consumer driven health care. He does not merely report on events but has been involved in organizing conferences both here and abroad and is a featured speaker at dozens of events every year.
Garrison Bliss, MD -- Pioneer in Medical Practice
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr. Bliss is a board certified physician with 30 years of practice in primary care. His Seattle Medical Associates was the second practice in America to test a monthly fee "concierge medicine" approach to primary care. His new company, Qliance, is bringing the same principles to working people, including those who are uninsured. He is a past president and chairman of the Society for Innovative Medical Practice Design, and widely considered the leading voice for patient-financed medicine in the United States.
Tony Miller -- Pioneer in Benefit Design
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Tony Miller was instrumental in pioneering the concept of Health Reimbursement Arrangements and bringing the principles of consumer empowerment to the boardrooms of America. His was not just an intellectual exercise. He proved the concept as a business model and built an enormously successful company around it. Tony embodies the combination of vision and business savvy that characterizes a new generation of health care entrepreneur. His work in persuading corporate America of the merits of consumer driven health care also paved the way for the later enactment of Health Savings Accounts in 2003.
Travel, Hotel, Conference Discounts
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If you need a hotel room or to fly in for the meeting, you may take advantage of the substantial discounts offered by the CDHCC conference.
Stay at the hotel for $225/night by registering by November 9th and telling them that you are a CDHCC attendee. The phone number at the Hyatt Regency is 800-233-21234.
Flight discounts are available through United Airlines. Call 800-521-4041 and refer to CHW Meeting Number 529TY.
CHCC members also get a 30% discount on registrations for any of the Consumer Health World conferences To register or just get information, go to http://www.consumerhealthworld.com/cdhccf07/ and use this code -- XCNTEMSOND
September 20, 2007 - Click here to discuss this topic
There are two great movements going on in health care today --
On one hand the politicians -- both Republican and Democrat -- are scurrying around to come up with Grand Designs to “fix” the system. They want to control things from the top through the use of committees, bureaucracies, agencies, rules and regulations.
On the other hand, there is a growing grassroots movement of consumers who say, Give Us the Money and we will make our own decisions. We will spend it as we see fit -- on the services and providers who provide the best value.
In just a few years, this consumer movement has grown dramatically. With the help of Health Savings Accounts and other forms of consumer empowerment, we are taking more control over the money. Now we are demanding reliable information and transparency. Once we have money in one hand and information in the other, we will radically change health care so it is more efficient, more convenient, of better quality, and far lower costs.
Consumers for Health Care Choices is at the cutting edge of this transformation. We are a national organization that is dedicated to putting the consumer in the driver’s seat of health care. We want to restore the patient/physician relationship and increase competition throughout health care so we will have an array of choices.
But we need your help!
Become a Sustaining Member
and get a free coffee mug!
These mugs are sure to become classics. On one side is the CHCC Logo, and the other side says, “I Like My HSA!” It will be mailed to you upon receipt of your $120 membership fee to become a Sustaining member of CHCC.
In addition to a coffee mug, you will be eligible to participate in all the activities of Consumers for Health Care Choices, such as:
-- Full representation with political and industry leaders.
-- Weekly newsletter (Consumer Power Report) via email.
-- Washington Watch and Action Alerts via e-mail.
-- Voting rights for Board of Directors and organizational policy .
-- Opportunity to serve on CHCC committees.
-- Access to Direct Laboratory Services with Member Discounts.
-- Access to DestinationRx, an industry leader in consumer drug comparison and purchasing.
-- Discounts on meeting registration.
-- Ability to post articles on web site.
-- Participation in CHCC Speakers’ Bureau.
-- Membership in State Chapters (where available).
-- Participation in conference calls with national thought leaders.
Go to the Join/Renew Page on the left hand column to begin your membership!
September 05, 2007 - Click here to discuss this topic
Next Corporate Roundtable Meeting September 26th
The Roundtable will be meeting from 9:00 a.m. – 12:00 on September 26 at the Hyatt Regency in Washington. This meeting is in conjunction with the National Consumer Driven Summit that begins on the 26th and goes through September 28. The meeting is open to members of CHCC's Corporate Roundtable and to prospective members by invitation.
The organizers of the Summit have given CHCC members a $500 discount on registrations. By using the discount code you may register for the whole Summit for $995, instead of the usual $1,495. Find out more about the Summit by going to -- http://www.consumerdrivensummit.com/
Our Roundtable meeting will be important because it will give us an opportunity to discuss how to manage our businesses during a time of increasing political heat and partisan divides. Believers in consumer empowerment will need to be prepared to respond to baseless accusations, but not get distracted from our essential purpose of building market share and acceptance of free market approaches to health care reforms.
The stakes could not be higher, not only for your company, but for the future of the health care system itself and the lives and well-being of our families.
We will also be discussing putting together a workshop featuring Roundtable members at the CDHCC conference in December.
Please come and help CHCC craft a better strategy and message for the coming months. RSVP to me at greg@chcchoices.org. Also I will give you the registration code so you may get the CHCC discount for the Summit.
-- Greg Scandlen
March 18, 2007 - Click here to discuss this topic
FOR IMMEDIATE RELEASE Consumers for Health Care Choices
Press Release
American Media Ignore Swiss Vote
Single Payer Rejected by 71% of Voters
Hagerstown, MD, March 15, 2007 CHCC President Greg Scandlen issued the following statement today
“On Sunday the Swiss people voted overwhelmingly to reject a Single Payer system. But there has been not a word about it in the American press – other than a single paragraph in the trade publication Business Insurance (http://www.businessinsurance.com/cgi-bin/news.pl?newsId=9723)
“The vote was on whether to replace Switzerland’s current system of mandatory health insurance coverage provided by 87 private health plans with a single payer system based on income-related premiums. It was rejected by 71% of the voters.
“If the vote had gone the other way – if the Swiss had embraced Single Payer – it would have been front page news in every newspaper in the United States, it would have been a lead story in every broadcast. Reporters would have booked flights to Geneva to interview citizens and political leaders.
“This provides a sobering example of why public policy goes so wrong in the United States. The public is informed of only one side of the story. Reporters and editors are biased in favor of government intervention and against free markets. They are part of a privileged elite who think consumers are incapable of making sound decisions and intelligent choices.
“But the people of Switzerland made the same choice as the American people make every time they have had an opportunity. Voters in Oregon rejected Single Payer by a vote of 79% to 21% in 2002. People do not want to be herded into a government-run cattle car. We want and demand freedom of choice in health care as in every other aspect of our lives.”
About Consumers for Health Care Choices
Consumers for Health Care Choices is a national membership organization of citizens devoted to putting the consumer in the driver’s seat of the health care system. It was organized just over one year ago and is growing quickly as more people realize the future of health care rests with empowered consumers. The Board Chair is Daniel (Stormy) Johnson, Jr., MD, a radiologist in Metairie, Louisiana, and former president of the American Medical Association.
Website: http://www.chcchoices.org
Consumers for Health Care Choices
Greg Scandlen
President
email: greg@chcchoices.org
phone: 301-606-7364
December 19, 2006 - Click here to discuss this topic
Consumers for Health Care Choices held a Board of Directors meeting, an Awards Banquet, its annual Members Meeting and a Consumer Education Workshop on December 10 and 11th in Washington, DC. Here is a scrap book of some of the highlights.
Board of Directors Meeting
CHCC President Greg Scandlen welcomes the Board and introduces Mark McClellan, MD, PhD, as the recipient of the "Pioneer in Public Policy" award for 2006.
Mark shows off his Jefferson presidential dinner plate while CHCC Board Chair Stormy Johnson, MD, looks on.
CHCC Board of Directors hard at work. From left, Tom Lagrelius, MD, Robert Berry, MD, Jim Porterfield, Robert Hamilton, MD, Bill Sweetnam.
Awards Banquet
CHCC Chair Stormy Johnson welcomes attendees
Pat and Karen Rooney at dinner
Karen Kerrigan and Jack Strayer get caught up.
CHCC Secretary John Young thanks the Corporate Sponsors – CareGain, N.A.S.E., and WageWorks.
CHCC Treasurer, James Knight, MD presents John Goodman, PhD, with “Pioneer in Health Economics” award for 2006
Dr. Goodman gestures during his presentation
CHCC Vice President Richard Matthews presents Robert S. Berry, MD with “Pioneer in Medical Practice” award for 2006.
Dr. Berry makes a point.
Stormy Johnson presents Pat Rooney with “Lifetime Achievement” award for 2006.
Mr. Rooney discusses hospital pricing
Consumer Education Workshop
First Panel – How to Buy Health Insurance
Tim Pitcher, Atlas Financial; Bob Hurley, eHealthInsurance; and Dick Matthews, Desjardins-Matthews.
Second Panel – How to Manage Your HSA
Roy Ramthun of HSA Consulting Services explains new HSA legislation
Jill Kelly, The Bancorp Bank and Mike Baker, Vested Health.
William Short, First Horizon MSAver
Third Panel – How to Get the Information You Need
Mike Dermer, IncentOne; Teresa O’Keefe, ConnectYourCare; Toby Rogers, DestinationRx; and John Young, CIGNA
Fourth Panel – How Providers areResponding
Robert Berry, MD, PATMOS EmergiClinic, discusses insurance-free medicine.
Maria Todd, PhD, HealthPro Consulting, explains medical tourism
Laura Maxwell, MSN, FNP, The LittleClinic, looks at retail clinics.
Tom Lagrelius, MD, Sky Park Medical, on concierge medicine
Another Successful Meeting –
Greg Scandlen, Russell Lamontagne, and Stormy Johnson wrap it up.
September 29, 2006 - Click here to discuss this topic
I had a whirlwind tour of New York this week.
