Category: Public Option

Dr. Chris McCoy: Dear AMA: I Quit!

Dr. Chris McCoy: Dear AMA: I Quit!:

“Dear American Medical Association,

“I recently had the opportunity to read your response to the Senate Finance Committee proposal [pdf] for health care reform, and it is clear to me that I cannot remain a member in your organization. Please remove my name from your membership rolls, effective immediately.

“In reading the response, I was frustrated and disheartened by the fact that you couldn’t get through the second paragraph before bringing up the issue of physician reimbursement. This merely highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession. As a physician, I advocate first for what is best for my patients and believe that as a physician, as long as I continue to maintain the trust and integrity of the profession, I will earn the respect of my community. The appropriate financial compensation for my endeavors will follow in kind.”

Read on. I agree with everything he says here, and yet, until the AMA House of Delegates meeting this week has concluded, I will withhold judgement and retain my membership.

If the floor fight at the House of Delegates takes shape as I predict, the old (literally) guard will get reaffirmation of every anti-reform policy reaffirmed and get an anti- public option policy added and will force the AMA leadership (progressive as they might be) to act like the AMA of old and start fighting reform.

We’ll see. I have friends in leadership in AMA and they say it has changed.

We’ll find out very soon.

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com:

“As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.”

I am OK with opposition to making participation mandatory if one accepts Medicare for the obvious reason is that it is coercive, but mainly, because the plan should be able to stand on its own and thrive. If it does not, then something is wrong in the way it was set up, and it should fail.

So I believe we MUST have a good public option, but it must be good in all senses: promoting better use of resources, reducing administrative waste, continuing Medicare’s freedom to choose providers and so on.

Can’t wait for the AMA meeting outcome…

***UPDATE***
Check out the letters in response which, perhaps led to the AMA press release:

AMA COMMITTED TO HEALTH REFORM THIS YEAR
Make no mistake: health reform that covers the uninsured is AMA’s top priority this year. Every American deserves affordable, high-quality health care coverage.
“Today’s New York Times story creates a false impression about the AMA’s position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

Thanks to my peeps at Doctors for America for the heads up!

Baucus Watch, Public Option issues: Columbia Journalsm Review

Baucus Watch, Part X : CJR:

Columbia Journalism review tries to get reporters to focus on the substance of the Public Option debate, rather than on the horse-race, who’s up, who’s down BS they generally like to cover ’cause it’s easier and more fun. As a reminder of the thinking in general, you can read more about the “weak” vs. “strong” public plan options here.

“To move this story—and it’s an important one—beyond the process of reform to the substance of reform, we offer a few questions for reporters:
• Who will really be able to join a public plan—everyone, or just those who don’t have other coverage or are too ill for insurers to take them on as customers?
• Can workers with coverage from their employers go to a public plan if it’s cheaper? In other words, is there a real choice for everyone?
• How will coverage be financed—by taxpayer dollars, or by premiums from people needing insurance?
• Will the government provide the coverage, as it does for Medicare’s hospital and doctor benefits, or will private insurers provide it, as they do for Medicare’s prescription drug benefit? There’s a big difference here.
• What will the benefit package look like? Which special interests are working to make sure that their latest gee-whiz technology gets covered?
• Will doctors and hospitals be paid the Medicare rates, or something higher?
• If they get the higher rates, then where will the cost-savings come from?
• If private carriers provide the benefits with more of the same inefficient billing costs, where will the administrative savings come from?”

Public Plan Options: Strong, Weak, and MRP?

Courtesy of Health Affairs Blog, and Harold Luft:

“The two options are the “strong” and the “weak” versions of a public plan, referring not to the strength of the proposals, but the power of the public plan. The “strong” version, as advocated by Jacob Hacker, among others, is a near-clone of Medicare adapted for those under age 65. It uses Medicare’s buying power in setting fees for providers, thereby keeping down the premium cost relative to private plans without such leverage. Not surprisingly, providers and private insurers vigorously oppose the idea, which they see as inevitably leading to a “Medicare for all” single-payer system. The proposal has other important features largely tied to parallel changes that need to be legislated for Medicare. Holding out for the “strong” plan risks having a political stalemate kill any chance of reform, but even if passed, it will not transform the health care system. “
….
“A “weak” public plan, as proposed by Len Nichols and John Bertko, would compete with private insurers by being transparent, nonprofit, and well-intentioned. It would follow all the rules required of private plans and not leverage Medicare’s buying power. Such a plan will need public funding to get started, probably bringing the public contracting, employment, and other rules that would hobble its ability to compete. An alternative to the “build your own” version is what many states have developed for their employees: a public plan that designs benefits and provider networks and carries risk, but leaves administration up to contractors.”
….
“I propose an alternative avoiding the weaknesses of both the public solutions such as Medicare for all and current private insurance plans, while building on the strengths of each. It establishes a publicly chartered major risk pool that eliminates the need for the problematic behaviors of private health plans while enhancing choices for providers and patients.

