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Not perfect, but what legislation ever is? - Health Care Rx Panelists

Not perfect, but what legislation ever is?

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Unlike so many, I find myself being more impressed each time I delve into the new law. This is, ultimately, a piece of legislation that WILL achieve many stated and even unstated objectives:

1. It will extend the Medicare Part A trust fund for just long enough to allow BOTH sides to discuss meaningful reforms to make it truly sustainable.
2. It provides a real commitment to our nation's poor; and strengthens Medicaid at the same time. Here, too, there are opportunities for additional reforms, but this makes clear what our priorities are; and, importantly, demonstrates our national humanity and compassion for those less fortunate.
3. It dramatically reforms our understanding of and right to health insurance. We have never had a federal definition of health insurance and this begins that discussion in a meaningful way.
4. It is financially sustainable, as long as our elected officials do not undo the tax and revenue-generating items.

What do we need to wait for and hope for?
1. Tort reform and/or Malpractice reform. This should have been firmly part of this law, but will have to wait.
2. Sustainable Growth Rate legislative reform: This is universally recognized as necessary and putting it off, even for a few months, is a big disappointment.
3. Implementation of insurance regulation and insurance exchange regulation will be the first real tests of the success of the law.
4. Taking the Medicare savings and law changes as a first step; and not ignoring the very real legacy costs that we still have to address. AND working with the private (for-profit and not-for-profit) sector to develop a structure and process for improving the delivery of high-quality health care with consideration of cost.
5. Revisiting the notion of better patient education and not being scared off by hateful rhetoric. Discussions around end-of-life and compassionate care should not be politicized or used for pure political gain.

I remain very optimistic about this country and about seeing our elected officials, of both parties, come together around common goals and purposes. In the mean-time, I am proud of the many elected individuals (and their staffs) for having stood behind their promises and made this a reality.

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Not Lucy Ricardo, but not Godot - Health Care Rx Panelists

Not Lucy Ricardo, but not Godot

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It's better to take more time rather than rush through a Pandora's box of perverse incentives like the 1,900-page House bill (HR 3962). The quality of the reform is far more important than the date of enactment. At the same time, that doesn't mean it's OK to kick back and relax for another 15 to 20 years.

Open the House bill and out flies a menagerie of stinging things: Job-killing employer mandates, payroll taxes and surtaxes. Hazy market rules to be set and re-set by a powerful "Health Choices Commissioner." A public option menacing private markets and amplifying the financial disasters of Medicare and Medicaid. Onerous red-tape and reporting requirements for firms and individuals. Dozens of new government agencies. New incentives for lawsuits. And a staggering price tag, according to the nonpartisan Centers for Medicare and Medicaid Services (CMS) and the Lewin Group (which analyzed an earlier, but similar, version of the bill).

Reform that improves on the status quo must meet several conditions: Lower costs over the long haul. No damage to the quality of health care. No bureaucrats interfering with doctor-patient decisions about care. Easier shopping for health insurance. And above all, no threat to Americans' financial security.

HR 3962 fails on these counts and more. Far better to tear off a few more calendar pages than to rush through a destructive assault on one-sixth of the U.S. economy. No segment of society needs reform more than small business does. Millions of independent firms and their employees have struggled with suffocating costs and administrative burdens for nearly a generation. The status quo is unacceptable, but the House bill shows how to make things even worse.

So what's the ideal pace for the Congressional proceedings? The actual pace seems to alternate Waiting for Godot (talk, talk, talk) and Lucy and Ethel in the chocolate factory (1,900-page dump-and-vote). Something in the middle would be nice.

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(NOTE: At this writing, the new Senate bill isn't out yet.)

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Keep employers in the driver's seat - Health Care Rx Panelists

Keep employers in the driver's seat

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My spirits tend to sag a little bit at this time of the year. I'm pretty sure it's a sunlight/Vitamin D deprivation sort of thing. But the health-care non-reform legislation coming down the pike has me dragging even more than normal compared to the typical Wisconsin November. We've read proposed legislation from the House of Representatives that expands access to care dramatically (with an expanded price tag to boot) while doing nothing to rein in wasteful spending nor drive towards health. In its present state it's just another deferred tax for our children and their children and their children's children to pay. So where's the health-care delivery transformation in the bills being bandied about in Congress? Where's the waste removal effort going to come from? Certainly not from government. And that's why my biggest beef is with the weak employer non-penalties for non-participation.