Empire Center Conference. We started in Albany with a presentation to a conference of about 100 legislative staffers and health policy advocates organized by the Empire Center, a project of the Manhattan Institute. I got the distinct impression that legislative staff rarely gets a chance to rise above the immediate concerns -- like whether to apply Average Wholesale Prices to Medicaid formularies -- to look over the horizon at the bigger picture. So, E.J. McMahon, Tarren Bragdon and the rest of the Empire Center should be congratulated for providing this opportunity. Go to --the Empire Center web site for more information.
In Training. I took the train from Albany to New York City to get to our Corporate Roundtable meeting. The train ride is beautiful, running right along the Hudson River all the way into the City. It is the way to travel. Spectacular views of the river with tree-laden hills on both banks.
Ground Zero. I’ve been in New York City a bunch of times in the past five years, but until now, I couldn’t handle going to Ground Zero. The emotions were too raw. This time I made myself go over there. My God. The rubble has all been cleaned up and now it’s a construction site, but there remains a ghostly presence of the Towers. The streets in that part of town are pretty narrow and the buildings closely packed, which makes the absence of the towers all the more conspicuous. Surprisingly (at least to me), there is still no memorial of any kind there. Only a photo display mounted on the fence around the site.
The Corporate Roundtable meeting was fascinating. A big thanks to Chris McFadden and the folks a Goldman Sachs for hosting it. The room was perfect and the location, just off Wall Street in the Financial District, was inspiring for an entrepreneur. In attendence were,
Jim Phillips, Veritas Health Solutions
Bill West, First HSA
Matt Brow, US Oncology
Lisa Manarky, The Bancorp Bank
Michael Dermer, Incent One
Matthew Sydney, Health Equity
Chris McFadden, Goldman Sachs
Ted Sharon, Janus Funds
Mike Baker, Vested Health
John Kessler, Wage Works
Mike Beene, NASE
Bob Hughes, NASE
David Lenihan, CareGain
Tom Reed, Personalized Physician Care
Russell Lamontagne, Corinth Group
Jim Yokum, Destination Rx
The discussion was free wheeling but a number of issues and concerns came out.
The need for price transparency continues to be a top priority. Unfortunately, this topic often gets lost in the simultaneous discussions of quality transparency. Quality is extremely difficult to define and measure, while prices are easy. It would not be good to allow quality issues to delay the rollout of price transparency, and in fact may be used as a delaying tactic by those who want neither.
Consumer/employee education remains a vital component. Related to that is a concern over the negative press Consumer Driven Health has been getting lately. Some members felt that the terminology of “consumer driven” is a negative and needs to be recast into something more positive. Some also felt that it is a fallacy that Americans care a lot about saving money. They are more concerned about convenience. But the takeaway from this discussion is that we need to do a much better job in the Public Relations battles that lie ahead. We need to take control of the message and trumpet real-life examples of success in this space. The need for CHCC to upgrade our media presence was evident.
Politics/Policy. There was less concern about the political/policy issues. Consumer Choice is on a roll and there is little Congress can do to stop it. It will rise or fall on its own merits.
Loss Ratios. But there is concern that the insurers are still not providing enough concession on premium, even though the evidence is mounting that loss ratios drop dramatically when a group converts to an HSA.
Diamond/Goldman Sachs Symposium. The next day Goldman Sachs and Diamond Consulting held a big symposium on Consumer Directed Health Care with about 300 people in attendance, mostly representing institutional investors and vendors. I couldn’t stay for most of this, but I did participate in a press briefing in the morning that was pretty lively.
-- Greg Scandlen
September 06, 2006 - Click here to discuss this topic
Book Review for “The End of Medicine” by Andy Kessler
Submitted to CHCC by Richard A. Matthews
Before you take the time to read either this review or the actual book, I offer “fair warning” on the following:
1) Kessler writes with very “colorful” language. If you are easily offended by profanity – don’t read this book.
2) Kessler writes with a “stream of consciousness” as this is really more of a diary of his adventure to see if scalable technology can be applied to medicine, than a typical work of non-fiction. The book is often disjointed and it requires a fair amount of concentration to keep the focus. Some of the medical and scientific research is obviously difficult for lay people (like me) to understand and the fact that Kessler writes of his experiences as they occur does nothing to make understanding any easier.
3) I have a huge personal bias toward technology as a viable solution to most of “what ails us” – in every sense of the word. Kessler simply validates my inherent bias, so this will be a favorable review. If you think I hype his research and conclusions and avoid any “balance” – well, you will simply have to read the book and do your own personal critique.
Kessler is a retired money manager who made a fortune for himself and others investing in technology. He has written two books on the subject and has great “street cred” in both the technology and investment communities. His premise for “The End of Medicine” is quite simply this: technology has completely changed such industries as finance, computing, telecommunications and music/video by taking expensive breakthroughs and making them incredibly cheap through scalability. The disruption has been on a truly massive scale. Why not apply that same principle to the $1.8 trillion health care business where the easiest way save money is to stop people from getting sick in the first place?
Because of his credibility, he gains access to physicians, researchers, code writers and entrepreneurs that have already made the major breakthroughs to bring about the end of medicine as we know it today. You get to meet the folks that have set the stage for the massive disruption that is about to take place – with physicians, insurance companies, Big Pharma, and (gulp) even those of us who sell health insurance for a living.
The focus of his journey is what Kessler calls “The Big Three” – heart attack, stroke and cancer. These medical problems represent the lion’s share of expense in the U.S. today. He begins by investigating EBT scanning and getting his calcium score, (say goodbye Lipitor) then moves to 256 slice CT scanning, 3D technology, and the SilverHawk Plaque Excision System brought to you by Dr. John Simpson, the man that developed angioplasty in America (say hello plaque removal) ends by watching what he calls “naked mice” (they have no fur) injected with cancer cells and then injected again with molecules that find the cells and actually light them up – pointing to the exact spot of the cancer (say goodbye mammogram).
Kessler says the breakthroughs already exist to turn these three medical challenges – heart attack, stroke and cancer – into very inexpensive preventable events. All we need is scale, challenge to the current parties interested in the status quo, and a little help from the FDA.
Because so much of scanning and imaging already uses silicon, it is only a matter of time (when it comes to silicon remember that time moves very rapidly) before we can scan individuals for $100 per visit, determine if they have arterial plaque, and excise it if they do. Breakthroughs in the GRIN technologies (genetics, robotics, information, and nano) and the use of molecular imaging make it possible to actually light up cancer cells from the inside – as opposed to using radiation from the outside that really has no way to identify a cancerous mass in soft tissue (most cancers) until it has become very large. We can then use the very same technology to “zap” it on sight.
The challenge now is to create the scale needed to allow for huge and massive change. Kessler discusses how Big Pharma and their allies will fight to keep statins as a better option to prevention through what he calls the “cholesterol conspiracy”. He doesn’t accuse hospitals and physicians of creating a “cancer conspiracy”, but he does wonder out loud if there might be such a problem given the huge amount of money involved. Finally, Kessler points out how the FDA is essentially built along a “treatment rather than prevention model” in their approval process.
His question is a simple one: with the billions of dollars being spent to treat “The Big Three” – doesn’t it make sense to spend a fraction of that amount on preventative research? His answer obviously is yes – and the challenges mentioned above are now starting to crumble.
The VCs (Venture Capitalists) are starting to circle the startups in the scanning and imaging business. The huge players like GE, Siemens and others now have a competition every year in San Francisco called the “Face Off” dueling each other with faster and more detailed scanners and 3D imaging, and the attendance is off the charts. Retired Cisco executive, Don Listwin has invested millions with the Hutchinson Cancer Research Center in Seattle and now spends his time and talent raising millions more to research molecular imaging. Finally, George Mills (Deputy to the Deputy Director of the FDA – you just have to love this stuff) has set the protocols in place for limited use of molecular imaging on real live people so long as they are tied to other drug testing. The “back door” to early detection is open.
Kessler’s own words:
“All of these eureka moments woke my sleepy butt up. Seeing digital imaging and plans for a cancer detection chip and a back door open at the FDA for all of this was all I needed. Change was a-comin’. The geeks weren’t just the gate, they’d laid siege and were halfway up the ladders with Treos drawn, ready to attack.
The same thing that happened in other endeavors is about to happen in medicine: embedding the knowledge of doctors into software and silicon. It produces medicine for consumption. Microsoft and Intel did this for computers. The high priests of mainframe computing gave way to empowered users. Their programming expertise became embedded into a consumable spreadsheet product – customize for your own use. Eventually, the COBOL programmers disappeared, opening up massive new markets.
You can smell it from this far away. Doctors are toast. It’s the magic pill – heart attacks, stroke and cancer are cured. Except there is no magic pill, but we get the equivalent of it. If health care budges even slightly from chronic care to early detection, the waves of change rip through medicine like CAT 5 hurricanes. Every assumption about how many doctors and what type and what they do comes into question.
I fired my doctor, but what a huge hassle it was even to get my blood drawn. But it’s just starting. Radiologists are being replaced by computer-aided detection. Ophthalmologists are being shut out by LASIK. Pharmacists dispensing statins will be replaced by cheaper-in-the-long-run plaque-removing procedures. Dieticians will be replaced by minimally invasive stomach-stapling surgery. Physical-peddling physicians will be replaced by 256-slice scanning machines. And then, we can only hope cancer specialists get replaced by an antibody-laden cancer detection chip.
Will we see doctors in soup lines or selling pencils out of tin cups on the street corners? Are you kidding me? There is so much work to do. When the PC kicked mainframe booty, tech employment went up by a factor of 1,000, maybe more. But it shows up in a different form.
It’s all about research and development and specialists. Which antibodies do we put on the chip? What patterns are we looking for in the arteries leading to the left ventricle? Which drugs, as proved by imaging, actually kill tumors?
Those who figure this out, the knowledge creators, don’t sell their knowledge in eight or ten minute chunks. It’s not a game of one-off, but of selling in mass quantities. They’re the Embedders and Productizers – the Scalers.
This could really flip. Medicine really could go from chronic care to detection. Just a change in how dollars are spent means we would get a huge growth area in the economy instead of a huge financial burden. A double whammy. The stock market will help allocate capital to this business, rather than some socialist system of sphincter pricers at Medicare in Washington, D.C.
