Greg Scandlen
Greg Scandlen is the founder of Consumers for Health Care Choices, a non-partisan, non-profit membership organization aimed at empowering consumers in the health care system.
Mr. Scandlen is an accomplished writer, researcher, and public speaker. He is considered one of the nation's experts on health care financing, insurance regulation and employee benefits. He testifies frequently before Congress, and appears on such television shows as the O'Reilly Factor, NBC Nightly News, and CNN. Mr. Scandlen gives three dozen speeches a year to organizations representing employers and labor, hospitals and physicians, insurers and pharmaceutical companies.
He has published many papers on topics such as health care costs, insurance reform, employee benefits, individual insurance programs, HSAs and HRAs, and every aspect of consumer driven health care.
Mr. Scandlen has worked for several Washington-based think tanks, was the president of the Health Benefits Group and the founder and executive director of the Council for Affordable Health Insurance. He also spent 12 years in the Blue Cross Blue Shield system, most recently as the director of state research at the national association.
Sunday, July 20, 2008Resisting Tax IncreasesBusiness in Maine and Mass. Get Some Backbone By Greg ScandlenCategories: Maine, MassachusettsHere’s a news flash for you – UNIVERSAL HEALTH CARE COSTS MORE THAN PROPONENTS CLAIM! Yes, indeedy! Folks get these sweeping bills enacted by promising they won’t cost the taxpayers much. And a year or two later they ALWAYS come back for a tax increase to “complete the job.” The Maine legislature enacted a raft of new taxes to pay for its Dirigo program – a first-ever tax on soft drinks, a doubling of the tax on beer and wine, and a 1.8% tax on all health care claims paid by insurers and TPAs – all to pay for a teensy 13,000 people now enrolled in the Dirigo program. But a new business coalition was formed to put an initiative on the ballot to repeal these taxes. Business Insurance reports that the “Fed Up With Taxes” coalition has succeeded in gathering 90,000 signatures to put the measure on the ballot in November. SOURCE: Business Insurance And in Massachusetts, the business community is finally getting some backbone and resisting a proposal by Governor Deval Patrick’s to raise another $100 million in taxes on business, insurers and hospitals to pay for the Commonwealth program. The governor, of course, describes the tax increase as “modest,” a hint that there is more to come. In fact, people in Massachusetts tell me off the record that the business community is talking about preparing an ERISA challenge to the pay-or-play assessment in that state. They haven’t bothered to do so until now because the assessment was modest and they wanted to be cooperative to have the old “seat at the table.” But now they expect the bite to sink deeper and start to hurt. Well, duh! What in the world did they expect? By the way, if they do bring an ERISA challenge, it will succeed and the program will be killed unless the state finds another source of subsidy. SOURCE: Boston Globe
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Saturday, June 7, 2008More on MassachusettsThey'd be better off buying coverage in Connecticut By Greg ScandlenCategories: MassachusettsA new paper by Sharon Long about the Massachusetts experience was published in Health Affairs. It is quite a nice look at how things changed from the fall of 2006 and the fall of 2007. The state did indeed reduce the numbers of uninsured and secured better access to health care services for it residents. Curiously, though, the improvement in access to services was not as dramatic as the reduction in uninsured. The percentage of the uninsured population dropped from 13.0% to 7.1% in one year (this is all based on an independent telephone survey of some 3,000 people). But most of the access measures were far more modest. The percentage reporting they has a "usual source of care" increased from 86.5% in 2006 to 88.7% in 2007, “had a doctor visit in the past year" went from 80.0% to 81.6%, and so on. Out-of-pocket spending for services (not premiums) dropped somewhat. So, an honest reading would have to say that Massachusetts has had some success.But an honest reading would also have to say that it has picked the low-hanging fruit and the rest will be far more difficult. For instance, all population segments have grown in support of the program – except the uninsured themselves. Their support has dropped from about 63% to 44%. The remaining uninsured tend to be young, low-income males in good health. Four out of vie, or 80% say they would have trouble paying for health insurance, 41% say they have had trouble paying other bills in the past year, and one-third are not even aware that there is a mandate. The Heath Affairs study didn’t deal with the cost of the program, but other articles have. The New York Times reported that 340,000 of the state's residents have gained coverage, including 174,000 in Commonwealth Care (the subsidized program) and the governor "has requested $869 million for Commonwealth Care, but his aides have already conceded that will not be enough." Let’s see, that is $4,994 per person in Commonwealth Care, exclusive of any premiums paid by enrollees. I suppose any state could lower its numbers of uninsured if it is willing to spend $5,000 per enrollee. Interestingly, the most expensive policy available next door in Hartford, Connecticut for a 35-year old male costs just $2,744 a year. This is for a zero deductible, zero coinsurance HMO. Other plans cost half of that or less. Massachusetts would have been better served if it simply allowed its residents to buy coverage next door and paid all of their premium.