It's a very simple formula, folks. Public option + weak employer penalties = socialized medicine.

Why do I want to see employers retain responsibility for providing health-care? Because employers -- not government -- will drive accountability, innovation and value in ways that government simply will not.

Can Congress present something by year's end to President Obama? Is it feasible or even necessary? In its present form, I certainly think not. It seems that the House passed its legislation, packed as it is with bogies, knowing that in reconciling their bill with the Senate many of the more left-leaning pieces would be shot down when the moderates finally flex their muscles. At least I hope that will prove to be the case.

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There is no nirvana - Health Care Rx Panelists

There is no nirvana

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I've lived and worked in the United Kingdom and received care in both the public National Health Service and the private sector. As a health economist and management consultant, I've worked with clients in other European countries' health systems along with Canada's.

There is no Nirvana, no Hope-in-a-Health-System pill for us to swallow. The American health system reform challenge won't and can't be solved by importing any single nation's health system into U.S. borders.

Health care financing and delivery in the U.S. has morphed into the oxymoronic "system" it is due to its historic roots based in World War II era wage controls. Sixty years later, a holey, patchwork quilt of incentives has driven stakeholders -- providers, payers, suppliers, and patients -- to our current state of high-cost, low-value, resource-wasting dissatisfaction.

Improving the U.S. system will require us to learn from the best practices of our peer-developed countries' systems; the recipe would include:

- The equity of the United Kingdom's NHS ushered in through the Beveridge Report in 1948
- The satisfied physicians of France
- The mixed public/private system of Switzerland
- The electronic health infrastructure of Denmark.

Furthermore, we'll usher in a new era of participatory medicine where health citizens collaborate in their own care with providers. Today's launch of the Journal of Participatory Medicine formalizes this movement.

With greater involvement of American health citizens, ours will be a uniquely American system that will move the U.S. up from our position as No. 37 on the World Health Organization's global league table of health nations.

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Amelia - "We need to restore competition to the market place"

Competition is great for items like Lexis cars that you do not want eveyone to have. The market sets a reasonable price, and those who can afford them, get them. It is terrible for those items you want everyone to have.

In colonial times, fire departments were competitive companies. You signed up with a company, and got a medaillon which you put on your house. If the Penn Mutal fire dept arrived and your house had a Green Tree medaillon, they let it burn to the ground. Soon we had what we have today, a municipal socialized fire dept which everyone pays taxes to support.

Other advanced countries get better health care as measured by all 16 of the bottom line public health statistics, and they do it at HALF the cost per person. None of them have competitive free market health insurers. You can look at the history of health insurance in this country and see clearly that competition simple does not work in this case.

We can reform it but we need to go much further than the Dems even believe and the Pubs could stomach.

We need to restore competition to the market place. The first real step happened yesterday when the House voted to repeal of the exemption for health insurers to anti-trust laws. (I find it ironic that the Republicans - the champions of capitalism - didn't vote for this.)

The next step is to restore consumer influence on costs. I think that means requiring providers and insurers to publish the real cost of services. They do this in Singapore. Negotiated rates between providers and insurers leaves the consumer out of an ability to influence health care costs - consumers are only choosing based on premium, co-pays, and co-insurance. I would even suggest we do not allow insurers to negotiate rates with providers.

We need to remove the burden of providing heath insurance from business. Our business cannot compete on a global market while bearing the constantly increasing cost of health care. Go to The Kaiser Family Foundation web site for more information, but note the decreasing number of employers who offer health insurance and, particularly, the statistics regarding employer health insurance at small businesses, the jobs engine of our economy.

We need a public option to cover those who cannot afford health insurance and a mandate that everyone is required to have health insurance.

As long as insurers are allowed to negotiate rates with providers, Medicare, Medicaid, and any public option insurance run by the government should be allowed to negotiate rates, too. No, not allowed - required.

All this just food for thought. But, what the Dems propose and the nothing the Pubs propose is not enough to bring capitalism's advantages and constraints back into the health care industry.

The problem is that people are heatedly fighting public option out of ideology. Conservative leaders, who will always be able to afford health care, denounce pubilc option, then the followers repeat their words.

Even after an avalanche of propaganda and pathetic scare tactics, a solid majority of American people support public option. Every industrialized, 'civilized' nation (and a few that are not) have humane health care policies.

