Friday, July 18, 2008

Preventive Care Still Expensive Policy 

By Joseph D. Coletti

Categories:  Individual Mandates, Insurance Regulation, Medicaid, Nanny State, North Carolina

• posted by Joseph D. Coletti
• 1:21 pm
• 0 comment

Tuesday, July 15, 2008

Massachusetts Plan not Working for Some 

State raising prices and fining those who don't purchase

By Marc Kilmer

Categories:  Individual Mandates, Insurance Regulation, Massachusetts

Looks like some folks in Massachusetts aren't too happy with the new health insurance mandate. The Commonwealth Health Insurance Connector Authority is budgeting 10% of its funds to deal with residents who are appealing their fines for going without health insurance. Around 2,500 people filed appeals this year but the Authority expects about 8,000 to appeal this year. Why? The fine for not having insurance is scheduled to go up.

Interestingly, the idea that this mandated insurance may cost too much for some people (maybe those who are appealing their fines?) doesn't seem to matter to the board members:

the board is considering regulations that would set a minimum standard for what kind of coverage individuals must buy, and members said that probably would also raise the price of coverage.

If this mandated product is already costing too much for some, is it really a good idea to raise its price even further? This situation is just another example of how the Massachusetts Plan is fundamentally flawed and why top-down solutions (as opposed to consumer-directed solutions) to our health care problems just won't work.

• posted by Marc Kilmer
• 1:20 pm
• 0 comment

Saturday, July 12, 2008

Romney on RomneyCare 

By John LaPlante

Categories:  Individual Mandates, Insurance Regulation, Massachusetts

Mitt Romney, former governor of Massachusetts, reflects on that state's one-year old health-care program. He praises the Bush Administration for granting a Medicaid waiver that enabled the program to get underway.

He lauds the program, despite the criticism it has received here and elsewhere, saying for Bay State residents, "there is no more worrying that if you lose your job, you lose your health insurance."

Romney points out that through Commonwealth Care, people making less than 300% of the federal poverty level buy insurance on their own, with pre-tax dollars. On their own, pre-tax? That's good.

Romney offers several items of praise for the program: Lower-than-projected costs, increasing the number of people with insurance, and having "tackled the free-rider problem."

He then gives several "mid-course corrections," including requiring that everyone in the program pay something.

• posted by John LaPlante
• 10:47 am
• 1 comment

Thursday, July 10, 2008

Minnesota's New Medical Home Mandate 

By Peter Nelson

Categories:  Individual Mandates, Minnesota

Medical homes were an important part of the policy discussion in Minnesota this year.   In a health care system that can often be fragmented and confusing, especially for people with complex or chronic problems, a medical home offers a health care delivery model where patients can receive more comprehensive and coordinated care from a primary care practice. 

Dr. Mike Ainslie, the Chair of the Minnesota Medical Association, describes a medical home quite aptly (and simply) as the place “where all of a patient’s care comes together.”  Ideally, the medical home takes responsibility for all of the patient’s health care needs, either directly or by arranging and coordinating care with other professionals. 

The hope is that this type of care will create an ongoing and trusted relationships with patients, empower patients to make informed decisions, expand access through longer hours and more channels of communication, avoid duplicative services, reduce medical errors, and increase the use of preventive care.  All together, patients should be healthier and less likely to need more expensive treatments in the future.

To date, few primary care practices take on this added level of responsibility because public and private health plans don’t pay for it. 

Various medical home proposals in Minnesota would create a system to certify and license medical homes and then force public and private health plans in Minnesota to include medical homes in their networks and to reimburse medical homes a monthly management fee.

The proposals differed on how to define the medical home and which health plans should be forced to integrate medical homes into their products.

As these differences and issues took shape over the course of the legislative session, I offered these three recommendations for improving the medical home proposals: (1) The definition for medical homes should be flexible; (2) medical homes should be facilitators, not gatekeepers; and (3) medical homes should not be mandated.  I go into much further detail on these recommendations in the paper, “Medical Home Policy Recommendations.”

Unfortunately, the final legislation ignored most of these recommendations.  While the legislation did allow for a more flexible definition, it gave too much power to the state to control the definition.  Health plans were not given any freedom to define a medical home on their own terms.  Most troubling, Minnesota health plans will now be mandated to include medical homes in their products and they must pay medical homes according to the state’s payment method.  This adds yet another benefit mandate to Minnesota’s nation-leading list numbering 64. 

While Minnesota's government has not taken complete control over how medical homes roll out in the state -- a health plan could conceivably develop their own model and offer it alongside the state model -- it certainly risks discouraging health plans and providers from developing their own competing model.  (How many health plans will want to confuse their customers with two medical home models?)  Without competition, patients will play no role in deciding what a "patient-centered" medical home should be. 

• posted by Peter J. Nelson
• 4:16 pm
• 0 comment

Monday, July 7, 2008

Heavy Regulations, High Costs 

By John LaPlante

Categories:  Individual Mandates, Insurance Regulation, Texas

A few years ago I spoke with someone in Texas's health and human services department. He told me something along these lines: "We're pretty tight here. You don't get on Medicaid unless your pregnant or living in a homeless shelter."

