Here's one for a Harvard Business School case study: A few months before voters in the state are going to decide the future of your industry get into a losing battle about retroactively canceling sick peoples' health insurance policies.A unanimous California Appeals Court decision has decided that California health insurers have a responsibility to check the accuracy of applications for health
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The First Year For This Blog
This month marks the first anniversary for this blog.As of today, folks have visited 95,558 times. From less than a thousand visitors that first month, 14,000 a month now visit and that number continues to grow briskly.As long as you keep reading it, I'll keep writing it.
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A November Ballot Initiative Over California Health Reform Would Be The Biggest Thing Ever To Happen In The Debate
With news that California Governor Arnold Schwarzenegger (R) and the Democratic controlled General Assembly have agreed on a health reform proposal we may be on the cusp of a huge referendum on the Democratic version of health care reform.The next step is for the State Senate to approve the plan. The Assembly approved it earlier this month on a party-line vote with Republicans in opposition. The
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Why Couldn't CIGNA Make the Right Decision In the First Place?
The Christmas weekend was full of news stories about a 17 year-old girl who was denied a liver transplant by CIGNA.The insurer ultimately reversed its decision but the girl died a short time later.I have no idea if the outcome would have been different had CIGNA made the decision to approve the transplant in the first place.Health insurance contracts--and government plans like Medicare and
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"Health Care Quote of the Year"
Brian Klepper joins us again today with his nomination for the "Health Care Quote of the Year."Health Care Quote of the Yearby Brian KlepperI was reading through some other peoples’ blog posts yesterday and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston. Paul made news by establishing a blog called "Running a Hospital."I think
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Washington Post: McCain "Has Some Good Ideas on Health Care"
The Washington Post is not known for favoring Republican prescriptions for health care reform. That is why their editorial today calling the McCain health care reform proposal, "the most detailed and thoughtful of the Republican proposals," caught my eye.McCain has gone further in some respects than his Republican opponents on health care. Instead of providing people with a tax deduction, McCain
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The State of Primary Care--How Much Responsibility Do Specialty Physicians Bear?
Our good friend Brian Klepper, posting over at "The Health Care Blog," has some provocative things to say about the state of primary care and the role the specialties, and even the American Medical Association, have had in getting us to where we are.Among Brian's points:"American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes
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The Shadegg Bill––A “Health-Insurance Solution” That Is a Waste of Time
Merrill Mathews, writing on yesterday’s Wall Street Journal op-ed page, asks why Representative John Shadegg’s (R-AZ) “Health Care Choice Act” isn’t a “no-brainer” for the Congress to pass.Shadegg’s proposal would enable consumers to buy a health insurance policy in any state thereby bypassing the states with the most costly benefit mandates. At the top of his costly mandate list are state “
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Health Wonk Review Is Up!
David Harlow over at the "HealthBlawg" has a particularly entertaining holiday edition of Health Wonk Review up. It covers some of the best posts in recent weeks from the world of health blogs.
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Republican Candidates Wouldn't Have Been Able To Get Coverage Under Their Own Health Reform Plans
Republican presidential candidates have called for a greater reliance upon the individual health insurance market. But many of these same candidates have had cancer and wouldn't have been able to get individual coverage under their own health reform plans at the time of their treatment.Ricardo Alonso-Zaldivar had a great story in the Los Angeles Times recently.Ricardo points out that Rudy
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Mike Huckabee's Health Care Plan
Mike Huckabee is now among the front runners for the Republican nomination. So, what is his health care plan?First, he doesn't have a plan so much as a set of principles that would have to be detailed. On the surface he seems to want a lot of it both ways--no more government but lots of new program ideas. For example, he calls for tax credits to help low-income people purchase health insurance
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More People Think Health Care Is An Urgent Issue Than Think The Iraq War Is
A recent Wall Street Journal poll caught my eye.The poll found that 52% said the economy and health care are most important to them in choosing a new president compared to 34% that said terrorism and social and moral issues were most important.That is the opposite of what people thought at the time of the 2004 election.Here's the surprise for me. The poll also showed, "health care eclipsing the
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Pete Stark Regrets the Stark "Self-Referral" Laws!
David Whelan was kind to point out a great story he just did at Forbes.com on the Stark anti-kickback laws and the bans on provider "self-referral."David writes, "Yet in an interview today the Congressman lamented that he ever made this legislative intrusion into medical practices."Congressman Pete Stark (D-CA) went on to say the laws, "gave every shyster and promoter a loophole" and that he
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If Grady Fails--The Crisis At Atlanta's Grady Health System Is A Symptom Of Bigger Problems In The U.S. Health Care System
Brian Klepper joins us again today this time with a post on Atlanta's Grady Health System. Grady is an inner city safety-net hospital now going to extraordinary lengths to remain open. Brian makes the point that the Grady situation is by no means unique but instead represents a national issue as safety net hospitals struggle to maintain health care for the uninsured while being underpaid by their
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"Health Wonk Review" Is Up
The latest edition of "Health Wonk Review" is up over at "Health Care Renewal."I must say it is a very well done and interesting review of some of the best in recent health care posts--this time crafted by Dr. Roy Poses.
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The Last One is Gone--CIGNA Buys Great West Life Health Insurance Business
The recent announcement that CIGNA has purchased the U.S. health insurance business of Great West Life for $1.5 billion in cash struck me as more than the minor headline it was back on page C5 of the Wall Street Journal.The last one is now history.Metropolitan, Prudential, John Hancock, Mass Mutual, Hartford, Pacific Life, Phoenix Mutual, and so many more, are all out of the medical business.I
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One Heck Of A Budget Mess and Lots of Ugly Consequences--But Watch The Pork
With the Congress set to come back to attempt to break the budget impasse in the few weeks before the holidays, many in this town are ready to see the Congressional Democrats and President Bush agree to disagree and let the budget problems slide for a year under a series of lengthy continuing resolutions (CRs).The problem with CRs is that they only allow the agencies and programs to continue at
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"Cavalcade of Risk" Is Up
The latest edition of the "Cavalcade of Risk" is up over at "Colorado Health Insurance Insider." This edition includes some of the best posts from the last couple of weeks in insurance, finance, and investing.
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California Policy Cancellation Scandal Heats Up As Republican Candidates Propose Health Reform Based On An Individual Health Insurance System
All of the leading Republican candidates for president favor health reform based on the individual health insurance model instead of the more common employer-based system.Apparently, a number of health insurance companies would like to derail those Republican health reform plans by scaring the heck out of consumers and voters picking the year before the election to hold a policy cancellation
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SCHIP, Medicare Physician Fee Cuts, and Medicare Advantage--We're Getting Down to Crunch Time
Since September of 2006, I have been pointing to this year-end as the time that would require some big budget decisions impacting SCHIP, the scheduled 10% Medicare physician fee cut, and corresponding Medicare Advantage cuts to health plans to pay for the doc fix.Guess what? New Year's is just over six weeks away.For now, each of these issues is bogged down in the overall budget stalemate between
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VEBA's--The New Growth Opportunity
With word that Ford workers have followed those at GM and Chrysler in ratifying their new labor contracts we may be at the cusp of the next big growth opportunity in the health plan business.GM alone will transfer as much as $50 billion in long-term retiree health care liabilities to the Voluntary Employees Beneficiary's Association (VEBA) and Chrysler and Ford will also set up the structure over
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Health Wonk Review Is Up
Maggie Mahar does a particularly good job this time of accumulating some very good posts from the best of the health care blog world.This is also an opportunity for you to check out her new and excellent health care blog, "Health Beat" which is "a project of the Century Foundation."
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Part D Medicare Drug Plans See Major Price Increases--Why?
The Part D Medicare drug program's weighted average monthly premiums will increase 17% in 2008 and 23% since the program's January 2006 inception. The 2008 increase is well above basic pharmacy cost trend meaning the insurers are doing some rate catch-up. The average is weighted by actual enrollment.Premiums for the top two Part D Plans (PDPs) by enrollment are up dramatically. According to a
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Giuliani Puts His Foot In It With the Claim He Would Have Only Gotten Quality Treatment For His Cancer in the U.S.
There is this myth that all of the extra money we spend on health care at least gets us the best care in the world. Study after study debunked that long ago and the fact that someone running for president doesn't understand that claim is a myth is inexcusable.But Rudy Giuliani actually has a radio ad in New Hampshire that repeats the myth.All Giuliani's remark did was give opponents of a market
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Report: "Health Insurer Tied Bonuses to Dropping Sick Policyholders"
It's hard to imagine a worse headline for the health insurance industry just as we are heading into what will be a fundamental debate over who should run our health care system.It is even harder to imagine a dumber thing for the insurance industry to do than continue to argue and litigate the notion that an insurer can cancel--or rescind--an insurance policy for a misstatement of fact on an
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Sometimes It's the Little Things--The NCQA Announces an Agreement Between Providers and Payers to Better Pay for the Quality of Care
Particularly in this election season we tend to focus on the big health care reform plans. It is natural to want to see a big fix to a big problem. But everyday things are going on in the market that can make a difference. Make no mistake, these good works will not replace the need for systemic health care reform but it would be wrong to think just big policy changes are the only answer.A case in
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What Will It Take to Get a SCHIP Bill This Year? The Budget Outlook Deteriorates Even More
Democratic and Republican negotiators are hard at work to get an agreement on the State Children's Health Insurance Program (SCHIP) extension.The current SCHIP bill failed to get a veto-proof majority in the House.President Bush has said there is no way he will sign a SCHIP bill with a tax increase in it--the current bill would increase the per pack cigarette tax by 61 cents.The only way the
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The Best Places To Get the Inside On the Workers' Compensation Market
Workers' Comp has always been a unique niche in the health care business.If WC is on your mind, I was reminded again today how important it is for you to be a regular visitor on Joe Paduda's "Managed Care Matters." While Joe is also a great source on all things health care, his perspective on WC is a must for those in that business. It's the real insider view that I always enjoy. His recent post
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Romney Says There Are Already "Pots of Money" in the States to Pay For Health Care Reform---Where?
