National Health Care Reform Posted:
05/15/2009 08:49am
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(5 ratings)
Is anyone concerned about national health care reform? By reading the WorldatWork blogs, it sounds like our association is looking for member feedback on what concerns/design features/etc you feel are critical in the current national debate.
If I have read the news properly, we don't have much time to waste. Recently the House Speaker promised the President that Congress would deliver proposed legislation by July. That gives us a month and a half to influence the shape of the legislation.
National Health Care Reform Posted:
05/15/2009 08:56am
Revised: 05/15/2009 10:38am
One issue that I am concerned with is maintaining an incentive for private sector companies and employees to continue health care benefits. I have seen some ideas floated to cut the tax break that companies get for providing health benefits, and taxing employees for the company contributions to health benefits. To me this sounds like the wrong direction. We should do everything we can to encourage companies to provide health benefits and give them full tax breaks for their premium contributions. And we should be encouraging employees to enroll in those company-provided health benefits by continuing the tax-free treatment of the company contributions.
National Health Care Reform Posted:
05/15/2009 08:59am
Revised: 05/15/2009 10:38am
I am concerned about the alarmist tactic of saying the current health care system is broken when there is evidence that suggests that we have the best national health care system in the world. What is the truth? Does anyone have some evidence of our system being broke, or of how our system stacks up with the rest of the world?
National Health Care Reform Posted:
05/15/2009 07:46pm
(1 rating)
As posted over in the Public Policy Friday-Wrap-up blog: We need to hurry and adopt the Canadian single-payer chaos model where each Province has its own required programs and the waits for elective surgery are endless, before the masses of Canadians seeking superior care and service flooding into American hospitals drive our prices even higher. Health care is booming, especially below our Northern border. I'm just below the BC border, and there are more Canadian license plates than US in the parking lots of our hospital, clinics and doctor offices.
National Health Care Reform Posted:
05/15/2009 11:35pm
Revised: 05/15/2009 11:42pm
(1 rating)
I haven't looked into any research on the topic in depth compared to other countries. Just from a personal perspective, it seems like the exponential rise in health care costs indicates that some sort of more innovative or resourceful solution should be sought out or investigated. Rising health care costs have far exceeded the rise in cost of living or inflation (even is zero/dis-inflationary times, it was rising at frightening rate). Seems that we could be doing better on that front.
I agree that we don't want the Canadian model if what it offers is exorbitantly long wait times.
I heard that the Obama administration was studying a model that was operational in some rural US vicinity. The fact that it is for a rural community may preclude it from being appropriate for the main urban populations.
There is probably no easy solution, but I do feel that more effort should be appropriated to the subject.
What you mentioned, Paul, does seem to be logical - that we should be encouraging employer coverage and tax concessions, as well as contributions made by employees. The opposite position does seem to be going in the wrong direction; I don't get the intent there.
I do welcome a vigorous discussion of the subject, as I do feel that the topic deserves it, and we as the professionals charged with leading the design and management of such plans have more expertise and more of a vested interest in seeing that the new proposed legislation is one that has been well thought out.
National Health Care Reform Posted:
05/16/2009 03:43pm
Revised: 05/16/2009 03:48pm
(1 rating)
Vita reminds me that we have published substantially the same cautionary warning about executive pay trends and double-digit health care cost compounding in our Update newsletter almost every quarter, including on page 2 this quarter. Maybe the executive pay rip-offs might decline a bit now, due to adverse publicity, but the health care connundrum remains.
We have seen dramatic curtailments in executive compensation at large publicly traded corporations (per our most current news release), but smaller public entities with LITRPs and counter-cyclical profit situations or those with lagging pay and measurement cycles, not to mention the private firms, will still continue to siphon off massive amounts un-noticed. (Sorry; I should have put that sentence over in the compensation board.) But health care costs are much larger in real dollars than executive pay and medical costs have skyrocketed for years, completely unaffected by economic downturns as was exec comp after 9/11 and this last six months.
