Friday, January 25, 2008

The Trouble with New York's Health Plan 

By John LaPlante

Categories:  New York

"New York is the third-largest state in the union and about as good a laboratory as we'll find for the national health-care market," writes Tarren Bragdon.

So how has the state's efforts to put put more people into insurance gone? Not very well. 

• posted by John LaPlante
• 11:12 am
• 0 comment

Friday, January 18, 2008

Affordable Insurance for New York 

By Tarren R. Bragdon

Categories:  New York

What's the best way to ensure that all New York State residents-adults and children alike-have access to affordable health-insurance coverage?

Over the past decade, the state government has answered that question by expanding publicly subsidized forms of health insurance, building on what was already the nation's most expensive Medicaid program, while maintaining insurance regulations that make private coverage both scarce and expensive.

There are better alternatives. 

• posted by John LaPlante
• 6:06 am
• 1 comment

Saturday, January 5, 2008

Wealthy State, Big Spending ... Many Uninsured 

The problem with New York

By Tarren R. Bragdon, John LaPlante

Categories:  Insurance Regulation, New York

"Why," asks Tarren Bragdon, "does New York spend more on Medicaid -- a health-care program for the poor -- than every other state but still have a larger portion of its population walking around without health insurance than states that spend far less?"

Writing in today's Wall Street Journal (link for subscribers), Bragdon explains that regulations on individual insurance are one reason. (Individual and family policies purchased outside the employer market cost about twice the national average.) 

These regulations include community rating, guaranteed issue, and a long list of mandated benefits.

Gov. Eliot Spitzer, meanwhile, wishes to further weaken the private market by expanding government health insurance programs--to families making as much as $80,000 a year.

• posted by John LaPlante
• 8:29 am
• 0 comment

Monday, December 10, 2007

Is NY A-G Cuomo Supporting or Strangling Physician Quality Rankings? 

If New York Times, AARP, and Consumers Union Endorse It, It's Gotta Be Bad

By John R. Graham

Categories:  Insurance Regulation, New York

Supporters of consumer-directed health care have privately told me that I have been too hard on doctors and too accomodating to the health insurers.  This has been in response to my posts on health plans ranking doctors' quality and NY Attorney-General Andrew Cuomo's opposition to it.

I had hoped that Mr. Cuomo's deal with the Empire State's health plans might let me off the hook: I sure don't want to be remembered as the insurers' sweetheart.  Unfortunately, the New York Times has editorialized in favor of the arrangement, and Consumers Union and AARP also support it.  Now, to be fair, support from these august liberal bodies does not necessarily mean that a proposal is wrong, but it's a pretty good signal.  Let's recap: 

Basically, NY's physicians had gotten riled up that health plans' "quality" rankings would recommend physicians to patients based on cost, not quality at all.  This got Mr. Cuomo's attention and he blustered that he would stomp all over health plans who publicly ranked doctors - even though no rankings were actually taking place, and it wasn't clear how such rankings would be illegal.

Many health plans quickly fell into line, submitting to Mr. Cuomo's demand for a standard ranking method that, it appears, is unlikely to offend any doctors.  On the other hand, it's unlikely to divulge any information of value to patients, either.  Albany's legislators quickly agreed to pass a bill incorporating Mr. Cuomo's demands, as well as those of doctors' lobbyists and self-styled "consumer" groups.

There is one positive condition in the agreement: health plans can pool information on doctors so that each plan will not base its rankings on selective data.  However, my understanding of the federal McCarran-Ferguson Act is that it already permits insurers to pool claims information, so Mr. Cuomo's "safe harbor" provision is not very useful.

On the other hand, the agreement is likely to result in a sclerotic, unresponsive, and monolithic physician ranking "system" for New York.  For example, physicians hold an effective veto over the rankings: plans must submit changes to physicians 45 days before making a change, and cannot change a physician's rank if the physician appeals the change.  Perhaps even worse, insurers must submit to a "Ratings Examiner" ("Rx", which is a confusing acronym because it also symbolizes a prescription), who is paid by them but answerable to the attorney-general.