Mitt Romney says states could implement comprehensive health care reform without having to raise taxes.However, states trying to replicate the Massachusetts health plan would likely have to raise taxes in order to pay for it. That is the conclusion of a November 3rd Boston Globe article. Here are some points:Massachusetts had something other states don't have--a $610 million uncompensated care
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Medicare Buy-In For Retirees--Private Options Make It an Even Better Idea
"We should act now to let companies and unions buy their early retirees into Medicare." That's the point of a Washington Post op-ed today by Democratic Congressman Rahm Emanuel and the president of the Democratic Leadership Council, Bruce Reed.These two former Clinton aides are arguing that:"The troubles at GM and Chrysler--and Ford, which reached a tentative labor agreement this weekend --
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"Medicare Advantage: Wrong Way to Spend $54 Billion"--The AMA Goes After the Medicare HMO's Money
The American Medical Association (AMA) in an editorial in its journal, American Medical News, has pulled no punches in its argument that Medicare HMO plans (Medicare Advantage) need to be cut in order to find the money to fix the upcoming Medicare physician fee cuts--10% in 2008 and another 5% in 2009.Without a doubt their attack on "excess payments" to insurers is self serving--as about all
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Why Consumers’ Checkbook v CMS is a Sideshow--Bush Administration Refuses to Release Provider Data
Brian Klepper joins us again today with another one of his welcome posts. This time he points out the hypocrisy in CMS, which has been calling for market transparency, refusing to provide provider data to a consumer group.Why Consumers’ Checkbook v CMS is a Sideshowby Brian KlepperThere are people who call for market solutions as the answer to every societal problem, but who then work to restrict
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A Good Idea and Bad Leadership--A Way Out of the Entitlement Crisis Meets Partisan Politics
I call your attention to a column this morning by the Washington Post's David Broder.He tells us that there will be an important Senate hearing tomorrow on the issue of Social Security and Medicare entitlement costs.It seems that two Senators, one a Republican and one a Democrat, are trying to create a bipartisan task force that would have the power to fast track a solution to this huge emerging
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Bush Ups the Budget Pressure--Shows No Sign of Compromising on SCHIP
President Bush just made a statement on the SCHIP bill and the upcoming 2008 budget votes. Standing in front of the White House with the Republican leaders behind him, he blasted the Democratic Congress, the recent SCHIP bill passed by the House, and rumored efforts on the part of Democratic leaders to couple defense and Iraq spending bills with domestic budget bills.The bottom line is that the
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House SCHIP Vote Fails to Attract Veto-Proof Majority
Yesterday evening, the House passed a slightly modified version of the SCHIP bill President Bush vetoed last week, this time by a vote of 267-142. That is still likely at least 7 votes short of the two-thirds needed to overturn the expected Bush veto.The bill now goes to the Senate.It is possible that both sides will try to work out a compromise--but not likely.Expect the Senate to pass it, Bush
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Poll Shows Democratic Presidential Candidates Attracting Independents and Moderates With Their Health Reform Plans
I was struck by this conclusion in today's Los Angeles Times regarding their recent voter survey:"In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate."The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" -- the
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Discussions Regarding Scheduled Physician Fee Cuts and Possible Reductions in Medicare Advantage Payments Getting Serious
As the year winds down, the Congress must deal with the scheduled January 2008 9.9% Medicare physicians fee cut. Both Democrats and Republicans want to fix it.To fix the physician fee cut, proposed cuts to Medicare Advantage have been on the table.Senate Finance Chair Max Baucus (D-MT) has been working on a package that would cost $25 to $30 billion and fix the physician fee problem not only for
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New Study Shows Lower Costs in Consumer-Driven Plans--But the Findings Won't Settle the Debate Over Just How Effective C-D Plans Are
HealthPartners, a highly regarded not-for-profit Minnesota health plan, has issued an important report on its consumer-driven care book of business. It includes Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).Their findings include:After adjusting for "illness burden," HealthPartners found that heath care costs were 4.4% lower for members in a consumer-driven plan compared
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Democrats Pushing to Vote on New SCHIP Bill This Week--Bush Starting to Give
Democratic attempts to modify the SCHIP bill just enough to pick off the seven more Republicans they need are intensifying.The House failed to override Bush's veto by 13 votes last week.Yesterday, Bush's lead person on the SCHIP issue, HHS Secretary Leavitt, said the administration is now willing to consider covering kids up to 300% of poverty--they had said they would not go above 200%. Leavitt
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The Fight Over SCHIP Tells Us This Budget Season is Going To Be One Big Food Fight--Medicare Payments to HMOs and Physicians Are in the Middle of It
Now that the House has failed to overturn President Bush's veto of the SCHIP bill by just 13 votes, Democrats are looking to tweak the $35 billion expansion of SCHIP just enough to get the extra Republican votes they need to get their bill passed.The House Democratic leadership is now in discussions with Republican House members who voted with their President last week and who might be persuaded
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A Detailed Analysis of Rudy Giuliani's Health Care Plan
A Detailed Analysis of Rudy Giuliani's Health Care PlanRudy Giuliani's health care reform plan generally follows the Republican health care reform template that places the emphasis on making the health care market more effective in controlling health care costs and thereby enabling more people to be covered.Giuliani would remodel the income tax system to help people buy coverage and encourage
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Health Wonk Review is Up
Jason Shafrin is hosting this edition of "Health Wonk Review" over at the "Healthcare Economist."
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SCHIP Veto Override Fails in the House--Now What?
As expected, the SCHIP veto override effort in the House failed by a vote of 273-156--thirteen short of the two-thirds necessary.Now what?First, SCHIP will not expire. A continuing resolution funds the program at current levels until mid-November and that can likely be extended indefinitely. However, at current levels hundreds of thousands of kids will eventually fall off the program.The
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Why Bush is So Ready to Use the Veto Now When He Never Did When Republicans Were "Spending Like Drunken Sailors"
This from an article in today's Washington Post stood out for me:"President Bush declared yesterday that he remains 'relevant' despite his political troubles, and he derided Democrats for running a do-nothing Congress that has failed to address critical domestic, economic and security issues in the nine months since they took control of Capitol Hill."Back on August 2nd, I did a post, Why Is
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Kaiser Family Foundation Creates a Great Tool to Compare Presidential Candidate's Health Care Plans
The Kaiser Family Foundation interactive comparison tool for the presidential candidates' health care plans can be found here.You can find my evaluation of each candidate's plan in the index on the right side of this blog.
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The CED Health Reform Plan Gets It Right Until They Have to Make the Tough Decision
The Committee for Economic Development (CED) has released its report, "Quality, Affordable Care for All."A few days ago I asked a number of questions about just how far the CED would go toward creating a better health care system.While I think the group has made a number of very valuable suggestions, when it comes to cost containment they don't offer more than the long list of incremental and
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Upcoming "Common Good" Forum: Health Courts, Administrative Compensation & Patient Safety: Research, Policy & Practice
For years we have debated reforming the medical malpractice system. But, most of that debate has focused on capping a system most people believe just doesn't work when it comes to improving the quality of our medical care. To me, that has always begged the question, Why cap a system that is fundamentally flawed?Common Good has been doing good work on that more fundamental question and will have
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Committee for Economic Development (CED) to Release Its Health Plan This Week--The Questions to Ask Them
David Broder gave us a preview of the Committee for Economic Development's (CED) upcoming health care reform plan. With the likes of Alain Enthoven and "a high powered business group" involved, we all need to pay attention.Key points the report will make according to David's column:Business can no longer afford afford to pay for health care.Five years ago the group laid out a strategy for
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Health 2.0 and the Promise of Market-Based Health Care Reform
"The ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technologyinfrastructure, evidence-based best practices, transparency and decision-support, and
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SCHIP Veto Override Vote on Thursday--The Ragged Line Between Those Who Need Assistance and Those Who Don't
The House is scheduled to vote on overriding President Bush's veto of the State Children's Health Insurance Program (SCHIP) expansion.As I said last week, I believe the Democrats will come up about ten votes short in their attempt to override. I would be surprised, but not shocked, if they can find the two-thirds necessary to override the President.One of the arguments opponents of the SCHIP
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When It Comes To Drug Prices the Europeans Are Better Health Care Capitalists Than We Are!
Sometimes I think the government-run European health care systems do a better job of using market tools to control their drug prices than we do in the U.S. market.For example, some government-run systems in Europe, France for example, are not afraid to take a drug off their official formulary if they don't get a competitive price.In January, the Democratic House passed a bill requiring Medicare
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Cavalcade of Risk--Recent Posts From the World of Risk Management
Today, it's my turn to host the "Cavalcade of Risk." Every two weeks the Cavalcade offers insights into efforts to manage risk.Having spent substantial time at a main line property and casualty company, when I hear the term "risk management" my thoughts go to the things that corporate insurance managers do to limit their "loss costs."The popular notion of individual responsibility, and the
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Aetna to Provide Managed Care Services to the British National Health Service--Say What?
Aetna has been approved by the British National Health Service (NHS) as one of the suppliers who can provide local Primary Care Trust (PCT) managers "a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services."Where's Michael Moore? He needs to do an addendum to "
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Means Testing for Medicare--It's Unavoidable If Politically Problematic
Means testing is politically problematic but necessary and probably unavoidable if we are to shore-up Medicare.The Bush administration is pushing a proposal to begin means testing on the new Medicare Part D drug benefit. They would increase deductibles and premiums on single seniors with incomes over $82,000 a year and couples with incomes over $164,000 a year.We already have a means test on
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An Important and Disciplined Review of the Health Care Marketplace--The Latest Site Visit Report From 12 Markets
Good health care market intelligence is hard to come by. Information tends to come in the form of detailed and narrow, often backward looking, surveys that give us little texture for what key players are thinking. Or, at the other extreme, market information is often based on a relatively few almost random anecdotal impressions by "experts" as they do their work in the market.The highly respected
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Health Wonk Review is Up
Jane-Hiebert-White has the latest Health Wonk Review up over at the Health Affairs blog.This sample of some of the best recent posts in the health blog world not surprisingly has lots to say about the SCHIP debate and other timely health reform issues.I wonder what 1993 would have been like if we'd had the blog world?
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SCHIP Supporters Are At Least Ten Votes Short to Override a Bush Veto
The Democrats are now going to take two weeks to try to change some minds before they attempt to override the Bush veto of the SCHIP bill--scheduling a vote for October 18th. If nothing else they will continue to hammer on the President and his Republican supporters over what is turning out to be a very unpopular stand by the President.The Senate approved the SCHIP compromise by a vote of 67-29.
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Now That The UAW Is On The Hot Seat to Manage Its Retiree Health Costs Will Their View of Health Care Management Change?
Brian Klepper joins us again today this time with an astute analysis of the UAW/GM deal. Now that the UAW owns their GM retiree plan will they look at health care management differently?The Hot Seatby Brian KlepperI agree with Bob that the GM-UAW deal is a turning point for American health care. In a stroke – OK, it was a 456 page stroke – GM agreed to turn over as much as $35 billion, about 70
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Reforming Our Health Care Financing System Won't Mean Anything if Americans Don't Start Taking Better Care of Themselves
Ken Thorpe, along with associates David Howard and Katya Galactionova, of Emory University has expanded on his earlier work on chronic disease in the U.S. and its impact on our health care costs in a web article for the journal Health Affairs. He compares chronic disease in the U.S. and Europe and looks at the difference as a means to help explain our higher health care costs.As all of the
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The Country's Political Center is Shifting and With it the Health Care Reform Debate
I always thought it was shortsighted for the Republicans to avoid comprehensive health care reform in the six years they controlled the White House and the Congress (2001-2006). Instead they just added $8 trillion in unfunded liability (Part D) to a Medicare system they've been telling us from the beginning is unsustainable as it is.Eventually the political pendulum swings to the other side.
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The GM-UAW Deal--If UAW Workers Can No Longer Count on Employer-Provided Health Care Then Neither Can Harry and Louise
I'm not the first one to suggest the GM-UAW deal to set up a VEBA is a watershed event. Most observers are focusing on the trend it will accelerate in the employee benefits market--and it will.I will suggest another dramatic impact that it will have--on voters.The polls already tell us that health care is by far the top domestic policy issue and second overall only to Iraq.This deal is also going
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If the $35 Billion Expansion of SCHIP is About Moving to Government-Run Health Care Why Does the Insurance Industry Support It?
