HEALTHCARE BROKEN? WHO BROKE IT

Orange County Register - Oct. 24: Politicians tell us that health care in America is "broken." The best initial response to that assertion is to ask yourself whether you think that your own health care is broken. And if it is, do you want to turn your decisions about your own health over to politicians who claim they can fix health insurance? Or, if you are generally satisfied with your health care, do you want politicians to take your current care away and replace it with a uniform government system? That is what they want to do, whether you think your own health care is broken or not.

More generally, we all need to ask why politicians assert that American health care is broken, and what agenda does it serve. We should ask, if health care is broken, who broke it, and how did they break it?

Health care was much more affordable in the 1960s. The government paid for less than 10 percent of all health care. Then the federal government created Medicare and Medicaid and wrote 130,000 pages of Medicare regulations. Now the government pays for 50 percent of all health care.

Has that fixed health care, or broken it?

In the same period, state regulation of medical insurance rapidly expanded, adding many coverage mandates that each policy must comply with. In some states you have to buy coverage for electric shock therapy, or in vitro fertilization, or acupuncture, or chiropractic, or hairpieces, a social worker, marriage counselor or a long list of other things, whether or not you want such coverage. And new mandates are added all the time, driving up insurance costs every year.

Moreover, you are not allowed to buy better-priced insurance from a competing provider in another state.

Has that fixed health care, or broken it?

The government could easily make reforms that would reduce the cost of insurance without any additional spending: basic policies without mandates, tax-deductible premiums, competition among insurance companies across state lines.

Why is it, then, that the more government controls health care in order to fix it, the more expensive health care invariably becomes?

Politicians who broke health care and now complain that it is broken do not want people to be able to afford reasonable insurance. They see that as an obstacle in their path to eliminate all private insurance. They are not in favor of fixing anything, but of making us all dependent on the favor of politicians for our health and well-being.

State legislators and members of Congress have destroyed objective law and created a litigation system that is designed not to justly compensate those who have been harmed by medical mistakes but to create a gigantic and perpetual financial bonanza for a relatively small number of trial lawyers.

Liability insurance premiums have exploded and increased the cost of all health care for everyone  as has the "defensive" medicine of unnecessary tests and procedures that physicians have had to adopt to protect themselves from such legal extortion.

Has that fixed health care, or broken it?

When confronted with claims that health care is broken proffered by the politicians who broke it, the last thing we should do is give them additional powers to do further damage. Instead, we need to direct them to reverse the damage they have done, to stop forbidding the options that would make insurance affordable and to start leaving our health care alone.

More Calif. employers offering CDHPs

Business Insurance-Posted On: Dec. 19, 2008 3:05 PM CST Joanne Wojcik

OAKLAND, Calif.—The dominance of managed care in the California market led many benefits experts to doubt if consumer-driven health plans with high deductibles would gain much traction there.

But a recent survey has found that 38% of employers in the nation's most populous state now offer high-deductible health plans to their employees, up from 18% in 2007.

However, only 10% of employers offering HDHPs to their employees also offer a health savings account, while less than 1% offer a health reimbursement arrangement, according to the latest edition of the California Employer Health Benefits Survey, a joint project of the Oakland,Calif.-based California Healthcare Foundation and the National Opinion Research Center.

And even through the percentage of employers offering HDHPs in California surged, the number of employees enrolling in the plans remained unchanged from 2007 at 4%. By contrast, enrollment nationally in the plans doubled from last year to this year to 8%.

More than three-quarters of California workers were given a health maintenance organization option in 2008, according to the survey, compared with just 41% of workers nationally. As such, California workers have been consistently more likely to enroll in HMOs than covered workers nationally, who are more likely to enroll in preferred provider organization plans, the survey noted.

In California, 52% of covered workers were enrolled in HMOs in 2008, while 33% were enrolled in PPOs, 11% in point-of-service plans and 4% in HDHPs. By comparison, 20% of U.S. workers are enrolled in HMOs, while 58% are enrolled in PPOs, 12% in POS plans and 8% in HDHPs.

Among other findings of the survey:

• Employer-based health care premiums rose by an average of 8.3% in 2008, the same as 2007.
• More than half of California employers offered coverage for same-sex domestic partners, more than double the national average. Due to a change in survey wording, the 2008 results could not be compared to prior years.
• Thirty percent of covered workers in California were enrolled in a partly or completely self-insured plan in 2008, compared with 55% nationally. The gap between the state and national figures is associated with California’s high HMO enrollment since HMOs are less likely than other plans to be self-insured, the survey noted.

This year's survey, which was conducted by interview from April to July, included 796 randomly selected participants drawn from the Dun & Bradstreet list of private employers with three or more workers.

For complete results of the survey, visit www.chcf.org.

Survey Shows Consumerism Uptick in Health Benefits

Associated Press Online Tom Murphy - December 11, 2008

Years of rising health care premiums are making U.S. workers less willing to choose plans with higher up-front costs, according a survey by consulting firm Watson Wyatt.

A survey of large company employees shows that workers are significantly less willing to pay higher premiums to keep out-of-pocket expenses like deductibles and copays lower this year compared with 2007.

Only 19 percent of employees surveyed this year were willing to opt for higher premiums, compared with 38 percent last year.

Rising premiums and employers who are shifting more of the health insurance cost burden to their workers have motivated employees to look closely at what they get for their money, said Cathy Tripp, national leader of consumerism for Arlington, Va.-based Watson Wyatt.

"Some employees that have for years overpaid for coverage have now looked at how much they actually consume and realized it's not the right choice," she said.

