Grace-Marie Turner
Grace-Marie Turner is president of the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform. She speaks and writes extensively about incentives to promote a more competitive, consumer-driven marketplace in the health sector.
The Galen Institute has been instrumental in promoting Health Savings Accounts and other consumer-friendly ideas that transfer power over health care decisions from bureaucracies to individuals.
In December of 2004, Grace-Marie was invited by President Bush to speak on HSAs and consumer-directed health reform at the White House Economic Summit. She recently was appointed by former HHS Secretary Tommy Thompson to serve as a member of the National Advisory Council of Healthcare Research and Quality.
Grace-Marie also is founder and facilitator of the Health Policy Consensus Group, which serves as a forum for analysts from market-oriented think tanks around the country to analyze and develop health policy recommendations.
She is the editor of Empowering Health Care Consumers through Tax Reform, published by the University of Michigan Press.
In 1995-96, Grace-Marie served as executive director of the National Commission on Economic Growth and Tax Reform. For 12 years, she was president of Arnett & Co., a health policy analysis and communications firm in Washington, D.C.
Her early career was in politics and journalism, where she received numerous awards for her writings on economics and politics.
Wednesday, August 27, 2008We Need a National Market for Health InsuranceBy Grace-Marie TurnerCategories: Insurance RegulationMuch to our surprise, the Census Bureau reported yesterday that the number of people in the U.S. with health insurance actually increased by 3.6 million last year. That's the good news. The bad news is that nearly three million of them got their coverage through government programs. The slide toward a government-dominated, taxpayer-supported health sector will continue unless the 45.7 million Americans who don't have insurance now are given more opportunities to buy private coverage. States could help by lightening their regulatory burdens to encourage greater competition for more attractive and affordable coverage. The federal government needs to do its part by updating today's tax policies to better fit a mobile, 21st-century economy. A new study by University of Minnesota economists Stephen Parente and Roger Feldman shows that Congress could boost by more than 12 million the number of people who have health insurance without spending taxpayer dollars. The change required is to allow people to buy health insurance across state lines, so they can shop for less expensive policies. The cost of health insurance varies widely, but it is closely tied to state regulations and legislative mandates dictating what services and providers must be covered. More regulation and less competition generally mean less affordable coverage, and vice versa. For example, a typical health-insurance policy in heavily regulated New York costs more than three times as much as in less regulated Iowa ($388 a month versus $98 a month for the same coverage). (Read the rest at The Wall Street Journal...)
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Monday, August 25, 2008Better to Compromise Cost-Effectiveness than Care-EffectivenessBy Grace-Marie TurnerCategories: Single-Payer FolliesMany political leaders have called on governments to evaluate the relative impact of various drugs and medical treatments in an effort to control health costs. But history has shown just how dangerous this approach to medicine can be, wrote Center for Medicine in the Public Interest's Robert Goldberg in The Oklahoman earlier this month. Based on state-run comparative-effectiveness trials, Britain's National Health Service has been pushing patients onto a less expensive cholesterol-lowering drug called simvastatin in favor of Lipitor. While the British government has probably saved some money, it comes at a cost, according to Goldberg. An eight-year study found that "major cardiovascular events" had increased by more than a third among patients forced to make the switch. As politicians grope for ways to control health care spending, they should be sure that their policies don't do more harm than good. Comparative-effectiveness research has a role to play in fostering more cost-effective use of health resources -- but not at the expense of patient care.
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Friday, August 22, 2008Affordable DestinationsBy Grace-Marie TurnerCategories: Medical TourismMore than 750,000 Americans left the country last year for less expensive medical treatments, a number projected to grow to six million by 2010, according to a study from the Deloitte Center for Health Solutions. Other key findings:
A separate study from Deloitte finds that the number of retail clinics in operation has soared by 220 percent from just 250 clinics in 2006 to more than 800 serving patients by the end of 2007. Consumers are flocking to retail clinics not only for convenience, but also for the relatively low prices compared with visiting their primary care physicians for the same treatments. The cost of services provided by retail clinics ranges from $50 to $75, with the majority priced at $59, compared to a physician's office visit, which can cost from $55 to $250. Additionally, the cost for a retail clinic physical, at $25 to $49, can also result in savings compared to a physical at a physician's office that can cost anywhere from $50 to $200.
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Thursday, August 21, 2008Affordable DestinationsBy Grace-Marie TurnerCategories: Medical TourismFees for medical treatment abroad can range from one-half to as little as one-fifth the price in the United States, depending on the destination country and the type of procedure performed, writes Devon Herrick in "Medical Tourism: Health Care Free Trade." For example, Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the U.S. Medical licensing laws should be brought into the information age, where distance (or country) is irrelevant in procuring many medical services, writes Herrick. Further, insurers and employer-sponsored health plans should be able to offer financial incentives for seeking care abroad, much as they do currently for medical services within their network, without facing increased liability risks. Federal and state government should lead by example, by allowing Medicare and Medicaid programs to send willing patients abroad. Medicare would particularly benefit from cost savings since it pays for a large volume of orthopedic and cardiac procedures.
