In all the discussion about the auto industry’s financial problems, health care costs for retirees are often brought up as one of the major challenges the big 3 domestic companies. This is not a new issue, and one that I actually researched in the early 1990s when I worked for a Congressman from the Detroit area. What is new is that the companies had worked out an arrangement with the United Auto Workers union to turn paying for retiree health costs over to Voluntary employees’ beneficiary associations (VEBAs). These VEBAs – one for each company – were created in the fall of 2007, and were funded by the companies as a way to relieve the them of the unpredicatbility of future costs for retiree health benefits starting in 2010.…
Health Reform – Achieving Universal Coverage
During the holidays the Obama Health Transition Team urged people to organize discussions about health care in their homes and communities – and then to report back. Reading about these discussions – including the one that Secretary Designee Tom Daschle attended in Indiana – made me think about what things are going to be needed to make health reform actually work.
My end-of-year reflections and ruminations led me to conclude that one of the most challenging parts of health reform will be to actually get more people enrolled in whatever expanded coverage plans are developed and implemented. Enrollment barriers are not new, but they are frequently not highlighted because they may present great political and fiscal risks.…
Transparency v. PAYGO in Health Reform Legislation
One of the looming questions for health reform legislation in the 111th Congress is how will it be paid for? Or will that be less of a concern because deficit spending in a recession is deemed to be OK?
In earlier times, (i.e., 1990s), the projected costs of legislation had to be “paid-for” under the so-called PAYGO rules – which stands for “pay-as-you-go.” However, in recent years those rules have lapsed or been waived.
Three recent nuggets of information indicate that transparency in the legislative process may be replacing PAYGO in the coming years. First was the Obama Transition Team’s extra-ordinary level of transparency, exemplified by their policy of having information from all meetings with outside groups being posted on the Change.gov…
Health Reform – How Much Expansion?
Morton Kondracke, a columnist for Roll Call newspaper, (sorry on-line subscription required to read the full article), had a very interesting and insightful piece yesterday where he outlines some of the reasons that health reform in 2009 will be more expansive than in might have been a few years ago.
He makes two very concrete and connected observations. First, that the economic downturn will increase the number of people without health insurance by 5-6 million, and probably add a similar number to the rolls for Medicaid and SCHIP – which will add to States’ budgetary problems. And second, that the costs of health reform are likely to be much greater than expected – assuming of course that there isn’t a dramatic economic rebound. …
Making Physicians Better, and Making Better Physicians
A few recent reports point to ways for improving the quality of physician delivered care that has little to do with technology or complex interventions. The first involves how physicians interact with patients, and the second examines the work hours for physicians in training.
Etiquette in Medicine
The first article, by Dr. Michael Kahn in the New York Times, describes six recommended actions for physician to create a good rapport with hospitalized patients. Dr. Kahn collectively calls these actions “etiquette-based medicine”:
- Ask permission to enter the room; wait for an answer
- Introduce yourself; show your ID badge
- Shake hands
- Sit down.
Healthcare Consumerism, Deductibles and Copayments, and HSAs — More from HUMANA
Humana’s “educational” YouTube video series expanded this week with three new videos that range from benign, to strangely confusing, to something else.
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The first video, “Deductibles and Coinsurances,” does a reasonable job of explaining the different ways people can pay their share of healthcare costs after the monthly premium, i.e. what is a copay, and how a deductible is applied. The one area where they could have been clearer is explaining that a co-pays and coinsurance both are the portion that a patient pays for healthcare services, but that a co-pay is a fixed dollar amount, while coinsurance is a percentage of the costs of the service, i.e.…
Baby Biotechs Treading Water
Monday’s Boston Globe had an article about how smaller biotech firms are having to cut spending to stay afloat since the current economic environment has made it almost impossible to raise more cash. This shouldn’t be surprising given that these companies spend years (and years) developing new treatments and technologies before they are ever able to sell anything – assuming that their R&D does produce something that can be sold. And the investing/lending world is currently not very interested in such long-term and speculative prospects. The immediate result is that these companies are laying people off, reducing their office space and actually mothballing research projects.…
Humana Does Drugs
Humana has put another couple of videos on YouTube in their ongoing series to explain – from their perspective – how the healthcare system works.
The first new video is “Insurance Companies and Prescription Drugs.” Like their other videos, this one paints the insurance industry’s as rosy and altruistic, while stating that “Prescription drug manufacturers are allowed to set their own prices, and they often build large profit margins into name brand drugs to recoup the costs of researching, marketing and advertising.”
This statement strikes me as very curious. First, how do companies “build large profit margins into name brand drugs?”…
Another Humorous? Humana Video
Last week I wrote about Humana’s YouTube videos designed to “explain” parts of the healthcare system. Well they just put another one titled, “Some Doctors Cost More. Why?”
Two interesting points about this video: First, at the beginning they describe insurance companies (like Humana) as “Providers.” (The narration uses the term “health coverage providers,” but the graphic shows “PROVIDER.”)
While physicians and other clinicians really dislike being called providers, I think they wouldn’t want to see that term used for insurance companies either, since it implies that the insurance company is actually providing healthcare. (I usually reserve the term provider to describe broad groupings of clinical entities, such as, “providers of oncology care in the Chicago area,” – which would include physicians, nurses, hospitals, etc…)
And second, the title and content of the video doesn’t focus on the total costs of care or services provided by individual physicians, but mostly only patients’ co-pays – which are lower when they use the physicians that are in-network for their insurance plan.…
Managed Care/Health Insurance Direct-to-Consumer Advertising or YouTube Educational-Propaganda Videos?
I saw a very interesting couple of videos today put on YouTube by Humana – the managed care insurance company. Apparently they are the first in a series that they are calling “Stay Smart Stay Healthy.” According to an email I got today promoting the second video, “Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry. Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.”
While that sounds like good corporate citizenship, the actual content of the videos doesn’t seem quite so innocent.…
Spreading the Wealth
In the Presidential campaign, one of the criticisms of Barack Obama’s positions was that he wanted to, “Spread the wealth.” This sprung from a comment he made to Joe “the Plumber” Wurzelbacher in Ohio about his tax proposals not increasing taxes for anyone earning under $250,000/year. This was one of the issues that was pretzelized in the closing weeks of the campaign, which is why I was interested to see a graph showing the income distribution in several developed western countries in a recent issue of the Economist in an article titles “Pain all around, please.”
This chart – using OECD data – shows that while all these countries have wide distributions between the highest and lowest income groups, the spread in the United States is by far the greatest. …
McCain Plan Would Tax 100% of Health Insurance Costs
I had a revelation tonight at an event about women’s health issues in the Presidential election at the Kennedy School of Government’s Institute of Politics. One of the speakers was Gail Wilensky – a Senior Health Care Advisor to Senator McCain’s campaign. I asked her a question about how Senator McCain’s proposal to eliminate the tax deduction for employer provided health benefits would effect non-profit organizations since they don’t pay taxes.
Gail Wilensky’s answer really shocked me. I’ve been doing health policy work for about 20 years, and following the election’s health issues for the last year. What she said was that it wouldn’t matter whether the person worked for a non-profit or a for-profit company, since the employee would be the one paying tax on the entire cost of their health insurance – whether it was their contribution, or dollars coming from their employer.…