Reform Effort Morphing

[Crabcake Johnny]

In Sacramento's tent city, a torn economic fabric - Los Angeles Times

Yes, it's amazing to watch the liberal hypocrisy out there in good 'ole Sacramento. I wonder how many "SUV liberals" out there are lending a hand to help these people in need.

 

[moonlightandmargaritas]

Yes, it's amazing to watch the liberal hypocrisy out there in good 'ole Sacramento. I wonder how many "SUV liberals" out there are lending a hand to help these people in need.

Be careful - Comrade Al with his intellectual superiority might get upset with you...

 

[Crabcake Johnny]

washingtonpost.com

Senate Finance Committee eliminating the public option.

 

[Norwayguy]

If there's competition carriers would still need agents. It's a carrier's wet dream that an exchange would gain them the amount of business they need, but it wouldn't.

We'd either see around 5% or a fee per app.

HealthAgent in Maine we have a public option right now it is Dirigo..it pays a Whopping $12/month/app....and family coverage is easily $800 - 1200 per month so maybe we will get 1.5% ...I remember a broker that could offer Blue Cross medsupps in Maine he told me the commission was 2% to him and if I wanted to write them under him I would get 1%.

 

[somarco]

Did they reopen Dirigo? Thought it was still closed to new enrollments.

 

[Winter_123]

Did they reopen Dirigo? Thought it was still closed to new enrollments.

I don't think they have taken a new enrollee in over two years but there have been plenty of teaberry shuffles going on just to try to keep it open for the very limited people it does serve. It was run by Anthem up until last year and then they begged the state to be let out of it, and I think Harvard Pilgrim runs it now but who knows. It is pretty much a dead program so I dont keep up with it.

No one wants to fund it so there is a new funding gimmick every year. Last year the legislature came up with the great idea of taxing beverages to pay for it. Problem is, the voters killed it at referendum shortly thereafter. This year the great idea is to fund it through part of a tax increase/restructuring plan that was passed this past winter. Problem is, it is right on the ballot to be overturned at referendum in the fall. That dog don't hunt as they say in the South.

The other thing that has propped it up for another year is that the state has raided the stimulus funds to put bailing wire and bondo on it for a while.

You know a program is a real dog when no carrier wants it and the state has to go around with a begging bowl to find a carrier. We went also through this in Maine about 15 or 20 years with medicaid managed care for long term care. The state came up with the great idea of moving all the elderly into MaineNet so-called, a managed care program for the elderly. They solicited carriers from around the country. All the libs bitched about what a big giveaway boondoggle it was for the carriers. Turns out, none of them wanted it. New York Life (Nylcare or whatever it was called) came close and stayed with it for a long time as the others dropped out. In the end they said frig it too. They couldnt put a provider network together with the low reimbursement rates being offered. In the end, the state never went forward with the program. They built it. No one came.

My point in going in to all that? You can offer a public option but you have to get the providers to participate and unless they just flew in from Pakistan last week, it is remains to be seen where they will come from. Something for Obama to think about.

 

[Norwayguy]

Did they reopen Dirigo? Thought it was still closed to new enrollments.

Yes/No .. Dirigo is still closed to new individual/Sole Proprietor enrollees...Business can still enroll but it will be without any subsidy....i was just commenting on the low commission rate....In my opion Dirigo is a dog that needs to be taken to the vet and put down.

 

[Winter_123]

In my opion Dirigo is a dog that needs to be taken to the vet and put down.

Not just yet. Obama wants to use it as a model for the national plan. Whether something works or not is not one of the criteria that he looks at. Maine and Massachusetts plans were supposed to work but they didn't. That's close enough for government work.

Our forum brothers here in other states might well ask why Maine has Dirigo if we already have guaranteed issue. Answer: Because no one can afford guaranteed issue premiums which the state instituted so you have to set up another state program to deal with that.

Toto, we are not in Kansas anymore.

 

[tcarlj]

Any proposal is not even worth reading unless it is preceded by substantial malpractice tort reform. This is all about bringing down cost isnt it? I cant think of a better place to start.

 

[Bruce]

The HC legislation (as well as arguments against it) has incredibly little to do with Health Care in terms of how it is delivered and how much it costs. I suppose it is inherently a good thing to increase access to health insurance and I can also agree doing so will result in a lower incidence of more costly advanced illness, but only in the currently uninsured population.

GI, and financial incentive/penalties put on lower and middle class people currently without coverage can only result in adverse selection, the cost of which will get spread over all insureds. So increasing insurance access without lowering costs by a larger amount accomplishes nothing sustainable in terms of solving the cost problem.

I urge all of you to take a look at some balanced "white paper" analysis on HC Reform. All of the major University Economics Departments have done a lot of good work on the topic as well as many not-for-profit organizations. I prefer the Kaiser Family Foundation as a solid source.

To me, the biggest risk in the morphing of the issue from Health Care Reform to Health Insurance Reform is the impact on the middle class, as defined by family income between 200%-400% of the Federal Poverty Level ($44,000-$88,000).

While the vast majority of the current uninsured nonelderly population are lower income (66%), a full 25% (about 11 million) are considered middle class. And it is within the middle class where growth in uninsured is exploding, affordability dropping and access shrinking. A few facts:

*70% of the growth in uninsured from 2004-2007 is in the middle class
*73% of middle class are insured through employer plans (note only 38% of lower income class is covered through employer plans)
* Between 2000 and 2008, premiums grew at 3x the rate of wages
* Small employers (under 200) offering health insurance dropped from 68% in 2000 to 62% in 2008.

I suppose I could go on but if you take the above, add in what will inarguably higher average insured claim costs with subsidized access to the lower and lower-middle inclome classes, the overall cost of employer plans cannot do anything other than spike up at a rate currently exceeding current trend, again assuming cost savings do not provide an over-commensurate offset.

Toss in the current economic environment, especially the effect of twice the traditional average rate of unemployment and it's fairly impossible to conclude anything positive.

I'm dismayed by the lack of discussion on actual reform of how Health Care is delivered, as it is here the only hope resides. What is being talked about; Medicare "waste reform," technology, electronic records, etc... is all well and good and, if successful, will succeed in lowering costs on a "one time basis" (just like pre-cert in the 80's), but does nothing to lower the slope of the rate of cost increase. (As an aside, I think the "medical information technology" piece portion of and passed legislation is a cinch and companies like Eclipsys Corp. and its peers/competitors are must considers for any portfolio).

Finally, you cannot begin to think any Health Care Reform will succeed until start talking about how to slow the rate of innovation and the use of incredibly fast developing treatments and technologies. I am not suggesting rationing, but rather how to slow the pace of the increase.

Here's two last facts. In the U.S. we spend:
1) 97% of our Health Care dollars on 50% of our population.
2) 23% of our Health Care dollars on 1% of our population.

How can we expect to control costs with this? We can't. And the pure and simple fact is that the current Health Care Delivery model is absolutely dominated by the use of incredibly costly treatments on an incredibly small percentage of the population.

Personally, I don't see a solution, other than perhaps a mix of a gov't based, fully-mandated minimum plan (subsidized in full at the lowest income levels) and private plans (not unlike the Japanese model where per cap HC spending is 1/3 of what it is here and there are are no uninsureds).

Sorry for the length.