Health Care

WPC's Center for Health Care develops patient-centered solutions to reduce costs and improve the availability and quality of health care for businesses and individuals, providing the only detailed, independent critique of health care issues available in the Northwest.

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Medicare Administrative Costs Are Higher, Not Lower, Than Private Insurance

July 1, 2009 in Blog

Since rising health care costs are the number one issue in the health care reform debate, it is essential that any reform addresses this problem. The Heritage Foundation published an interesting study that found administrative costs to be higher, not lower as frequently cited by proponents of a public plan, than private insurance.

"On a per-person basis Medicare's administrative costs are actually higher
than those of private insurance--this despite the fact that private
insurance companies do incur several categories of costs that do not
apply to Medicare."

You can read about it here , from June 25th.

Massachusetts' Health Care Plan for the Nation?

June 30, 2009 in Blog

Many of the national health care reform measures currently under debate in Congress have been in place since 2006 in the state of Massachusetts. Major reform was implemented that year in a bipartisan fashion with a Republican governor and a Democratic legislature.

Those reforms include:

   *  Individual mandates - all residents must purchase health insurance.

   *  Employer mandates - each employer must purchase health insurance for his employees or pay a fine.

   *  An insurance "connector" to offer a "market place" for insurance plans. The state then dictates benefit mandates and pricing of the plans within the "connector".

   *  State subsidies for the poor.

   *  A goal of universal coverage.

Since these same reforms are now being debated in Washington, D.C., it is reasonable to see how they have worked in Massachusetts? A recent Rasmussen Report found that only 26% of the state's residents view the program as a success, with 37% convinced it is a failure and 37% unsure. Only 10% feel that the quality of their health care is better, while 29% believe it is worse and 53% see no change.

Michael Tanner at the CATO Institute has found that although the number of uninsured has decreased in MA, this decrease is mainly the result of the generous state subsidies and not the individual mandate. Costs have spiraled out of control and the state is currently lobbying the federal government for upwards of $1 billion dollars to cover cost over-runs. Access is also an issue, especially in the area of primary care.

Congress has to look no further than Massachusetts to see that more government control of our health care will not lead to more access and patient satisfaction, better care, and cost containment. Instead, the  Massachusetts experience should be used as a model of what not to do to reform our health care system.

Government Plan Takes the Competing Aspect Out of Competition

June 26, 2009 in Blog

As I listened to President Obama describe the prospect of a government run health care plan at his press conference Tuesday, I thought that his proposal sounded reasonable enough. After all, the public plan would offer among other things, "a better range of choices, make the health care market more competitive, and keep the insurance companies honest." This all seems well and good, but one important detail the president failed to mention is how the inherent structure of the public plan would create an environment that would destroy competition. The public plan would not have to compete with anyone, because it is impossible for private insurers to compete with the United States Government.

Scott E. Harrington, a professor of health care management and insurance and risk management at the Wharton School of the University of Pennsylvania, wrote on this exact problem and the possible ramifications in this article from The Wall Street Journal on June 15th. 

As Mr. Harrington notes, a government run health insurance plan would soon be nothing more than a single-payer system.

Government Option? - Look no Further Than Medicare

June 26, 2009 in Blog

Congress currently has three bills under consideration that all include a government-run option to private health insurance.

In 1964, over 60% of seniors had private health insurance. Medicare was passed in 1965 as a government option health care plan for seniors. By 1970,the private market for senior health insurance, except for co-pays and deductibles, was gone. For the past forty years, seniors have had the government-run Medicare plan as their only option.

Medicare now has an unfunded liability of at least $67 trillion and is rapidly becoming financially insolvent. Access for seniors to health care is now being limited by decreasing provider reimbursements and lack of provider participation. The paper work and regulatory burden for hospitals and doctors has reached formerly unimaginable levels.

Using Medicare as an example, the currently proposed government option for non-senior health insurance would unquestionably destroy the private health insurance industry. Likewise, there is absolutely no reason to believe that a government-run option health care plan for non-seniors would ultimately be different than the financially unsustainable Medicare model.  

The House Health Care Reform Plan

June 19, 2009 in Blog

The US House of Representatives released its 850 page bill for health care reform today. Although the details at the margin are different than the Kennedy-Dodd bill in the Senate, there are some fundamental similarities:

   *  A government-run health insurance exchange.

   *  A government-option health insurance plan to "compete" with private insurance.

   *  Subsidies for the purchase of health insurance up to 400% of the federal poverty level.

   *  Guaranteed issue - i.e. anyone, regardless of prior illness, must be offered health insurance.

   *  A cap on out-of-pocket expenses.

   *  An individual mandate - everyone must have health insurance.

   *  An employer pay-or-play with a penalty fee of 8% of payroll. To avoid the fee, employer-       sponsored plans must meet minimum benefit and contribution requirements set by the government.

The one glaring item not addressed in the bill is how to pay for all of this government-run health care. As the House leadership has stated, however, everything is "on the table" - read increase taxes and further deficits.

Now that the reform proposals in Washington, D.C., are actually coming out on paper, the taxpayers of the nation are starting to understand the real impact of these broad sweeping health reform plans. The debate is just now starting as more people understand the restrictions of liberty and the costs of government controlled health care.


