Saturday, April 11, 2009
Health insurance problems solved...or not?
LOOKING AHEAD by Wally Dobelis
US health insurance is dysfunctional and in need of repairs. Some 46M Americans are under- or uninsured. They abuse the hospital emergency rooms, at an average cost of $560 per visit of those under age 45, and $832 for 45-64 (2003 figures, per AHRQ). Later figures put the overall average at $2000 for admittedly senior-heavy Florida. The private insurance plans cannot accommodate all of us consistently longer-living Americans with increasingly expensive chronic healthcare problems at the same premium rates. The President has charged the US Congress with developing a reform program.
First, use of private insurance. Disingenuously, some newspapers (e. g. Miami Herald, 3/31) have discovered that people with certain impairments and using heavy drugs cannot buy insurance. They call it using a secret blacklist. They ignore the fact that insurance is the social remedy whereby people with like health history buy age-rated insurance to pay for those who get impacted by a disease, whenever it occurs. Rating up or excluding heavy risks is the just way to spread the exposure among like groups of population. The same people who readily complain that mortgages were issued indiscriminately, to both people with ability to pay and those who could not pay, thereby endangering both groups, not to speak of the national economy, now are complaining of discrimination, snooping and worse. Insurers, like banks issuing mortgages, do not want to buy a claim.
This puts privately financed 100% insured health insurance in the realm of impossible .Further, the reform measure of eliminating tax-exempt employer-provided health coverage and replacing it with private personal insurance (once McCain’s suggestion, now somewhat embraced by Obama), which deemed such employer contributions a tax break for the firms and their upscale employees, will not be bought by organized labor. It would profoundly upset the economy and personal lives. Single-Source Universal Coverage with decrees reforming physician and hospital compensation plans, like those already in Canada, UK and much of Europe, though totally revolutionary in social context for the US, would be much simpler to implement. That’s what was already in the hopper in the early 1990s Clinton years, eventually found useless and tossed away without much ceremony. Today, although both houses are in Democratic hands, it would take a longer wasted discussion effort to dissimilate.
There does not seem to be much doable in updating current insurance coverages, although it would help if the government were to establish qualified group plans, and improve premium rates for individuals and small businesses, along with simplifying procedure costs through uniform electronic health records. The latter has been objected to by defenders of privacy (HIPAA, Gramm-Leach-Bliley Act and ACLU) but should be overcome by rational record-keeping regulation processes. According to insurance actuaries, administration adds only 15% processing to the claims cost.
The best would be a separate public plan for uninsurable, high-risk and poverty-ridden members of the uncovered 46M demographic group. Such Public Plan (a truly catchy term apparently invented by NY Times that they think will really fly) could be a near-relative to early Medicare or Medicaid, and would be a means of slowing down the growth of health care costs, by using a CPT code- based schedule of payments. The Public Plan would be enable administration to negotiate lower standard rates with hospitals and physicians, meanwhile providing them with a steady controlled source of income and planned use of equipment, unlike the emergency room rush, which is a material source of higher insurance costs for employers and private insureds. The insurers and political ideologues may consider such a Public Plan a step towards Socialism, but the current anarchy and disparity in health care is worse.
An alternative to the Public Plan, or as a separate project, could be the establishment of low-cost publicly supported clinics throughout the country. Privately funded, they exist in some shopping centers and WalMart stores, 76 units in 12 states. WalMart intends to open 400 in next 3-4 years, expanding to 2000 by 2012. They cooperate with university and BlueCross/BlueShield teams in developing Dossia, an information technology system for privacy- assured recordkeeping and administrative functions. The independently owned clinics are established in cooperation with local hospitals.
Hospitals and doctors worry that a Public Plan might overwhelm its private competitors and destroy the public system, eventually turning into a fully equipped and organized single-pay system. The conservative economists feel that the public, when “properly informed” about the costs of full coverage for 46M of their fellow citizens, poor, overage and heavily medical cost-burdened, will not accept the additional load of taxes needed to provide it (I’d think better of us). They would replace the Public Plan with a portable insurance policy scheme, purchased either inside or outside the employment place. It would enable the insured to move from employment to employment, so regrettably common in the 21st century, without going through the COBRA (federal subsidy for 12mos extension of health insurance for laid-off employees) system, which has also grown very expensive because its utilization is riddled with anti-selection. Tax credits for insurance purchased would be provided. Of course, nothing mandatory in this ‘plan” about coverage for all.
I’d put my money on the WalMart Alternative, now that’s a catchy title (invented here). Washington to copy.