Other employees are simply choosing the option that leaves the most money in their paychecks. Tripp also noted that benefits companies provide more tools to help workers understand their health care choices and find the right fit for them.

"I think there is an uptick in kind of consumerism in general about awareness around what you're buying," she said.

Watson Wyatt surveyed more than 2,400 workers employed by large U.S. companies last spring and compared their responses for several issues to what they said in 2007.

The study also found that 66 percent of workers took steps to improve their personal care, up from 61 percent in 2007. However, 17 percent skipped a doctor's visit this year to save costs, and an equal percentage failed to fill a prescription or passed on medicine for the same reason.

The survey had a margin of error of 2 percent, Tripp said. Watson Wyatt conducted it in May and June.

Tripp said some of the disparities in responses between this year and last may have widened since spring, with the economy continuing to falter.

"I do think in some ways satisfaction might be higher because I think some employees are just happy to have a job and benefits," she said.

OBAMA HOPES TO AVOID CLINTON HEALTHCARE MISSTEPS

The Associated Press - Dec. 6: Washington - President-elect Barack Obama and his aides are determined not to repeat the mistakes the Clinton

Tom Daschle, Obama's point man on the issue, discussed the early strategy, although details of Obama's proposals won't be finalized for a while.

Already, however, the political and public relations parts are coming into place. The strategy begins with giving people the chance to highlight their concerns and experiences. Daschle invited people around the nation to hold what amounts to house parties from Dec. 15-31.

By asking anybody and everybody to share their health care experiences, Daschle is confronting one of the major criticisms of 15 years ago: that the effort to craft former President Bill Clinton's plan for universal coverage was too secretive.

"We have to make this as inclusive a process as possible," Daschle, the former Senate majority leader from South Dakota, said in a speech in Denver.

It was his first since Democratic officials confirmed last month he was offered the job as health and human services secretary and that he had accepted.

"They are clearly trying to do it differently and help the American public see the case for reform in human terms," said John Rother, public policy director for the advocacy group AARP.

Daschle maintains the efforts to bring about universal health coverage in the first two years of the Clinton presidency took too long. In a book published this year, he urged the next president to act immediately to capitalize on the good will that greets any incoming administration. His speech and recent behind-the-scenes meetings with lawmakers and consumer groups address that point.

"We need to be on the offense," Daschle said. He cited other lessons, too. This time around, lawmakers cannot try to address every detail when it comes to legislation.

"Details kill," Daschle said. "If we get too far into the weeds, if we produce a 1,500- or 1,600-page bill, we're going to get hung up on all the details and we're never going to get to the principles."

Once Congress does take up a health plan, it also can't divert attention to other subjects, he said. "Let's not put it down, let it lie there for months and months and figure out a time when we can get back to it later," Daschle said at a Colorado Health Care Summit organized by Sen. Ken Salazar, D-Colo.

Nevertheless, any overhaul will cost a lot. During the campaign, Obama said he planned to pay for expanding health coverage in part by increasing taxes on the wealthy and requiring larger businesses to provide health coverage or contribute a portion of their payroll to a new public insurance plan. The current recession provides a significant obstacle to both options.

Daschle did not provide any details about how the incoming administration would pay for expanding coverage. Instead, he made the case that not dealing with health care would worsen the economic problems because companies such as General Motors spend more on health care than steel and Starbucks spent more on health care than on coffee.

"Health care is going to destroy many of our manufacturing industries unless we fix the system," he said. He outlined an array of problems with the current system: high costs, lack of access and mediocre quality. He said the myth has long been that the U.S. had the best health care system in the world, but statistics and an increase in medical tourism show that is not the case.

Health insurers put out their own plan this past week and it mirrored some of Obama's proposals, including expanding programs such as Medicaid to help out the poor. But the insurers want to require that people buy insurance, while Obama only supports a coverage mandate for children. They also oppose requiring companies to provide insurance or pay into a pool, referred to as the "play or pay" mandate. administration made 15 years ago in trying to revamp the nation's health care system. That means applying some of the lessons learned moving fast, seizing momentum and not letting it go.

Drug Industry Defends Prices

Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson blasted a study in the Journal of the American Medical Association on brand-name medicines and generic drugs. “The contention that brand-name medicines drive up the cost of health care is fatally flawed.” The growth of prescription drug costs in the U.S. has been modest, as evidenced by Centers for Medicare and Medicaid Services data showing that drug price growth was 1.4% in 2007. CMS has also reported that in 2006, prescription drug spending grew at its second lowest level in 11 years. In fact, medicines accounted for roughly 10% of total health spending in the U.S. in 2006 – the same proportion as in 1960.

She said that price trends for brand-name medicines are influenced by many factors, including the significant investment required to research and develop and gain regulatory approval of an innovative drug.

It takes an average of 10 to 15 years to develop a new medicine from the earliest stages of discovery through Food and Drug Administration approval. And only two of every 10 drugs that reach the market ever earn back enough money to match or exceed the average R&D cost of getting them to the marketplace.

What’s more, by the time a medicine makes it through the entire development process, a pharmaceutical innovator often has a limited number of years to recoup its investment and generate the funds needed to re-invest in research and development.

In addition, pharmaceutical prices in America today are determined by market transactions and health plans and payors are able to negotiate for discounts. The plans bring powerful tools to their side of the price negotiations, including the fact that they are negotiating on behalf of millions of patients and can decide whether to cover a drug and the extent of the coverage. For more information, visit www.pparx.org.