Consider the Swiss approach. Paul, this ball should be in your court, because Switzerland will not permit postal service to any family not covered by health insurance. Very simple and quite elegant. Except here, maybe we would have to expand the penalty ban to cover cell phone, email and internet service. That would certainly raise employee pressure on employers and force them to offer health or face a union that would demand it.
National Health Care Reform Posted:
05/16/2009 05:51pm
Revised: 05/17/2009 08:48am
just reviewed some old blog discussions on health care and found this one on
April 15, about the detailed provisions of The Healthy Americans Act:
You (the blogger) quote the OMB as expecting employers to convert prior health care insurance payments into raises to their workers. Why would any exployer do that? What is the economic incentive to continue to spend ~34% of payroll on something that is now covered by a Federal Public Health Plan? How could a board of directors escape charges that they violated their fiduciary responsibilities if they so diverted funds that ought to be used to cover losses or distributed to shareholders? Giving away money without cause is pretty abnormal behavior, as well as legally actionable if you are accountable to owners. WHOA! I just read the fine print at the end of the OMB document. Employers would both pay new taxes AND be REQUIRED (not "expected") to "cash out" their employees, giving them permanent increases in amount of the residual. (There's a big land-mine right there, just figuring how to distribute health-care "residuals".) Furthermore, employers who had negotiated a really cost-effective excellent health plan would be penalized compared to those who offered lousy or no benefits. Typical clever gov-think.
Unsure if The Healthy Americans Act is still advancing, or if those provisions are in the Obama Plan, but I'd sure worry about details like these.
This morning, reviewed the Association's briefing paper in the Benefits Blog and posted this over there, too:
The employer requirements and punishments in the document are disturbing, with (1) (a) (ii) denying a company tax deduction for any employee who refuses company coverage in favor of the FedPlan. Entire bloc-coverage is an essential actuarial assumption behind carrier coverage pricing estimates. If large numbers of healthy ees refuse the company plan for the free FedPlan, the private plan will cost more, initial company prices will rise, experience ratings will get worse and later prices will rise, the tax-deductibility of "the whole company payment" might be challenged (if every employee isn't enrolled) and either the company will drop their private plan or the private insurer will go broke. Section 2 contains a problematic punitive assessment to employers, no matter what they do. Assume that means they will pay for their own plan and simultaneously fund the FedPlan. A recipe for disaster, I fear.
National Health Care Reform Posted:
05/18/2009 05:04am
(5 ratings)
Paul,
As you know from our prior conversations, I've been looking at the U.S. health care issue since 2001. Here are a few stats that I’ve collected about the US health care system. Couple these with the Institute of Medicine’s (IOM) 2001 report entitled "Crossing the Quality Chasm" that basically says that 30% of all health care costs can be attributed to the poor quality within the U.S. health care system and I think you can easily see there is a big problem. I don’t know of any other industry that would tolerate a 30% quality problem in their operations. (I recently saw an article where Price Waterhouse Coopers now puts that number at more like 40%.)
�
U.S. rated last among 19 industrialized nations in health care systems outcomes, quality, access and efficiency -2008 Commonwealth’s 100 point scorecard.
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The U.S. spends nearly double the average of other industrialized countries on health care with no better, and in some cases, inferior outcomes. $477 billion more per year than the other countries. This wastes 3.6 % of the nation’s entire economic output or $1645 per person per year. McKinsey Global Institute study 1/2007
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People with chronic conditions account for 75% of health care spending.
(Employee Benefits News, Sept 15, 2008)
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Americans with chronic diseases get the recommended care only 50% of the time, and less than 50% of them have their disease satisfactorily controlled. ( Employee Benefits News, Sept 15, 2008)
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The odds of U.S. patients receiving the proper care were only slightly better than a coin toss (55%) regardless of race, gender, income or insurance coverage. RAND Study 2006.