“The new entity would be publicly chartered, but nongovernmental. Independence from direct
congressional oversight means that it avoids being hamstrung by special-interest groups. It has a publicly appointed board with long terms, similar to the Federal Reserve, with even higher expectations for transparency. Aside from some start-up funding, the pool is self-financing.

“The major risk pool would not itself offer coverage directly to consumers; instead, it would offer reinsurance for hospitalization and chronic care — the most expensive components of health care — to health plans, which would sell comprehensive wraparound packages. In my book, Total Cure: the Antidote to the Health Care Crisis, I use the term “Universal Coverage Pool,” or UCP to describe most of these functions. The plan for health reform called SecureChoice in Total Cure has income-based subsidies and other features that may or may not be included in the current legislative discussion. Here I use the term “major risk pool,” or MRP, to describe a more narrowly construed publicly chartered plan.

‘The rationale for the MRP is twofold. (1) By pooling risk for the most expensive and financially threatening components of health care, it spreads risk broadly. Allowing health plans to buy coverage at demographically determined rates, it eliminates significant administrative and marketing expenses. (2) By paying in new ways for what covers, it will transform the delivery system.”

I will admit that this is beyond my amateurish economic capabilities to evaluate well. So, I’ll wait until Hacker or Nichols or others do, and keep you posted…

Letter – Schumer Health Care Plan – NYTimes.com

Letter – Schumer Health Care Plan – NYTimes.com:

“Re “Schumer Points to a Middle Ground on Government-Run Health Insurance” (news article, May 5):
There are a number of problems with Senator Charles E. Schumer’s so-called middle ground on universal health care. While your article acknowledges some of the structural ones — like whether a federal program could ever be subject to state laws — it doesn’t acknowledge the major issue: What is best for health care consumers?
What system is going to provide the best care? How can we provide meaningful health care to the greatest number of people with the resources available? What policies can we carry out now to ensure that there will be sufficient caregivers to meet our needs in the future?
These are the questions that we should be asking. As an advocate for consumers, I am distressed to see yet another health care discussion that focuses on the impact on insurance providers’ bottom line. The fundamental purpose of the health care system is to provide health care, not to protect and perpetuate an industry.
Richard Mollot
Executive Director, Long Term
Care Community Coalition
New York, May 5, 2009″

Well said. I was listening to a Center for American Progress Podcast of a talk given to them by Max Baucus, and I kept thinking, where is the vision? It was mostly about how we were stuck with working with our current system and tweaking it into some public-private amalgam that would be “uniquely American.” This is disappointing in many ways, but I primarily am disappointed that he reflects that stubborn conservative world view that we cannot learn from other countries, that their experiences mean little or nothing to us. If you take that view, then transformational change is impossible to envision, and you are stuck with timid change.

But also troublesome is the complementary idea that America cannot do this, because we must think so timidly, in such limited ways. JFK said, “we choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Where is THAT America, Senator Baucus, Senator Schumer?

Uwe Reinhardt: A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com

A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com:

“A public health plan, however, strikes fear in the hearts of many interest groups. There are several reasons for this.

“First, it is only human that the politically powerful private health-insurance industry opposes competition from such a plan. The industry argues, not without justification, that a public plan might be advantaged by dictating to providers lower prices for health care services and products, and it might benefit from hidden subsidies. That unfair advantage could squish the private plans to the wall.

“But even if those comparative advantages could be eliminated through careful design of the public plan, the industry probably fears the inherent appeal that a public plan might have among the American people.

“The providers of health care and health care products, to whom “national health care spending” represents “national health care incomes,” fear the market power that a public health plan might bring to the demand (payment) side of the health sector.

“Greater market moxie on the demand side, they fear, might significantly bend down the lush, currently projected, long-run growth path of America’s health spending, which has national health spending rise from the current 16.6 percent of gross domestic product to 20.3 percent by 2018 and to 38 percent of G.D.P. by 2050. Once again, it is only human that the supply side of the United States health system prefers a continuance of the weaker, more fragmented demand (payment) side that for four decades now has allowed health spending to grow in excess of 2 percentage points faster than the rest of the G.D.P.

“The most powerful ordnance lobbed at the public health plan by its opponents is the dreaded “R” word, that is, the prediction that it will lead to the rationing of health care in America. In the debate on health policy, getting slapped with the R-word has always has been the kiss of death for any proposal.

“Evidently, many Americans do sincerely believe that when a public health plan refuses to pay for a procedure it is “rationing,” while denial of health care to an uninsured, low-income individual who cannot afford to pay for that care is not. But as textbooks in economics explicitly teach, the role of prices in a market economy is precisely to ration scarce resources among unlimited demands.