The agreement has room for a lot of "gotchas" if the A.-G. decides to go after the health plans.  Interestingly, the health plans agree not to act against the A.-G. if he does something they think violates the agreement, but the A.-G. reserves the right to act against the health plans, agreement notwithstanding.

Why did the health plans cave in so quickly?  One is forced to consider the possibility that the originally proposed health rankings were the result of the market telling NY's insurers to compete on quality.  (As I noted in previous posts, patients do not trust health plans' rankings today, so for plans to launch significant new investments in publishing rankings must indicate that they think that they have to shape up in order to thrive.)

By buying in to Mr. Cuomo's "standard" they (might) implicitly collude to forestall this competition because they can claim that to do anything more than what the new law demands will risk litigation by the "Cuomortician".

So, despite Mr. Cuomo's antagonistic stance, the result of his interfering in health plans' ranking physician quality is more likely to result in a comfortable life for physicians and health plans alike.......Not what the patient ordered, I'm afraid.

• posted by John R. Graham
• 5:35 pm
• 0 comment

Monday, December 10, 2007

Making Headway in New York 

By Grace-Marie Turner

Categories:  New York

The Galen Institute's friends at the Manhattan Institute and the New York State Health Foundation are sponsoring a conference tomorrow to try to inject some sense into that state's overly dysfunctional, micro-managed health sector.

Gov. Eliot Spitzer has pledged a major effort toward state health reform. But first, the Manhattan Institute warns, lawmakers should consider the consequences of previous reform efforts, both intended and unintended, and carefully examine the needs of New York's uninsured population.

You can register for "New York's uninsured: Looking back and moving forward" here.

• posted by Grace-Marie Turner
• 10:29 am
• 0 comment

Friday, October 19, 2007

The "Cuomortician" Attacks Health Choice in New York 

Attorney-General Wastes Precious Health Resources

By John R. Graham

Categories:  New York

For some reason I just can't stop blogging about the Empire State, even though I'm on the other coast.  I should be grateful to Attorney General Cuomo and Governor Spitzer for giving me so many reasons to write about the state that ranks dead last in the U.S. Index of Health Ownership!

Anyway, here he goes again: the NY attorney general has released a second arrow from his quiver to stop health plans from doing what they aren't even doing yet -- ranking providers on quality, which he thinks they'll abuse to steer patients to lower-cost providers.  (But so what? It's not like your health insurer's potential future provider quality rankings will be your only source of information.  Others already exist.) I've already written about the absurdity of his August attack on Cigna, Aetna, and UnitedHealthCare.

Now he's going after Empire Blue Cross Blue Shield, Preferred Care, and HIP/GHI.  Maybe the crusade has not been advancing as well as originally planned: the August 16 press release "warned" the carriers that they might be displeasing the "Cuomortician", but yesterday's was only "requesting information."

Nevertheless, the letters project an arrogant presumption of guilt, demanding that the plans divert precious resources to churning out paperwork for Mr. Cuomo's bureaucrats to wade through on a ridiculous fishing expedition, asking health insurers to prove that they are not breaking laws that he has not even charged them with breaking! (How could he, anyway? The quality improvement programs don't exist yet.)

And people wonder why the administrative costs of health insurance are so high.....?

• posted by John R. Graham
• 5:27 pm
• 0 comment

Monday, October 1, 2007

Escape From New York (Hospitals, that is)! 

Gov. Spitzer Has $360 Million to Shut Hospitals - But Not to Insure Kids

By John R. Graham

Categories:  New York, SCHIP

A couple of weeks ago, New York Gov. Spitzer got himself into a high dudgeon about President Bush's new rule requiring states to enroll 95 percent of kids in families below 200 percent of the Federal Poverty Line (FPL) in state children's health insurance plans (SCHIP) before signing up those in higher-income families.  According the governor, this rule would prevent the Empire State from enrolling 70,000 young knickerbockers that he hoped to rope into SCHIP.

Reflecting wistfully on his salad days as a crusading prosecutor, Gov. Spitzer today announced a multi-state lawsuit against George W. Bush, in anticipation of the President's veto of reckless SCHIP expansion legislation.

