In an 11th hour attack on health care reform, a coalition of employer groups, including the Chamber of Commerce, wrote to House Speaker Pelosi and Republican Leader Boehner at the end of October opposing the Democrats' health reform bill. (The group includes The Business Roundtable, the American Benefits Council, the Corporate Health Care Coalition, the National Association of Manufacturers, the National Association of Wholesaler-Distributors, the National Coalition on Benefits, the National Retail Federation and the Retail Industry Leaders Association.)
Over at THCB, two commentators have suggested that these business leaders may “Send reform back to the drawing board.”
“What is needed now is an orchestrated, mobilized, highly visible campaign effort that features the faces and voices of well-known American CEOs, and that leverages the full force of business' leadership across industries,” write Brian Klepper and David Kibbe.
Will this coalition have the clout to derail reform? I don’t think so.
These days, the title “CEO” has lost some of its luster. In the 1980s, our captains of industry became celebrities. You saw their shining faces on the covers of magazines everywhere. But by the end of the 1990s, small investors began to realize that some of those very same CEO/celebs had been cooking their books—and lying to us about their companies’ earnings. Meanwhile, it became apparent that corporate lobbyists all but “owned” some members of our Congress. And today, in the midst of the banking bail-out, more and more Americans are questioning the seven-digit salaries that many of our top executives haul home.
Then there is the story that appeared in the Washington Post today, revealing that this very same group of business leaders have been “collecting money to finance an economic study that could be used to portray the [reform ] legislation as a job killer and a threat to the nation's economy.” The Post’s Michael Shear reports that, “according to an e-mail solicitation . . . written by the Chamber of Commerce’s senior health policy manager and obtained by The Washington Post,” the group proposes “spending $50,000 to hire a ‘respected economist’ to study the impact that health care legislation, which is expected to come to the Senate floor this week, would have on jobs and the economy.
“Step two, according to the e-mail, appears to assume the outcome of the economic review: ‘The economist will then circulate a sign-on letter to hundreds of other economists saying that the bill will kill jobs and hurt the economy. We will then be able to use this open letter to produce advertisements, and as a powerful lobbying and grass-roots document.’"
In other words, it seems that said respected economist would be expected to sign on off on a foreordained conclusion—in return for $50,000.
In response to the Post’s query, Randy Johnson, the Chamber’s senior vice president who handles health-care issues, acknowledged that the e-mail had been “inartfully worded” and said the group never intended to suggest that the outcome of the study would be preordained.
"‘It's not saying that we would tell the economist how it should come out. Perhaps it wasn't artfully phrased,’ Johnson explained. ‘It's based on what we think the economist will come out with. It doesn't mean we know what the economist will come out with.’"
Johnson added that the Chamber always intended to be transparent about who funded the study. Asked whether the Chamber would release the study if it concluded that the health bill would increase jobs and improve the economy, he initially said, ‘We would cross that bridge if we came to it.’”
It took Johnson only a few minutes to realize that wasn’t “artfully worded” either. “On reflection,” he said “a positive finding from the economist would help to educate the business groups and would play a role in the position they take on the legislation.”
Somehow, I don’t think this coalition is going to prove much of a threat.
That’s ironic, because The Hill reported on a new report commissioned by the Business Roundtable, an organization that represents more than 50 of the nation’s biggest corporations like AT&T, Chrysler Group, General Electric, Johnson & Johnson and Pfizer, praised aspects of President Obama’s top initiative.
The report claims that parts of the Democratic legislation could cut healthcare costs substantially. Future healthcare costs could fall by $3,000 per employee with passage of the legislation.
While the 24-page report does not specifically back any of the Democratic healthcare measures, it cites cost-cutting provisions in the legislation that could lower the “trend line” of rising employer healthcare costs, which it predicted could reach an average of $28,530 per employee by the year 2019.
The Roundtable group maintains that the study of the economic impact of healthcare reform is not driven by any political agenda. Obama said in a statement, “comprehensive health insurance reform is one of the most important investments we can make in American competitiveness.” And good ole Baucus echoed that point.
Another case of Republican right-wing political pressure!?
groups of small employers who have always opposed such bills and often don’t offer coverage, continue to oppose. big employers, the roundtable boys, who already provide expensive coverage, typically favor reforms thinking they may help control costs and, in any event, level the playing field by requiring their competitors to cover workers. large employers have been supporting mandatory coverage for years now.
Health care is going to require everyone to give a little. Employers being pressed for 8 percent of payroll for each employee is not unreasonable. However, the medical industry itself also needs to bear part of the burden. There is an average increase of 125% in insurance premiums since 1999, this is too extreme to simply lie on the shoulders of the insurance companies alone.
According to Dr. Eva Mor “The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.”http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107
Many doctors and medical professionals are facing the health care debate and reassessing the industry on a whole. There are many aspects such as IT that could assist in the decrease of overspending. However, several of them also believe in an need for regulation in procedural costs.