“The American health system has rationed health care by price and ability to pay all along for a sizeable segment of the United States population. In its report “ Hidden Cost, Value Lost,” for example, a distinguished panel of experts convened by the Institute of Medicine of the National Academy of Sciences estimated that some 18,000 Americans die prematurely for want of health insurance and timely medical care. That is rationing life years.”

Health Affairs Blog Lessons Of Medicare For The New Public Health Insurance Plan

Health Affairs Blog: Lessons Of Medicare For The New Public Health Insurance Plan:

“As Congress grapples with whether a new public health insurance plan should be created as part of health care reform, they should take stock of the nation’s experience with Medicare as a public program. Medicare’s strengths and limitations offer a number of lessons for the current debate.”

A nice summary of what is right about Medicare, as well as what to avoid (i.e., Medicaid) as we develop a Public Plan. Quick summary:

1. Medicare is stable and secure. Medicaid is subject to the whims of state governments and is therefore neither.

2. Medicare is nationally uniform, Medicaid, not so much. In fact Medicaid is pretty awful for uniformity and results in rationing of health care in many parts of the country.

3. Transparent and consistent, resulting in lower administration costs, and more predictability for all. But, they argue, and I agree, that congress should not be making the detailed coverage decisions. these should be delegated to an independant board.

4. Provide innovation and leadership in payment reform.

5. Minimizes administrative costs in a variety of ways. I know I can’t watch a sporting event, television program or anything without seeing my “not-for-profit” insurance company logo all over the place.

6. Public accountability. I always am disbelieving when i hear my conservative friends talk about governement as if it is not us. I reject this, because when we participate, it does work. Of course, the last eight years showed us that the trolley can go off the rails, but we eventually correct.

Senate Finance Committee Hearing on Expanding Health Care Coverage

“Roundtable Discussion on “Expanding Health Care Coverage”
May 5 , 2009, at 10:00 a.m., in 106 Dirksen Senate Office Building

Over at the PNHP Blog, Don McCanne points out that the voices for single payer are being stifled and excluded because of the view of most in the Congress that it is a politically unviable proposition, though he “respects” their views.

Even more problematic was an exchange later in the hearings between Sen. Pat Roberts and Scott Serota, CEO of the Blue Cross and Blue Shield Association.

Sen. Roberts told the tale of how a group of surgeons and anesthesiologists surrounded him after his knee surgery and told him and said they’d all quit if we went to a national health plan or even, I believe, to a public option and their reimbursements were to be decreased.

I don’t have the transcript, but he went on to say something along the lines of how there was no way to control costs in a national health system and then asked Serota what he thought.

Of course, Serota explained in that patrician way of so many how there was no way in the world to produce high quality and lower costs than we have in the US now with private insurance.

Now, if Sen. Baucus doesn’t want single payer advocates around because he doesn’t think it is politically viable, that is one thing. But what he doesn’t seem to realize is that having a knowledgeable single payer advocate and someone knowledgeable about international comparative health care in the room would have resulted in the particular line of BS that Roberts and Serota were peddling to be swatted down without breaking a sweat.

That is why it is so critical to have a broader range of views at the table. There was no one there willing to point out the obvious: Reducing future surgeons’ income from $500 K to $400 K, for example, will not bring the world to a halt. Essentially every country in the world controls costs and maintains quality at massive savings compared to the disastrously inefficient US private insurance industry.

But there was no one at the table willing to tell them that.

Schumer Offers Middle Ground on Health Care – NYTimes.com

Schumer Offers Middle Ground on Health Care – NYTimes.com:

“Scorched by Republican opposition to the idea of a new public program like Medicare, Senate Democrats are looking for a middle ground that would address the concerns of political moderates. One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible.

“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market. Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work. In so doing, they look for the support of influential moderates. But in the last few days, three moderate senators — Ben Nelson, Democrat of Nebraska; Olympia J. Snowe, Republican of Maine; and Arlen Specter of Pennsylvania, who switched parties to become a Democrat — have expressed reservations about a public plan.

Insurers also remain skeptical. Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of ongress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.

Linda Douglass, a White House spokeswoman, said that Mr. Obama was for a public plan but that he realized it could be defined in different ways. Mr. Schumer said his goal was “a level playing field for competition” between public and private insurers.

But Ms. Ignagni said, “It’s almost impossible to accomplish that objective.””

…with high corporate salaries, really nice corner offices, expensive buildings, luxury sports boxes and all those other bare necessitites of modern corporate life!

Firedoglake also has a good post on this as a capitulation.

And Rachel Maddow reported tonight about White House talked about offering some concessions in the HC reform debate and that, in return, the Republicans offered (wait for it!) nothing!

Paperwork, profits clog health care’s efficiencies

Paperwork, profits clog health care’s efficiencies:
DEAN CALBREATH, San Diego Union Tribune

“Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.

““You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”

“Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.

“Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?

“The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.

“Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.

“Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.

“As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?

““Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said. “