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I'm a Minnesota Girl, living in the south. I tell my friends I try not to talk and think like a Yankee, but sometimes I slip up!

Saturday, August 29, 2009

I found these interesting

Thanks to for the poster.

Keep in mind that I work for a managed care insurance company (health and workers compensation insurance). Working as I do, I know that not all companies in this business can be tarred with the same brush. I need to be careul of how I speak out on healthcare reform. Here's what I believe: My company is not a villain. My company is not profligate; it is the most conservative in spending of any of the 4 Fortune 500 Companies I have worked for, by far. There is not a lot of waste. The management of my company sincerely wants to improve people's health.

The process to pay claims (insurance companies paying doctors for their services) is fraught with poor technology, poor procedures, ultimately one of the most unworkable business processes I have seen. This is not unique to my company. It is true fairly broadly throughout managed care; that includes Medicare, Tricare and Medicaid. (It may be that someone has an efficient method. If they do, it is a hugely kept secret!)How I wish Google would tackle claim payment in the healthcare industry. Managed care firms tackle the magilla by trying to cut costs...outsourcing, finding labor in third world countries; when what is needed is a universal claim management system that all health insurance needs to use. It would save billions every year. It would allow physicians to reduce fees and insurance companies to be more profitable, while becoming more humane, or doing "pro bono" work for those who do not have insurance. Who would build such a system. Not the government; not the insurance companies; ever seen a doctor tackle business technology? Nah.... we need Google. Or Google type thinking.

So, I don't know how health care reform will come out. I am leaning towards a public plan, but discarding the single payer option. That way, there will be some competition in the market, and the insurors/pharmaceuticals will have to drive down their piece of the pie, allowing medical cost to shrink/stabilize. Dare I say it, as an independent leaning towards the left, I kinda think we should have single payer as well, although I would be happy to yield that as single payer for each state. That way a doctor in Florida wouldn't have to file claims with 17 different Medicaid providers (yes, it is true in Florida), Tricare, Medicare, and let's see... a good provider of medical services in Tampa would probably need to support at least 12 different managed care plans. Yes, folks, they have to file their claims about 31 different ways. Why is this not efficient?

I will tell you one thing. Medicare is successful in all things but funding the cost and the Fee For Service and Part D Prescription junk that was passed in the last Administration. And those two "new" Medicare parts can be cured by better lawmaking. Just the same way the regular Medicare plan has been made better over nearly 40 years. And, oh, by the way, by not funding wars with the Medicare $$ pool, and with an efficient medical claim system, we probably wouldn't have to worry about whether we can, as a country, afford Medicare.

Oh, and maybe the pharmaceutical companies would have to stop insuring that pharmacies charge $175 for a pen of insulin that lasts two weeks, and insurers won't cover it. Someone, somewhere, should be willing to settle for $35 to cover that pen.... $5 for it cost to make the drug, $10 for the delivery system (the pen) and $20 profit/cost for the drugmaker to deliver it and Walgreen's to dispense it. Maybe that $20 should be $30. I don't know. I will tell you that that $20 profit/cost should not be $160, which is what is cleared on every one of those pens that those elderly people would actually use to take the insulin they need, instead of the difficulty they have in administering countless needle injections to themselves.

I don't pretend to know enough to solve all the health care reform machinations. I just hope we get something done, dammit. Then sit back, see if it works, and improve it over the next two decades. PUL_EEZE!!

But I was interested in the Washington Post editorial about the much-maligned Massachusetts Universal coverage (and I hear the city of San Francisco launched a great public plan). And, in the way that my father admired most everything Walter Cronkite and Eric Sevaraid had to say, I believe in the principles that Bill Moyers expouses. Forgetting that he is on the Bill Maher show (trust me, Bill doesn't go over the top...why would you do that in front of a great man like Bill Moyers??)

So here is the link to Moyers, and here is the text of the Massachusetts Op Ed. Two of the best things I've read about healthcare in a never-ending partisan battle of idiots.

Editorial from the Washington Post - Healthcare in Massachusetts

Massachusetts’s experiment in near universal health care coverage has become a favorite whipping boy for opponents of health care reform. They claim the program is a fiscal disaster and that the whole country will be plunged into a similar disaster if President Obama and Congress’s Democratic leaders have their way.
That is an egregious misreading of what is happening in Massachusetts. The state’s experience so far suggests that it is more than possible to insure almost all citizens and stay within planned budgets — although it will take great creativity and political will to hold down rising costs so that the program is sustainable.
Three years after the program began, 97 percent of Massachusetts residents have health insurance — by far the highest rate in the nation. That has been achieved without huge increases in state spending.

The Massachusetts Taxpayers Foundation, a non-partisan research group, recently concluded that the cost of achieving near universal coverage “has been relatively modest and well within early projections of how much the state would have to spend to implement reform.” That is heartening news given that the major features of the Massachusetts reforms are similar to those under consideration in Washington.

Massachusetts requires everyone to take out health insurance or pay a tax penalty (unless they are deemed unable to afford coverage). It requires employers to offer coverage or pay a modest fee. It has expanded Medicaid to cover more of the poor and provides subsidies to help other low- and moderate-income residents buy insurance. And it has established an exchange where people not covered at work can choose from policies offered by private insurers who compete for their business.