Both the House and Senate have now passed the $35 billion expansion of SCHIP. The House by 265-159 and the Senate by a vote of 67-29. The Senate bill got exactly the two-thirds it needs to override the expected Bush veto and the House fell 25 votes short of the 290 it will need.Opponents of the bipartisan compromise to renew and expand the State Children's Health Insurance Program primarily
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Who's More Frustrated With Bush Over His SCHIP Veto Threat--Republicans or Democrats?
These days its hard to get Democrats and Republicans to agree on anything. But there is one bipartisan bill that has incredible support in both parties--the $35 billion expansion and renewal of the State Children's Health Insurance Program (SCHIP).By any measure SCHIP has been an incredibly good success--covering 6 million kids. There have been some legitimate questions about it growing beyond
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Health Wonk Review is Up!
Joe Paduda is hosting Health Wonk Review over at "Managed Care Matters."Not surprisingly he's got lots of blog entries regarding Senator Clinton's new health plan and lots of other samples of some of the best blog posts from the past couple of weeks.Also making the big time this week was our good friend, Brian Klepper, who had the following letter published in the New York Times regarding Senator
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Medicare Advantage Cuts Still on the Table to Offset the Medicare Physician Fee Fix
The House/Senate deal to renew the State Children's Health Insurance Program (SCHIP) does not include a fix to the January 2008 10% Medicare physician fee cut. It also doesn't include the $51 billion in cuts to the Medicare Advantage (MA) program the House had in their bill to pay for that fix and other Medicare improvements.As I have said many times before, that only means that the Medicare
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Hillary Clinton's Health Plan
Here is an excerpt from the Clinton campaign's press release outlining her $110 billion a year health care reform plan:FOR IMMEDIATE RELEASESeptember 17, 2007The American Health Choices Plan:Ensuring Affordable, Quality Health Care for All AmericansHillary Clinton unveiled the third part of her plan today to ensure that all Americans have affordable, quality health insurance. Building on her
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SCHIP Agreement "Near"
There are a number of published reports indicating that the House and Senate have reached an agreement to extend SCHIP along the lines of the earlier bi-partisan Senate agreement.That would mean a $35 billion SCHIP expansion paid for entirely be a new 61 cent tobacco tax.Bush says he would veto such a deal. While the Senate seems veto proof on this one, the House is another matter.If Bush is
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Hillary Clinton's Health Plan--the Republicans Better Take it Seriously
Sometimes I think that all the Republican candidates for president think they need do is go into a crowded room and yell, "Hillary Care," and all of the voters will run for the exits in terror.This is not 1993 and this is not the inexperienced Hillary Clinton who tried to drop her drafted-in-secret 1,400 page health care proposal on us all in one "take it or leave it" roll out.She has changed
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SCHIP Negotiations Not Going Well--Medicare Physician Fee Cuts and Medicare Advantage Payments Hang in the Balance
Negotiations between the House and Senate over how to extend the State Children's Health Insurance Program (SCHIP) before its September 30 deadline are not making much progress.The Senate passed a bipartisan extension of the plan that included $35 billion in new spending and paid for it with a hefty 61 cent per pack tobacco tax.The House passed a solely Democratic bill that would spend $60
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Hillary Clinton to Outline Her Health Plan on Monday--She Will Target Insurers as the Bad Guys
Senator Clinton will unveil her health plan in Des Moines on Monday. The heavy betting is that it will look a lot like the general Democratic health reform template that draws on the recently enacted Massachusetts health reform law.We do know this, she will do what she did in 1993 and 1994 and demonize the insurance industry. On Wednesday she said, "I intend to dramatically rein in the influence
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The UAW's Negotiations With the "Big Three" Automakers Over Retiree Health Benefits and Why They are Important to California Health Reform
The health care reform debate in California has come down to whether there should be an individual mandate to purchase health insurance and whether a big chunk of the cost of the program should be put on the employer community in the form of a 7.5% payroll tax for businesses that don't provide their workers with coverage.Organized labor is firmly behind the Democratic legislature's efforts to
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Health Insurance Premiums Rose Only 6.1% in 2007--But This May Be The Last Year the Trend Rate Will Fall
According to the annual Kaiser Family Foundation survey of employer health benefit plans, the average employer premium rose 6.1% in 2007--the lowest increase in four years of successively falling trend rates.The increase was 13.9% in 2003 (the recent peak), 11.2% in 2004, 9.2% in 2005, and 7.7% in 2006.The average cost of family health insurance also rose to an incredible $12,106 while the
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Jane Sarasohn-Kahn Joins the Blog World
A very smart lady who knows a lot about the intersection of health care and technology has joined the health care blog world.Jane has a post up today that puts the new figures on personal health care spending in context with what Americans spend on technology.Her new blog is, "Health Populi."
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Could America Reap International Good Will By Ramping Up its Health Diplomacy Efforts?
Brian Klepper joins us again today with one of his welcome posts:Reasserting Global Health Diplomacyby Brian KlepperA couple weeks ago the Washington Times ran a sensible and honorable article by Susan Blumenthal MD and Elise Schlissel at the Center for the Study of the Presidency (CSP) in DC, arguing that America could reap a huge benefit in good will by significantly ramping up its health
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The Cavalcade of Risk Is Up
Dave Williams hosts the latest "Cavalcade of Risk" over at his "Health Business Blog."Check out his picks of the best on insurance risk in the blogosphere.
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Schwarzenegger is Right––You Can't Achieve Universal Coverage on the Backs of the Employer Community Alone
The California legislature has passed a major health care reform proposal but Republican Governor Schwarzenegger says it isn't good enough and he will veto it and bring the legislature back to do it over again in a special session.Give the California governor and legislature credit for hitting the problem of health care head-on. If the biggest state can make headway, it could well open up the
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The Obesity Epidemic--It's Time to Deal With it the Same Way We Did Smoking
While we debate just how we will change our health care financing system so that more people can be insured at an affordable cost, we are too often overlooking one of the biggest drivers of health care costs--America's obesity epidemic.The latest report on obesity in America by the Trust for America's Health found that the problem is growing at an ever larger rate despite recent "wellness"
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People Who Say Insurance Regulation Creates More Uninsured Are Missing the Forest for the Trees
The health insurance trade association, AHIP, just released a new study on the impact of state health insurance reforms on the market and argues that the "unintended consequences" of these reforms hasn't been good.Here is an excerpt from their release:“This report offers important lessons. It demonstrates that insurance reforms without universal access drives up health care costs for consumers
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How Will SCHIP Be Extended and What Will Happen to Medicare Advantage and the Upcoming Medicare Physician Fee Cuts
Health Market Survey publisher Bill Boyles joins us again today. After getting his perspective on the State Children's Health Insurance Program (SCHIP) debate yesterday, I prevailed upon him to put a post together for our readers.Bill has some very important news on just how this debate, which involves three greatly important health care issues--the SCHIP extension, proposed Medicare Advantage
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Health Wonk Review is UP
This time Brian Klepper over at "The Doctor Weighs In" has an assortment of provocative posts on a wide range of health care policy and marketplace issues.Check it out.
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Romney Wants to Reform State Health Insurance Regulation--Just What Does He Mean by That?
Republican presidential candidate Mitt Romney is calling for the cutting of state health insurance regulations to make policies more affordable. He blames the over-regulation of health insurance at the state level as one of the primary reasons health insurance costs so much.Of course the reason that health insurance costs so much is that health care costs so much, but we’ve discussed that one
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Mitt Romney's Health Plan--A Foot in Each Canoe
Up in Wisconsin's Northwoods, camp counselors play a game with the kids in which they put two canoes together in the lake and have the kids try to stand up with one foot in each canoe. As you can imagine it's an almost impossible balancing act.I was reminded of that last week sitting by our lake reading reports of Mitt Romney’s health plan proposals.Romney has two canoes to deal with:He signed,
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"Don't Pit Children Against Seniors"--The AHIP Takes the Medicare Advantage Debate to Another Low
When the health insurance industry trade association, AHIP, tried to employ the NAACP in their battle to protect Medicare Advantage (MA) payments last May by arguing higher payments to the industry are good for poor people, I asked, could they have sunk any lower?From the looks of a letter to the editor in Sunday’s Washington Post, the answer is yes.The title of AHIP CEO Karen Ignagni’s letter is
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Health Care's Tougher Problem--Solving the Access Problem Isn't Enough If We Don't Deal With Costs
Today we honored to have Brian Klepper post for the first time. Brian's posts have been appearing on some of the leading health care blogs and I finally pestered him long enough that he agreed to begin doing some here. Today, he reminds us that solving our health care access problem is far from enough if we don't get costs under control:Health Care's Tougher Problemby Brian KlepperHealth care
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The Nursing Shortage--Important Data On Why
Brian Klepper has another one of his great posts up—this time over at “The Health Care Blog.”We all know there is a nursing shortage but Brian sheds a new light on just why.Here is a small sample from his post, “Benign Neglect and the Nursing Shortage:”"Almost three-quarters of Nursing schools surveyed said the main reason that they can't train enough new nurses is a lack of qualified faculty.
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"Undue Advantage"--The Washington Post Calls for Medicare Advantage Cuts
Tuesday's Washington Post had an editorial on the debate over whether HMOs should be paid more than Medicare receives for the same senior's health care.Originally, the Congress decided to pay private health plans more as a means to "prime the pump" to encourage both private health plan insurers and seniors to give the new Medicare Advantage plans a try. Both had some bad experiences in the late
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Medicare Will Stop Paying Hospitals for Errors--Will Private Health Plans Follow?
Medicare will stop paying for the costs associated with "hospital errors." These can include the costs for treating infections, falls and other things Medicare deems the hospital should have been able to prevent.Health plans tend to follow Medicare policy in their payment practices. Many believe the private sector is going to follow suit.On its face, the new policy makes sense. If you get your
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Fred Thompson—Too Good to Be True? Thompson Says He Will Shake Things Up In the Health Care Debate
The Washington Post’s David Broder is one of those people I have only the greatest respect for. So his recent column, recounting an interview with soon to be Republican presidential candidate Fred Thompson, caught my eye.Broder described a Fred Thompson that sounds too good to be true:“When Fred Thompson makes his long-delayed entrance into the Republican presidential race, he will not tiptoe
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Democratic Presidential Candidate Bill Richardson Announces a Health Reform Plan
Democratic presidential candidate Bill Richardson recently announced his health reform plan.Richardson's health care proposal follows the general outline offered by other Democratic candidates in that it focuses first on getting everyone insured and falls short in getting at the fundamental problem creating so many uninsured--health care costs.Bill Richardson's health plan also builds on existing
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Good Riddance to Karl Rove--How Part D Left an $8 Trillion Debt and Got Them Nothing
It seems to be the Washington summer sport to pile on Karl Rove in the wake of his announcement that he will be leaving the White House.Let me add my own good riddance.America’s health care dilemma is one of our greatest problems. Our inability to provide basic health care services at an affordable cost to all of our people is nothing to play around with.Politicians—Democrats and Republicans
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The Latest Health Wonk Review is Up!
