quinnscommentary

I am assuming that the pending health care legislation is signed into law by the end of January 2010, not much a risk in that assumption.

Don’t go to the doctor with every distemper, nor to the lawyer with every quarrel, nor to the pot for every thirst.

Along with enactment come a myriad of new regulations, direct and indirect taxes, cost shifting and creative accounting for the federal budget.  In other words, a somewhat less than honest presentation to the American public of what it takes to truly reform health care in the United States, a goal yet to be reached even with this legislation.

So what would it take to reform health care and be honest with all stakeholders?

Here are a few thoughts; you can likely add some of your own.

1. Look folks, high cost does not equate to high quality health care.
2. The fee-for-service payment for health care provides the wrong incentives and rewards and has to change.
3. Health care can never be affordable (or of the highest quality) if you follow the concept that nobody will ever come between you and your doctor when making treatment decisions
   1. Not every procedure or test that is ordered is effective or medically necessary and in some cases they should not be paid for.
4. Some inconvenience in receiving health care is a fact if we are going to manage costs.  That means you may have to travel longer than five minutes to receive a test or the closet hospital may not have every service possible.
5. As long a you are not paying for 100% of your own health care, the people who are (that’s all of us) do have some say in how the money is spent.
6. Health insurance was never intended to pay 100% of every health care expense, it is insurance (or was originally) and thus intended to protect you from unforeseen, unmanaged medical expenses, not pay for routine expenses. You have a personal responsibility to pay many of your expenses and those expenses come before other things you may wish to spend money on.
7. One of the drivers of health care costs is the fact that most Americans do not have a direct financial stake in their care.
8. Americans, if you want to help control health care costs, get in shape, change your lifestyle, and maintain your health.  This is your responsibility even if it costs you money to do so.
9. You do not have a right to not carry health insurance (because it is impossible for your health care expenses not to affect other people in one way or the other).
10. The favorable tax status of employer based health benefits is unfair to millions of Americans who pay for their own coverage, at a minimum there needs to be some limit on how much of a tax free benefit each person can receive.
11.  Assuring that all Americans have access to health care and that the cost of providing that care is spread fairly among society requires a great deal of money.  To truly pay for basic health care for all Americans requires that each American pay 8% of his or her income (a rough estimate) toward that goal.
12.  Health insurance companies are not responsible for controlling health care costs, you are.
    1. The premiums charged by insurance companions are not the problem; the problem is that insurance premiums are high because of the underlying cost of the care provided.
13.  Affordable health care cannot be sustained while maintaining today’s income levels for physicians, especially for many types of specialists.
14.  Advertising for prescription drugs and health care services, hospitals, etc. serves no valid purpose other than to generate additional revenue for the advertisers and must stop and be replaced with fact bases resources so patients can evaluate all health care options and services.
15. There is no valid reason for the best treatment technique of any kind to be an exclusive right of any hospital or organization but rather should be shared across the U.S.
16. Health care costs will continue to increase at rates above general inflation no matter what is done with legislation as long as we have an aging population, expect the latest in technological advances, indirectly subsidize other countries health care costs, maintain a largely fee for service system, do not change our lifestyles, continue to have unrealistic expectations for the health care we receive and play politics with health care.

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Bob Herbert writing in the New York Times December 29 outlines the real impact and assumptions surrounding the 40% tax on so-called Cadillac health plans contained within the Senate version of health care reform.  This tax, the revenue from which is based on absurd assumptions will adversely affect more and more middle class families in the future as employers (none of whom will actually pay the tax) reduce benefits to stay under the arbitrary cap set by this legislation. 

This is just one of the several less than honest ways in which this legislation seeks to change health care and how it is paid for.

Oh calm down, you voted for change didn't you?

As I have said many times on these pages, the “savings” generated in all of this have little to do with the millions of Americans who have health insurance, especially those with coverage through an employer.  Rather, at least for the next ten years, the combination of changes including those affecting Medicare and Medicaid, the cost shifting, new mandates and more combine to increase costs for already covered Americans.  In addition, the increased obligations for the states through expanded Medicaid benefits will translate into higher local taxes for residents in those states (except Nebraska of course).

As Herbert notes, a little honesty would be nice.

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The obvious absurdity of what we are doing with health care in America is most evident in the statements of the supporters of the current legislation.  Simply put, they miss the boat and focus not on the problems, but on the symptoms.  A good example of that is the position of the AMA (an organization as bogus as the AARP in terms of representing its supposed constituency).  Consider this excerpt from a letter to the editor of the Wall Street Journal by the President of the American Medical Association. 

HEY, IT’S MY JOB TO PROTECT OUR FEES…THE INSURANCE COMPANIES PAY TOO LITTLE

Our current health system is fragmented, and it’s not working for far too many patients and the physicians who dedicate their lives to patient care. Reform of our health system is needed, and the Senate bill includes key benefits that will increase choice and access while eliminating insurance company tactics like denying coverage for pre-existing conditions. 

What we fail to understand is that the fundamental problems of health care in American start when you enter a doctors office, not when you file a claim.  Forty- eight years of managing health benefits and of hearing claim appeals from employees tells me very clearly that people don’t get it, they want it all, they do not want to pay for anything, they think every test and procedure ordered by a doctor is warranted, and they never ask why something cost so much, but they always ask why the health benefits did not pay more.   That is what is wrong with health care in America.

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I just listened to the President speak on the success of the health care reform legislation and then take a slap once again at insurance companies. He was full of promises from lowering costs to bending the increase curve to improving quality. Shortly after the speach I read an article in the Wall Street Journal about how employers will be cutting back on retiree benefits as a direct result of new taxation contained in the legislation.