Investors will swarm like killer bees. Once there’s a product to consume, one that gets cheaper and cheaper every year, well, then, change is almost automatic. Control shifts. Industries die and new ones are born. Boil some water. Get clean sheets. Call the midwife. Start picking names. This will be the first really new industry in the 21st Century.
Time to start another hedge fund?”
Should the “flip” Kessler mentions above take place it will mean massive disruption. His main focus is on the medical community but of course the impact will be huge on the financing side as well. But I think an argument needs to be made that the solution to so many of our current challenges in financing health care at both the Medicare and employer level might actually lie in this disruption – not to mention better results and longer lives through prevention.
Despite the fact that the book is a bit disjointed, it is an easy read. I strongly encourage anyone engaged in the debate about the future of health care and health care financing to read this book. There is so much going on right now that the mainstream media misses completely. Personally, I think Kessler’s book underscores how completely out of touch the mainstream is right now. But, you know I would say that.
Richard Matthews is a broker in South Carolina and Vise President of Consumer for Health Care Choices. Contact him at ram@dmcollc.com
August 23, 2006 - Click here to discuss this topic
Redefining Consumer-Driven Health Care
Review of Redefining Health Care: Creating Value-Based Competition on Results, by Michael E. Porter and Elizabeth Olmsted Teisberg (Boston: Harvard Business School Press, 2006); 506 pages, hardcover, ISBN: 1591397782, $35.00
By Joseph Coletti
Government policies, malpractice lawsuits, the co-payment culture and provider responses to past attempts at reforming health care have created a system in which doctors resent “know-it-all patients,” health insurers limit care and everyone thinks somebody else should pay the bill.
Competition guru and Harvard Business School Professor Michael Porter has teamed with Darden Business School professor Elizabeth Olmsted Teisberg for the third time in a decade to examine American health care. They find that competition is wrong in a number of ways and needs to move to a focus on results and value. “Perhaps the single most important step in reforming the health system,” they conclude is “mandatory measurement and reporting of results.”
The good ideas Porter and Teisberg offer on competition make their attack on consumer-driven health care and their advocacy for mandatory universal coverage disappointing.
Consumer-driven health care, in their view, is simply about allowing individuals to choose among health care plans with no regard to choice of providers. Despite its lack of focus on provider competition, “The role of the consumer is taken too far [in CDHC], as if consumers can replace doctors and make medical decisions entirely on their own.”
Deregulation of the insurance and provider markets would allow for rapid evolution in getting important information to health care providers and consumers, and in the behavioral responses of providers and consumers to that information. But Porter and Teisberg advocate for “the federal government, or a consortium of states” to mandate changes instead of simply ending prohibitions against them.
Porter and Teisberg acknowledge the distortion in tax treatment of health insurance provided through employers and the advantages large corporations have in the form of self-insurance not subject to state mandates but would penalize employers now and only address taxes “in the long term.”
The authors also recognize that mandated benefits make insurance expensive, but then suggest a national minimum standard for insurance set by “a respected, expert body [that] must act on behalf of all Americans.”
Consumers could choose how to pay for their health care with some deregulation, such as allowing more competition among insurers and providers, more direct payment for services, more neutral tax treatment of insurance and more ability to set premiums based on behavioral risk factors such as smoking and physical activity. The authors, however are not content with deregulation.
Porter and Teisberg are right in their conclusion that health care can be like other markets, with positive-sum, results-based competition. If only they would trust the market to achieve that result instead of trying to impose such competition through government fiat, especially given their recognition of this fact: “Health care … is simply too complex, too subtle, too individualized and too rapidly evolving to be manageable by top-down management.”
Joseph Coletti is Fiscal Policy Analyst at the John Locke Foundation. He also covers health policy.
August 07, 2006 - Click here to discuss this topic
Cabrini-Green Health Care
David Broder had a great column in the Washington Post on Sunday, August 6. It was about the change in low-income housing in Chicago. They have torn down the infamous Soviet-style projects like Cabrini-Green and Ida B. Wells and replaced them with mixed-income, low density communities. These projects had destroyed the lives of tens of thousand of families and ruined viable neighborhoods.
Broder chalks the projects up to “misguided urban planning,” but takes his analysis no further. In fact, anyone but an idiot -- or a bureaucrat, (but I repeat myself) -- could have seen that cramming a community’s poorest, least functional families into a housing project set apart from the rest of the community would be a disaster. But the idea was steamrollered through by people who wanted to help poor people get affordable housing. Anyone who expressed reservations was silenced by being accused of opposing poor people getting affordable housing. How reactionary! How mean-spirited!
What does this have to do with health care? A lot. The very same phenomenon is at work today but in a different arena.
The very next day after writing about public housing, Mr. Broder wrote a news article about the Bush Administration’s push for “health information technology.” HHS Secretary Mike Leavitt apparently told a meeting of the National Governor’s Association that the “administration will soon launch an ambitious effort to require that all providers of federally financed health care adopt quality measurement tools and uniform standards for their information technology.”
This will be done through Executive Order and will affect any doctor or hospital that serves people on Medicare or other federal programs. It will “set standards for care of specific health problems” and will measure and report “the outcomes of treatments.” He encouraged the governors to follow suit with their own state programs, and large employers to also fall in line.
So, Mr. Leavitt (and Mr. Bush) think that they know the best way to treat a patient with a particular disease, and they also know what the best standard for information technology is – even though all of this is currently rapidly evolving. They will “require” all the hospitals and doctors to do what the Administration tells them to do.
This is all done in the name of reducing “health care cost inflation while increasing the quality of medical services.” Just as with public housing in the 1960s, anyone who has reservations – who thinks perhaps Mr. Leavitt does not know the very best way to practice medicine in all cases – will be accused of defending bad quality and high costs.
Not surprisingly, Mr. Leavitt says that all the doctors he talks to think this is a good idea. Case closed.
Perhaps Mr. Leavitt should apply his own “evidence-based” standards to this proposal, instead of just talking to his buddies and sycophants. Try it out in a randomized, controlled trial before inflicting it on the entire country. But like most politicians, Mr. Leavitt isn’t about to abide by the same rules he wants to inflict on everyone else.
And that is how we got Cabrini-Green in the first place.
-- Greg Scandlen
July 20, 2006 - Click here to discuss this topic
Wal-Mart Bill Overturned – Statment from CHCC
July 20, 2006, Hagerstown, MD The president of Consumers for Health Care Choices, Greg Scandlen, issued the following statement on the so-called Wal-Mart Bill.
Yesterday a federal judge granted summary judgment to the Retail Industry Leaders Association (RILA) that Maryland’s “Fair Share Health Care Fund Act” (the Wal-Mart Bill) is pre-empted by ERISA. At the same time Judge Frederick Motz found against RILA in its claim that the bill violates the Equal Protection Clause of the Constitution.
Neither decision is the least surprising, as we have been saying since well before the legislation was enacted. I believe the operative expression was that the bill had “a snowball’s chance in hell” of surviving an ERISA challenge.
“Utterly Out of Line With Reality.” Like it or not, ERISA preempts state laws “relating to” employee welfare benefit plans. While clever attorneys can argue endlessly what “relating to” means, the Supreme Court has already issued dozens of decisions making it crystal clear that a state or local government may not tell an employer how to run a benefit plan, including how much of its payroll it should spend on those benefits. The Maryland legislature has wasted a lot of time and taxpayers money on a bill that had no chance of surviving. Judge Motz said as much in his opinion when he said of one of the state’s arguments, “While the Secretary’s argument may be evidence of the active imagination of his lawyers, it is utterly out of line with reality.” The same could be said for the entire legislation and legal defense of this bill.
Uniform National Benefits. The proponents of the Wal-Mart bill have been crowing about how they have set a model for the nation, and that many other jurisdictions are considering similar legislation. This argument backfired when Judge Motz acknowledged that many states and even local governments (New York City, Suffolk County, New York) have been encouraged to take similar action, and concluded that, “the Act violates ERISA’s fundamental purpose of permitting multi-state employers to maintain nationwide health and welfare plans, providing uniform nationwide benefits and permitting uniform national administration.”
Individual Mandates Probably Okay. At the same time, Judge Motz emphasized that he was “expressing no opinion on whether legislative approaches taken by other states --- would be preempted by ERISA.” As an example he cited Massachusetts’ individual mandate. Such laws may be badly flawed and lousy public policy, but they would not violate ERISA. So, we can expect that some of the energy that has gone into Wal-Mart type proposals around the country may now be transferred into supporting individual mandates instead. Except that organized labor doesn’t like individual mandates because they let employers off the hook. This may presage a split between Labor and the rest of the Universal Health Insurance movement.
Employer-Based Coverage is Shrinking. Maryland’s Wal-Mart bill and all the copy cat versions of it around the country are based on the idea that employers are the natural source of health benefits coverage. Even many employers agree with that notion and resist ideas that would equalize the tax treatment of health benefits for people who get coverage outside of the job. Many other employers, of course, do not agree and say so by not providing coverage at all. The proportion of Americans who get job-based coverage has been shrinking over the past decade and there is a growing demand that individual insurance coverage should receive the same tax benefits as employer-based insurance coverage.
Why Trust Wal-Mart? It is curious that the supporters of the Wal-Mart bills typically despise Wal-Mart for being unfriendly to workers, yet would still want Wal-Mart to make all the benefit decisions for their employees. They don’t trust Wal-Mart to make decisions about wages, hours, and working conditions. Why in the world do they trust Wal-Mart to make decisions about employee health care? Labor might be better served if it acted as the “trusted agent” on behalf of its members and provided health coverage directly.