Let's debate the "public" health care option for small businesses

June 19, 2009 in Blog

Today the Puget Sound Business Journal (subscription required to read the whole article) ran an op-ed by Ana
Castro, a small business owner in White Center, on why small businesses need a
government-run health care option in order to offer “choice” in the

I will agree with Ms. Castro that small business owners
often think of their employees as family, and that the price of health care has
seen an extensive rise over the past decade. But Ms. Castro is severely
misguided if she thinks a government-run option will provide the choice she

First off, it’s always disappointing to see proponents of a
particular policy option whip out the preemptive ad hominem attacks. When Ms.
Castro says “In a smear campaign designed to kill reform, the insurance
industry’s public relations machine will try to scare us about a ‘government
takeover’ of health care, long waits and rationed care,” she is basically
saying that any debate, any position counter to her position, is a smear
campaign not worth listening to. So much for high-minded debate.

Secondly, Ms. Castro asserts, “For small businesses like
mine that currently have no good choices, the public plan would compete with
private insurers to lower costs across the board and guarantee coverage we can
count on.” If Ms. Castro were paying attention over the last decade in which
premiums skyrocketed, she would have to acknowledge that one of the main
reasons for these cost increases was greater government involvement (at the
state level) in the insurance market. How many insurance companies operated in
Washington in the 1990s? How many are there today?

The lack of choice does indeed cut down on competition. And competition is
good. At least Ms. Castro and I would agree to that.

Third, let’s address government “competing” in the
marketplace. I am curious how government will efficiently, and fairly, compete
in a marketplace it regulates. How will the government throwing around its weight affect innovation in research and development in the private sector?

Fourth, we cannot simply sweep aside the “cost” factor.
Again, Ms. Castro’s bromides include floury language such as “Our health care
system will work best when everyone has the opportunity to fairly contribute to
health care…” But she does not mention that $1 trillion in additional national
to insure 16 million people and that this costs does not include the public plan she is pushing.

The bottom line is that small businesses are hurting and
need help in this important area. And Ms. Castro and I agree that competition
is one of the keys towards health care reform – small businesses need more
choices than they are offered now. But a government-run plan will not meet
those needs and in fact, most likely deprive millions of Americans of their
private insurance plans and increase the load on the public plan, therefore
increasing costs and reducing choice even further. 

Read more on the ongoing health care debate.

Preview of Government Run Health Care

June 17, 2009 in Blog

If anyone wonders what government-run health care reform will look like, look no further than our current Medicaid program. Because of severe cost over-runs and the accompanying decrease in physician reimbursements, patients are experiencing the predictable decrease in provider participation.

The Wall Street Journal reports children in the Medicaid program are finding it much more difficult to see doctors. Even when appointments are made, the wait times are nearly unacceptable compared to traditional times in this country.

Access to a waiting list is not the same as access to health care.

Cost of Kennedy-Dodd Health Care Reform Plan

June 16, 2009 in Blog

The nonpartisan Congressional Budget Office (CBO) released a preliminary estimate of the cost of the major Democratic health care reform bill yesterday. The Kennedy-Dodd Plan would increase the deficit by $1 trillion over the next ten years.

Once the plan was fully up and running, the CBO projects 39 million people would obtain insurance through the government-run health insurance exchange. Unfortunately (but predictably), the CBO estimates at least 10%, or about 15 million individuals, would switch from employer paid coverage to the government plan. In addition, coverage from other private sources would fall by at least 8 million. Hence, the government plan would decrease the number of uninsured by a net of only 16 million. This is truly a small number for the enormous cost.

As if this wasn't bad enough, the CBO estimate does not even include the cost of the proposed Medicaid expansion proposed in the bill.

Safeway Provides a Free Market Solution to Health Care Reform

June 15, 2009 in Blog

Last week, Steven A. Burd, the CEO of Safeway, provided an op-ed piece in The Wall Street Journal that clearly showed a free market solution to the run-away costs of heath care in this country. Safeway is self insured and by recognizing that 70% of health care costs are a result of behavior, the company has provided financial incentives for its employees to adopt healthier life styles.

Since 2005, the company has charged different health insurance premiums based on employees' participation and demonstration of decrease tobacco use, weight loss, blood pressure control, and cholesterol control. 

Health care costs have risen nationally by 38%, whereas Safeway has maintained costs at their 2005 level - essentially a 40% savings.

Paying for Health Care Reform

June 11, 2009 in Blog

Very little is being said about funding the massive health care reform now debated in Washington, D.C. The largest revenue generator would be eliminating the employer tax deduction for employee benefits. This idea is attributed to Senator McCain during the presidential campaign. President Obama opposed this concept then and only recently has put it back on the table.

What is lost in this discussion, however, is the fact that McCain tied the elimination of the employer tax deduction to a tax credit for individuals and families. In other words, McCain wasn't talking about a revenue source, he was talking about giving individuals more control over their health care dollars and decisions.

Employer tax deductions for employee health benefits has been around since WW II. It seems ludicrous that federal tax policy has been driving our health care policy for the past sixty years. Individuals, not employers or the government, should control their health care dollars.