But there's more than one way for a state government to be active in stepping into the world of health care. The Tyler Morning Telegraph (PDF) cites the work of the Texas Public Policy Foundation in a recent editorial on health insurance mandates.

It turns out that Texas imposes 55 mandates on individual insurance policies, making the market there one of the most heavily regulated in the country. 

• posted by John LaPlante
• 7:36 am
• 0 comment

Wednesday, June 25, 2008

Universal Coverage: Easy to Promise, Expensive to Have 

Massachusetts at One Year

By Tarren R. Bragdon

Categories:  Individual Mandates, Massachusetts

• posted by Tarren Bragdon
• 5:35 pm
• 0 comment

Monday, June 16, 2008

Massachusetts Health Reform: More Money, Please 

If the New York Times endorses it, it doesn't necessarily mean it's bad.....

By John R. Graham

Categories:  Individual Mandates, Massachusetts

.....but it's a pretty good bet.

One can never really be sure one's right on public policy until the New York Times weighs in on the issue.  And so it has, giving the thumbs up to Massachusetts' two-year old health reform, which largely consisted of ordering its residents to buy health insurance.  There is a substantial thread here, discussing the pitfalls of Massachusetts' experiment with mandatory, "universal," private health insurance.

OK, says the Times, maybe only about half of the uninsured have signed up yet; and two thirds of those get subsidies to enrol.  Never mind that those who have to pay full premiums are staying away in droves: premiums for that part of the program are only going up 5% this year.  But how much would they expect premiums to go up, for a health plan that nobody wants to join?  Or how about this:  The Commonwealth could be keeping premiums artificially low in order to attract non-subsidized people to sign up before next year, when the penalties for non-submission ratchet up and they might have a tax revolt on their hands.

The fact that the proposed budget for the program is much higher than anticipated only two years ago does not sway the Times, nor the fact that health spending has spiralled upward while access to care has improved minimally, at best.  Indeed, that may be why the editorialists call it an "entitlement" and not a "mandate".

All the state needs to do is find "new sources of revenue".  Come on, fellows, come right out and say it: tax hike! According to the Times, it's not the government's job to allow people to figure out health care that serves their needs; it's the people's job to fund health care that serves the government's needs.  Let's wait and see what they have to say on the third anniversary.

• posted by John R. Graham
• 3:28 pm
• 0 comment

Tuesday, June 10, 2008

Stephen Colbert and George Will Discuss Health Care Mandates 

By Paul Gessing

Categories:  Individual Mandates, New Mexico

As I've mentioned before on this blog, health care mandates are a big problem with increasing health care costs. Rarely is this issue discussed in the media, but George Will recently brought up the point with Stephen Colbert on health care and mandates (click here and fast-forward two-thirds of the way through).

According to data compiled by the Council for Affordable Health Insurance, New Mexico has the 9th-highest mandate total (51) in the nation. Obviously, forcing people to buy a "premium" health insurance product if they are to buy any insurance at all is a big factor in giving the state the 2nd-highest-in-the-nation uninsured rate.

• posted by Paul Gessing
• 6:31 pm
• 0 comment

Monday, June 9, 2008

Schwarzenegger Supporter Advocates Government Monopoly Health Care 

Union Boss: "I pledge...Canadian...health care..."

By John R. Graham

Categories:  California, Individual Mandates, Single-Payer Follies

One of Gov. Schwarzenegger's reasons for his Health Care Deforminator ABX1 1, which would have imposed a massive tax hike to fund "universal" private health care, was that it would short circuit calls for single-payer, government-monopoly, "universal" health care. Indeed, Gov. Schwarzenegger vetoed a single-payer bill, SB-840, in September 2006.

And yet, a handful of the governor's supporters are barely camouflaged fans of government-monopoly health care. I already reported a radio debate I had with the scholar who wrote the analysis supporting the governor's reform for the New American Foundation, who pretty much admitted that the real, long-term, objective of reform was single-payer health care.

Now, another supporter has come out even more forthrightly in favor of a complete government take-over of health care. Here's Andy Stern, President of the SEIU (Service Employees International Union), at the SEIU's annual convention in Puerto Rico just days ago, pronouncing:

"If we pass the Justice for All plan, and we take advantage of this unique moment in political history, then I pledge we will, before the next convention, proudly join our Canadian brothers and sisters to be a nation that guarantees affordable health care for every man, woman, and child. ..."

(That would be the Canadian, government-monopoly, health care system that the Canadian Supreme Court itself found violates Canadians' civil rights by denying access to health care.)

So, why did the SEIU support Gov. Schwarzenegger's legislation, if Gov. Schwarzenegger's plan would stop single-payer? Indeed, the SEIU's in-state "ally," the advocacy group Health Access California, wrote an analysis supporting the bill!