US health insurance is dysfunctional and in need of repairs. Some 46M Americans are under- or uninsured. They abuse the hospital emergency rooms, at an average cost of $560 per visit of those under age 45, and $832 for 45-64 (2003 figures, per AHRQ). Later figures put the overall average at $2000 for admittedly senior-heavy Florida. The private insurance plans cannot accommodate all of us consistently longer-living Americans with increasingly expensive chronic healthcare problems at the same premium rates. The President has charged the US Congress with developing a reform program.
First, use of private insurance. Disingenuously, some newspapers (e. g. Miami Herald, 3/31) have discovered that people with certain impairments and using heavy drugs cannot buy insurance. They call it using a secret blacklist. They ignore the fact that insurance is the social remedy whereby people with like health history buy age-rated insurance to pay for those who get impacted by a disease, whenever it occurs. Rating up or excluding heavy risks is the just way to spread the exposure among like groups of population. The same people who readily complain that mortgages were issued indiscriminately, to both people with ability to pay and those who could not pay, thereby endangering both groups, not to speak of the national economy, now are complaining of discrimination, snooping and worse. Insurers, like banks issuing mortgages, do not want to buy a claim.
This puts privately financed 100% insured health insurance in the realm of impossible .Further, the reform measure of eliminating tax-exempt employer-provided health coverage and replacing it with private personal insurance (once McCain’s suggestion, now somewhat embraced by Obama), which deemed such employer contributions a tax break for the firms and their upscale employees, will not be bought by organized labor. It would profoundly upset the economy and personal lives. Single-Source Universal Coverage with decrees reforming physician and hospital compensation plans, like those already in Canada, UK and much of Europe, though totally revolutionary in social context for the US, would be much simpler to implement. That’s what was already in the hopper in the early 1990s Clinton years, eventually found useless and tossed away without much ceremony. Today, although both houses are in Democratic hands, it would take a longer wasted discussion effort to dissimilate.
There does not seem to be much doable in updating current insurance coverages, although it would help if the government were to establish qualified group plans, and improve premium rates for individuals and small businesses, along with simplifying procedure costs through uniform electronic health records. The latter has been objected to by defenders of privacy (HIPAA, Gramm-Leach-Bliley Act and ACLU) but should be overcome by rational record-keeping regulation processes. According to insurance actuaries, administration adds only 15% processing to the claims cost.
The best would be a separate public plan for uninsurable, high-risk and poverty-ridden members of the uncovered 46M demographic group. Such Public Plan (a truly catchy term apparently invented by NY Times that they think will really fly) could be a near-relative to early Medicare or Medicaid, and would be a means of slowing down the growth of health care costs, by using a CPT code- based schedule of payments. The Public Plan would be enable administration to negotiate lower standard rates with hospitals and physicians, meanwhile providing them with a steady controlled source of income and planned use of equipment, unlike the emergency room rush, which is a material source of higher insurance costs for employers and private insureds. The insurers and political ideologues may consider such a Public Plan a step towards Socialism, but the current anarchy and disparity in health care is worse.
An alternative to the Public Plan, or as a separate project, could be the establishment of low-cost publicly supported clinics throughout the country. Privately funded, they exist in some shopping centers and WalMart stores, 76 units in 12 states. WalMart intends to open 400 in next 3-4 years, expanding to 2000 by 2012. They cooperate with university and BlueCross/BlueShield teams in developing Dossia, an information technology system for privacy- assured recordkeeping and administrative functions. The independently owned clinics are established in cooperation with local hospitals.
Hospitals and doctors worry that a Public Plan might overwhelm its private competitors and destroy the public system, eventually turning into a fully equipped and organized single-pay system. The conservative economists feel that the public, when “properly informed” about the costs of full coverage for 46M of their fellow citizens, poor, overage and heavily medical cost-burdened, will not accept the additional load of taxes needed to provide it (I’d think better of us). They would replace the Public Plan with a portable insurance policy scheme, purchased either inside or outside the employment place. It would enable the insured to move from employment to employment, so regrettably common in the 21st century, without going through the COBRA (federal subsidy for 12mos extension of health insurance for laid-off employees) system, which has also grown very expensive because its utilization is riddled with anti-selection. Tax credits for insurance purchased would be provided. Of course, nothing mandatory in this ‘plan” about coverage for all.
I’d put my money on the WalMart Alternative, now that’s a catchy title (invented here). Washington to copy.
# posted by Wally Dobelis @ 10:46 AM 