Stand as Written. In any event, the state of Maryland will be sure to appeal Judge Motz’s decision, but the opinion is so thorough and so well-reasoned that it is doubtful any appeals court will even grant certiorari in this case and it will most likely stand as written
July 03, 2006 - Click here to discuss this topic
Approaching Independence Day, it is worth considering Milton Friedman’s view on liberty and health. Milton Friedman is, of course, a Nobel Prize winning economist, professor emeritus of economics at the University of Chicago and probably the greatest advocate of economic freedom of our times. The following is excerpted from an interview Hillsdale College President Larry Arnn conducted with Dr. Friedman on May 22, 2006 in San Francisco.
Larry Arnn: Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets?
Milton Friedman: Yes, in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there's a third party payment system. It is a communist system and it has a communist result. Despite this, we've had numerous miracles in medical science. From the discovery of penicillin, to new surgical techniques, to MRIs and CAT scans, the last 30 or 40 years have been a period of miraculous change in medical science. On the other hand, we've seen costs skyrocket. Nobody is happy: physicians don't like it, patients don't like it. Why? Because none of them are responsible for themselves. You no longer have a situation in which a patient chooses a physician, receives a service, gets charged, and pays for it. There is no direct relation between the patient and the physician. The physician is an employee of an insurance company or an employee of the government. Today, a third party pays the bills. As a result, no one who visits the doctor asks what the charge is going to be—somebody else is going to take care of that. The end result is third party payment and, worst of all, third party treatment.
Larry Arnn: Following the recent expansion in prescription drug benefits and Medicare, what hope is there for a return to the free market in medical care?
Milton Friedman: It does seem that markets are on the defensive, but there is hope. The expansion of drug benefits was accompanied by the introduction of health savings accounts—HSAs. That's the one hopeful sign in the medical area, because it's a step in the direction of making people responsible for themselves and for their own care. No one spends somebody else's money as carefully as he spends his own.
HAPPY INDEPENDENCE DAY!!
June 16, 2006 - Click here to discuss this topic
Highlights from the CHCC Workshop on teaching consumers how to cope with a new world, held in conjunction with the CDHCC Conference in San Francisco.
Founding Member and Harvard Business School professor Regina Herzlinger starts things off with an overview. Dr. Herzlinger is also the editor of "Consumer Driven Health Care" available at the CHCC Bookstore.
CHCC Board Chair, Daniel (Stormy) Johnson, MD, moderates one of the sessions.
Greg Westcott of WestMSA explains how consumers can pick an insurance plan that is right for them.
Bob Hurley of eHealthInsurance explains on-ine insurance shopping.
Bill West, MD, founder of FirstHSA helps consumers understand how to manage their HSA funds.
CareGain CEO Amit Gupta explains some of the new tools available to consumers.
Jeremy Snyder of MedTerra and John Young of Cigna pay rapt attention as Jamie Spriggs, CEO of ConnectYourCare, explains his company's work in information technology and patient support services.
Tom LaGrelius, MD in a lighter moment before he explained how physicians are responding to consumer demands with concierge medicine practices.
Some of the audience during a question and answer session.
CHCC President Greg Scandlen and Board Secretary John Young are proud of their pink ties at a reception afterwards.
May 06, 2006 - Click here to discuss this topic
Halfway through the latest road trip, there are some pretty interesting things to report.
We started at the Johns Hopkins School of Public Health on Wednesday May 3, with a discussion about Maryland's new "Wal-Mart Bill." This is the law the legislature passed to require all employers in the state with over 10,000 employees to spend at least 8% of their payroll on health care. One of my co-panelists was Vincent DeMarco, president of the Maryland Citizens' Health Initiative. Mr. DeMarco was simply thrilled that the law was passed because he was interviewed by reporters from all over the world and 30 other states have introduced similar legislation.
I responded that, while the new law might be a nice ego boost for Mr. DeMarco, it will do next to nothing to help increase coverage in Maryland and may even make it worse. First, it will probably not survive an ERISA challenge, and even if it does and goes into effect as scheduled, all it will do is get Wal-Mart to go from paying the current 5.3% of it's payroll on health care to 8.0% -- big whoop. Further, I said, it continues to rely on the employer to provide coverage with all the problems that entails. How many people really want Wal-Mart to choose their health plan?
Mr. DeMarco's other big cause is raising the state tobacco tax. He must have said a dozen time that raising the tax by a dollar will be the salvation of Maryland. Hmmmm. It would certainly make merchants in Virginia, Pennsylvania, Delaware, West Virginia, and the District of Columbia happy, but it is hard to see how it will do much for the state of Maryland.
I went on to Chicago that evening to give a talk to the Society for Innovative Medical Practice Development (SIMPD), the "concierge medicine" folks. My presentation was sandwiched in between Dr. Connie Mariano, and Regina Herzlinger. Dr. Mariano was President Clinton's personal physician at the White House, and has gone on to start a concierge practice in Arizona, and Dr. Herzlinger, of course, needs no introduction. She could well be named to Godmother of Consumer Driven Health Care.
What a wonderful crowd this was. They were pumped up and enthusiastic. I have never seen a group of physicians who are so excited about practicing medicine. They have freed themselves from the burden of managed care and they get to spend as much time as they need with their patients.
Former Secretary of HHS Tommy Thompson also spoke. What a disappointment. He said the health care system will collapse in 2013 without change, starting with Medicare. That is probably true, but his remedies were pathetic - emphasize prevention, raise cigarette taxes by $1.00, simplify claims forms, and mandate coverage. He said, "we do it (mandate coverage) with auto insurance!" Well, yes we do, and the percentage on uninsured drivers is almost exactly the same as the percentage of people without health insurance. And, since he and Mr. Demarco both agree on raising the cigarette tax by a buck, I guess it is "bipartisan" and therefore, "good."
On to California and the California Medical Association Leadership Academy.
April 27, 2006 - Click here to discuss this topic
Two Cities, Two Days, Two Perspectives
I just got back from giving two presentations – one in Washington at the National Managed Health Care Congress (NMHCC), and the other in Chicago to the American Association of Clinical Endocrinologists. (AACE).
I gave the exact same talk to both groups, explaining how the culprit in the health care system is Third-Party Payment. I told both groups that payers (insurance companies) cannot also be “medical managers.” They aren’t qualified to do it and people don’t trust them. Even more importantly, there is an inherent conflict of interest when the payer gets to decide what is “medically appropriate.”
Not surprisingly, the endocrinologists agreed with this. What did surprise me was that the managed care people did, as well. After all, the people who work in managed care are just people. They also are patients and family members of patients. They aren’t thrilled with the idea of withholding needed care to save insurance company money, despite the official position of the companies they work for.
During a break, I had a chance to talk with a fellow who has been exhibiting at these conferences for fifteen years, and he told me that fewer people attend each one. And the ones who do attend seem dispirited. The era of managed care is rapidly fading.
-- Greg Scandlen
April 20, 2006 - Click here to discuss this topic
Many of us have agreed that having health insurance is no guarantee that one will get health care. Equally obvious, or it should be, is that getting health care does not mean you have to have insurance.
I read and hear Single Payer supporters and marketplace allies all saying that in order to get health care, you have to have insurance.
My belief is that we should not be promoting insurance as the solution to making it more affordable, health care more accessible/available and as a way to bring costs down. It’s a slippery slope with no hand rails to a single payer system.
We need less insurance, not more. We need less aggregation of people and money, not more.
Insurance is just one option for people to consider when establishing a plan to fund health care costs. For most people, their insurance premiums over a lifetime will exceed their health care costs. This is the equivalent of self insuring. Of course the knot in that rope is what happens if you have a major under funded medical bill? In those cases insurance may be a good fit.
Another stumbling block to self insuring is “who does it”? By the time we get our kids off to college, we are just maturing enough to think ahead to consider these kinds of things.
Cash equivalents can be used to pay for health care expenses. Credit cards and loans also come to mind. Considering the high price we pay for insurance administrative & profit costs and the ripple effect up and down the delivery side, paying interest or finance charges on loans and charge cards may be a better, more cost effective way to buy health care.
It’s all about education and being informed.
-- Joe Pugh
April 04, 2006 - Click here to discuss this topic
More Notes from the Road
I was honored to be one of the speakers at the annual Pennsylvania Leadership Conference in Harrisburg, PA on Saturday. This was just an amazing event. There was plenty of politics going on, with speeches by Senator Rick Santorum and GOP gubernatorial candidate (and former Pittsburgh Steelers wide receiver) Lynn Swann. But this was no mere GOP rally. The unifying theme was Liberty, and the 600 or so people in attendance were more interested in securing liberty than in any political labels. They will support any party or candidate who will defend and extend liberty and oppose any who would restrict it. The program says the organization is "working to fight for better schools, lower taxes, responsible spending, open government, and stronger families." There were presentations on school choice, right to work, property rights -- and of course, health care.
Pennsylvania is in for a very interesting election. There has been a popular revolt over the arrogance of the current political leadership, both Republican and Democrat, as signaled by a secret pay raise snuck through by the legislative (Republican) leadership that outraged the electorate. The resulting fury caused the legislators to quickly repeal the pay hike and unseat a sitting member of the Supreme Court. The Wall Street Journal's John Fund gave a terriific speech laying out the incredible corruption in Pennsylvania politics, and promising to keep an eye on state politics as the elections unfold.
It was good to see Grover Norquist at the event and to get re-acquainted with Jake Haulk, the president of the Allegheny Institute for Public Policy. But I was especially happy to spend some time with our dear friend and CHCC Founding member Jim Pendleton.
Let's hope other states pay attention to the revolution that is going on in the state that gave us our Declaration of Independence and our Constitution.
-- Greg Scandlen
March 31, 2006 - Click here to discuss this topic
One of our Spanish speaking Zarephath Health Center volunteers, a hair-dresser with no insurance, went to the ER with chest pain. She was placed on a monitor for a few hours, had an EKG, chest x-ray and blood work. Maalox finally took away her pain.
The pain really began when she got the hospital bills totalling $2600.
