Dear Prez: Taxing Benefits is Bad Health Policy

March 21, 2009

I realize writing a letter to the president is like writing to Santa Claus.  Yes, Jim, there really is a Santa Claus; but the elves read the letters.

Short letter.

Dear President Obama:

Taxing benefits is a bad idea!

It is bad politics

It is not just that you thought it was a bad idea during the campaign and now you have flip flopped.  You are allowed to flip flop on some issues. Read the rest of this entry »

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The Stimulus and the right wingers on health care

February 7, 2009

In discussing the nation’s health care system, “broken” is the most common descriptive term.  Almost all stakeholders seem to agree on the adjective.  Not Mr. Tevi Troy, writing recently for the Weekly Standard.

Health Care Reform Can be a Stimulus

I have argued that a major overhaul of health care would be a significant stimulus to the economy by leveling the competitive playing field for both employers and workers – those currently working, those out of work and those working on the margins.  In the long term, it would free up capital, both the monetary kind and the human kind, for more productive investments.

It does not surprise me that Congress might see things differently.  The major health care provisions in the stimulus package that will be approved by the Senate have very little to do with stimulus and everything to do with safety net.  Support for state Medicaid programs and provisions related to COBRA.  There are two small provisions in the package that do attempt to push the reform agenda a tiny fraction of an inch.

There is a provision in both House and Senate versions of the bill for for further development of electronic medical records and there is money for “comparative effectiveness research”.

These are hardly earth shaking provisions, unless you are listening to the likes of Mr. Tevi Troy.  To Mr. Troy and his ilk, these measures are the Ft. Sumter of the liberal war on the US health care system.

What planet to these people live on? 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 »


10 Health Care Reform Principles for 09

December 27, 2008

The blogosphere is buzzing with discussions about the promise of health care reform.  For a weekly poster like me, it is impossible to keep up.  As 2009 approaches, and more importantly, as 1.20.09 approaches, I thought I would offer my insights into the topic from the perspective of the administrator of an employer and union sponsored health benefit plan

If there is one thing that unites the comments it is their oppositional posture.  Insurance companies are the most common enemy, but hardly anyone escapes.

So I would like to go on the offensive and tick off a few positives that I would like to see in health care reform.  Please indulge my autocratic use of the term “will”.  

1. Every individual will be required to have health insurance.  Read the rest of this entry »


QMCSO – Say what?

December 6, 2008

In my last post, I wrote that health care reform proposals need to focus on the patient side of the health care delivery system by designing systems that eliminate the cumbersome, even tortuous routes that patients must travel to enter that increasingly privileged space – a person with health insurance.

An illustrative example is the Qualified Medical Child Support Order (QMCSO).  QMCSOs apply to those children who live with one parent but the court orders the other parent to provide the health insurance.  The parent who has custody of the child is called, logically, the custodial parent.  The other parent is called, can you guess, the non-custodial parent. Read the rest of this entry »


Health Insurance for Small Business

November 22, 2008

Every health care reform proposal attempts to offer some relief for small businesses.  According to the National Federation of Independent Businesses (NFIB), small businesses create 2/3 of American jobs, yet half of the uninsured are in small businesses.

Look at President-elect Obama’s health care proposal on his campaign’s web site.  The first two items:  

  • Require health insurance companies to cover pre-existing conditions so all Americans regardless of the health status or history can get comprehensive benefits at fair and stable premiums.
  • Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.

What’s remarkable about these proposals is that we are still discussing them. Read the rest of this entry »


For College Students – It’s not simple

November 15, 2008

I support a simpler health care system.  That is my number one priority.   Thus I am unimpressed with the health care reform platform of our newly elected president.  I do share the hope and optimism of many that meaningful change can and will happen. 

But getting a simpler health care system means that some of the stakeholders need to be cut lose from the system.  That is a politically daunting task. It is why most health care reform proposals try to add more patches to what is already a shabby patchwork quilt of private and public programs.

One effort does try to simplify a small part of our current system.   Read the rest of this entry »