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Electronic Medical Records used by 98% of doctors in the Neatherlands, 89% in Britain, but only 28% in the U.S. (7/24/08 – The Commonwealth Fund’s 100 point scorecard)
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Only 10% of doctors use e-prescribing. Today, 20% of prescriptions go unfilled – Mark Merritt, president of PCMA (Pharmaceutical Care Management Association) 8/3/2007.
�
U.S. health spending is projected to top $2.5 trillion this year (2009). That’s a rise of 5.5% from last year’s estimated spending — less growth than we’ve seen in recent years, but still pretty vigorous, given that the overall U.S. economy is projected to shrink slightly this year. Indeed, the projected contraction in the nation’s overall GDP, combined with the continued rise in health spending, will mean that health spending as a percentage of GDP will climb to 17.6% this year, from 16.6% last year. The figures were put together by Medicare’s Office of the Actuary and were published online in the journal Health Affairs.
The problem does not lie just with the actions of physicians and hospitals, but also with the level of corporation support (or lack thereof ) for their employee's health care needs as well as with the employees and dependents themselves and their unhealthy lifestyles and general misuse of available health services and treatment protocols that lead to far more expensive complications. These three stakeholder groups, with the government's support, need to join forces to adequately resolve the issue. I do not believe that a nationalized health care system is the answer, which seems to be where this may be going.
National Health Care Reform Posted:
05/18/2009 06:51am
Revised: 05/18/2009 07:07am
When Bob Holben says that a nationalized health care system is not the answer, and that solutions to current problems can be developed through better partnerships with stakeholders in health care delivery, people should listen.
Bob has created just such a partnership in the Savannah, Georgia area with years of measurable results. Check out the Savannah Morning News article here. Check out a more recent summary of Bob's success as highlighted on pages 7 & 44 of the Center for Health Transformation report, "Healthcare That Works: Answering President Obama's Challenge of Finding What Works" here.
The last document is particulary noteworthy since it provides:
Top Ten Transformational Healthcare Solutions
Prevention and Wellness
Improving the Delivery of Care
Lowering Costs
Increasing Access to Care
Top Ten Action Items to Adopt Best Practices
Top Ten Action Items to Create an Electronic Health System
National Health Care Reform Posted:
05/18/2009 08:40am
What a wonderful fact-filled post! Thanks so very much, Bob.
I will take up your gauntlet, though, thrown when you said: "30% of all health care costs can be attributed to the poor quality within the U.S. health care system and I think you can easily see there is a big problem. I don’t know of any other industry that would tolerate a 30% quality problem in their operations."
Meterologists would probably make more if they could have such a "low" error rate. The Gaming Industry does quite nicely with a 49% loss rate in their cash gambled. And our own profession is also plagued with much data of questionable accuracy. I stopped relying on certain surveys with >50% standard error statistics (but my lips are sealed) long ago, and most pay surveys won't even reveal their underlying reliability statistics. Sources can be so abberational that one of our mantras is, "if a court won't accept the figures as reliable, why should your management?"
When I was suffering from iatrogenic health issues, the nurses kept reminding me that they call it "the practice" of medicine. That said, "poor quality" could just mean that the preliminary working hypothesis used for initial treatment proved to be wrong. We should be so lucky as to have a 70% first-shot accuracy rate in, say, the art of problem performance correction, for example. Not to say that we should ignore the obvious disconnect between the obscene amounts we expend on medical care and the often-pitiful results we get, of course.
Let's hope that we see lots more equally incisive facual posts as yours!