ER visit Acuity 4 -- $1,316
Nebulizer treatment -- $130
Troponin I -- $161
CMP -- $166
PT -- $44
PTT -- $95
EKG -- $229
CXR- single view -- $233
The docs had a separate bill--
Evaluation -- $371
EKG rhythm interp -- $81
Pulse oximetry -- $72
TOTAL -- $524
At my prompting, she called the number on the bill and spoke with someone, who got angry with her. "We do not have a contract with you, so you have to pay it." Also, when she talked about the program on "60 Minutes," he said, "Now that you've brought that up, we won't reduce your bill at all!" Perhaps he was emboldened by her Spanish accent, but he was totally inappropriate. I need to price this bill out, and see what Medicare would pay. The hospital president will hear from us. So little compassion for the uninsured is not the way our hospitals were founded.
Alieta Eck, MD
March 06, 2006 - Click here to discuss this topic
Notes From the Road
I was very pleased to speak on Friday at the 17th Annual Symposium of the North Carolina Association of Health Underwriters. I’ve addressed a lot of state chapters of the health underwriters and this was far and away the biggest, most enthusiastic, and best organized of all of them. There were 600 people in the audience and the exhibition area was huge with over 75 display booths. Congratulations to NCAHU president Pete Burger, symposium chair Tim Walsh and the many people who worked hard to make the meeting a success.
The theme of the symposium was “Tools of the Trade.” These tools are evolving quickly, so it was a real added value to expose agents and brokers to what is new out in the world. The agenda included sessions on Long Term Care, Medicare Part D, Dental benefits, Disability income benefits, and of course Consumer Driven Health Care (my session). The downside of the symposium theme was that the gift bag provided to the speakers cleverly included actual tools such as screwdrivers, a hammer, needle nose pliers, and a utility knife – all of which were confiscated by airport security on my way home.
Another quirky aspect to the meeting was the location – High Point, North Carolina. I have never visited an odder town. This is a fair-sized city with lots of 1950s era office buildings, department stores, theaters, and so on. The buildings are all in good shape. Well-maintained, but completely empty 48 weeks a year. The entire city has no restaurants, no gift shops, no newsstands, and no traffic. Other than the hotel, the place is entirely deserted – except for two weeks in the spring and two weeks in the fall when the “furniture market” comes to town. During those four weeks, High Point draws 85,000+ people from all over the world – furniture manufacturers, distributors, retailers. The buildings fill up with displays of new furniture. Buyers come in to examine the merchandise, negotiate the deals, sign the contracts, and then pack up and go home.
But in between times, there is lots of conference and exhibit space available. And I was pleased to be a part of the program.
-- Greg Scandlen
February 18, 2006 - Click here to discuss this topic
Insurance, at least to me, is financial protection against a particular event. (Sometimes, as with life insurance, the event isn’t particularly rare. It’s just that the timing is unpredictable).
This means that insurers must collect the sum of payments plus investment income that is equal to the expected value of future payouts for policy holders with given sets of characteristics plus a normal profit.
So if you are talking health, someone with diabetes would have to pay the premium for someone of equal age and circumstance plus the expected value of the additional health expenses generated by a diabetic in the future, properly discounted. Or have expenses related to diabetes excluded.
I agree, everyone is insurable at some premium. But reasonably speaking, people who already have AIDS are not insurable at any premium they are likely to be willing to pay for. Unless the insurer is way better at disease management or discount pricing or investment than they would be on their own, they’d be better off paying cash and avoiding the insurance overhead. And if a market was truly in operation in health care, they could probably buy the discounting services from a firm that specialized in package treatment for AIDS patients.
In the current policy debate, being insured means nothing more than being assured that somebody else will pick up the bills for your health care, or at least the health care that you are allowed. It has nothing to do with risk, premiums, investment income, or expected value. So what we are currently involved in is a gigantic game of hot potato in which the horrid pay-as-you go system keeps passing costs to someone, anyone, else. And since government is the biggest payer with the most power it gouges the employers, impoverishes the physicians. Next drive the insurers out of business by banning catastrophic policies, passing price controls, and instituting ridiculous mandates. No insurers? Loot the pharmaceutical companies. No more money in that? Force the hospitals to provide care but don’t pay them. Make everybody pay but the consumer, because if a single consumer has to pay he doesn’t have insurance by definition.
This is why it is so important to protect HSAs. They seem to offer the best chance of transitioning to an individual, market based, payment system based on actual insurance over the next 30-40 years. As with life insurance, it will work because most policy holders would end up paying for decades before they make a claim.
It seems to me that compound interest, like truth, offers the best hope for setting us free.
--Linda Gorman, Independence Institute
February 11, 2006 - Click here to discuss this topic
My wife is a migraine sufferer, bad enough that I've had to take her to the emergency room three times over the past four years. After the last visit a few months back, she mentioned it to a friend of hers who recommended a neurologist specializing in migraines in the Chicago area.
Here's the deal - this doctor is a cash-only doc. He'll give you the forms necessary to file with your insurance company, but he refuses to deal with insurers. He has exactly one staffer, who handles his scheduling and runs the office. No nurse.
My wife probably has experienced about 20 doctors over the past 10 years for various things - optometrist, laser eye surgereon, ob/gyn, GP, the normal stuff one might expect a relatively healthy female who's moved around a bit and so has had to find new doctors regularly.
In that time, she's had to deal with a legion of incompetent staff, long waits, scheduling screw ups, billing nightmares, doctors where you can't even reach their NURSE let alone the doctor on the phone, and visits where the actual time spent being seen by the doctor sounds more like the 40-yard dash time for a relatively swift lineman than a professional consult.
She said the visit with the neurologist was hands down the best experience she's ever had with a doctor. She spent 50 minutes with him describing her migraine history, talking treatment options, and learning more about the causes of migraines (which are still somewhat mysterious). No waiting, no rushing, just her and a doctor working to improve her health.
Interestingly enough, the runner-up with my wife for best doctor visit was to the laser eye surgeon, which is of course also a cash transaction. He's only number #2 because he didn't do the surgery - the guy was a perfectionist, told her that he could do the surgery and she'd probably get back to 20/20 but because she had worn contacts since a young age, he could only operate once. Typically, this surgeon will perform a second operation free of charge if he doesn't hit 20/20 on the first try in order to get you to 20/20. He told her to wait 2-3 years and the technology would be such that he could just about guarantee 20/20 on the first shot.
So, the two best experiences my wife ever had were both with cash-only docs. There's a lesson somewhere in this...
-- Name withheld for privacy reasons
February 07, 2006 - Click here to discuss this topic
Katrina and Third Party Payment
(Note: Joe Pugh is a broker in Diamondhead, Mississippi, and a former NAHU president. He was nearly wiped out during Katrina and is currently enduring the efforts of FEMA and his P&C carrier)
The Corp of Engineer's Blue Roof program for national disasters is just plain
void of common sense.
The Blue Roof program provides blue plastic tarps for homes with damaged roofs.
The Corp of Engineers, in my area, pays a contractor $175 a sq. to nail this
tarp over the damaged roof. They won't cover carports, though. The blue tarp is
designed to minimize/eliminate additional water/mold damage until a roofer can
repair or replace the old roof. Sounds sensible,
right? Hold on....
Pre-hurricane pricing for new roofs were about $95-$100 a sq. Post hurricane
pricing began at about $185 a sq., then rose to over $200 a sq. Why the change?
Can some of it be blamed on limited supply? Well no, in our case. If anything, we
had an over supply--roofers and roofing. There were roofers tripping over each
other trying to sign folks up who needed roofs. Maybe the pricing was higher
because manufacturing and transportation costs rose sharply? That could be some
of the cause, I suppose.
Could it be the Blue roof program that lead the way to higher roofing pricing? Do
the math. Pay a contractor $175 a sq to spread a large blue tarp over a roof and
then nail a few 1x2's to hold it down. Done in a few minutes to a couple of hours.
Tearing off the old roof, then applying new felt and shingles could take days and
you also have the mess of clean up & hauling off the old roofing materials.
It did not take roofing contractors long to figure it out. Common sense.
But was there another force at work that drove roofing pricing higher?
Absolutely. Third party payment on the private side. Whenever there is a disaster
with massive wind/tree damaged roofs, the P&C carriers know the prices for
reconstruction are inflated well above pre-disaster pricing. Common sense.
As we all have been told "when some one else is spending your money, they won't
spend it like you would" and that is putting it mildly.
The key to cost control will always rest with those who hold the keys to the
purse string. The more money we can keep in our possession means less third party
waste & inefficiency & arbitrary controls.
We will not have the health care system we envision until consumers are paying
the majority of their lifelong health care costs with their own money that only
they have access to.
-- Joe Pugh
February 03, 2006 - Click here to discuss this topic
Chronic Conditions
I just had an exchange with someone that finally shed some light on the issue of HSAs and chronic conditions. As you know, the complaint is that people with "chronic conditions" are responsible for 75% of all health care spending and will blow through their HSA each and every year. So HSAs wouldn't work for all these folks. The question is, of course, how is "chronic" defined. One person told me it includes cancer patients -- which seems pretty "acute" (not chronic) to me.
Well, it turns out that "chronic" is defined as anything that lasts three months or more and doesn't fix itself.
Weeeeeell, now. Ain't that a kettle of fish? In defining it so broadly, no wonder virtually everything is included. I'm sorry, but 3 months ain't chronic in my book. And it sure doesn't speak against HSAs. Someone who is ill for 3 months and then recovers certainly can pay out of an HSA in one year and go back to building up funds the very next year.
The definition should be something that lasts at least 18 months -- probably 24 months or more -- maybe that is permanent. Then there would be a real worry about blowing through the HSA year after year. And it wouldn't even approach 75% of all spending -- maybe 25% or less.
This is so typical of the level of discussion in health policy circles. Take a term and inflate the hell out of it until it loses all meaning, except to lay people who assume the term means something other than how it is defined in the fine print. Scary.