Julie Ferguson over at "Workers'Comp Insider" has done her usually astute job of compiling the best from the health policy and market blog world in the latest edition of "Health Wonk Review."Her digest makes for great summer reading!
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Rudy Giuliani Announces a Health Care Proposal That Would Provide Tax Incentives for Consumers to Purchase Individual Insurance
Rudy Giuliani announced that he will be proposing a system of individual tax incentives to enable consumers to purchase individual health insurance in addition to any employer options they might have. His proposals are also designed to shift the U.S. health insurance system away from employer-sponsored coverage.Under the proposal:Giuliani is proposing a $15,000 family/$7,500 individual standard
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Why Is President Bush So Willing to Veto Spending Bills All of a Sudden?
This President didn’t veto a single spending bill during the first six years of his presidency when the Republicans were in control. You might recall John McCain’s characterization of the Republican Congress when he said they spent money “like drunken sailors” all with the concurrence of President Bush.Now, with the Democrats in control, the President seems more than ready to confront
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SCHIP Reauthorization and High Stakes Politics
Everyone agrees that the State Children’s Health Insurance Program (SCHIP) needs to be reauthorized.But Washington couldn’t have made such a simple idea any more complicated or controversial.So far:The Senate has come to a bipartisan agreement, supported by lots of Republicans, that would increase spending by $35 billion, add another three million kids to the six million already covered, pay for
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A Comprehensive and Independent Progress Report on the Massachusetts Health Plan
The Center for Studying Health System Change has issued a comprehensive report on the progress of the Massachusetts health reform plan.Anyone interested in the plan's progress will find this must reading.From their overview:As Massachusetts' landmark effort to reach nearly universal health coverage continues, affordability of coverage remains a key concern for individuals and small
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Health Wonk Review for July 26, 2007
This time it's my turn to host Health Wonk Review, a compendium of some of the best health care policy and market posts from the health care blog world.Joe Paduda seemingly gave up his extra summer time researching the arguments against universal coverage. Joe digs into the logical, philosophical, and political issues; there's also a great summary. With all the recent attention to other nation's
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Romney Condemns Obama's Health Plan--But Obama's Plan is a Clone of the Massachusetts Plan Romney Signed!
Mitt Romney criticized Barack Obama's health care proposal over the weekend in New Hampshire. According to The Baltimore Sun, Romney said, "Barack Obama said we're going to have the government take over health care. He at least had the integrity to say he wants to raise your taxes." He added, "The right answer is not a government takeover, it's not socialized medicine. It's not Hillarycare."
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Massachusetts Expected to Further Backpedal on its Individual Mandate
The Boston Globe is reporting that the Massachusetts legislature "will probably make changes" to the new health care law that could well include capping what a person has to pay for health insurance at 10% before the individual mandate law can be enforced.Presumably, this would mean a family with a household income of $50,000 per year would have to pay no more than $5,000. I fear that is still
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New York AG Objects to Insurer's Method for Ranking Doctors by Cost and Quality--Just What We Need in Health Metrics--Lawyers
At the core of any market-based ability to control costs--pay-for-performance or consumer-driven care--is the notion that patients and payers have information available to them on a health care provider's cost and quality results.Too often the health plan rhetoric--or marketing brochures--have got out ahead of anyone's real ability to measure cost and quality both accurately and in a way that is
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Bush Reaffirms Veto Threat Over SCHIP Despite Strong Republican Support for Bipartisan Compromise—What’s Really Going On Here?
The most exasperated person in Washington has to be Senator Chuck Grassley (R-IA). The Ranking Republican on the Senate Finance Committee has worked out a bipartisan compromise with his good friend Senator Max Baucus (D-MT) to continue the State Children’s Health Insurance Program (SCHIP) past its September 30 expiration date.The plan currently covers 6.6 million low income kids and would cover
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"Cavalcade of Risk" is Up Over At "Sentinel Effect"
Richard Eskow has more than two dozen carefully selected posts from the world of insurance blogs up over at his "Sentinel Effect."Richard has put a lot of time into giving us a wide array of good work.
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"Government Subsidies That halve Premiums Would Cut Number of Uninsured by 3%"--No Surprise There But it Was the Wrong Question
That's the headline on a story regarding a Rand study that says giving people subsidies won't do much to decrease the number of those uninsured.But here's the problem with that study: Paying for half the cost of health insurance that averages more than $11,000 for a family in the U.S. still makes health insurance prohibitively expensive for all but the well off.As I posted yesterday, voluntary
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California Health Care Reform—An Individual Mandate is Nowhere Near as Important as Affordable Health Insurance
California is entering the final weeks of a major effort to reform the state’s health insurance system.Good for them and in particular good for Governor Schwarzenegger who is willing to tackle this most prickly of domestic policy issues!The Governor and the legislature will need to get a deal done by the end of September if it is going to happen in this session—or maybe for a long time to come.As
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President Bush is Not Backing Down on His SCHIP Veto Threat
The President is sticking to his guns over his threatened veto of the Senate Finance Committee bipartisan deal to reauthorize and expand the State Children's Health Insurance Plan (SCHIP) at a cost of $35 billion. The deal would expand S-CHIP and pay for it with a big 61 cent cigarette tax--taking the federal per pack tax to $1.A White House spokesman said on Saturday that his advisers "will
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The Latest Health Wonk Review is Up
Here's a summary from the latest edition over at "Colorado Health Insurance Insider:"The Health Wonk Review is THE top health policy roundup in the blogosphere. It’s known for only including the best and brightest, and only the keenest observations of the health policy community. The collection of articles below represent the cream of the crop of recent entries in the ongoing US health care
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Key Republican Senators Call on President Bush Not to Veto S-CHIP Reauthorization--A President Acting Like He Has Nothing to Lose
On Thursday I commented on the Senate Finance deal to reauthorize the State Children's Health Insurance Plan (S-CHIP). The bipartisan deal calls for a $35 billion expansion of the program, reversing state efforts to use it to cover adults, and pays for it with a whopping new 61 cent per pack tobacco tax.Yesterday, two very important Republican members--Grassley and Hatch--of the Senate Finance
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"Those Crazy Californians. This Time Its Childhood Obesity."
That's the title of Brian Klepper's recent post over at the Blog, "The Doctor Weighs In."He mentions my recent post on this and takes it further. It's a good read.Here's the first part and a link to the rest:California always seems to be ahead on things that matter. A CNN story this week highlights that state's terrific anti-obesity TV campaign. The ads have cute kids sweetly asking "Dad, could
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United Health Launches a New Health Plan That Rewards Healthy Workers--Immediately Criticized for "Turning Health Care Into a Police State."
Under a new program announced by United Health, health plan participants who take tests and other evaluations to prove they are meeting goals for blood pressure, cholesterol, height/weight ratio, and smoking status would be eligible to receive $500 reductions in their health plan deductible ($1,000 family) for every goal met.The plan starts out with a $2,000 single/$5,000 family deductible.In a
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Senate Finance Committee Reaches Bipartisan Agreement to Fund S-CHIP Expansion With a Tobacco Tax--No Cuts to Medicare Advantage
The Senate Finance Committee has reached a tentative agreement to expand the State Children’s Health Insurance Program (S-CHIP) by increasing the tobacco tax by another 61 cents—for a total per pack federal tax of $1. With state taxes, the average per pack tax would rise to about $1.68.Under the agreement, the Senate would not go forward with any Medicare Advantage cuts to fund S-CHIP.While 2
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The Best 39 Minutes You Can Spend Understanding the Various National Health Systems
NPR's "Fresh Air" broadcast a 39-minute interview with Jonathan Oberlander, a political scientist with expertise in health care politics and policy and the University of North Carolina at Chapel Hill.Studying other systems is important as we in America look to reform our health care system. Unfortunately, we hear many things out of context and some outright myths.Listening to Professor Oberlander
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Can the Democrats Take the Health Care Agenda Back? S-CHIP is the First Test and the Test is On
The debate over how the State Children's Health Insurance Plan (S-CHIP) will be reauthorized is really about whether the Democrats can finally take the health care agenda back from the Republicans.If the Congress cuts private Medicare plan payments to pay for a bigger S-CHIP, it will be a double whammy--a bigger government health plan and potentially a smaller private Medicare program.Congress is
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"Sicko" Revenue Wanes at the Box Office--Why Didn't "Sicko" Resonate?
The Michael Moore movie about the U.S. health care system's problems, "Sicko," had incredible press before its debut. Moore appeared on the likes of Larry King, Leno, and Letterman, and about everywhere else in the days before its premier to hype his newest critical documentary.Last week when the movie grossed only $4.5 million (putting it in 9th place) supporters pointed out that it only opened
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New Tool Kit: Massachusetts Health Reform
Ed Howard and his team at the non-partisan Alliance for Health Reform here in Washington have done another of their great jobs in putting together a resource for anyone interested in the Massachusetts health reform plan.From their overview:"Starting July 1, every adult in Massachusetts is required to have health coverage (except for 60,000 people exempted by the state). To help you understand the
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The Market Has a Place in Health Care But It Also Has Its Limits
Every leading health care proposal today includes a place for the market. Some believe government should run it all and then there are those who believe the real solution lies in just letting an unfettered market get it all done.Health care is not like buying a set of tires. We lose our market-driven objectivity pretty quickly when we are faced with scary medical decisions for ourselves or for
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CBO Issues a Major Report on Medicare Advantage Plans--Pours More Fuel on the Private Fee For Service Fire
Yesterday, the Congressional Budget Office (CBO) issued a very comprehensive report on Medicare Advantage plans.I found the following to be an especially important finding:"In 2007, CBO estimates the average payments to such plans [MA] is 12% above traditional FFS costs. The difference is larger for private fee-for-service plans: According to estimates by the Medicare Payment Advisory Commission
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"Mid-Atlantic Convergence"--The European Government-Run Health Care Systems Are Coming Our Way!
One of the themes I have often heard in international meetings on the topic of health insurance is the term, "Mid-Atlantic Convergence."That is, our system may be gravitating to look more like those in Europe and theirs maybe moving more toward ours.One of the people I often see at these meetings is Bill Boyles, publisher of Health Market Survey and Consumer-Driven Care.Today, I have asked Bill
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The Cost to Administer Medicare Versus the Cost to Administer Private Health Plans--The Difference Isn't Anything Close to 25%
Those that favor a single-payer government-run health care system have been reenergized by the Michael Moore movie, "Sicko."One of their contentions I keep hearing is that we could save 25% by getting rid of private health insurance plans and creating one big government-run plan. They point to Medicare's expense factor of 2.9% as evidence.The private health insurance plans have much higher
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"AMA Takes on Retail Clinics"--Oh Come On!
That was the headline in today's Chicago Tribune.The American Medical Association (AMA) is having their annual meeting in Chicago and is considering opposing the opening of in-store health care clinics in places like Wal-Mart and Walgreen drug stores.The docs are arguing that this new phenomenon in health care, that would give consumers a low-cost and quick access to very basic medical care,
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A Canadian-Style Health Care System--How Would We Get From Here to There?