National Health Care Reform Posted:
05/18/2009 01:04pm
(1 rating)
Jim,
The 30% number does not include what we currently don’t know about how to cure certain diseases. It actually reflects deviations from best practice protocols based on evidence based medicine. For example, if you go to www.ncqa.org/tabid/836/Default.aspx you will find the 2008 Report on the State of Healthcare Quality. The shortfalls in the HEDIS measures are the causes of many of the catastrophic claims that continue to drive up our healthcare costs each year. These are the quality gaps that we need to be looking at closing to help reduce our country’s healthcare costs. By the way, these gaps are not all due to the medical community. Much is due to our employees’ and their dependents’ lack of compliance with their physicians’ orders. That is why a partnership needs to be established between U.S. companies, the physicians and their patients (our employees and their dependents) to begin to work together to help solve this country’s healthcare cost problem. To begin, employers should review their claims data to see just how close to the HEDIS measure targets the data from their covered lives fall. Then decide and take action on things they can do to improve that position.
National Health Care Reform Posted:
05/19/2009 06:44am
(1 rating)
Paul:
Thanks for starting this discussion and (along with Jim, Bob and others) pointing us to great resources and information to help get up to speed on the health care reform debate.
I've tried to carve out time over the past few days to review the links and articles referenced here, as well as to do my own research, in order to make a helpful contribution to this discussion.
It is a complex topic with a lot of individual threads and issues. I wonder if this is the reason that the discussion here has been mostly limited to very senior and experienced members. Many of the rest of us may feel intimidated by the breadth and depth of the topic.
It seems that a cornerstone of the debate at this time is whether or not to add a public plan option to a healthcare reform bill. This is the point that stalled Senate discussion last week. Many believe that such an option would invariably pull people away from private insurers, who would be unable to compete with heavily subsidized government policies, and lead to a single payer system where the federal government is the sole entity controlling and administering healthcare coverage. Per Jim and Bob's comment, I don't see this as a positive direction. (Although I did read and appreciate Pawel's link to the Bloomberg article, which seeks to allay our fears about a single payer system.)
I really like the "build on our strengths" approach and recommendations advocated by the Center for Healthcare Transformation, in that it represents a combination "bottom up" and "top down" approach, where government serves to enable, promote and incent the institutionalization of existing successes that are occurring at a grass-roots level around the country. This seems to me a solid compromise between a pure "let the market do as it will" approach and a centralized, government controlled system. The kind of partnership and transparency outlined here would provide the checks and balances that are missing from our current system and that I fear would also be absent from a single payer system.
Some of my thoughts. Thanks again for providing this forum for discussion and learning on the topic.
National Health Care Reform Posted:
05/19/2009 01:35pm
Here is an article that just came out from WorldatWork that indicates the many companies view that answer to the healthcare cost problem to be drop coverage or shift more cost to employees.
That is not the answer. Company executives and their benefits departments need to look for ways to maintain medical coverage while reducing the cost through innovative cost savings programs. There are many examples of these types of initiatives that can be emulated. Management must stop viewing the dollars it puts into healthcare as simply an overhead cost and start viewing those dollars as an investment in the health and productivity of its employees and the profitability of the company itself.
National Health Care Reform Posted:
05/19/2009 08:35pm
(3 ratings)
I have been in the benefits arena for 25 years. For most of that time, I supported an employer mandate for health care insurance. It seemed only fair that an employer mandate leveled the competitive playing field.
More recently, I have come to support a single payer system. I am closer to the end of my career than I am to the beginning, so perhaps I can take more risks.
Most policy makers, when they talk about reform, focus on the care delivery side. Medical homes, chronic condition management, wellness promotion, electronic medical records, payment system reform. Robert Holben touches on some of those topics.
But before you can organize the care delivery side of the equation, you need to organize the patient delivery side.
We give people access to the health care system based on income, or age, or military status, or employment status. And most people move in and out of plans throughout their lives.
If you don't fit the criteria to pass through one of those portals to gain access, you have the option to buy insurance on your own, provided you have enough money and are healthy enough.
We have carved out goofy laws to cover exceptions, like domestic partners and Michelle's law.
I say goofy, not as a pejorative of the people in those classes, but that we need to fashion laws and complicated regulations just top permit a small group of people access to health care.
Can you honestly say this system makes sense?
What does make sense is a system that gives everyone equal access to health care based on ability to pay. A system that is not connected to employment and which people can carry with them their entire lives.