All told, this program has raised state and federal health care spending in Massachusetts from $1 billion a year in fiscal 2006 to a projected $1.7 billion for fiscal year 2010 — with the federal and state governments each paying half of the added costs, or about $350 million. Massachusetts’s overall budget for 2010 is $27 billion.
A remarkable and encouraging development is that employers, who faced only a modest penalty if they dropped or failed to provide coverage, have chosen instead to expand coverage, in part because their workers were clamoring for group coverage. Indeed, employers and their workers have made a greater contribution to expanding coverage than the state has.

When the Legislature recently imposed cuts that forced the program to reduce benefits for thousands of legal immigrants, critics were quick to charge that the program was unraveling. But as state tax revenues have dropped during the recession, virtually all state programs have had to accept cuts. The demand for subsidized care has also risen as people have lost jobs.

There have been growing pains and glitches. The initially generous insurance benefits had to be scaled back to keep costs manageable. Cigarette taxes had to be raised to help pay for the reform. The number of people reporting problems paying medical bills and gaining access to care, after falling sharply, has begun to rise again. Tens of thousands of people who make too much to qualify for subsidies have to be exempted from the mandate each year on the grounds that they cannot afford to buy insurance. People just above the exemption level who lack employer coverage often face what they consider very high premiums.

Such problems are a warning perhaps that subsidies need to be extended higher up the income range. Massachusetts gives subsidies to families of four earning $66,000 a year, while pending Congressional bills would provide subsidies for those earning up to $88,000. That could mean added strain on government budgets.

What Massachusetts has not yet figured out is how to slow the relentless rise in medical costs and private insurance premiums, although premiums within the exchange have been held to 5 percent annual increases. The state’s political leaders decided to expand coverage first, while postponing the hard decisions about cutting costs until lots of people, businesses and institutions had a stake in the success of the enterprise.
Now the state seems poised to tackle costs — with an approach that is far more ambitious than anything currently being contemplated on Capitol Hill.

A special commission has just recommended that the state try, within five years, to move its entire health care system away from reliance on fee-for-service medicine, in which doctors are paid more for each additional test or procedure they provide.

In its place, the commission wants a system in which groups of doctors and hospitals would receive fixed sums to deliver whatever care a patient needed over the course of a year. The hope is that doctors would be motivated to deliver only the most appropriate care, not needless and excessively costly care, with safeguards to ensure that they do not skimp on quality.

In Washington, as Congress and the administration look for ways to slow the rate of increase in health care costs, they are focusing on a range of possibilities and planning pilot projects to test them. That seems to be a more judicious approach given uncertainties as to what will work. Whatever Massachusetts chooses, Congress should keep a close eye. And the public should demand an honest assessment, from critics and supporters.


Pam said...

Very thoughtful post, Quid. Much of what you said, and Moyers said, make sense.

As a very healthy 65 year old who is some 6 months into Medicare, I've had several glitches that were hair-pullers! They were eventually resolved after headaches for both the doctors involved.

I do know that many physicians don't want to take on new Medicare patients due to the reimbursement nightmare for them. Multiply that by coverage for all Americans and the single payer option ( via Government) is a horror movie scenario.

I don't know the answer. I hear about all the govt. run systems worldwide and the main issue seems to be waiting times and rationing. Most of them provide a private option for those with the $$$s to pay or go to a country like America where they don't have to wait.

Something HAS to be done. I don't dispute that at all! I might be naive but I don't see why the first tier of implementing something new wouldn't be coverage for those without health-care insurance.

Also givens: The rising costs of medical care and of prescription drugs. I also think that until the issue of tort reform and malpractice insurance is taken on not much in the way of cutting costs can be done.

Also, no matter what is said, there is just no way universal coverage can be accomplished without additional funds. That means more or higher taxes.

Right now with the still tottering economy something like a value-added tax as in England or other taxes that slam the consumer who is just barely making it as it is, would be disastrous.

Something has to be done, but, for many of us right now it's a struggle to make ends meet, period. It's hard to wrap our brains around all that needs to be thought out before the health care system is overhauled. Our schools are cutting costs, we're clipping coupons and cutting to the bone each month.

And in the end we don't have that much say in what happens with all this health-care debate. It's in the hands of professional politicians (sure, we elect them, but with the cost of running it's rare that your next-door neighbor is going to be elected to represent you) who have all the health care they or their families need.

Easy to make decisions for the populace when you can run to any doc you choose for a hang nail.

I don't know. I've heard bits and pieces of reform ideas that sound so right and so simple. Then, I'll read about why this or that won't work or won't work on a large scale.

No one seems to be able to take all the really good ideas out there, all the good puzzle pieces, and fit them together to solve this massive health-care puzzle.

Too much partisan bickering and too much rigid ideology on both sides of the aisle.

And, bottom line, that's why we need a Google, like you said, to get the politics out of it. There are some smart people out there who could find a way through this seemingly endless maze of contradictory idea and come up with a REAL workable solution.

Serena said...

It's all very complicated and I don't pretend to know what the answer is. Fundamental changes need to be implemented at many levels, but I fear they'll be a long time coming.

Debby said...

Tim and I disagree vehemently on the healthcare. He's anti, I'm pro. We can't talk about it at all. Shoot. We might as well be politicians...

Bob said...

I am SO conflicted about this, Quid. Thanks for a very thoughtful post.

Texan Mama @ Who Put Me In Charge said...

Happy Sharefest Saturday, SITStah!

This is a really interesting post! I am going to forward it to a few friends, if you don't mind!

Thanks for the info!!!