The movie "Sicko" inevitably gets us talking about making over America's health care system into one that would resemble the single-payer government-run systems like those in Canada, Britain, France--or now even Cuba!I find the proposal a simplistic one.Having spent so much time in Europe and Canada working with health care policymakers and major stakeholders there, let me first tell you I have a
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A Review of the Movie "Sicko"--Michael Moore Blew It!
Michael Moore's new movie, "Sicko," was supposed to be this great argument for a "single payer" government-run health care system.It turned out to be exactly the opposite because Moore overplayed his hand and did his argument more damage than good.The first half of the movie would have had anyone mad at the system--and for good reasons. It's real easy to find lots of examples of market stupidity
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Will Medicare Advantage Payments Be Cut as Soon as 2008?
That's the question a poster asked today and it has been an issue on my mind. So I will address it here.First, CMS has already started the rate setting process for 2008 and will have it finalized by early September. While the Congress makes the rules and can do anything it wants, it would be very difficult to change the 2008 deal with the private sector after early September.The only way we would
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Commercial Health Care Cost Trend—Finally Hitting Bottom?
Commercia health insurance cost trend peaked in 2003 when costs hit 13.9%. On the same basis, health care cost trend fell to 7.7% in 2006 (Source: Kaiser Family Foundation Survey).Will medical cost trend keep falling in 2007 or are we near the bottom?The health insurance business tends to benefit from falling trend rates. Employers and benefit consultants tend to look backward when health care
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Leading Democratic Presidential Candidates Comment on Health Care This Week
Joe Paduda, over at Managed Care Matters, is attending the "Take Back America" conference in DC this week. Joe has been posting a review on his site of each of the Democratic candidates comments on health care.Comments include a review of Clinton, Edwards, Obama, and Richardson.
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Cavalcade of Risk #28 is Up
Julie Ferguson, of Workers Comp Insider, hosts this week's "Cavalcade of Risk."This edition includes a couple of dozen of the best recent blog posts on the issue of managing risk.
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Senator Max Baucus Is Crucial to the Health Insurance Industry's Continued Medicare Advantage Funding--But How Sympathetic Is He?
Everyone knows that House Ways and Means Subcommittee Chair Pete Stark is the Medicare Advantage program's biggest high-powered Congressional critic.The view of Medicare Advantage health plan payments, particularly for the controversial Private Fee For Service (PFFS) program, is more moderate in the Senate. Undoubtedly, the House Democrats will be more aggressive in the cuts they want than will
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"Sicko"--Hate it All You Like But Don't Ignore It! The Best Response is to Satisfy the Customer!
Michael Moore's harsh critique, make that condemnation, of the health insurance industry is going to be hard to watch for those who have spent their careers in the business.The worst thing we can do is to rationalize it away as just another "single payer's" prescription for socialized health care.Thirty years ago, I was taught by the insurance company I worked for that the way to be profitable
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Biggest Employers Propose Their Own Health Care Reform Plan––Moving Toward Individual-Based Benefits
The ERISA Industry Committee (ERIC) has proposed a far-reaching reform of not only the health insurance system but the employer-provided retirement system as well.They call for the movement of these important benefit plans from the workplace to individual ownership and responsibility.The group represents many of America's largest employers and covers 30 million people in their benefit plans.They
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MedPAC Recommends a Reasonable Road Map For Reducing Private Medicare Advantage Payments--Plan Would Equalize Payments Over a Five-Year Period
The Medicare Payment Advisory Commission (MedPAC), the Congressional advisory group on Medicare payment issues, has sent a report to Congress recommending that the Congress structure future private Medicare plan payments in a way that eventually equalizes private plan and public plan costs.MedPAC said in its report that current Medicare Advantage reimbursement does not promote increased
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Wall Street Comes to Washington--A Fascinating Discussion Between Wall Street Analysts and the Washington Health Policy Community
Paul Ginsburg, of the Center for Studying Health System Change, has been hosting a conference for 12 years where he brings some of the leading Wall Street analysts following the health care sector to Washington and puts them in a room with 400 Washington health policy people.The interchange, and the different perspectives, between the Wall Streeters and the Washington policy people is
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Industry Trade Association Pledges to Halt Medicare Fee For Service Marketing Until Sales Abuses Are Cleaned Up--But Forgot to Mention One Thing
This from the June 15 AHP health insurance trade association news release:"Taking a major step to give Medicare beneficiaries peace of mind, today seven of our member companies are making a pledge to voluntarily stop marketing non-group Medicare Advantage Private Fee For Service plans and to strengthen consumer protections by implementing now the Centers for Medicare and Medicaid Services (CMS)
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You Can't Have the Medicare Advantage Private Fee-For-Service Training Wheels Forever
Actually, my point was that the industry's arguments to preserve private fee-for-service payments amounted to an appeal to preserve corporate welfare, not that the original PFFS program is corporate welfare, but I'll accept the gist of this story:APConsultant Favors Cuts to Medicare PlansThursday June 14, 3:06 pm ETBy Matthew Perrone, AP Business WriterConsultant Says Congress Should Limit
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Wall Street Journal Sends Shockwaves Through the Health Insurance Markets With the Headline "Health Savings Plans Start to Falter"
It's the kind of headline I would have expected to see in the New York Times instead of the Wall Street Journal but there it was in Tuesday's edition.Vanessa Fuhrmans' article seems to have unleashed some pent-up frustration in the health benefits market on the subject of health savings accounts (HSAs) specifically and consumer-driven care generally. It is as if it represents a turning point for
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Can We Control Health Care Costs Without Universal Coverage?
My good friend, Joe Paduda, over at his blog, "Managed Care Matters" has responded to my recent post: The Mandate Myth--Health Reform Plans Don't Have to Mandate Coverage to Work But They Do Have Be Affordable.Joe has made the point that it might be important to mandate coverage in order to prevent cost shifting. He is pointing out that unless we mandate that everyone is in the health care
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Latest "Health Wonk Review" is Up
David Williams is hosting the latest edition of Health Wonk Review over at his site, "Health Business Blog."It is the bi-weekly compendium of some of the best posts in the health blog world!
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Why Does Health Insurance Cost So Much in New England?
I guess the easy answer is because health care itself costs so much in New England.As I travel around the country, I continue to hear that plan sponsors and insurers are all frustrated by the comparatively high health care (and insurance) costs in New England. For example, according to CMS, health care spending for Massachusetts residents exceed the national average by more than $1,500, or 33% in
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McCain to Propose a Health Care Reform Plan--Both Democrats and Republicans Becoming Predictable on Health Care
Republican presidential candidate Senator John McCain said this weekend that he is working on a health care reform proposal. He gave no time for its release but did mention a number of components:His plan will not include tax increases.It will not include any coverage mandates--presumably individual or employer mandates.He would make greater use of health care information technology.It will
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The Mandate Myth--Health Reform Plans Don't Have to Mandate Coverage to Work But They Do Have Be Affordable
As the presidential candidates, Republican and Democratic, begin to come forward with their health reform plans, a side debate is heating up about whether any meaningful health care reform plan has to have a mandate, individual or employer.The reasoning goes that for health care reform to work we need to get about everyone in the pool--both in order to solve the uninsured problem and to be able
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Giuliani Set to Announce a Health Care Proposal--But He Has to Make it Affordable for Everyone
Republican presidential candidate Rudy Giuliani is set to announce a new health plan this summer that would provide incentives to shift private health insurance from the employer group model to the individual health insurance model, according to an article in Thursday's Wall Street Journal.Details are sketchy. We understand that it would still allow the traditional employer plans to continue, it
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New Ideas in Medical Liability Reform: Health Courts
Today, our guest contributor is Brynna Pietz of Common Good. Common Good has been a leader in arguing that it isn't enough to simply cap medical malpractice damages and call it reform. Instead, they believe we need to fundamentally change the health care tort system to one that does a better job of more quickly compensating the injured patient--and perhaps more importantly--improving the quality
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Barack Obama on Health Care Reform and the Insurance and Drug Industries--a Healthy Cynicism
Earlier this week I wondered why Hillary Clinton continues to try to isolate and demonize the insurance and pharmaceutical industry in her comments about health care reform: Hillary Clinton on Health Care--Trying the Divide and Conquer Strategy Once AgainI pointed out that you would think she would have learned from her failed divide and conquer tactics in 1994.It is interesting to contrast
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Hillary Clinton on Health Care--Trying the Divide and Conquer Strategy Once Again
In Sunday's Democratic presidential debate, Hillary Clinton once again tried to isolate the insurance industry (as well as the pharmaceutical business) as a means to advance her health plan.On health care Senator Clinton said, "What's important, and what I learned in the previous effort is you've got to have the political will--a broad coalition of business and labor, doctors, nurses, hospitals..
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Latest "Health Wonk Review" is Up
The newest version of Health Wonk Review is now up over at Richard Eskow's "The Sentinel Effect." It a sample of some of the best posts from the world of health care blogs and worth a read.
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Drug Reimportation from Canada––The Drug Industry Loves It
Well, the illegal kind of reimportation anyway.For many years we have been debating the issue of drug reimportation--the importation of American drugs from other nation's, such as Canada, at much lower prices which their government-run systems enable their pharmacies to charge.Drug reimportation was never going to be much of a solution to America's high drug price problems--just how many excess
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Giuliani, McCain, and Romney--Where Are Their Health Care Plans?
Looking at the leading Republican candidates for president you wouldn't think health care is much of an issue.In fact, finding anything the top three Republican candidates have said regarding health care is sort of like playing, "Where's Waldo."A recent tour of their official campaign Websites:Rudy Giuliani - Click on "On the Issues" on Giuliani's Website and health care isn't listed as one of
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Clinton, Edwards, Obama--Offering Health Care Reform Proposals More Similar Than Different
In sailboat racing there is a strategy called "covering." It means that when your competitor makes a move you make exactly the same move. That way, you have covered their every move and they can't get away from you because of any new tactic they aim to employ.When you "cover" you intentionally stay even during that phase of the race--you have no intention of getting ahead at that point.On health
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Hillary Clinton Outlines the First Elements of Her Health Care Reform Plan
Hillary Clinton took the first steps in outlining her health care reform platform this week. This time focusing on the underlying problem in the health care system--costs.They were just first steps, fairly vague and hardly controversial.We hear that she will deliver two more speeches in the future outlining her thinking on quality and insurance coverage.This is how Mrs. Clinton says she would
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$6 Billion for Something Called aQuantive and $1.3 Billion for Chrysler--What's Wrong With This Picture?
A lead story in Saturday's Wall Street Journal caught my eye: "Microsoft agreed to buy online-ad specialist aQuantive for $6 billion."Then there was the big story on Friday: Private equity firm buys 80% of Chrysler for $1.3 billion. The private equity firm will also contribute $6 billion to Chrysler and the separated Chrysler will assume all of the estimated $19 billion in health and pension
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Bush Administration Threatens to Veto Democratic Budget if it Doesn't "Address the Unsustainable Growth in Entitlement Spending"--What Chutzpah!!