Not only does that make sense from a health care delivery standpoint. It makes sense from a workforce development perspective.
We all hear about the tragic stories that we unfortunately don't pay attention to until they happen to someone we know. People who don't have insurance or whose insurance doesn't cover the treatment they need. These are not just stories of economic and emotional stress. They are too often stories of people who have been denied the opportunity to contribute to the American economy.
By separating health care from employment, we would really being laying an important foundation for the 21st century workforce.
you know the employment and demographic trends far better than I do. Job-sharing, part time and part year employment phased retirements, work hardening, freelancing all become easier decisions when health care is removed from the equation.
We need to put knee jerk ideologies aside and put health care to the service of the American workforce.
I have a day job, so don't expect many responses from me during work hours. I also blog on this topic at http://thehealthcaremaze.wordpress.com. But I am anxious to hear your responses.
I really think the health care debate needs to be reframed as a workforce issue and not an insurance issue and there is no better group to do that than this group.
One final note. I am very sympathetic to Robert Holben's point of view. The one vital strength of the employment based system is its closeness to its employees and therefore its ability to promote wellness initiatives. But I have learned that those can and do occur in countries with national health care systems, countries like Canada, Finland, and New Zealand. There are plenty of reasons to promote wellness other than lowering your health insurance premiums.
National Health Care Reform Posted:
05/20/2009 07:22am
Revised: 05/20/2009 03:49pm
(3 ratings)
James:
I really appreciate the chance to read your well-written thoughts and your point-of-view ... and your blog provides a wealth of information (I will subscribe going forward). I agree that we, as reward professionals, need to play particular attention to the care delivery and care access side of this debate as the workforce issue is central to our roles.
Some counterpoints that I would welcome your thoughts on-
In your blog you speak of the problem of gatekeepers to health insurance and care. One of my key concerns about a single payer system has been the placement of our government in the position of gatekeeper to health care. This concern of mine is illustrated in the recent decision by Medicare/Medicaid to decline all coverage for virtual colonoscopies. A WSJ article earlier this week articulated many of my fears about what a move like this portends for a government controlled system.
At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.
Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.
The article notes that part of the public payer option would be the use of "comparative effectiveness research" to examine clinical evidence in order to asess what "works best," enabling the elimination of treatments deemed to be wasteful and/or ineffective, as a way of reducing healthcare spending. However ...
The problem is that what "works best" isn't the same for everyone. While not painless or risk free, virtual colonoscopy might be better for some patients -- especially among seniors who are infirm or because the presence of other diseases puts them at risk for complications. Ideally doctors would decide with their patients. But Medicare instead made the hard-and-fast choice that it was cheaper to cut it off for all beneficiaries. If some patients are worse off, well, too bad.
The American College of Radiology issued a release condemning the Medicaid/Medicare decision, stating that it "is not supported by the latest clinical evidence and may result in tens of thousands of unnecessary deaths each year from colorectal cancer, particularly among minority and underserved populations."
Which leads me to my greatest fear, that as cost pressures come to bear, politics will ultimately hold the most sway over health coverage and care decisions. From the WSJ article:
Mr. Orszag <Budget Chief> says that a federal health board will make these Solomonic decisions, which is only true until the lobbies get to Congress and the White House. With virtual colonoscopy, radiologists and gastroenterologists are feuding over which group should get paid for colon cancer screening. Companies like General Electric and Seimens that make CT technology are pressuring Medicare administrators too. More than 50 Congressmen are demanding that the decision be overturned.
With this in mind, I honestly lean toward a solution that works toward universal coverage via an alternative to the "government as single payer" like that recommended in Patients Choice Act introduced in Congress today which seeks to redirect the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advanceable tax credits that they can use to purchase health insurance and invest in HSAs, and which includes a safety net which guarantees that those with pre-existing conditions would have access to insurance. Employers, under this approach, would still be able to recognize any health insurance costs for employees as business expenses - but it would also serve to delink coverage from the workplace.