After the decimation of our economy in the nation of 'free-market' capilalism, the ideological arguemtns against public option are bankrupt. Rev. Bookburn - Radio Volta

We came together during WW2 for a common cause, and could do so again if we had the national will. Some things are just the right thing to do. We seem to be a religious nation - where is the outcry? Are we not so concerned about the health of the born as the unborn? Cut with the arguing, the discussions about socialism, and just agree it has to be done. Then figure it out. It won't be perfect and may require some sacrifice or adjustment by all of us.

I recently read J.R. Reid's book the Healing of America in which he compares the health care system in various countries. I seems clear to me that among the major industrialized countries we have the worse health care system for people. It is interesting that Germany's system was developed by Bismark who was an avid anti-tax leader. On the other hand, we have the best system from the perspective of the health care industry. It is all a matter of perspecive. Our political system needs money to support reelection and the policies that come out of congress reflect that fact.

I am a mathematician and the inability of smart people to face facts on "tort reform" is driving me nuts. These facts are clear. States with tort reform not only have no lower health costs, but the frequency of tests and treatments is similar to those states without tort reform. Trot reform , caps on malpractice suits, does not save money. If you go to page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, you will see much of the data.

Is there any way I can get people to face facts besides going to the Mall, pouring gasoline over myself, and lighting a match?

There may be no panacea, but there are some things than can & should be done in the US:

1) Tort reform is necessary - no other country has this problem, & other country's systems never had to deal with it.

2) Insurers must not be allowed to "cherry pick" the healthiest clients by denial of service, and must offer the same level of benefits at the same price for all.

3) Youths must be covered under parents policies up to age 26 at least, so long as they are in school

4) Everyone must buy in, and those without employment or otherwise indigent should be covered by Medicare/Medicade - these would provide the "government option".

5) Government should re-structure health insurers as "Non-profit", and control the outlandish CEO salaries & perks these companies pay.

6) Government should establish a universal health claim form and procedure codes that all insurers, hospitals, and physicians use to make & pay claims.

If the plans being debated do all these things, then universal coverage just might work here.

How to figure out 2 + 3

Suppose we had the problem of determining 2 + 3. We had been using 23 as the sum which seemed pretty reasonable, but it hadn't been working out so hot. The rest of the world has been using 5, and they've been getting pretty good results. They live longer than we do. Their babies weigh more at birth. And so on. AND they've been saving a bundle.

So we say we're gonna reform our 2 + 3 policy. We gonna consider every and all possibilities and pick out the best. I like 6; it works well for the product. Why not for the sum?

BUT wait a minute. We want a UNIQUELY AMERICAN solution. We will not consider 5. We won't even discuss 5. Our newspapers will delete 5 from their fonts. If you try to talk about 5, YOU WILL BE ARRESTED! We sure don't want to do what them damn ferriners do.

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NFIB's Take - Health Care Rx Panelists

NFIB's Take

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I'll defer to National Federation of Independent Business (NFIB's) official statement, from Susan Eckerly, Senior Vice President:

"Today's Finance Committee vote is pivotal as we evaluate the future of comprehensive health-care reform. NFIB appreciates the many provisions in this package that reflect small businesses' needs, which are rooted in approaches that aim to lower cost, increase coverage options and provide real competition in the private marketplace.

"We commend committee members for ensuring that an employer mandate and public option were excluded from the revised package. While NFIB greatly appreciates efforts to hold the line on these issues, we have strong concerns that, moving forward, attempts will be made to weaken the framework established by the Finance bill. We deeply believe that if any of those attempts are successful, they will derail health-care reform altogether.

"This is the only comprehensive health-care reform bill that provides a meaningful pathway to achieve the goals long supported by NFIB, including:

-- Individual and Small Group Market Reforms - Federal rating reforms in the individual and small group markets are essential to any reform effort, and must include protections against pre-existing conditions. It is imperative that the variation for age, geography, family composition and personal behavior are preserved or strengthened, but not lowered, as this legislation moves forward.

-- Health Insurance Exchange - An exchange modeled on provisions under the SHOP legislation (S. 979) will improve competition, allow small businesses and individuals a broader choice of plans and create a simpler and more efficient way to purchase insurance.

-- National Plans/Interstate Sale of Insurance - Allowing national benefit plans to be purchased across state lines can and will produce competition. The interstate purchase of insurance has been proven to foster competition in the marketplace, and gives additional options to consumers.

"NFIB has been a constructive participant in the health-care debate and has spent more than a decade voicing our need for reform. As floor debate begins, small business must weigh the benefits of reform against the potential new costs of doing business. Small businesses will have a difficult time supporting a final health reform package if its long-term costs outweigh the benefits we have worked to secure.

