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Friday, May 16, 2008Price-Fixing in Government Health CareBy John LaPlanteP.J. O'Rourke's recent talk to a Cato Institute audience (PDF link) is worth a read, in some measure because of his comments on health care politics. "Another thing that gets me about Hillary is this: why is price-fixing such a great thing when she does it, but if a couple of businessmen get together on the golf course that's a big crime?" Since the name of this site is State House Call, I'll say this: Substitute the name of any number of governors and legislators for "Hillary," and the problem remains. So often, government attempts at "health care reform" mean government-imposed price controls on health care services.
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Friday, May 16, 2008Saving on Surgery by Going AbroadBy Grace-Marie TurnerCategories: Medical TourismMedical tourism can produce significant discounts on care, writes U.S. News & World Report as part of its "Consumer's Guide to Medical Travel." Thousands of Americans — estimates range from 5,000 to 500,000 annually, if minor procedures are counted — leave the U.S. for surgery, especially if they are paying for the procedure themselves. For example, Brad Barnum, a 53-year old building contractor, had knee and hip replacement surgery in India for $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80% less than the $125,000 or more he expected it to cost in a U.S. hospital, reports the magazine. Medical travel has captured the world’s attention and imagination, but a new McKinsey study suggests that the market isn’t as large as reported and that most medical travelers seek high quality and faster service instead of lower costs.
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Thursday, May 15, 2008HSAs for State EmployeesBy John LaPlanteCategories: HSAs, etc., MichiganThe Mackinac Center for Public Policy suggests a way to save taxpayer money, and advance a patient-centered approach to health care at the same time: shift state employees to high-deductible health insurance plans coupled with health savings accounts (HSAs.) The state would come out ahead even if it maxed out the annual contribution to the HSA each year and also paid all of the premium for the insurance policy. Michael D. LaFaive and James Porterfield estimate that the state could save $16.2 million in the first year alone.
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Thursday, May 15, 2008Illinois Cooking the Medicaid BooksGovernor still looking to expand program in face of deficit By Marc KilmerCategories: Illinois, MedicaidThe Chicago Tribune reports:
But, of course, the governor wants to continue with expansion plans even though the state cannot afford the current size of the program. At least he is meeting some resistance from the legislature. In many states, such as Ohio, the desire to expand these expensive programs sails through without much opposition. It will be interesting to see how this fight in Illinois plays out.
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Thursday, May 15, 2008DC Universal Health Plan "Isn't Financially Sustainable"By Marc KilmerI had previously written about efforts to enact a universal health care plan in Washington, D.C. The plan would be funded by increasing taxes on HMOs, tobacco, and health insurance premiums and would also receive money from CareFirst BlueCross BlueShield. Now, however, it appears that CareFirst is questioning the government's numbers. The city says it would take $55 million to provide coverage. CareFirst, perhaps looking at other health care expansions around the nation, says that is probably too low. Not deterred, the city is pressing forward. Ben Young, the chief of staff for the councilman pushing this plan, does not seem too concerned about the fundng numbers: "Young said the D.C. Council could still pass legislation to offer health care coverage for the residents and work out how to pay for it and manage it at a later time." Doesn't that sentence neatly sum up the problems of "universal health care"?
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Thursday, May 15, 2008Looking for Answers in all the Wrong PlacesBy John LaPlanteCategories: MinnesotaPeter J. Nelson, of the Center of the American Experiment, has been watching the designs of lawmakers in Minnesota's capitol. Though there has been a lot of legislative activity since he wrote this essay, the principles endure. He writes in part:
Nelson then explains that much of the problem with health care today is the "near absence of health-plan consumerism" and lack of competition among health care providers.
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Thursday, May 15, 2008Medica Rolls out Comparison ToolBy John LaPlanteCategories: Minnesota, North Dakota, South Dakota, WisconsinIf patient-centered care is ever going to take hold in health care, we're going to need some tools to help people figure out which doctors, hospitals and clinics are doing the best jobs at the lowest prices. Fortunately some tools are being developed. One is Angie's List, which is expanding its "tell your neighbors" approach from lawn care services to health care. Meanwhile Medica has developed Main Street Medica, which lets you rank physicians, clinics, and hospitals by price, number of patients seen, and other criteria. It's far from perfect, but it's a good start.
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Wednesday, May 14, 2008California Budget Revision Proves It: You Can't Trust the State With Health CareBut those dependent on government programs refuse to see it By John R. GrahamCategories: California, MedicaidAs California struggles to get control of its budget deficit, Governor Schwarzenegger (who as recently as January collaborated with Democrats to almost wrangle a $15 billion health care tax and spending increase through the legislature) has been forced to propose cutting $2 billion (5 percent) from the state budget for health and human services - mostly Medi-Cal (Medicaid) and other services for low-income Californians. The state's long-suffering doctors will be asked to take a ten percent pay cut to balance the budget. How clever is that, when an increasing number of doctors nationwide take no Medicaid patients? And why should California's physicians suffer because the state government cannot spend within its means, but lurches like a drunken sailor from one annual fiscal crisis to the next? (My apologies to drunken sailors, many of whom are fine people, I'm sure.) The fact is that governments cannot act as responsible insurers, for health care or any other social service. If the government let you and I control more of our health care money, at least we'd have the choice of saving up in the good times to ensure we'd have enough money to pay for our health care when income runs short - but the state forbids the poorest Californians from making this choice, even more so than the rest of us. And yet, self-styled "advocates" for the poor continue to bleat for increased government dependency. Incredible!
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Wednesday, May 14, 2008Private Initiative is Transforming Health CareBy Grace-Marie TurnerAt the Consumer Health World conference in Las Vegas, I was once again awed and by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. The real news at the conference was from business and medical leaders who are leading market changes, including: Digital medical care, the globalization of medicine, medical tourism, the unstoppable demand for more personalized information from consumers, technologies to extend a medical home, sophisticated employee wellness programs, and ways to dramatically reduce health costs through efficiencies in the delivery of care. More and more companies from other industry sectors are focusing their skills, technologies, and experience on the health care space, with the potential to produce dynamic, bottom-up change. The political climate matters a lot in being receptive to these changes, but these companies have the potential to be transformative in reducing costs and increasing quality if we will let the market work.
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Wednesday, May 14, 2008Why High Health Care Costs in Milwaukee?By Linda GormanCategories: WisconsinThe Wisconsin Policy Research Institute has issued a report on high health care costs in Milwaukee. I was the author. The basic conclusion is that prices would be lower if hordes of expert American shoppers were set loose on its highly integrated health care providers. It includes an overview of the literature on hospital pricing behavior in integrated health care systems. People who want to extend government control over health care generally laud integrated health care systems as a way to lower costs and generally save the world. As was the case when the same group of people said HMOs and capitated care would save the world, the truth is probably more complicated. The report tries to promote a beginning understanding of the behavioral drawbacks inherent in promoting integrated systems as the cure du jour. Understanding those drawbacks is essential to making cogent arguments against those who think more government is the cure for what ails us. The opening sections include some discussion of the more common claims about why health care costs are so high. The paper also contains an extended discussion of the savings that can accrue to purchasers of health insurance when they combine a health savings account (HSA) with a qualified high deductible health insurance policy (QHDP). Even under fairly severe assumptions about illness, there are still small lifetime savings from an HSA/QHDP. The calculations use real prices and make assumptions that would favor traditional low deductible insurance policies. Graphs are included. In addition, you might find the paper useful for its references.
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