President Bush spent considerable political capital passing the Part D Medicare drug benefit. That benefit alone increased the long-term Medicare unfunded liability by $8 trillion over the next 75 years. All of Medicare now has a $32 trillion unfunded liability.The President used substantial political capital just after his reelection trying to change the Social Security system because he made
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The “Realistic” Way to Do Health Care Reform
There is a debate about whether we ought to do incremental health care reform as the political process allows us to do so, or whether that is a major waste of time unless we deal with all of the big problems--particularly soaring costs--in a comprehensive way.This Massachusetts health care reform experience and all the problems it is having comes to mind as a case in point.In March, the Senate
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"Florida Health News" Debuts
Always glad to plug folks doing a good job in the states.If you are interested in health care policy and market activities in Florida, check out the Florida Health News, sponsored by the Florida Health Policy Center.It's a non-profit run by folks now doing it as a labor of love.So--to all of you making tons of money in health care down in Florida--give them a hand!
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The California HealthCare Foundation Launches a New Site Following California Health Reform
An excellent non-partisan website covering health reform efforts in California has recently launched--CalHealthReform.org.They explain themselves:"Health care reform has become a major topic of discussion and a key priority for California policymakers in 2007. The California HealthCare Foundation (CHCF) is working to inform statewide efforts to expand access to affordable care and coverage. CHCF
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The Kerry Reinsurance Plan--Important Improvements and the Need for Fundamental Cost Containment
My good friend, Richard Eskow, on his blog "The Sentinel Effect," has published another one of his thoughtful posts this time commenting on John Kerry's proposal to have the federal government absorb large health claim costs from employers: "John Kerry's Reinsurance Bill: Will it Work?"Richard is responding to an earlier post I did (John Kerry's Health Reinsurance Idea is Counter Productive--
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The Debate Over Medicare Advantage Funding--The NAACP Goes "Whoops!" and Stark Tries to Start a "Food Fight" Over Who Has to Come Up With the Money
The History--Skip it if you do this everyday.The Democratic Congress needs billions to offset the 10% Medicare physician fee cuts that will happen on January 1st if action isn't taken and to reauthorize the bipartisan State Children's Health Insurance Program (S-CHIP).S-CHIP will take at least $15 billion over five years--many Democrats (but not enough) want to expand it for a total cost of $50
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Health Wonk Review--Recent Posts Worthy of Your Time
Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog. For participants, it's a way to network and share ideas, and for those
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As Part D Drug Prices are Rising are Profits Falling?
The House Oversight and Government Reform Committee says the prices paid by consumers for the ten most prescribed drugs in the Part D program rose an average of 6.8% since December. At the same time, the committee says wholesale prices have risen just 3%.The committee also says that rebates from the drug companies to the Part D players total 4.6% of total drug costs--down from 5.2% last year.
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The Massachusetts Health Plan--Even the Uninsured Deserve Choices
The publisher of Health Market Survey returns with comments on what he believes is the fatal flaw in the new Massachusetts health plan:The Danger In The Massachusetts Health Planby Bill BoylesReputable and well-meaning people continue to applaud the Massachusetts health plan as a flawed but solid first start on covering the uninsured. A guest New York Times columnist last week fell into the trap
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The Service Employees International Union (SEIU) Leads by Example--The Importance of Reaching Out in the Health Care Debate
Fundamental health care reform will not occur until the traditional opponents in the debate are willing to work together to build the foundation for a national consensus on how our health care system will work. No one side is ever going to win this debate and until the big players come to understand that the health care debate will give us more frustration than results.The Service Employees
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The Senate’s Mixed Message on Drug Reimportation—They Voted For it Before They Voted Against It!
To be completely fair, they actually voted against it before they voted for it but the outcome is the same.A whole lot of Senators now go down as voting for the ability of drug wholesalers, retailers, and consumers to bring drugs in from industrialized nations where prescription drugs are a lot cheaper. This provision was one that could have really had an impact on drug prices.While drug
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Medicare Advantage Private Fee-For-Service Programs Take a Big Hit in New York Times Article
The health insurance industry's attempts to justify the Medicare Advantage private fee-for-service (PFFS) product took a big hit in a story in the New York Times today.The Medicare Advantage experiment was supposed to be about proving that the market could provide better cost and quality care then the traditional government-run Medicare program.Instead, Medicare Advantage, and in particular its
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John Kerry's Health Reinsurance Idea is Counter Productive--Kerry Would Transfer All Health Care Costs Above $50,000 to the Feds
Senator John Kerry (D-MA) has rewarmed a health care proposal from his failed presidential campaign in 2004.Kerry is proposing that the federal government reimburse (or reinsure) an employer's health care costs for any worker incurring more than $50,000 in annual costs. The employer would have to offer a comprehensive health plan to its workers below this point and also offer wellness
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The Health Insurance Industry Employs Minority Groups to Protect Medicare Advantage Payments--Could They Have Sunk Any Lower?
The Democratic led Congress is looking hard at cutting payments to insurers participating in the Medicare Advantage business.With both the Medicare Payment Advisory Commission (MedPAC) and the Congressional Budget Office (CBO) saying the private plans are overpaid by billions of dollars (the CBO says by $54 billion over five years) these HMO payments are a tempting target for Democrats looking to
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The Carnival of Risk # 24 is Up
The Carnival of Risk is up over at "The Digerati Life:""Welcome to the Carnival of Risk #24, where we showcase articles that discuss risk in all its forms, particularly touching on the subjects of risk management, insurance, investing and other articles on business and financial risk...read the rest.
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Humana Caps Annual Increases on Consumer-Driven Plans--Too Bad it Isn't a Real Guarantee
Humana says it will cap annual increases on self-insured consumer-driven plans for three years.Two problems:Humana is capping the costs of its "SmartResults" self-insured plans and only putting 40% of their fees at risk. If they were really putting their money where their mouth is they would be capping the cost of fully insured plans--and if they are so confident on their self-insured product,
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The Medicare Fee-For-Service Product is a Kamikaze Flight for Health Insurers--But Are the LBO Guys Interested in Humana Anyway?
There is plenty of speculation over just what the Congress will do about Medicare Advantage payments to health plans.I have posted on this many times before.To summarize, I believe:Medicare Advantage payments to health plans will not be cut by the Congress for 2008. But health plans will suffer some relative Medicare Advantage payment decreases in 2008 because the average 3.5% increase the plans
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Medicare Drug Negotiation Bill Fails in the Senate
Democrats fell short of the required 60-votes to pass a bill that would have allowed the Secretary of HHS the power to negotiate Medicare Part D drug prices. Democrats did get 55 votes while 42 Senators opposed the bill. The vote generally followed party lines.The Medicare Part D drug negotiation bill was little more than a political charade anyway since the bill would not give HHS any leverage
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Latest "Health Wonk Review" is Up
Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog. For participants, it's a way to network and share ideas, and for those
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Hillary Clinton Doesn't Like Health Insurance Companies and Never Has--But Demonizing Them Again Won't Get Us Health Care Reform
At a recent health care forum attended by Democratic presidential candidates, New York Sen. Hillary Rodham Clinton observed, "The insurance companies make money by spending a lot of money employing a lot of people to try to avoid insuring you, and then if you're insured, to try to avoid paying for the health care you received... ." (Newsday 4/14/07)I'm sorry to hear her say that.Health care is
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Democratic Presidential Candidate Bill Richardson Supports the Employer Mandate as a Way to Provide Health Insurance
Democratic Presidential Candidate Bill Richardson has weighed in on the health care debate with comments about what he would do on the issue:"You know, every time a Democrat, it seems, we propose a new [health care] plan, it's more spending or more taxes. I'm not that way...I would have a mandate. I would say every employer...has to have a health care plan. That's how you pay for it."Well
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The Imus Fiasco and the Virginia Tech Massacre—What They Have in Common
Why is it that these campus massacres seem to be a unique American phenomenon?Last week the country struggled to understand why the Imus fiasco hit such a raw nerve.This week, a 23-year-old Northern Virginia kid took some kind of rage out on dozens of innocent people at Virginia Tech.Could it be that the two share some kind of common thread?I believe they do.In my mind that thread has to do with
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Senate Developments on Medicare Advantage Payments to Health Plans and the State Children's Health Insurance Program (S-CHIP) Reauthorization
The Senate is back to work and two important developments occurred last week in the debate over Medicare Advantage payments to health plans and the reauthorization of the State Children's Health Insurance Program (S-CHIP).First, the Senate Finance Committee held a hearing where its chair, Senator Max Baucus (D-MT) and ranking Republican, Chuck Grassley (R-IA), both expressed concern about the
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More Than 10 Million Are Now Using Consumer-Driven Health Care Accounts--We Will Soon Have Enough Data to Know How Well HSAs and HRAs Work
Consumer Driven Market Report (CDMR) has issued a report on the success of consumer-driven care in the marketplace.CDMR reports that over 6 million people are participating in health plans that have a health savings account (HSA) as part of their plan—that is an increase of 2.85 million in the last year.Similar health reimbursement accounts (HRAs) now total 4.1 million and are growing at a rate
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Another Victory Declared in Massachusetts--The Connector Exempts 20% of Uninsured State Residents From the Requirement to Buy a Health Plan
The only place there are more victories being declared than in Iraq these days is in Massachusetts.The Massachusetts Health Plan regulator, "The Commonwealth Connector," has issued new rules that will exempt an estimated 20% of the uninsured from a state legal requirement to purchase health insurance.Since the health plan bids came in last month, it has been clear the prices would not make it
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The Medicare Part D Drug Benefit: "The Ugliest Night I Have Ever Seen" - "60 Minutes" Report on How the Medicare Drug Benefit Became Law
As any any of you who know me, or who have regularly read this blog, know, I have great disdain for the Part D Medicare drug benefit--the way it was passed and the horrible health care policy it represents.I do believe seniors are entitled to coverage for their drugs. But instead of layering $8 trillion of unfunded liability (the whole of Social Security has a $4 trillion unfunded liability) on
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A Bipartisan Bill to Ban Genetic Discrimination Continues to Move Through the Congress
The House continues to move toward approving a genetic discrimination bill that would prohibit health plans from collecting genetic information and from requesting, requiring, or purchasing such information for insurance underwriting purposes.Employers would be prohibited from using genetic information in the hiring process.The bill is now working its way through the committee process with
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A Drug Reimportation Bill Continues to Receive Bipartisan Congressional Support
A drug reimportation bill that would enable consumers, drug retailers, and wholesalers to import cheaper foreign drugs from FDA-approved plants and warehouses continues to gain support. The CBO reported that the bill would generate $50 billion in savings for pharmaceutical purchasers over 10 years.While a floor vote has not yet been scheduled in either house, we continue to believe this, or a
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A Mental Health Parity Bill Still on Track for Passage
During the last few weeks we reported that it is likely a bipartisan mental health parity bill will emerge from this Congress after years of inaction on the issue.That prediction still holds today.In past years, the Republican Congressional leadership blocked the bill even though the votes were there for passage--with many Republicans behind it. With the Democrats now controlling the
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The Health Wonk Review--A New and Improved U.S. Health Care System
Jane Hiebert-White host's this edition of Health Wonk Review over at the Health Affairs Blog. Health Wonk Review is a bi-weekly round-up of the best in health care policy blogging. This edition is loaded with commentary on how we might achieve universal coverage--or not.