"NFIB remains committed to supporting reform efforts that provide more affordable and accessible health-care options for small employers and their workers. It is essential that a final bill makes their core needs and common-sense solutions a priority."

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14-9 and Still Counting - Health Care Rx Panelists

14-9 and Still Counting

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Sen. Baucus may have won a hotly contested playoff game, but a tougher divisional match and ultimately the championship still lie ahead. In the weeks and months to come, what the House and Senate produce will say as much about President Obama's political game and the legislature's resolve as it will about the fundamental American ethos. Since its inception and the framing of the Constitution, the American republic has been rooted in John Locke's theory of individual rights and shaped by competing Federalist views. We've espoused the mantra of limited government but with bipolar tendencies toward expansive federal programs (i.e., Social Security and Medicare). Historically, we've tolerated government incursions in health care but only when it concerned the purview of the deserving poor, disabled or the elderly.

On the other hand, our individualism has been tempered by a righteous sense of empathy and social fairness. Even so, the question lingers: are we ready to climb that proverbial Mount Everest of ideological shifts? Will we foray into that cultural tempest of universal coverage? Or will the heavy burden of government-sponsored anything scare us back into the arms of familiar traditions? At stake, will be a broken system and the millions of uninsured.

Indeed with the Finance Committee's 14-9 vote, the Congress undoubtedly inched closer to advancing what has been an arduous path to reform. Odds are some form of health legislation will pass, but whether the final incarnation represents substantive change, however, remains to be seen. The Baucus bill, the least politically offensive, won the coveted moniker of bipartisan, though barely. In exchange for a lone Republican vote and in the hopes of assuaging more conservative Democrats, Senator Baucus abandoned the public option. Instead he pegged health-care cooperatives and insurance exchanges as a viable alternative. These approaches, inherently weaker in nature, will unlikely wield enough leverage against an insurance industry, which in recent days has proved onerous and sadistic.

If individuals will be mandated to purchase health insurance then the public should be offered meaningful competition, which is best achieved through a more muscular government-backed option. The insurance industry and many others in the health-care sector are poised to reap an influx of potential customers. The Finance Committee proposed safeguards to protect ordinary citizens. It ensures guaranteed issue and caps annual out-of-pocket expenses. Rather, it concedes variations in premiums based on age, family composition and tobacco use. Ultimately, it leaves open the door for consumers to be bullied by gluttonous industry practices.

Throughout history we've acted out-of-character. Nixon, a limited-government Republican, proposed employer-mandated coverage in addition to a form of public option. Likewise, both Republican and Democratic administrations have tolerated a "backdoor approach" to universal coverage with incremental expansions of Medicaid. But yet again history is calling. And, if we follow the leads of FDR and Johnson we may be able to do something bold and characteristically American.

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Missing the Forest for the Trees? - Health Care Rx Panelists

Missing the Forest for the Trees?

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Mandates, whether for individuals or employers, are one of the most critical issues in the reform debate. Republicans fear employer mandates will impose significant financial burdens on companies and put them out of business. Democrats argue that employers have to take responsibility for the health of their workers. Both have a point.

Is it realistic to believe that if employers were not required to contribute funds to employees' health plans, they would reinvest that money into salaries? These days, sadly not. It follows that many businesses, fighting to stay alive in a global downturn, may choose the path of self-preservation and least expense. And if that path leads to a fine, management may very well choose it.

That's probably true in many, if not most, cases. Fortunately, there are a few notable and laudable exceptions in the business community. Starbucks, for example, is a successful American company that provides health benefits to all of its full and part-time employees. They serve as the example that comprehensive employee coverage and success in business aren't mutually exclusive.

On the other hand, if we legislatively compel employers to contribute to workers' health plans and the costs put them out of business, unemployment rises and with it, the ranks of the uninsured. And then we're back at square one because we'll be worse off than we currently are.

Rather than becoming mired in a debate about the means, let's focus on the desired end: How do we ensure that workers have good, reliable and continuous coverage without breaking the backs of America's small businesses?

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Keep Sight of the Goal - Health Care Rx Panelists

Keep Sight of the Goal

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For the past 50 years, Americans have looked to their employers for their health care. This has been so prevalent that most Americans have not even considered looking elsewhere for health care coverage until recently. Employer health plans are no longer the solution as these same plans have contributed to the downfall of many of those companies that offered them. In Michigan, the big three cite the costs to carry those plans as a factor in their inability to be competitive with imports made by companies that don't have to factor in exorbitant health care plans -- competitors whose employees for the most part have universal health care coverage.