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Thursday, April 3, 2008Masking Propaganda as ResearchThe recent "study" of physician attitudes By Greg ScandlenHere’s a survey question for you. Please check the box that is closest to your beliefs and return the form to me – ___ Reporters are idiots ___ Reporters are morons The results will be published in the prestigious Annals of Internal Medicine. This survey would have as much validity as the latest “study” that is making the rounds in the nation’s press. The Reuters headline is, “Doctors Support Universal Health Care: Survey.” The South Florida Sun Sentinel puts it, “Study: Most Doctors Support National Health Insurance.” I won’t regurgitate the content of the articles here, other than to say they uncritically parrot the line put out by the “authors” of the “study.” Let’s look instead at the “study” itself. This is not as easy as it sounds. Yes, it was published in the Annals of Internal Medicine, but the content is available only to paid subscribers. Fortunately a friendly internist was able to send it to me. I opened up the file on my computer and was surprised to learn that it wasn’t a “study” at all. It was a one-page letter to the editor. Now a letter has the distinct advantage of avoiding the peer review process that applies to published articles. It is also able to avoid including any embarrassing information about methodology. The letter was written by Aaron Carroll, MD and Ronald Ackerman, MD, both of the Indiana University School of Medicine. I don’t know about Dr. Ackerman, but Dr. Carroll is a member of the board of directors of Physicians for a National Health Program (PNHP), so is hardly an unbiased researcher. Interestingly, the Annals requires the disclosure of financial conflicts of interest, but not political conflicts or biases. The survey itself, though only summarized in the letter, apparently asks only two questions -- 1. In principle, do you support or oppose government legislation to establish national health insurance? And 2. Do you support achieving universal coverage through more incremental reforms? They sent this out to 5,000 physicians and got back 2,193 responses. So the sample was entirely self-selected. And who knows what their cover letter might have said? Coming from a leader of PNHP, it might have been calculated to infuriate physicians who believe in freedom, resulting in these doctors discarding the survey. So, there was absolutely nothing scientific about this. It was pure propaganda. But the idiotic reporters take it at face value, much as they did a few years ago when the Commonwealth Fund published a startling survey finding that the vast majority of employers supported an employer mandate. Few reporters questioned the unlikely finding, so I dug deep into the survey and discovered that Commonwealth gave these employers only two choices – an employer mandate or a single-payer. Pick your poison. And you wonder why we enact such horrible policies in this country.
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Tuesday, March 25, 2008Consequences of Mandatory CoverageBy Greg ScandlenCategories: Individual Mandates, Insurance Regulation, IowaAn op-ed by Adam Thompson in the Des Moines Register indicates that Iowa is close to passing an Obama-type mandate on children. The piece mentions that of Iowa’s 50,000 uninsured children, 27,000 are already eligible for “Hawk-I,” the state’s SCHIP program. One might think that such a rejection rate would be seen as a failure of state government, but, no, government is incapable of failure in some eyes. So this is a failure of parents, and now they must be mandated to enroll the kiddos, even if they think the program is useless. Greg Scandlen
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Friday, March 21, 2008Consumer Driven Health Now 12% of the Market!What the EBRI-Commonwealth survey really says By Greg ScandlenCategories: HSAs, etc., Insurance RegulationThe Employee Benefits Research Institute and Commonwealth Fund have come out with their third annual survey of "Consumerism in Health." This edition is an improvement over earlier versions, though the commentary is every bit as negative as before. It is well worth looking at the underlying data if you can get beyond the infuriating narrative. Greg Scandlen
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Friday, February 8, 2008The "Hidden Tax" LieNew study finds the uninsured pay their share -- plus By Greg ScandlenCategories: California, Individual Mandates, Insurance Regulation, Massachusetts, Medicaid, SCHIPThe primary rationale offered by supporters of individual mandates is that the uninsured consume services that are paid for by the rest of us. It is, they contend, a "hidden tax" that adds as much as 20% to insurance premiums. This argument is destroyed by a new study in Health Affairs that shows conclusively that the uninsured in California pay a greater percentage of their bills than do people on Medicare and Medicaid, and about the same as people who are privately insured. Greg Scandlen, President Consumers for Health Care Choices