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The Real Reason Health Care Reform is Hard—Hillary Clinton Leads the Presidential Candidates With $26 Million in First Quarter Campaign Contributions
Reading the press, it’s as though raising money for a presidential run is a sweepstakes to be won—like it’s something to be proud of.Just exactly what should we all be celebrating?Hillary Clinton leads the way with $26 million raised in the first three months of the year before the presidential election. Senator Obama is reportedly going to come in well over the $20 million figure and John
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California Fines Wellpoint $1 Million for "Unfairly" Rescinding Health Insurance Polices--Was Wellpoint Fair or Not?
The California Department of Managed Health Care has fined Wellpoint $1 million because it says Wellpoint "routinely" violated state law when it canceled (or rescinded) individual health insurance policies after the policyholders filed claims. The state said that Wellpoint made no attempt to determine whether the policyholders merited such "harsh" treatment when it canceled the policies.From a
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Medicare Advantage “Overpayments”—Not As Simple As It Seems
Bill Boyles, Publisher of Health Market Survey, gives us another insider's view of the day-to-day debate over the appropriateness of the Medicare Advantage payments to HMOs.It seems that when you have seen one Medicare Advantange Plan you have seen one Medicare Advantage Plan. The "overpayments" reported by MedPAC and the CBO are nowhere near across the board.The debate is clearly getting into
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House Ways and Means Health Subcommittee Goes After Medicare Advantage Payments on Wednesday and Humana Stock Up 5% by Thursday Close
Apparently Wall Street doesn’t take Pete Stark and the Congressional Democratic Majority very seriously.The House Ways and Means Health Subcommittee held hearings on Medicare Advantage payments to HMOs on Wednesday morning. It’s no secret the Democrats have every intention of cutting those payments.No health plan has made the strategic bet on the Medicare Advantage program that Humana has. And
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The Latest Health Wonk Review
For all of you health care policy addicts, who spend your free time cruising cyberspace in search of the latest health care policy ruminations, the latest Health Wonk Review is up over at Matt Holt's "The Health Care Blog."
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The Reauthorization of the State Children's Health Insurance Program (S-CHIP)--A Surprising Contrary View
Bill Boyles, the publisher of Health Market Survey, fills the role of guest commentator again today reporting on a very different view on the issue of the reauthorization of the State Children's Health Insurance Program (S-CHIP).His report just goes to show that nothing in health care policy is simple:House Black Caucus Not Buying S-CHIP ExpansionIt seems like every interest group in the country
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Senate Budget Committee Adopts Budget Blueprint––Need for Revenue Continues to Endanger Medicare Advantage Funding
The Senate Budget Committee voted along party lines this past week to adopt a 2008 budget blueprint that includes substantial funding for the State Children’s Medicaid Program (S-CHIP), additional veterans care, and many other health care needs.Most notably, the blueprint has only identified $15 billion of the $50 billion needed to expand the S-CHIP program. They plan to get that $15 billion from
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Bush Administration Rejects Bipartisan Health Care Reform Recommendations From "Citizens' Working Group" Created by Medicare Act
The 2003 Medicare Modernization Act the Bush administration pushed through--it also created Part D--included a provision that established a "Citizens' Working Group" to study the American health care challenge and report back to the President and the Congress with suggested solutions.Their mission was to "promote a public debate" on solutions to the cost, coverage, and quality challenges we face.
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Medicare Advantage HMOs Gearing Up for Payment Cuts--Could They Come as Early as 2008?
Bill Boyles--Publisher of Health Market Survey--returns as a guest commentator. Bill keeps a sharp eye on the Medicare Advantage business and on Capitol Hill. Here's his take on what the Congress--and the health plans --are up to:We are hearing that the health insurers are getting ready to dump markets in response to the Democratic threat to cut Medicare Advantage payments. But first they will
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United Health Buys Sierra Health Plans--The Consolidation Begins Again--But What's the End Game?
After a period of quiet on the merger and acquisition front, it seems to be beginning again.Today, UnitedHealth announced an agreement to acquire Sierra Health Plans for $2.4 billion.With little in the way of growth in the commercial health insurance markets, and the recent surge in Medicare products about to settle down as the new Medicare Part D and Medicare Advantage opportunities reach a
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Bush Administration Ducking Its Own Commission on Health Care Reform
Joe Paduda reminds the Bush administration of its obligation to pay attention to its own commission over at "Managed Care Matters" today:Bush's non-responseActions, or lack thereof, speak louder than State of the Union addresses.From California HealthLine comes the news that the Administration has failed to comply with it's legal obligation to respond to the Citizen's Health Care Working
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It's a New Day in the Health Care Debate--New Efforts to Reform the U.S. Health Care System are Real and Serious
The following is a guest column I authored which recently appeared in the Employee Benefit Adviser:It Is a New Day in the Health Care Debateby Robert LaszewskiMarch 1, 2007 - New efforts to reform the U.S. health insurance system are real and serious, and it would be wise not to ignore what's happening.Health insurance reform is breaking out everywhere; 2007 is shaping up to be the "Year of the
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The Latest "Health Wonk Review"
The best and the brightest in the health blog world are at it again with their latest "Health Wonk Review" over at Joe Paduda's "Managed Care Matters."
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Part D Was “Financially Irresponsible”—The Medicare Part D Drug Plan Liability is Twice That of the Social Security System!
The passage of the Medicare prescription drug benefit—Part D—was a “financially irresponsible” thing to do. Those were the words of U.S. Comptroller General David Walker on CBS’ “60 Minutes" this past weekend.Amen to that.The Medicare Trustees, in May of 2006, reported that Medicare’s long-term debt is estimated to be $32.4 trillion dollars (over 75 years). The new Part D drug benefit is a
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The Massachusets Health Plan's Inability to Offer Affordable Health Insurance Premiums Will Stall-Out Other State's Efforts in Health Reform
Now that we know Massachusetts is not going to be able to offer affordable health insurance to the middle class, we can expect to see other similar state health reform efforts stall-out.Both California and Pennsylvania have already started down the Massachusetts health care reform road. But when state legislators find that families making $50,000 or $60,000 a year would be mandated under state
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More on the Massachusetts Health Plan's Unaffordable Costs
My old friend and colleague, Richard Eskow, has a great post on the affordability problems with the new Massachusetts health plan over on his blog, The Sentinel Effect.
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The Massachusetts Health Plan Will Turn Out to Be Little More Than a Fancy Expansion of Medicaid--Bids Come In At $250 Per Person Per Month
For weeks we have been warning that the Massachusetts health reform plan is at a critical point. The second round of health plan bids came out no better than the first. That did nothing to alleviate concerns that Massachusetts will not be able to mandate that its citizens buy the costly coverage.The first health plan bids averaged $380 per person per month. A family of three would have to pay
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Sierra Health Announces It's Already Losing Money in its 2007 Part D Medicare Prescription Drug Plan
Sierra Health, the leading health plan in Nevada, is already losing money in its 2007 senior Medicare Part D prescription drug program.For 2007, Sierra offered two primary Part D programs--a basic Part D drug plan and an enhanced plan that covers senior's medication in the "gap" or "donut hole." This "gap" lies between the first layer of coverage and the catastrophic insurance that Part D
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Medicare Payment Advisory Commission (MedPAC) Finds Medicare Advantage Plans “Overpaid” by 12%
Told you so—Part Deux.On top of this week’s CBO report saying Medicare could save $65 billion by equalizing Medicare Advantage payments made to HMOs with the traditional Medicare plan, MedPAC dropped the second shoe saying the very same thing in their annual report released yesterday.MedPAC is a commission created by Congress to advise on Medicare payment policy. It is composed of 17 members from
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If Medicare Advantage Rates Are Going to Be Cut, Why Have the Big Medicare HMO Stock Prices Been Up Since the Election?
That question came from Matt Holt today over at his blog: The Health Care Blog.Good question.As any regular reader of this blog knows, I have been arguing that the Democratic Congress is going to cut Medicare Advantage payments to HMOs as soon as they get their hands on the federal budget.If that is a good bet, why wouldn't Medicare HMO stocks be reflecting that risk? Instead, they have generally
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CBO Pours Gasoline on the Democratic Plans to Cut Medicare Advantage Payments to HMOs
Told you so.For some time I have been warning that the Medicare Advantage payments to HMOs are going to be "target number one" when it comes time for Democrats to reshuffle the federal health care spending priorities after 12 years of Republican Congressional rule.For the last year, a number of estimates have put the "over payments" to HMOs when compared to the traditional Medicare plan at around
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Deja Vu in Massachusetts--We've Been Down this Road Before--The Massachusetts Health Care Plan and Health Care Costs
The good news is that the health policy world is full of new and exciting health care reform proposals.The bad news is that while these plans focus on the all important access problems (the uninsured) they almost ignore the underlying problem that makes so many people uninsured in the first place--health care costs.With the federal government (The National Health Statistics Group at CMS)
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Barack Obama is a Rookie on Health Care Policy Reform
Barack Obama was recently quoted as saying he would institute a system of universal health care by the end of his first term. He provided no other details for what would be the Obama Health Care Reform Plan.He is apparently new at this--health care reform policy and fixing America's health care problems.Apparently, he doesn't understand it is the details that matter when it comes to health care
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Does the Massachusetts Health Plan Make Mit Romney Vulnerable Among Conservatives?
Former Massachusetts Governor Mitt Romney is working hard to boost his popularity among conservative Republicans. He seems to be saying all the right things for conservatives. That, plus the longstanding suspicion conservative Republicans have had for both Rudy Giuliani and John McCane have given Romney a shot at the party's powerful conservative wing.Romney has a certain amount of health care
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Congressman Waxman Ought to Ask AARP How Much Money It's Making on Medicare Part D
House Oversight and Government Reform Committee Chair Henry Waxman recently sent a letter to the CEOs of the 12 largest Part D insurers. In it, he asked them to provide the Committee with information on their Part D profit, drug discounts, rebates, and administrative costs.Two of these insurers--Kaiser Permanente and Highmark--are "not-for-profit" insurers.I am more curious about another "
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President Bush Has a Proven Strategy to Fix the Individual Health Insurance System!!!
The Bush administration has already implemented an individual health insurance system that is voluntary, community rated, and excludes no one--no matter what their age or health status.President Bush's recent proposal to reform the health insurance system (see post) is based upon greater use of the individual health insurance system. He would eliminate the employee tax exemption on
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Rural Health Care and Medicare Advantage Plans--A Sacred Cow for Both Republicans and Democrats?
If you have been reading this site for any time you know that I believe the Democrats are going to cut Medicare Advantage payments to the HMOs the first time they get their hands on the federal budget (see earlier post).But I also think there may be an exception to what will generally happen to Medicare Advantage (MA) HMOs--payments to plans operating in "rural" areas.The original Medicare
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10 Bipartisan Senators Offer a Health Care Reform Outline
Just a few weeks ago I wrote a post that began, it's a new day in the health care debate. Health care reform is breaking out all over.My point was that I haven't seen such enthusiasm for reform since the early 90's and the resulting Clinton Health Plan effort. Everyone seems to have a plan--not the least of which are offered by some very powerful bedfellows.That trend continued this week when
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Mitt Romney Looking for Support Among Conservative Republicans--A Health Care Achilles Heel?