I eagerly anticipate thoughts and reactions to this.
This is an interesting discussion - I have learned a great deal from those who've shared their thoughts and resources here, and I appreciate the chance to participate in the dialogue.
National Health Care Reform Posted:
05/20/2009 07:26am
Revised: 05/20/2009 03:50pm
Me, again. I see that only part of my previous post got published here ... not sure where the rest of it disappeared, and now I have to run and deal with other committments....
Update - Tried again later with a re-written post - better success this time...
National Health Care Reform Posted:
05/20/2009 05:01pm
(1 rating)
You raise an important point, but in my mind, not a key point.�
In any system there is and will always be that tension between new, “experimental” ideas and "generally accepted medical practice" - the term of art in insurance and ASO contracts. The progress of health care depends on continually pushing and redefining those boundaries.�
�Early in my career, when I was working as an account executive for a health insurance carrier, I had to explain to a group representative that the bone density test prescribed by his wife’s doctor for her osteoporosis would not be covered. At that time, the test was considered “experimental”. Today it is routinely given to much younger women.�
Until there is broad consensus on a new treatment modality, people will always be on different sides of the issue. That is the way it should be.�
The important questions are�
1. Who makes those decisions?�
2. What is the process for making those decisions? and,�
3. Who pays for new and experimental treatments?�
You seem to take issue with the fact that the government is making the decision. is that really the issue? �Generally speaking, CMS has a fairly open process, just like the FDA. I trust that they are making their decision based on objective criteria that have something to do with whether or not the new treatment has improved outcomes over the current treatment, and presumably weighs the cost effectiveness of the new treatment.�
I don't pretend to suggest that government makes good decisions.� �
Let’s contrast that with some situations that I have encountered in my own experience.�
My experience with employment based plans, is that benefit design decisions are frequently based on criteria that have very little to do with outcomes or even cost effectiveness. They are frequently motivated by much more short sighted notions.�
Let me illustrate with two stories from my own career. Again, many years ago, working for the same insurance carrier, I was brought into a situation where the teacher’s union wanted to dump our insurance company. “Your company sucks!” was how they judiciously described it.�
I was able to convince the leadership, that their benefit design had not been updated in many years and that it provided little coverage for services that were now being performed on an outpatient basis instead of an inpatient basis. (I am dating myself) They explained that the attitude of management and the school board had been to assume that any changes to the benefit plan were just concessions to the union and should be resisted.�
This is hardly an open process, nor one with�discernible�objective criteria.�
As a post script to the story, They invited me to speak to the membership at an in-service day. When I arrived, they introduced me by saying, “Before I bring up the next speaker, we need to take up a collection for Mrs. X whose outpatient chemotherapy bills are not being paid by our insurance company.”�
A second example. A plan does not provide coverage for bariatric surgery. When that provision was put in, bariatric surgery was much rarer and, perhaps, less safe and effective. While the decision makers may have concerns about the safety and efficacy of the procedure, I suspect that the overriding consideration is cost. And that is the costs of the surgery, not the long term cost to the Plan or even to the employer.�
Participants and doctors don't understand and complain that the benefit is mandated by the state and approved by CMS. But the Plan is bound be neither of those. Is the process using criteria that advance the health outcomes of its participants?�
In the end, I have more confidence that the government will have a more objective and open process that what often takes place in the private sector.�
The last point I wanted to touch on is how “experimental” treatments are paid for. I will lay out what I perceive as two end points with some likely middle ground. At one end of the continuum, the patient pays for treatment not deemed to fall within “generally accepted medical practice.” After all why should the group pay for services that the group has found to lay outside its definition of “generally accepted medical practice”? Why should the a patient feel entitled to such services? Is there any limit to how far outside the norm?�
At the other end of the continuum, services come out of a provider “budget” of some sort. Under that scenario, the patient is absolved of the cost.�
The key is that there is openness about the process and the rules. Under the current system, doctors and patients are hamstrung by an infinite set of often contradictory rules. Both end up frustrated.�
But you do touch on the reason why I would rather see multiple regional plans that one single national plan. Large organizations are slower to change. Smaller organizations can set their own pace of change. They can choose to lead in some areas and follow in others.�
That doesn’t change any of the core ideas in my original post. Health care needs to be de-coupled from employment. Providers need to be paid based on their performance and not who they are treating, and premiums should be based on ability to pay.�
National Health Care Reform Posted:
05/21/2009 09:50am
(1 rating)
Hi Everyone,
Here are some ideas for how I think the healthcare system should look like:
1. Instead of one single payer system a network of non-profit self sustaining healthcare funds. Initially starting capital for those funds could be provided by federal government but going forward funds would have to be funded by premiums paid by participants (no subsidies from the government). Board of each fund would be elected by plan participants. This model is better than one single payer because it retains competition and I strongly believe that competition would be a vital force in improving healthcare quality and affordability.