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Saturday, January 5, 2008The Sorry History of Mandatory CoverageBy Greg ScandlenCategories: California, Insurance Regulation, Massachusetts, WisconsinI rarely agree with David Himmelstein and Steffie Woolhndler, the husband and wife team of Marxist doctors from Boston who run Physicians for a National Health Plan. So it was something of a shock to read an op-ed they had in the New York Times, and discover that I agreed with every word, except two concluding paragraphs.They look at the history of mandatory insurance coverage at both the state and federal levels, beginning with President Nixon’s pay-or-play proposal in the early 1970s. They then discuss the Massachusetts effort in 1988, Oregon’s in 1989, and similar laws in Minnesota, Tennessee, Washington, and Vermont in 1992-1993. In every case the laws are enacted with grandiose promises but end up making the conditions worse than before or are repealed or overturned in court before they van even be implemented. The article quotes Oregon Governor Barbara Roberts as saying at the time, “Our dream of providing effective and affordable health care to all Oregonians have come true.” Tennessee’s Governor Ned McWherter announced, “Tennessee will cover at least 95 percent of its citizens.” This should be mandatory reading for every advocate of mandatory coverage. Himmelstein and Woolhandler’s preferred solution, of course, is Single Payer National Health Insurance. They ignore that such a system would make all the existing problems in health care financing much worse. And they seem to have blind faith that the same politicians who made a hash of earlier efforts will miraculously transform into enlightened leaders once they control the entire health care system. No, no, no. Far better to put your faith in “the people” than in the politicians. Let the people control the money and get out of the way.
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Wednesday, January 2, 2008Maine's Failed Health ReformsBy Greg ScandlenCategories: Insurance Regulation, MedicaidMaine has recently joined the growing list of failed state reforms. As with other faillures, the Dirigo Care program was shoved down the throats of a bewildered legislature by an egotistical governor who promised Nirvana. You would think people would learn from experience, but a recent report sponsored by the Commonwealth Fund, Robert Wood Johnson Foundation, and Academy Health and conducted by the Mathematica research company shows what a dismal failure it has been.Of course, they don’t put it that way since these organizations are partly responsible for creating the program in the first place. No, they say things like, “DirigoChoice has faced a number of implementation challenges,” and the “eventual impact on the state’s rate of uninsured cannot yet be determined,” and “its early experiences are not indicative of future success.” But look behind the spin and the report is a devastating examination of a program that was poorly conceived and doomed to fail from the beginning – as many of us had predicted. It finds: 1. After 20 months of operation only 11,000 were enrolled in DirigoChoice (out of a total uninsured population of 136,000), and over two-thirds of these were already covered. 2. Of the small companies eligible to participate, only 2.5% actually did. 3. The financing scheme (a “savings offset payment”) is impossible to measure or implement. 4. Almost as many people (3,600) had disenrolled from the program as were newly insured by it. Although the report is fairly comprehensive at 26 pages, nowhere does it mention the cost of the program to Maine’s taxpayers or the cost per newly-enrolled person.
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Friday, November 30, 2007"Working as Intended"Consumer Choice is Sizzling in the Market By Greg ScandlenCategories: Insurance Regulation, MedicaidConsumer Driven Health Care is doing exactly what we predicted it would do. As consumers take more responsibility for their own health care spending they are changing their behavior -- choosing lower cost alternatives, investing in prevention, complying with treatment programs, and seeking out information. As a result, health care costs for CDH plans are rising at one-third the rate of PPO/HMO plans and enrollment is growing at the fastest rate of any benefit innovation of our lifetimes -- faster than IRAs, 401-Ks, or HMOs. Consumers for Health Care Choices released a paper (PDF link) this month compiling the growing body of empirical evidence that shows these trends, and comparing that to the negative arguments that are all based on biased survey data and outdated opinion pieces. There is a health care revolution underway and it is becoming increasingly difficult for even the most hostile opponents of consumer choice to deny the evidence.
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Friday, November 16, 2007Medicare's Biggest Little SecretMedical Savings Accounts Now Available By Greg ScandlenCategories: Medicare PlusWith Open Enrollment starting yesterday (November 15) and going to December 31, Consumers for Health Care Choices has released a new paper alerting beneficiaries to a new option -- Medical Savings Accounts. SPN members may want to alert their own constituents about this new opportunity. Greg Scandlen
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