Greg Scandlen
January 31, 2006 - Click here to discuss this topic
Consumers for Health Care Choices Lauds Bush Initiatives
President's Proposals Exceed Expectations
Hagerstown, MD, January 31, 2006 -- Consumers for Health Care Choices is delighted by President Bush's health care proposals as outlined in the State of the Union speech. The speech itself laid out only broad ideas, but organization founder and president Greg Scandlen said, "The accompanying detailed information released by the White House is very impressive. It moves the ball forward far beyond what most of us expected."
Scandlen added, "These initiatives will have a profound effect on reducing the cost of health care, increasing the number of insured Americans, and on making health insurance more accountable to the average consumer."
Click here for the full release
Click here for the White House Fact Sheet
January 20, 2006 - Click here to discuss this topic
Capitalism, Morality and Health Care
Capitalism is indeed a "moral" system, in that it allows for individual free will (God-given or natural, whatever your preference) to be experienced to its fullest. The only restriction is that you cannot steal from another - you must freely arrive at mutually acceptable terms with others who are in their own pursuit of their own free will. To do otherwise is to enslave another, to deny them their free will so that you may experience your own. There is a term for this: tyranny. Tyrants are free to pursue their own free will. As for the tyrant's subjects - well, some may consider "immoral" what their lot in life is.
In real world terms, that means that just because you WANT a colonoscopy, you are not allowed to FORCE someone to provide it for you, because the person providing the colonoscopy has free will too. If Fred only wants to spend $10 for a colonoscopy and nobody wants to provide him one at that price, he must use his own free will to determine: what value do I place on this procedure? What am I freely willing to part with in order to obtain this service? His only alternative is force, i.e. to deprive another of their free will. Fortunately, capitalism denies him the ability (or at least, the legal ability) to use force to obtain value.
Capitalism is not just "profit" or "supply and demand." It is rule of law, free entry for competitors, property rights, etc. One may indeed reasonably believe it is "immoral" not to provide Fred with his $10 colonoscopy. Perhaps, but how moral would it be to enslave another human and force them to violate their own free will, their own conscience, regarding what they value and what they wish to do?
If by "immoral" one means that you can't get what you aren't willing to freely exchange for, then yes, capitalism is "immoral." If you value human freedom, free will, and the right of conscience, then Capitalism is about as moral a system as you'll ever find for creating, exchanging, and preserving value.
-- Sean Parnell
January 17, 2006 - Click here to discuss this topic
I was interviewed by the local NBC affiliate about the so-called "WalMart Bill" today. This legislation was passed by the Maryland legislature, vetoed by Governor Ehrlich, and overridden last week. It requires any employer in Maryland with over 10,000 employees to spend at least 8% of payroll on health coverage. WalMart is the only company affected.
The reporter was surprised that a representative of a consumer organization wouldn't support this law. I explained that putting WalMart (or any other company) in charge of their workers' health care is not pro-consumer. I said it is a step backwards from the reforms that are needed. It is more of the same old stuff that got us into this mess and created a system that is inconvenient, unaccountable, bureaucratic, of questionable quality and way too expensive.
I said real reform would put control in the hands of employees. It would let them choose and own their own policies so they wouldn't lose their coverage when they lost their jobs. Personal ownership would mean that insurance companies would be accountable to individual consumers, not just to employers.
She asked if this bill was helpful in getting people covered. I said just the opposite. It is a distraction from what needs to be done. Most of the uninsured in Maryland work for small employers, not for WalMart. But the small group market in the state is a mess, with only two carriers providing close to 90% of the coverage. We need to open up the market to allow more competition and innovation. That would lower costs and allow more Mom & Pop stores to provide coverage. I added that people are critical of WalMart for driving these Mom & Pops out of business, but what hurts small employers even more is the lack of affordable coverage in the state, due mostly to excessive regulations.
I'm not too worried about the WalMart Bill because it is a flagrant violation of ERISA and will not survive a court challenge. The bigger problem is that some well-meaning legislators wasted their time on a bill that not only will do no good, but is actually a step back from legitimate reform.
--- Greg Scandlen
January 04, 2006 - Click here to discuss this topic
We have thought long and hard about the whole system of health care funding-- like all of us on the HBR message board. As hospitals close due to inadequate reimbursement, here is a way to buy them back. First, follow this analogy:
Housing--
There are three types:
- Government housing-- free, and possibly nice at first, but clearly substandard once repairs need to be done.
- Rental- no downpayment, more affordable at first-- but no equity, and you are subject to inflation. Once you stop paying the rent, you are out, and have nothing to show for it.
- Ownership-- the American dream-- Equity, a hedge against inflation, pride of ownership, what you fix up, you keep, etc....
OK-- let's look at Healthcare--
There are two types-- with the start of the third:
- Government- Medicare, Medicaid-- you know the pitfalls.
- Health insurance-- rental, if you will. Subject to inflation, especially when the government institutes "rent control," as it caps payments to doctors and hospitals in Medicare and Medicaid. Once you stop paying your premium, perhaps because you are too sick to work, you are out. You have nothing to show for it.
- Ownership-- the American dream once again. Some of us have MSA's, a partial element to ownership
But the capstone of ownership of healthcare, a new paradigm, will be medical timeshares. They will also be the answer to hospital closings, as people purchase them and thus own a part of the hospital.
This is what we will propose for Antigua. We cannot do it here yet because there would be many roadblocks in the way of lawyers, insurance companies, government bureaucrats and socialist do-gooders. So we have to start offshore. But once this takes off, it will spread back to the US.
A medical timeshare would cost about $30,000. At 7% interest and a 10 year payout, it comes to $348 per month. Once it is paid for, you OWN it.
It would include:
- 2-3 days PER YEAR in the hospital for any of the 90% of surgical procedures that are elective-- gallbladders, hysterectomies, prostatectomies, knee replacements, hip replacements, cataracts, hernias-- you get the picture.
- 7 days PER YEAR in a 5 star wheelchair friendly resort suite, where the patient's family can stay and the patient can return to recover a few more days before flying home.
- A contribution to a charitable fund that will be there to help for hospital bills for the 10% acute care surgery that cannot be delayed-- appendectomies, acute abdomens, etc. It would also go for other charity cases.
The medical timeshare would not pay for the professional services of the physicians involved, but these come to less than 10% of a hospital bill, and we would recommend an MSA to pay for these. You would also have to pay for your own hardware-- like the replacement knee or hip, but once the public gets involved, these will cost what the free market will pay.
Medical malpractice will be handled on a case by case basis. Just like you can buy flight insurance when you buy an airline ticket, you can buy event insurance in case one of those things you are warned may happen when you have surgery, happens. Instead of making the doctor into a villain, it would be treated like your house catching on fire. Payments would be made to restore you back as much as possible. Forget "pain and suffering." It's part of life. Of course, if the doctor does something criminal, you can sue just like for any other criminal act.
Now-- just like owning a house, there is maintenance involved in the timeshare arrangement. Remember, you would own a 100th of a hospital bed and a 50th of a two bedroom resort suite. So maintenance, cleaning, upkeep, taxes, insurance and the like would be paid on a yearly basis and is subject to inflation. We believe that this would run about $1200. per year per medical timeshare.
You might say-- I do not plan on needing surgery once a year-- but I bet you know someone who does. You could transfer it to a relative, a friend or sell it to a stranger in a given year. A church could own a few, and it would be part of their benevolence. Small companies could own a few, and send their executives for a week-long executive physical (which would really only take a day or two). That would be a rather nice perk.
What say you?
-- Alieta and John Eck, MD
December 29, 2005 - Click here to discuss this topic
Health Care Reform: How To Stifle Competition
Governor Mitt Romney may end up regretting his decision to try to expand health insurance to all citizens of Massachusetts. Right now the plan that the legislature is putting together puts the cost on businesses by taxing their payroll. However, not all businesses in the Commonwealth dislike the idea:
Proponents of the payroll assessment said the plan levels the business playing field, because employers who cover their workers currently pay an insurance surcharge that funds the Uncompensated Care Pool, which then pays for medical care given to uninsured workers at other companies.
The House plan would eliminate this $160 million annual surcharge, lowering costs for businesses that offer health insurance, McDonough said. More than 40 business leaders submitted a letter to lawmakers in mid-December supporting the House plan.
Offering health insurance is "just the right thing to do ethically," said David Copithorne, CEO of Aquarius Advisers in Newton. "But I don’t like competing with businesses who don’t bother to do that. It’s not a level playing field."
In other words, Copithorne sees an opportunity to increase how much business Aquarius Advisors, a marketing and communications firm, does. The new legislation, should it pass, will force other such firms to provide health insurance or pay a penalty. Those that cannot afford to will go out of business, leaving more market share for Aquarius Advisors.
I wonder if that is the "right thing to do ethically"?
-- David Hogberg
December 26, 2005 - Click here to discuss this topic
We visited with some neighbors on Christmas Eve. The lady is 75 yo, and had a bout with breast cancer. She received radiation but not chemo. Her doctor said the survival rate was 80% with radiation and 85% with both (I guess this is 5 year survival, though she wasn't sure), so she decided against going through the chemo. But it started me thinking.
These estimates have a pseudo-precision that sounds very scientfic, but what does it really say? Are these survival rates for 75 yo women, or women as a whole? Do they factor in comorbidities like diabetes or heart disease, or life style issues like obesity or smoking? Or do they apply only to patients precisely like this woman? 80% is presumably some sort of average, but what is the range and the frequency for different ranges? Is 80% the survival from breast cancer itself, or does it include other causes of death that might actually be increased by the procedure (a heart attack on the operating table is not a breast cancer fatality, or is it?).
This all left me more convinced than ever that "guidelines" are nothing more than window dressing -- scientific talismans that cover up our ignorance.
-- Greg Scandlen
December 20, 2005 - Click here to discuss this topic
Will GM Survive?
The General Motor¹s health-care deal with the United Auto Workers is
supposed to cut about $1 billion in costs for the troubled auto-making
giant. The details of the plan are fuzzy, but the press is reporting that UAW¹s
deal with Ford is similar to its one with GM. Thus, it is possible to get a
picture of what GM¹s deal is like.