Employers, like everyone in America, need to be part of sweeping health care reform. They need to contribute in the form of a tax or partial contribution to employee premiums. This will help offset the cost of covering everyone while still relieving major companies of high costs associated with employer plans. We can't lose sight of the goal: to provide affordable and equal coverage for all Americans. With or without mandates, the current proposed plan still falls far short of that goal.

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Killer Tax on Low-Income Workers? No! - Health Care Rx Panelists

Killer Tax on Low-Income Workers? No!

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The Finance Committee was right to keep an employer mandate out of health reform. It's a bad idea in good times. It is a really bad idea during a deep recession and has no place in health-care reform.

An employer mandate (or equivalent payroll tax or play-or-pay) is inefficient for several reasons: It doesn't reduce health-care costs and, instead, substitutes a hefty and direct penalty on the very people struggling to pay for insurance. It does nothing for the unemployed, self-employed or early retirees. It harms small and vulnerable firms, ultimately costing the economy jobs and revenue, which is particularly destructive in the current economic environment where hiring is stagnant and unemployment is climbing to nearly 10 percent.

There is consensus among most economists that an employer mandate is ultimately a tax on low-income workers, depressing the wages of some and throwing others out of work. In fact, Obama adviser Larry Summers explained how employer mandates cause unemployment among low-wage workers. Employer mandate advocates defend their position as "shared responsibility," an argument eloquently refuted by Obama adviser Ezekiel Emanuel and Victor Fuchs in "Who Really Pays for Health Care?: The Myth of Shared Responsibility":

"Employers do not bear the cost of employment-based insurance; workers and households pay for health insurance through lower wages and higher prices. ... Failure to understand that individuals and households actually foot the entire health care bill perpetuates the idea that people can get great health benefits paid for by someone else. It leads to perverse and counterproductive ideas regarding health care reform."

An employer mandate would do its worst to small-business owners and employees. A 2009 NFIB study (and summary) predicted that an employer mandate could destroy 1.6 million jobs (over five years), around one million of them in small firms. An employer mandate is especially devastating for the newest and most vulnerable businesses. Mandates lay heavy burdens on small firms, increasing their administrative loads and causing additional cash-flow problems, especially during their first five years. A mandate gives employers strong incentives to cut wages, replace full-time employees with machines or exempt part-timers, or to turn to foreign outsourcing.

Forcing small businesses to provide a benefit they and their employees can't afford won't solve the problems of our health-care system.

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Just a Distraction - Health Care Rx Panelists

Just a Distraction

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The employer mandate is a distraction in the health-care reform debate. Most Americans favor universal coverage regardless of employment. However, no one is sure how this will be funded. Meanwhile, those with insurance are defending their positions. The seniors do not want to lose Medicare benefits while those with employer coverage want to preserve it.

Sadly, both government and industry have poor track records in health care. Companies can no longer afford escalating health costs, particularly in a global economy. The auto industry has already buckled under such pressures. The federal government is destined for the same fate. Without additional tax revenue or reduced spending, Medicare will be insolvent within 10 years.

We need to return to fundamentals. The principle of universal coverage is that everyone contributes to this common good. This means a shared view of its value, and its affordability. We are a long way from that enlightened perspective. Health care has become a free-market circus, tying our political process in knots and confusing the American public. Because of this, we are mired in details like the employer mandate.

The founders of our country understood the value of aligned public interest. It started with the early settlers' notion of the "common", a public grazing ground shared by all. That same philosophy led to broader public interests like national defense and public education, which American taxpayers value and support.

The time has come for health care to be treated in the same way.

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What specifically is Dr Kelley advocating for? I hope he is not really advocating for a return to colonial days when the "common good" was determined by the financial elite (which he is currently a member of) even more than it is now. Seems to me that his notion of "common good" may be more in line with his interests as highly paid executive at Henry Ford Health System. President Obama has clearly outlined the principles and specific cost strategies of health reform that will significantly help all Americans. We will all bear the costs "proportionately"..ie, if you own more of the commons area you will pay more.

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About this Archive

This page is a archive of recent entries in the Employer health plans category.

Electronic medical records is the previous category.

Health Care Reform is the next category.

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