2. Premiums should be tax deductible for employers and for individual citizens.
3. Experimental versus generally accepted treatments. Federal “board” should be established (or maybe there is already institution that could serve this purpose) that would publish (let’s say biannually) a schedule of treatments consisting of lets say 3 groups:
I.Generally Accepted Medical Treatments
II.Treatments that are proven to work but there is no general agreement to include them in group “I” either because there are more cost effective treatments that can serve the same purpose or for some other reason (that would be medical experts job to decide how many groups should there be and what each group should consist of)
III.Experimental Treatments.
The board would consist of representatives from Health Care Plans, Doctors and Patient Groups.
4.Each healthcare plan sold on the market (from private insurers and non-profits) should cover at least treatments listed in group I. Each plan agreement should list coverage level (group I, II etc.), maximum out of pocket, deductible and co-pay. This way people buying insurance wouldn’t have to read tons of pages of what plan covers and which therapies are excluded for which in most cases they have neither ability nor knowledge to understand it.
5. Premiums should be based only on the level of coverage, not on applicant’s age, medical condition or ability to pay. However there should be some provisions for preexisting conditions in order to protect plans from abuses by for example people who are young and healthy and they don’t care about buying insurance until they get older or sick and then suddenly decide to get health insurance (you can’t insure burning house).
6. Insurers (for profit and non-profit) could not reject applications. This provision is to protect non-profits from being overloaded by participants that are old or in poor medical condition and therefore cost more.
This is just general outline of how I think the system should look like and I am open for discussion.
National Health Care Reform Posted:
05/21/2009 12:26pm
Pawel
Here are my thoughts
1. Sounds very much like the sytem in Germany and that works for the Germans. Notperfectly, of course. Nothing ever does.
2. You can't deduct something from nothing. This is key. Until you have a system that accomodates the no-income, the low income, and the sporadically employed, you aren't beginning to deal with the real world. We in the employment based system, tend to see health care in a very limited perspective. Barely half of health care expenses are paid for by the private sector. And the way NHE (National Health Expenditures) are calculated, private health care expenses includes the employee benefits of government employees. So actual tax dollars paying for health care exceeds 60%.
In fact, we pay more in taxes per capita for health care than Canada does.
3. When so many people have access to no care, I am frankly not overly concerned with access to leading edge care. that can be worked out.
4. I do suggest you take a look at Health Care Professionals for Health Care Reform www.hcpfhr.org Their proposal is not too far from you points 3 and 4 and 5.
5 and 6. You will not get a ban on medical underwriting without a mandate for coverage. As long as healthy people are free to opt out of the system insurers will assume that people seeking coverage are sick. Can you balme them?
While you did not specifically address the issue, you comments lead me to believe that you could support de-coupling health care from employment.
I would be anxious to hear how the group thinks that would impact employment practices, rewards, etc. It would open up opportunities for part time and part year work, job sharing, phased retirements. What else? Are these good things or not?
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