Mr. Stern's "pledge" clarifies that which confused me in my previous post: Why state senator Sheila Kuehl, the undisguised advocate of immediate state take-over, stop ABX1 1 in the senate health committee? Why the inconsistency? Why do "guerrilla" fighters for government-monopoly health care advocate getting half way there via "universal" mandatory private health insurance, while "stormtrooper" advocates resist this approach?

I now think that this is really about union power: specifically, which union would wield the power under government-monopoly health care. As I've written before, SEIU is in a bitter struggle against the California Nurses Association to organize in California (and other states). Senator Kuehl is an ally of the CNA, which mobilized to defeat Schwarzenegger's ABX1 1.

It is impossible to over-emphasize how important it is to union bosses that they take over health care through government monopoly. But this has nothing to do with "health care." Rather, it has to do with diverting money from actual health care to non-medical workers. In British Columbia, Canada, an economist found that wages in "hospitality"-type jobs were 9% to 39% higher in the unionized, government-funded hospitals, than in unionized, privately owned hotels! 

However, it's a winner-take-all outcome: there can be only one union running the show when the state takes over health care. (You don't see competing unions trying to sign up different U.S. Postal Service post offices, do you?)

So, a reasonable conclusion is that if the state takes over health care in the short term, both the CNA and the SEIU believe that the government will hand the prize to the CNA, and drive out the SEIU. If it goes through a period of mandatory private health coverage, the result could be the reverse.

Union versus union for control of California health care: It's not a pretty sight. But it's even uglier that Gov. Schwarzenegger doesn't realize that he's picking sides in a fight that he doesn't even want to be in.

• posted by John R. Graham
• 6:03 pm
• 1 comment

Monday, June 9, 2008

Give Them an Eye Chart 

By Sally Pipes

Categories:  Individual Mandates

The campaign trail is awash with promises to make universal health care a reality. Candidates claim they can lower costs — and insure everyone — through legislative mandates and increased government intervention in the healthcare market.

But they’re wrong. Only with a freer market can we improve America’s healthcare system.

For evidence, just look at Lasik corrective eye surgery. Because most insurance providers (including government programs like Medicaid) won’t cover the procedure, the market operates as it does for nearly everything else — through advertising, competition and consumer satisfaction.

In the past decade, over 3 million Lasik procedures have been performed.

During that time, the average price of Lasik eye surgery has dropped nearly 40 percent, from $2,200 per eye to $1,350.

Unfortunately, Lasik is a rare exception to the general rule. In most of health care, the government is far too heavily involved. In fact, the government now pays over 60 cents of every dollar spent on health care.

The key to lowering costs is to expand the Lasik model. That means encouraging competition by decreasing government’s role in the healthcare marketplace.

Lawmakers could start by letting Americans buy insurance plans from out-of-state providers. Right now, insurance is regulated on a state-by-state basis. And most states force residents to buy one-size-fits-all insurance packages that include all sorts of services that only a small slice of the population needs, like chiropractics and in-vitro fertilization.

These extraneous “mandates” increase the price of basic insurance by as much as 50 percent.

If people could simply buy plans from anywhere in the country, states and private insurers would be forced to compete. This would result in lower premiums and a reduction in overall healthcare costs. It would also let people buy insurance policies custom-tailored to their individual needs.

Politicians could also drive down prices by loosening restrictions on prescription drugs.

Prescription-drug spending accounts for just 11 percent of total healthcare spending. But it plays a huge role in holding down overall medical costs.

By keeping us out of the hospital, prescription drugs save our healthcare system a fortune. After all, a daily dose of Lipitor is far cheaper than heart surgery. Medicare saves over $2 for every $1 increase in prescription-drug spending, according to the National Bureau for Economic Research.

On average today, it takes nearly a billion dollars to bring a new drug to market. Much of that expense is a result of excessive government regulations and would be much better spent on developing new cures. Our elected representatives should strive to reduce those regulations and make it less expensive to bring lifesaving cures to people dying of AIDS, heart disease and cancer.

For more-common health issues, our leaders should work to increase over-the-counter availability of drugs that have been proven to be safe and effective. This would dramatically lower costs for ordinary consumers.

Consider birth control. Is it really necessary for a woman who has been taking the same pill for 15 years to visit her ob-gyn every year to get a refill?

Or look at Mevacor. This popular cholesterol drug has been sold safely over-the-counter for years in Europe, but it still requires a prescription in the United States. That might be a good deal for the doctors who are paid to write prescriptions, but it’s incredibly expensive for the patients.

Doctors who think they can profit from an overly regulated system are kidding themselves. In the United States, the average annual income for a doctor is more than $200,000. In Europe, many doctors make less than $60,000 a year because the government, not the market, sets their salaries. In other words, Europe’s so-called "universal care" has led to a 70-percent pay cut for doctors.

In short, our politicians should work to improve the health of patients, not special-interest groups. That starts with acknowledging a simple fact:

What the American healthcare system needs most is more freedom, not less.

Candidates who can’t see that clearly should go get Lasik.

• posted by Sally Pipes
• 10:03 am
• 0 comment