The deal between Ford and UAW includes: retirees will pay up to $752 more a
year per family; and Ford will divert 99 cents an hour in future wage
increases to a "health fund." It appears that employees will not be paying
higher health insurance costs.
One wonders if the deal GM got with UAW was even that good. Last week in the Wall Street Journal, GM¹s CEO Rick Waggoner doesn¹t seem all that sure as to whether GM is a business or a welfare agency:
Some argue that we have no one but ourselves to blame for our
disproportionately high health-care "legacy costs." That kind of observation
reminds me of the saying that no good deed goes unpunished. That argument,
while appealing to some, ignores the fact that American auto makers and
other traditional manufacturing companies created a social contract with
government and labor that raised America's standard of living and provided
much of the economic growth of the 20th century. American manufacturers were
once held up as good corporate citizens for providing these benefits. Today,
we are maligned for our poor judgment in "giving away" such benefits 40
years ago.
But it was a bad decision. Dressing it up in noble-sounding rhetoric like
"social contract" doesn¹t change that.
And it looks like the bad decisions continue. Instead of switching to a
consumer-driven plan with high-deductibles and HSAs for employees, GM
appears to continue the third-party payer, defined benefit plan that it
currently has.
How long before GM¹s health insurance problems return?
-- Dave Hogberg
December 16, 2005 - Click here to discuss this topic
From Laura Trueman at the Coalition for Affordable Health Coverage
Update on Reauthorization of High Risk Pool Legislation
One of the priorities for the Coalition for Affordable Health Coverage is to ensure that high risk individuals who lack health insurance are able to obtain coverage through state high risk pools. These pools operate in 33 states and have served as part of an essential safety net.
Congressional action is needed before this month’s recess to continue the federal program that provides vital support for the creation and existence of high risk pools.
The Problem
HR 3204, the “State High Risk Pool Funding Extension Act of 2005,“ has already passed the House, been amended, and a “pre-conferenced” version has passed the Senate. It awaits passage in the House. The compromise is supported by House leadership as well as House Democrats. So, where’s the wrinkle?
In keeping with his commendable commitment to fiscal integrity, Energy and Commerce Chairman Joe Barton (R-TX) has established offsets for this modest –but pivotal – program. However, those offsets exist in the House-passed Reconciliation bill. The Chairman wants those offsets to pass prior to the passage of HR 3204.
Last year, a similar scenario existed as we approached the end of the session, with everyone supporting the High Risk Pool bill, but, in the last days and hours of intense discussions on larger issues, the bill got caught (and stalled) in the crossfire of other matters. Obviously, our concern is that history not repeat itself.
CAHC Members Need to Voice Support
To ensure that this does not happen again, we need House members to make a commitment that one of four things will occur:
- HR 3204 is passed as authorizing legislation without the mandatory spending provision for FY 2006, relying on Reconciliation for funding; OR
- We receive assurances that HR 3204 will be passed in the House by voice vote immediately after the passage of Reconciliation; OR
- Language is inserted in the House Rule for consideration of Reconciliation that would deem HR 3204 as passed if the conference report of Reconciliation is passed; OR
- The final Reconciliation report incorporates HR 3204.
We urge to you to contact Speaker Hastert’s staff (Sally Canfield) and Chairman Barton’s staff (Bill O’Brien and Chuck Clapton) as well as other key members of the House Energy and Commerce Committee to thank them for their ongoing efforts and to let them know of your support for enacting this legislation this year.
Why December Passage is Critical
At least five state legislatures have been planning to create high risk pools but have been stalled, in part, because the seed money and operational dollars contained in HR 3204 have been uncertain. This fiscal year, no federal funding was provided for this program due to the lack of passage of this bill.
There is funding for high-risk pool programs in the House-passed Reconciliation bill but not the Senate version. However, important programmatic changes that are part of HR 3204 would not be included unless HR 3204 is also passed or incorporated as a whole.
As most state legislatures convene in January, they need to see a federal commitment to this program. Passage of HR 3204 this December would provide that.
Why is government support for High Risk Pools important for a private healthcare market?
These programs offer health insurance coverage to those who are uninsured and who already have a catastrophic or chronic illness and would not be able to afford health insurance premiums. Not only do high risk pools provide compassionate coverage at affordable prices to high risk individuals, they also help stabilize the insurance market so that the policy you and I have is more affordable.
In addition, the often-proposed alternative to high risk pools is a lethal set of mandates in the private market. If Congress does not support the high risk pool option, then others will press for federal and state mandates on insurers to cover everyone who comes in the door, regardless of their health condition when seeking coverage. Not only do they want to tell carriers whom they must cover (guarantee issue) but also at what price (community rating).
This mandate approach has been tried in a number of states and the result is always the same: there is no incentive for healthy people to get insurance since they can wait until they are sick to begin paying premiums, premium prices go up because healthy people wait to get insurance and sick people show up for coverage; more and more carriers leave that state because they cannot stay in business under those conditions, and the number of uninsured goes up because competition is reduced and no one can afford the ever-increasing cost of coverage.
Congress should support high-risk pools, or we run the risk of increasing the fodder of those who prefer government control and mandates.
States Uniquely Affected
The following states would be most greatly impacted by the delay of this legislation. Feel free to contact members and staff from these states to encourage them to support Speaker Hastert and Chairman Barton in enacting this legislation.
(8) States Seeking To Create High Risk Pools:
Georgia, Arizona, Ohio, Tennessee, North Carolina, Florida (re-open their pool), Nevada, Rhode Island
(19) States Relying on Operational Dollars for Existing High Risk Pools:
Alabama, Alaska, Arkansas, Colorado, Connecticut, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, Mew Mexico, North Dakota, Oklahoma, Oklahoma, South Dakota, Utah, Wisconsin
November 25, 2005 - Click here to discuss this topic
Physician Mentoring Program
CHCC Founding Member Mel J. Colón, MD has announced that his organization, the International Medical Institute, has started a new mentoring program, the Foundation for Physician Mentoring (FPM), to encourage young Hispanics to go into medicine. He notes that, while Hispanics comprise 14% of the population in the U.S., they make up only 4% of the country's physicians.
In a press release, Dr. Colón said, "We encourage freshman and sophomore potential premedical students to signup for a mentor, and we also welcome juniors and seniors who need a little more help in making any final decisions."
Groups of students will meet at least once a month to discuss medical school prerequisites, MCAT study tips, interview and application advice, and to meetings with the premedical directors, Dr. Mel J. Colón and other FPM physician mentors. The mentors will then call their mentees to answer questions, or address concerns. Furthermore, the mentors will always be available for help anytime that is scheduled.
This program allows students (and at appropriate times, their parents) to interact with physicians, patients, and other healthcare professionals. The students have the opportunity to shadow and work with physicians in a clinical or hospital setting. At the same time, students can turn to physicians for advice on medical schools, classes, applications, and internships. The students will engage in workshops that promote confidence-building and skill-enhancement.
Dr. Colón said the physician mentors currently include:
- Dr. Mel J. Colón (Foot and leg specialist)
- Dr. Frederick Sengstacke (Gynecologist, Reproductive Endocrinologist)
- Dr. Leo Reyes (Urgent Care and Family Medicine)
- Dr. Shiela Goel (Pediatrician)
He added, "We are in need of volunteers to assist in the operation of the International Medical Institute Foundation for Physician Mentorship (FPM)."
To contact Dr. Colón, call the International Medical Institute at 678-547-0000, or e-mail him at drs4drs@yahoo.com
-- Greg Scandlen
November 22, 2005 - Click here to discuss this topic
Cohn, Part II
Jonathan Cohn’s TNR article criticizing consumer-driven health care points to a serious weakness in the current health care system -- sufficient information for consumers:
Pretty much everybody would like to see consumers become more informed about their medical care and develop healthier lifestyles. But will HSAs really accomplish that? There's reason to wonder. Consumers need good information in order for a market to work. And good information on health care is just not that easy to find.
While this is definitely a problem, Cohn never explores why it is a problem. The reason health care information is limited is that the system isn’t consumer-driven. Areas of our economy where there is no shortage of information -- i.e., most areas of our economy -- are ones where the providers have to attract consumers. As options like HSAs and HRAs expand so will the demand for information. Over time, the market will meet that demand.
Cohn also raises the potential problem of “adverse selection”:
The trouble with HSAs is that they change the equation, dramatically, allowing people in relatively good health to keep much more of their own money. "One hundred percent of the time it makes sense for a healthy person to take the savings account," one benefits consultant explained in The Tampa Tribune. "That's a no-brainer." But, once that happens, there's less money to subsidize care for the people with high medical bills--which means those people must either make up the difference themselves or simply go without care.
What Cohn overlooks is that consumer-driven plans have considerable potential to expand the health insurance pool. Because such plans are much cheaper than traditional plans, they are more attractive to the uninsured. As data from numerous sources show, between 37 -- 40% of those signing up for individual HSA plans had been previously uninsured. While the scenario Cohn proposes is plausible, so is one in which people who were previously insured and sign up for a consumer-driven plan make up for any lost resources.
-- Dave Hogberg
November 16, 2005 - Click here to discuss this topic
Cohn, Part I
This begins a multi-part blog on Jonathan Cohn’s recent article in the New Republic, “Crash Course: The Danger of Consumer-Driven Health Care.” If you have not yet read it, you should. The article is lively and clear, with a very entertaining summary of the history of health insurance in 20th Century America. And although you may not find his arguments about consumer-driven health care convincing, you’ll probably find them thought provoking.
Let’s start, however, with the one obvious weak spot in Cohn’s article. Cohn begins his article with a narrative about the travails of an electrician, Rex Delph, who works as for the school system in Knox County, Tennessee. Mr. Delph’s wife has Addison’s disease and is reliant on his insurance policy. In August, the school board wanted to switch to an insurance policy that included deductibles and co-pays. Cohn writes:
…for Delph, who made around $30,000 a year and whose wife could no longer work, those $200 physician visit deductibles and $20 prescription co-pays loomed large: “Right now, with the bills I've got, we're just barely breaking even,” he said. “It would have been a pretty good hardship.”
