Do we want employment based health insurance?

January 31, 2009


Why is there not more support for an expanded employer role in providing health insurance to all Americans?  I sense a certain exhaustion among decision makers and employee benefit professionals as they grapple with costs that just defy control. I notice at professional conferences an increasing openness to the single payer model.    

We have seen one cost control fad after another.  More and more employers are dropping health benefits in order to stay afloat.  In this game of Old Maid, those employers who do provide benefits struggle to maintain their social compact with their employees without footing the bill for the rest of the world.

The rest of the world? How does that occur?  In a number of ways. Read the rest of this entry »


A True Embarrassment of Riches

January 28, 2009

I have often made the point that a major flaw in the health care  status quo – I balk at using the word “system” – is that no single entity accepts full responsibility.  With very few exceptions, everyone is trying to find someone else to pay the bill or the rest of the bill.

And too often the consumer is the rope in this tug of war.

I received a call from a member.  He wanted to drop his employment based insurance.  Why?  His wife had insurance.  Not an uncommon request in today’s market.  But some questioning revealed that it was a bit more complicated than that.

It seems the member had been admitted for emergency cardiac by-pass surgery.  After the surgery, he was referred to a rehab facility for cardiac rehabilitation.  But the rehab facility refused to admit him until they got clarification on which insurance was primary.

I have determined which insurance is primary.  I think I also understand a possible reason for the confusion.

I can not determine why a provider would deny care – or even suggest that care might be denied – when it was clear that one of the insurance companies would cover the services.

But that’s the way it is when everyone is looking for a way out.

Barack Obama – Can we re-imagine health insurance?

January 24, 2009


With the election of Barack Obama, there is a lot of hope and optimism about the potential for health care reform.

There is also some nervousness.

The nervousness originates from those who think that the current economic crises will inhibit reform efforts.  That somehow the price tag of reform will scare people away from health care reform.  I am encouraged by an insightful article by Ezra Klein on Obama’s choice of Director of the Office of Management and Budget.

According to Klein, Peter Orszag believes that health care reform is the key to the fiscal future.  Since it his office that will pin the price tag on any health care proposal, his biases matter.

Others are worried that Obama might be soft on insurance companies. Read the rest of this entry »

Health Care Reform – Three different themes

January 17, 2009

Three reports this week about the costs of health care and health care reform caught my attention.  One said that health care reform will be a sure fire economic stimulus because it will replace jobs lost from the current recession.   Another suggests that a modest upfront investment will produce $530 billion in savings.  The third moans that without a commitment to hard choices, we are doomed to health care spending profligacy.

John Nichols in The Nation describes a report and follow-on campaign by the National Nurses Organizing Committee/California Nurses Association (NNOC/CAN) that attempts to bolster the argument for a Single Payer health care system by describing its impact on jobs and the economy.

A report in Reuters describes a report by DeLoitte that argues that a $220 billion investment in e-prescribing and electronic medical records will produce $530 billion over ten years.

Lastly, Robert Samuelson in the Washington Post reports on findings of a report by the McKinsey Global Institute that provides valuable insights into why US health care costs so much more than it does elsewhere in the world.  Unfortunately,  it was short on constructive “shovel ready” policies. 

So how does one react to such disparate perspectives.   Read the rest of this entry »

Payment Reform – don’t put me in the middle

January 10, 2009

Just about every health care reform proposal includes payment reform as an important part of its platform.    Most of the proposals come from organizations representing providers.  Not much is heard form the other side of the exchange. 

Two stories recently highlight the need for payment reform from the consumer point of view.

Number one.            My son recently visited friends in New York City.  An unfortunate accident landed him in the New York University hospital for two days.  He is 23 years old and has his own very good insurance.

Several weeks after he returned home, he received a bill from one of the doctors that treated him in the hospital.  Apparently the insurance only paid him a bit more than $200 of the $800 bill.  Because he was an out of network doctor, he could and did bill for the balance.

Number two.            A Participant called our plan recently.  His daughter was travelling with her mother to visit  her grandmother in a southern state.  She too wound up in the hospital.  The family belongs to an HMO and so the HMO paid the Emergency Room bills and the follow on hospital stay.  But they are having difficulty with the follow up care.  HMOs routinely do not pay for services provided by out of network providers.

These examples represent the most frequent type of complaints that we hear from members and why payment reform should matter to consumers. Read the rest of this entry »

Health Care Reform as Economic Stimulus

January 3, 2009

There is some dicsussion that health care reform should take a back seat in an economic stimulus package. 

I suggest that health care reform can go a long way to jump start the economy by itself.  

I make that argument for three reasons.  First the current system of health care financing distorts the competitiveness of the American economy.  Second, the current system of health care financing distorts the job market.  Third, which is really an extension of the second,  the current system of employment based health care financing inhibits the very creative forces that can energize the economy. Read the rest of this entry »