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Wednesday, August 20, 2008Interstate Commerce: The Route to Wider CoverageBy Grace-Marie TurnerCategories: Insurance RegulationAllowing consumers to purchase health insurance across state lines could bring down premiums and significantly reduce the number of uninsured, reports a new study by Steve Parente, Roger Feldman and others, released at a recent American Enterprise Institute conference. The paper includes a simulation model and analysis of the impact of several new purchasing scenarios, including allowing competition among health insurers across state lines within four regions of the country. The study's authors determined that the moderate (most likely) impact would be that 11 million more people who are currently uninsured would obtain coverage, and conclude that opening insurance to competition across state borders would lead to substantial additional health care access and health improvements among the vulnerable populations who currently find health insurance unaffordable. In addition, development of a national market requires no additional federal resources other than support for legislation to permit it.
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Tuesday, August 19, 2008States of FrustrationBy Grace-Marie TurnerCategories: Individual MandatesLegislators are trying mightily to address problems in the health sector at the state level, but many of the forces driving their problems come from federal policy so they are continually frustrated. In fact, Harvard's Steffie Woolhandler and David Himmelstein, two policy experts with whom I seldom agree on policy, have an important analysis in the latest International Journal of Health Services that explains how frustrating state-level changes can be. They cite seven states that have undertaken major health reform initiatives since 1987, from Massachusetts to Tennessee to Washington State, only to see uninsured rates virtually unchanged, if not rising, by 2005, despite their massive and expensive reform efforts. (The authors, of course, are arguing for a government-run, single-payer system, but that's another story...) State leaders feel compelled to take action. And the public is watching. Four local TV stations and several major newspapers covered my talk in Oklahoma. Legislators, like many others in the health sector, are watching and waiting for the result of the November presidential election, which will be hugely influential in setting the tone and direction for health reform initiatives next year. Federal tax policy changes are vitally important as are state efforts to open up their markets and allow more competition and consumer choice in health care and health insurance products. Competition works.
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Monday, August 18, 2008Mandates are not OKBy Grace-Marie TurnerCategories: Insurance Regulation, OklahomaHigh health costs are very much on the minds of state legislators as they prepare for next year's sessions. I traveled to Oklahoma a few days ago for a speech before the House of Representatives' Health Care Reform Task Force in the beautiful and ornate House chambers. State Reps. Doug Cox and Kris Steele co-chair the task force, set up by House Speaker Chris Benge to investigate ways to expand access to health insurance for Oklahomans. In my presentation, I warned against adding more mandates and regulations or following the highly-regulatory lead of Massachusetts. Legislators often believe they are doing the right thing for their constituents by forcing insurers to charge level premiums to all policy holders, mandating comprehensive coverage of dozens of health care services and providers, and requiring companies to sell insurance to all comers. But these policies backfire and distort the market, discouraging young and healthy people from buying insurance, telling people they can wait until they are sick to buy coverage. For example, New York has both guaranteed issue and community rating laws, and it has health insurance costs that are 3.5 times higher than less-regulated Iowa, according to a Forrester Research study for eHealthInsurance.
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Friday, August 15, 2008Fiscal Flameout in the Free StateThe folly of financing government by taxing smokers is proven yet again By Grace-Marie TurnerCategories: Maryland, Nanny StateLast year, the Maryland legislature doubled the cigarette tax to $2 a pack to pay for expanded health-care coverage, but eight months later, cigarette sales have plunged 25 percent and the state is in fiscal distress again. In New York City and State, tobacco taxes have been raised so many times that the retail cost can exceed $9 a pack -- about double the national average. Members of Congress should take note, writes The Wall Street Journal. Democrats are now planning a $35 billion children's health program expansion funded by a 61-cent per pack tobacco tax increase, justifying the new levy as a "sin tax." Comments the Journal: "OK, but if Americans don't start sinning a whole lot more, states and Uncle Sam are going to go broke."
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Wednesday, August 13, 2008Infirm & EvictedBy Grace-Marie TurnerCategories: Long-term care, MedicaidLast week The Wall Street Journal reported that U.S. nursing homes are "forcing out frail and ill residents" and replacing them "with shorter-term residents likely to bring more revenue."
This is key: Medicaid reimbursements to nursing homes were $4.4 billion less than the cost of treating beneficiaries last year, the Journal reports, and approximately two-thirds of nursing home residents who stay in facilities more than 90 days depend on Medicaid to pay their bills. That's also fair warning to aging Americans who think the government will be there for them if they don't invest in their own long-term care insurance.
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Tuesday, August 12, 2008Primary MDs Need LifelinesOr they may flatline as a species By Grace-Marie TurnerCategories: Insurance Regulation, MassachusettsWithout some informed legislative correction, the days of of the trusted primary care doctor may very well be on the wane, wrote Dr. Kevin Kelleher recently in "'Who' not 'How': The Real First Step in Health Care Reform" for Medical Progress Today:
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