Then Cohn asks, “Is that the way we want to pay for health care in America? President Bush seems to think so, as does a chorus of Republican officials, conservative intellectuals, and corporate chieftains…In the scheme they envision, Americans would pay for everything else on their own, preferably by using money they've invested in special, tax-preferred ‘health savings accounts,’ or HSAs.”
Note the subtle shift, from a plan with co-pays and deductibles to that of HSAs. The problem is that the plan Mr. Delph faced, based on Cohn’s description, did not have an HSA option. Perhaps Mr. Delph would have been just fine if he had a plan that also included an HSA; perhaps he wouldn’t have been. We can’t tell based on Cohn’s article.
For an article that goes on to present a well-thought out challenge to HSAs, it would have been a lot more effective if the initial example Cohn used one with an HSA
--- Dave Hogberg
November 11, 2005 - Click here to discuss this topic
Last week, the Commonwealth Fund released a survey of patients in six countries titled “Taking The Pulse of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries.” Published in Health Affairs, it provides a fairly comprehensive look at those patients with chronic conditions in Australia, Canada, New Zealand, United Kingdom, United States and Germany.
The survey shows that all countries have their strengths and weaknesses. For example, the U.S. does very well on giving patients adequate instructions on which symptoms to watch for but poorly on errors on lab tests. However, there is one possible bias in the survey: Countries may have a lower error rate because they are not as effective at responding to errors. That is, a higher death rate due to medical errors would skew the results since dead people do not participate in surveys.
Nevertheless, the authors treated the results with even-handedness, noting that, “The United States often stands out for inefficient care and errors and is an outliers on access/cost barriers. Yet no country consistently leads or lags across survey domains.” Unfortunately, no such balance from the Commonwealth Fund, which sponsored the study. According to the Fund’s press release:
"A new international survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results-the highest rate of any of the six nations surveyed."
Guess which spin was picked up by the media? Typical was an account by the Washington Post:
"Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations."
Such studies can be useful for evaluating the strengths and weaknesses of a country’s health-care system. But not when they are used to score cheap political points against the U.S.
-- Dave Hogberg
November 06, 2005 - Click here to discuss this topic
Growing and Growing
A recent survey by Fidelity Investments found that 45% of large employers will offer a consumer-drive health insurance plan in 2006. Of those, 62% will offer one with a health savings account, and 38% will offer one with a health reimbursement arrangement.
Meanwhile, the list of health insurance providers who are offering high deductible plans with health savings accounts keeps growing. The list includes Conventry Health Care of Louisiana and Cigna.
Finally, banks are now jumping on the CDHC bandwagon. HSA Bank, a division of Webster Bank, is offering new tools to give accountholders greater access to their HSAs online. And ConnectYourCare is aiding banks with the tools necessary for administering HSAs.
Interestingly, Debbie Stabenow, Senator from Michigan, recently claimed that HSAs aren’t the way to go and called for a greater federal role in health care. Looks like the market doesn’t agree with her. But since when does the market know better than politicians?
-- Dave Hogberg
November 04, 2005 - Click here to discuss this topic
Dead Meat is a film about Canadian health care produced and directed by Stuart Browning and Blaine Greenberg. They are working on a feature length version, but have developed a 25-minute version that is free on the Internet. It is a powerful look at the devastating -- and life threatening -- waits that Canada's Single Payer system imposes on the people who are in ost need of health care services. The producers liken Canadian health care to Soviet-era bread distribution -- sure it's "free" but the waiting lines are endless. To download the film, go to -- http://onthefencefilms.com/video/deadmeat/
-- Greg Scandlen
November 01, 2005 - Click here to discuss this topic
From Modern Healthcare
Oregon system agrees to settle uninsured-billing lawsuit
Providence Health System, Portland, Ore., agreed to settle a class-action lawsuit brought by attorney Richard Scruggs on behalf of uninsured patients alleging that not-for-profit Providence violated its charitable mission by charging its highest prices to those least able to pay. A state Circuit Court judge in Portland must approve the deal. Providence admitted no wrongdoing and said it chose to settle to avoid "tremendous" legal costs. The system said it did not have an estimated value for the settlement. Providence is a unit of 18-hospital Providence Health System, Seattle, which is planning a merger with Providence Health Services, Spokane, Wash.
Under the settlement, any uninsured patient charged for care at any of Providence's seven hospitals in the past four years would be eligible for an estimated 30% reduction in the bill to reflect the average "preferred provider" private insurance rate at Providence. The system would offer additional reductions to uninsured patients living below 400% of the federal poverty level and waive the bills of those living at or below 200% of the poverty level and having limited assets. The settlement conditions would apply to all uninsured patients at Providence for the next two years. The proposed settlement follows another recent Scruggs victory in Portland -- class certification of a similar lawsuit against Legacy Health System.
-- by Laura B. Benko
October 28, 2005 - Click here to discuss this topic
Always Low-Cost Health Insurance. Always.
For those who like free markets, watching Wal-Mart in the last few days has been depressing, with the retail giant calling for more renewable energy and a hike in the minimum wage. But there may yet be a horse in this, um, pile:
Discounter Wal-Mart, which is often disparaged for its employee benefits, is set to unveil a cheaper health insurance plan aimed at expanding coverage for its low-income workers, according to a published report Monday.
The New York Times reported that the new "Value Plan" will have monthly premiums as low as $11. Additionally, Wal-Mart is offering health savings accounts, which the federal government introduced last year, the paper said.
For individuals, Wal-Mart will offer two HSA plans, one with a $1,250 deductible and another with a $3,000 deductible; Wal-Mart will match employees’ HSA contributions, up to $250 for the first plan and $500 for the second. There are two HSA plans for families too, with deductibles of $2,500 and $6,000; Wal-Mart will match contributions to these too, up to $500 for the first plan and $1,000 for the second.
The labor union website, Wal-Mart Watch, criticizes HSAs because, “Health Savings Accounts save WAL-MART Money and help wealthy shelter savings tax free.” It's a bit perplexing as to how this would "help the wealthy" since the HSAs would be owned by Wal-Mart employees and Wal-Mart Watch complains that the retailer offers “rock-bottom wages to its more than one million workers.” Perhaps the only way to explain it is that leftists like those at Wal-Mart Watch are conditioned like Pavlov’s dog to bark “tax break for the wealthy!” whenever someone brings up HSAs.
http://money.cnn.com/...healthcare/index.htm
http://money.cnn.com/2005/10/25/news/fortune500/walmart_wage/
http://walmartwatch.com/...Health_Plan_Changes.pdf
http://walmartwatch.com/home/pages/health_savings_accounts
http://walmartwatch.com/...better_lives_6_letters_new_york_times/
-- Dave Hogberg
October 25, 2005 - Click here to discuss this topic
I was the keynoter this morning at a meeting of a large group of employers in Lewisburg, Pennsylvania. A reactor panel, including representatives of three local health plans, one independent physician, and one hospital administrator, responded afterwards. The health plan folks didn’t care for my characterization of insurance companies as “Peeping Toms” for being waaaaay too interested in what happens in those intimate moments between a patient and a physician. In fact, the insurance execs and I disagreed on almost everything. They complained about physicians who don’t do “all the proper exams at the proper intervals.” As if an insurance company knows more about practicing medicine than the physician does.
One said that, “19% (of the population) admits to having no physical activity. We have to work on that.” Since when did it become an insurance company’s responsibility to make sure every Tom, Dick, and Harry is getting physical exercise? And since when did lack of physical activity become a crime that one “admits” to? These companies have become way too “big for their britches” (as my mother used to say). No one has appointed them arbiter of all things physical.
But a slide from another executive really caught my attention. This slide said, “Doctors owning equipment use imaging 2 to 8 times more than doctors who refer to radiologists” (emphasis in the original). The inference being that greedy Docs are over-prescribing X-rays, MRIs, and CT Scans to get rich on excessive use of radiology. If we ban physician ownership of imaging machines, we’ll lower costs.
Well, that’s one possible interpretation. But another interpretation is far more plausible – physicians whose practices require a lot of imaging may be the ones who buy the equipment so they don’t have to send their patients out to another facility to get the job done. A physician who tends to a lot of broken bones, for instance, may want to have an office X-ray so the patient doesn’t have to make additional appointments, run all over town, pay for another visit, and delay treatment. It may also be cheaper to do it in-office than it is to send it out to a radiology lab. If physicians were banned from owning their own equipment, costs could go up and outcomes worsen.
And here is the problem with giving insurance company executives too much power. They get fixated on little factoids like the one in this slide. They are – and will always be – bean counters with very little understanding of the dynamics of medicine. That’s okay. Bean counting is important. But it would be nice if they got that part of their business right, before trying to run the entire health care system.
-- Greg Scandlen
October 20, 2005 - Click here to discuss this topic
What Is An “Acceptable Wait Time”? Canadian Government Knows
I was at the doctor’s office the other day, and I waited over an hour to see him. He’s rather popular, so I didn’t mind the wait (too much). However, if the wait was unacceptable to me, I still have the freedom in the U.S. to switch doctors.
But in Canada, it is the government that is deciding what is an “acceptable” wait time. According to the Liberal Party’s website:
“By December 31, 2005, provinces and territories will be required to report to their residents the establishment of benchmarks for medically acceptable wait times, starting with five priority wait times areas – cancer, heart, diagnostic imaging, joint replacements, and sight restoration – identified in the Ten Year Plan to Strengthen Health Care agreed to by all First Ministers in September 2004.
”A benchmark is a measure – reflecting broad medical consensus based on available evidence – of the medically reasonable time a patient may wait for treatment or a corrective procedure. Establishing these benchmarks is a corners