I suppose the President is no different from any other politician but given more than half of Americans are not comfortable with these changes a little honesty would be refreshing.

I can’t take credit, but here is a good assessment of health care reform I read. Take a look.

Health Policy News

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Politico.com is reporting that the White House expects health care reform talks to go into February and not be finalized until after the State of the Union address.

There appears to be growing discontent in the House over what is or is not part of the Senate bill.

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The devil is in the details they say, so here is a detail that should draw the attention of large employers.  This is from a section of the Managers Amendments recently issued by the Senate.  On its surface it appears rather bland because all it requires is for the Secretary of HHS to cull data from existing Form 5550 filed by self-funded employer plans.  

‘‘SEC. 1253. ANNUAL REPORT ON SELF-INSURED PLANS. 

‘‘Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of Labor shall prepare an aggregate annual report, using data collected from the Annual Return/Report of Employee Benefit Plan (Department of Labor Form 5500), that shall include general information on self-insured group health plans (including plan type, number of participants, benefits offered, funding arrangements, and benefit arrangements) as well as data from the financial filings of self-insured employers (including information on assets, liabilities, contributions, investments, and expenses). The Secretary shall submit such reports to the appropriate committees of Congress. 

The question is why and why such reports will go to committees of Congress? 

Okay, so we all know why and that is because Congress will be looking for more changes to make in health care benefits.  Two words jump out at me, “funding arrangements.”   Many employers do not have funding arrangements, especially for a non-union workforce.  It is pay as you go. 

Hey, it's for informational purposes only...right Congressmen

Will Congress be looking to tighten up on this, to avoid any risk for plan participants, it is actually a problem?  Who knows, but you can be certain that some member of Congress will find a way to get into your knickers sooner or later because you all know where the devil lies.

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Regardless of your views on government involvement in health care, perhaps we can all agree that once politicians get into the act anything is possible including the wartering down of key provisions of pending legislation. Consider the all important 40% excise tax on high cost health plans. Already, the groups exempt from the tax are growing the latest union to be exempt is the longshoreman. Miners, some fisherman, electrical lineman and even the 17 states with the highest health costs get a deal on this one.

So, you have to ask yourself if this provision is so important in controling health care costs, how can we have all these exceptions and still reach the revenue and cost control goals?

Of course, the answer is you can’t but then again this tax achieving it’s stated goal was never a reality any more that the assumption that lowering the value of health benefits by employers to avoid the tax would translate to higher wages.

For those of us who shall we say have reservations about the ability of Congress to keep it’s hands off the final legislation for more than a month, this deal and others contained in the legislation give a good indication of what is to come and it is not higher quality, affordable health care.

State legislatures have been adding to the health care cost problem for decades with special interest benefit mandates and other restrictions and rules. Is there any reason to believe Congress will be different (although perhaps more stealth)?

Americans should be concerned what is lurking behing secret doors number 1,2 or 3.

You have to give Congress credit though, nobody will ever know what this all costs or how much they are truly paying for “reform.”

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As we get closer to health care reform as defined by the Democratic administration, we have legislation that everyone loves to hate, but we have it nevertheless. 

Liberals hate it, Republicans hate it, Conservatives hate it, the majority of Americans do not want it in the current form, and scores of interest groups do not like it for reasons that range from abortion to taxation, to Medicare cuts, to new administrative burdens on employers and insurers. Noted health experts make it clear that this legislation does not either address the real quality or cost issues.  The legislation supposedly saves money for the federal government by shifting costs to those Americans who already have health insurance, to the states, to many Medicare beneficiaries, to insurers, to employers and health care providers and according to the CBO by 2019, there will still be 23 million uninsured Americans. 

The legislation lacks any bi-partisan support; the House of Representatives passed its version by a small majority and the Senate by the minimum 60 votes.  To gain support from Senators individual deals were made left and right.

The stated objective of health care reform is to make quality health care affordable to all Americans.  There is little to improve the quality of health care in the general population, affordable remains defined as adequate subsides to buy health insurance the cost of which will remain out of control.

What happened, in a word, politics? What a way to run a country.

On to the House and Senate Conference.

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Well, it is one step closer to a done deal as they say.  Health care reform that will save the government money and by 2019 still have 23 million Americans without health insurance (although 1/3 of that number would be illegal immigrants).  Of course, the money saved comes from reduced payments under Medicare, cuts in Part C of Medicare, a new 10% sales tax on tanning salons (who cares), the 40% excise tax on high cost plans (expected to generate $35 billion in revenue in 2019) good luck with that and penalties paid by people who do not obtain coverage plus an increase of .9% in the Medicare tax for individuals who earn more than $200,000 a year.

Sen Ben Nelson cut a deal (despite the fact his office staff told me there was no way he was voting for the bill for many reasons) part of which is that Nebraska will have the entire additional cost of the Medicaid expansion under the legislation picked up by the federal government while other states will see an added expense for Medicaid in 2017.  There is a national view of doing the right thing.  I suspect Nebraska has a huge Medicaid population compared with New York, New Jersey and California.

Believe

The CBO estimates a lowering of the deficit by $132 billion over ten years as a result of this legislation (but an increase in insurance premiums for many people who already have coverage). That includes $72 billion in revenue for the new long term care insurance that will automatically enroll workers unless they opt out.

If there is anyone who believe that the federal government can estimate anything accurately over a ten year period or that future Congresses will not tinker with all this starting in  2010, make sure you leave some cookies and milk for Santa.

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