So, what does Gov. Spitzer plan to do with $360 million of his own state's money? Shut down 23 hospitals and seven nursing homes, the oversupply of which was blamed for rising health costs in a 2006 report commissioned by former Gov. Pataki.

Let's do the math: $360 million divided by 70,000 uninsured kids equals over $5,000 per kid.

And Gov. Spitzer claims he can't provide health insurance to New York's kids without raiding the federal treasury?

Furthermore, states where central planners limit the supply of hospital beds do not save health costs (as discussed in a chapter by Roy Cordato in a 2006 book I edited).  Like any Soviet-style economy, health care in New York is absurd and cruel.  Indeed, New Yorkers suffer the least health ownership of all 50 states, according to the U.S. Index of Health Ownership.

New York's health care problem is too much government, not too many hospitals.

• posted by John R. Graham
• 3:31 pm
• 1 comment

Friday, August 17, 2007

Ranking Doctor Quality: New York Needs Competition, Not Cuomo-tition 

Attorney-General Cuomo's Attack on Health Plans is Unprovoked & Frivolous

By John R. Graham

Categories:  New York

There's nothing new about state attorneys-general going on fishing expeditions (at taxpayers' expense) to find fertilizer for their trial lawyer buddies, but New York AG Andrew M. Cuomo threatens to outdo even his predecessor, Gov. Elliot Spitzer, with today's challenge to health plans ranking doctors by quality indicators.

Not that insurers are actually doing any ranking yet, but they intend to, and that's enough to put Mr. Cuomo in motion, demanding that they disclose their plans to him within 48 hours. His fear? That plans won't actually rank doctors by quality, but simply promote those who cost less.

Meanwhile, across the state line, Connecticut doctors' lawsuit against plans' rankings claims "defamation," although (as in New York) no rankings have yet been published! Of course, doctors are quite happy to see the health plans ranked on promptness of payment, but (as so often happens in American health care), what's good for the goose ain't good for the gander.

What are they worried about anyway? People do not trust their health plans, which rank below tobacco companies in HarrisInteractive polls. Unless health plans do something to turn around their plummetting status, nobody will pay attention to their rankings. If plans try to force them on us, we will rebel, like we turned on HMOs at the turn of the millenium. On the other hand, people do invest doctors with high prestige. There is nothing (except a natural instinct for collusion) that prevents the medical profession from ranking its own members.

In any case, this urge to rank doctors like singers on American Idol is overblown: if we were free to choose doctors and "rank" them by paying them freely negotiated rates, most of us would rely on word of mouth from friends and colleagues in our neighborhoods. Nevertheless, if health plans rank doctors, or doctors rank health plans, or nurses rank hospitals, or patient advocacy groups rank drug-makers, or wheelchair manufacturers rank tire-makers, who am I (or anyone else), to forbid it?

Which brings us back to Mr. Cuomo. New York ranks dead last in health ownership, according to the recently published U.S.Index of Health Ownership. The Empire State "suffers from government-health care programs that are out of control, a grossly over-regulated private insurance market, and almost completely uncompetitive provider markets" according the Index's insightful author (me). None of this is due to whether health plans rank doctors or not. When it comes to improving health care in New York, the AG and other politicians in Albany have much bigger fish to fry.

• posted by John R. Graham
• 4:14 pm
• 0 comment

Wednesday, June 6, 2007

Index of Health Care Ownership is Out! Every State Ranked! 

Utah Top of the List, New York Bottom of the Barrel on 24 Measures

By John R. Graham

Categories:  Alabama, Delaware, Maine, Nebraska, New Jersey, New York, North Carolina, North Dakota, Utah, Vermont

PRI has released the Index of Health Ownership, which uses 24 variables to rank all the states according to their residents' freedom from undue government interference in health care.

Top 5: Utah, Nebraska, Delaware, North Dakota, Alabama

Bottom 5: New York, Vermont, New Jersey, North Carolina, Maine

I know SPN wants to collaborate in promoting this effort and I'll be in touch with John LaPlante on that.  Any SPN members who want more color or would like me to speak in their state please contact me.  This is something we intend to repeat periodically, hopefully annually.

Go forth and own your health care!

• posted by John R. Graham
• 12:22 pm
• 0 comment