Former Massachusetts Governor Mitt Romney is working hard to boost his popularity among conservative Republicans. He seems to be saying all the right things for conservatives. That, plus the longstanding suspicion conservative Republicans have had for both Rudy Giuliani and John McCane have given Romney a shot at the party's powerful conservative wing.Romney has a certain amount of health care
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Waxman Investigates Part D Medicare Drug Plans
When the Democrats took over the Congress I pointed out that not only would they launch a health care legislative agenda of their own but they would also focus on the oversight of existing health care policy.Their greatest interest was always going to be the new Medicare Advantage plans and the Part D Medicare drug benefit. While the Democrats don't have the votes to repeal either of these
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Don't Forget Consumer Choice in Reforming the Health Care System!
Bill Boyles is the publisher of Consumer Driven Market Report and Health Market Survey. He is one of the most effective spokesmen for the consumer driven movement and the effectiveness of the market in managing the cost and quality of care.Today, he reminds us that those offering the new reform proposals shouldn't forget consumer choice:The Uninsured Need Consumer Choice FirstThe only humane way
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Mental Health Parity Legislation--This May Be the Year
Federal legislation that would require health plans to cover mental illnesses in the same way they cover other illnesses has been on the Congressional health care agenda for years.The late Democratic Senator Paul Wellstone of Minnesota, along with his Republican colleague Pete Domenici of New Mexico, have been the longtime bipartisan champions of eliminating what are common limitations on
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Joe Paduda Reflects on Today's Great Times in the Casualty Insruance Business
Joe Paduda may well be the smartest observer of the casualty insurance business--particularly the workers compensation sector.He recently had the following post on his bog, Managed Care Matters:Happy Days are Here Again Seventy years. That's how long its been since the P&C insurance industry enjoyed profit levels
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The Edwards Health Plan--Where Are the Other Plans?
Democratic presidential candidate John Edwards has proposed a comprehensive health care reform plan. (See the entire plan on his site).Good for him!It is going to be very easy for all of us to point to all the things we don't like about it.But I will suggest there is something more important for all of us to do--ask where all the other candidates, Democrat and Republican, are with their plans.It
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The Bush Budget--It's One Thing for People to Call You a "Lame Duck" and Another to Act Like It!
On health care, this Bush budget just tells me this President has given up.To start with, he would let scheduled Medicare physician fee cuts simply take place. Those cuts, now estimated to be 8.5% on January 1, 2008, will under no circumstances take place at anywhere near that level (if at all) and everyone in Washington, DC knows that.So why include this in your budget.The Bush budget calls for
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Bush Defends Medicare Advantage Plans--That and Five Bucks Will Get You a Six Pack
President Bush will shortly release his new budget. He will cut $70 billion from Medicare--largely from providers--and leave Medicare Advantage payments unchanged.President Bush's budget is about as close to irrelevant as it can be. The Democratic Congress will start from scratch.Doctors and hospitals have enormous clout on the Hill. Just as doctors have been able to protect their Medicare fees
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Medicare Drug Negotiation Legislation and a Drug Reimportation Bill––Will They Be Merged?
Legislation to give pharmacies and drug wholesalers the ability to take advantage of lower drug prices in places like Canada, where government controls produce much lower prices, has been introduced in the new Congress.Unlike bills that would only give consumers this ability to import drugs—something lots of people are doing anyway—this would turn the market upside-down by letting the big U.S.
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Medicare Advantage Payments to Insurers Will Be Cut
The State Children's Health Insurance Program (S-CHIP) needs to be reauthorized by the Congress. That will cost $13 to $15 billion over the next five years--something I detailed in an earlier post.Compounding the S-CHIP budget dilemma, Medicare physicians are scheduled to have their fee payments cut by 10% on January 1, 2008.When the last Congress reversed the scheduled 5% fee cut for 2007, in
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The Individual Health Insurance Market Isn't Ready for Primetime
Julie Appleby has an article on the front page of Monday's USAToday covering an issue I dealt with in an earlier post--insurers using post-claim underwriting to rescind people's health insurance policies.President Bush's health plan proposal would encourage consumers to buy their own health insurance. The President, and many others, believe that giving individuals more control over their health
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It's the Cost of Health Care Stupid!!!
We have seen a number of new health care proposals--many I recently cited in a post.My old friend and health care policy mentor, Henry Simmons, who is President of the National Coalition on Health Care, recently released a statement on President Bush's health care proposal.One of the key points he made is that any health reform proposal must be comprehensive and able to slow the growth in health
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Is the Bush Health Plan Tilted Too Far In Favor of Health Savings Accounts (HSAs?)
Chris Lee has an article in today's Washington Post that raises an important question.Has President Bush gone too far in tilting his new health care proposal in favor of health savings accounts (HSAs)?The President would level the health insurance tax preference playing field for consumers whether they get their health insurance at their place of employment or buy it in the individual
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Health Savings Accounts (HSAs) and The Massachusetts Plan--Two Great Experiments
In the wake of the President Bush's new health plan, much has been said about whether we should move to reform the health care system by building upon the traditional employer-based system (preferred by most Dems) or move to a system more controlled by individuals (preferred by most Republicans and the President).Democrats claim the President's plan would wreck the employer-based system--
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The Bush Health Care Plan and U.S. Health Care Reform
It’s a new day in the health care debate. Reform is breaking out everywhere.2007 is shaping up to be the “Year of the Possible” with notable health care reform proposals coming from a number of places almost at once:The new Democratic Congress is setting an ambitious health care agenda as they look to first reauthorize the very successful Medicaid State Children’s Health Insurance Program (
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More on the Bush Health Plan
My good friend Bill Boyles of Health Market Survey offers these comments regarding the President's upcoming health proposal (my own post is below this one):New Bush Proposal Takes Intriguing ApproachAfter six years of offering the same old thing, President Bush Tuesday will propose a creative new health reform that is drawing support from both sides of the political spectrum and could be taken
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New Bush Health Plan Proposal to Be Announced in State of the Union Address
President Bush is about to announce an interesting health care proposal that would cap the tax benefits on the most generous health benefit plans––often held by higher paid executives and some labor unions and use the revenue to cut the number of uninsured.Individuals, whether they got their health insurance from work or paid for it themselves, would get a standard deduction of $7,500 for an
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SCHIP Reauthorization--Will Medicare HMOs Pay for Some of It????
In the post below, I reviewed the need to reauthorize the very successful State Children's Health Insurance Program (S-CHIP).The Congress will have a real challenge coming up with the needed money--$13 billion to $15 billion. Finding the money will be hard because of the House Democrat's pledge to fully fund any spending--their "pay-as-you-go" policy.Where will the money come from?First, the
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Back to "Regular Order"--The House Medicare Part D Drug Bill and SCHIP Reauthorization
The debate over the House Medicare drug negotiation bill is now moving over to the Senate.My post from last Friday (next post below) still reflects what I am seeing on this issue. The Senate will move a drug bill on "regular order" which means we will see the standard committee hearings and process that could lead to floor action later in the spring or summer. The House Medicare Part D drug
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Grassley and Baucus Key to Any Drug Negotiation Compromise
In earlier posts, I have made the point that the House bill to require the federal government to negotiate Part D prescription drug prices will not pass the Senate.Developments in recent days have confirmed that opinion for me. The ranking Republican on the Senate Finance committee, Chuck Grassley, has said he would lead a filibuster of the House bill on the Senate floor and has said he is
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The House Part D Drug Negoatiation Debate is Heating Up!
I was quoted in the Washington Post today reiterating my concern that the House Part D drug negoatiation bill is a hollow political charade on the part of the Dems:"The federal government can get lower prices, but only if it's willing to exclude a certain number of drugs from the formulary," said Robert Laszewski, a nonpartisan health policy consultant in Washington. "And that's a huge political
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Health Care Trend Falling
According to a CMS report published in the latest issue of Health Affairs, health care spending increased 6.9% in 2005--the third consecutive year it has fallen.Given that medical cost trend, as reported by the health plan industry, fell again in 2006, I fully expect CMS to report a 2006 trend rate of around 6.5% when they do their calculation again next year. And, given that trend looks to be
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Good for the Governor of California!!!!
Governor Schwarzenegger’s new health plan proposal is full of controversy.It puts a provider tax on doctors and hospitals (which the docs have predictably already attacked), it hits HMO profits by putting a 15% cap on expenses and profits (WellPoint is currently operating on about a 20% expense and profit margin), and it mandates that both individuals, and employers with more than 10 employees,
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More on the Democratic Part D Drug Negotiation Debate
A friend in big pharma responded to my earlier post on Part D disagreeing with me that the Democratic proposal is not a threat to the drug industry.He made two points:The Dem bill does not prevent the government from requiring each and every plan to prior authorize a medicine for which it is unable to negotiate an "acceptable" price. They see such restrictions as possible because this would not
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HMO Stocks Fall on Medicare Advantage Worries---What Took So Long?
HMOs that play in the Medicare Advantage world fell on Wall Street last week on worries that the Democrat Congress has the power to end the industry's generous payments.Well, what took so long?Of course the Medicare Advantage payments are going to fall when the Democrats get around to the budget this fall.For the complete story on why you can see my earlier post on this.
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Bravo Kaiser Permanente!--As the Insurance Industry Defends Screwing its Customers
I have always had the greatest respect for Kaiser Permanente (KP) and the way it has always conducted itself--in its operations and in the policy debate.That confidence was reaffirmed this week when KP announced that it is working with the California Insurance Commissioner to craft new guidelines for an insurer's ability to cancel, or rescind, insurance coverage when the applicant made
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The Democrats' Hollow Part D Proposal
The House Democrats have announced the form their Part D prescription drug legislation will take.Throughout the 2006 campaign, they had pledged to lower senior prescription drug prices by requiring the federal government to negotiate directly with the drug companies--something the 2003 Medicare Act specifically prohibited. The Democrats went further saying that these negotiations would make it
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More Trouble for Humana's Part D Program
Boston's mayor has been sharply critical of Humana for raising his city's Part D premiums by 130%. Get in line Mr. Mayor, they've done it to millions of seniors who bought their plans!Joe Paduda, in his Blog "Managed Care Matters" has a post today that hits the nail right on the head.You can read more about how Humana got itself into this position in an earlier post I did on the subject of Part D
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The New Congress––Sniping or Civility?
Jerry Ford's funeral took place in our capital city today. I will admit to always being a fan.He gets an unfair rap for not doing a lot during his administration. But just getting our country back on track in the wake of Watergate was a major accomplishment in itself. Let's also not forget that he was the President who signed ERISA into law--something that was a major bipartisan
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Health Care Middlemen––Don't Forget Value!
Friday's Wall Street Journal ran the last of a series on health care "middlemen."The theme was about people taking big money out of the already incredibly expensive health care system but questioning whether they leave a commensurate value.The series included:"As Patients, Doctors Feel the Pinch, Insurer's CEO Makes a Billion," April 18."Selling Generic Drugs by Mail Turns Into Lucrative Business
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