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...
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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...
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...
"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...
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...
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...
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...
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...
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 Richardso...
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 ris...
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...
"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...
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...
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...
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...
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...
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...
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)...
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...
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 worl...
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...
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...
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...
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...
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...
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...
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...
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