There was an important job to be done and Everybody was asked to do it. Everybody was sure Somebody would do it. chi hair irons Anybody could have done it, but Nobody did it. chi flat irons Somebody got angry about that, because it was Everybody’s job.Everybody thought Anybody could do it but Nobody realized that Everybody wouldn’t do it. chi hair straightener It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.
Ya’all keep ignoring the elephant in the room.
Large Hospital systems are driving costs up, not something else.
Ed wrote:
Ya’all keep ignoring the elephant in the room.
Large Hospital systems are driving costs up, not something else.
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I am not ignoring this. When I get a Tricare/Medicare EOB, do you know that for outpatient care or private office care that in my area, these entities pay an 80%% reduced fee from what the full fee schedule is in my area. 80% reduced. Now what does that suggest to you?? For in patient hospital care, Medicare is already paying DRGs to contain costs. So the uninsured are charged 80% more than Medicare/Tricare patients, and the Medicare/Tricare patients have insurance for the left-over 20%. Not right.
All the power in healthcare is with providers until and unless all patients are grouped together in a bargaining unit against powerful provider interests. In other words, a single national or regional monopsony payer with good information about real costs could bargain with provider orgs to get the fairest, best price for all. Individual patients in a caveat emptor, non-existent market in healthcare will never get control of prices or create any kind of socially just system!
I hear your frustration NG, but the BIG elephant in the room is overtreatment and gaming the system by providers, biggest of which are the sophisticated hospital chains, non-profit or for-profit.
Ed wrote:
I hear your frustration NG, but the BIG elephant in the room is overtreatment and gaming the system by providers, biggest of which are the sophisticated hospital chains, non-profit or for-profit.
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Besides the fee schedule benefit of a monopsony type payer system that I mentioned earlier, real managed care could be imposed on the system as well. Unlike the piecemeal, profit only oriented, non-accountable private insurance company attempts at managed care back in the 1990s, a publicly accountable monopsony payer could use its knowledge and clout to rein in the excess you mention above. Does this maybe suggest a real reform way forward??
From:
http://thehill.com/blogs/blog-briefing-room/news/68079-gregg-senate-democrats-will-pass-healthcare
“Senate Majority Leader Harry Reid (D-Nev.) will “shop the votes” he needs to bring the bill to the floor and end debate when the time arises, and his efforts should again prove successful once the chamber considers a healthcare conference report, Sen. Judd Gregg (R-N.H.) told CNBC last night.”
Well that would be nice!
Gregory , Jim, Maguire, Ed, NG—Thanks for your comments —
Gregory–The report that you’re citing (and that the Roundtable commissioned) sounds good. (If you have a link, please send it to me).
I would say it’s very reasonable to assume that reform could reduce the cost of a (family) plan by $3000, lower the trend line, and over time, perhaps save more. (I think it’s plausible that a public option family plan could cost $9,000 in today’s dollars—versus the $13,500 that it costs today. $2000 of that savings is lower administrative costs of it’s a gov’t plan, and $2,000 is how much I think we could reasonably trim by cutting waste and refusing to over-pay for some over-priced products and services.) ) And it’s definitely true that, without reform, insurance could easily cost $28,530 by 2019 (assuming the inflation of the past 10 years continues—and unless someone does something to begin reducing the unnecessary and over-priced treatments, it will.)
Jim— Yes, large employers favor mandatory coverage. But the question is—what kind of coverage? Over at The Health Care Blog, Klepper and Kibbe are arguing that employers don’t want a public option—though some of the employers they are talking about are small employers (retailers, etc) they are also talking about the Roundtable (which tends to be quite conservative when it comes to government intervention.)
I understand why some small employers are upset. Some have labor-intensive businesses and pretty narrow profit margins—for example, your typical moderately priced neighborhood restaurant. Unless it has a huge bar business (and is essentially a bar with food) , the owner is probably netting a modest profit ($125,000 or less) and has 18 to 25 employees. He really can’t afford to buy insurance for them. So ultimately, I think regulations mandating that small businesses provide insurance have to look, not just at revenues, or even profits, but the ratio of employees to profits, exempting not terribly profitable labor-intensive businesses, and letting those employees go into the Exchange—and get subsidies. (In businesses like modestly-priced restaurants, a great many employees are low-income.)
On the other hand, there are thriving medical practices, made up of well-paid specialists, that don’t provide health insurance for their clerical employees!
I suspect we’re going to need additional legislation to fine-tune mandates for small employers.
Maguire—
You’re absolutely correct—everyone is going to have to give a little. 8% of payroll per employee sounds reasonable, though it depends on how profitable the business is. If the owner, works full-time in the business and makes only about $90,000 a year, and has eleven employees—that 8% could force him to close down. So many variables involved in small businesses . .
But I definitely agree that insurers cannot carry the rising cost of healthcare. We need to make many targeted cuts in reimbursements to many hospitals, many specialists, and stop over-paying for many drugs and devices.
Ed—Many large hospital systems are inefficient, and help drive costs higher. But they are only part of the problem.
NG—Under reform, I’m hopeful that hospitals will not be allowed to over-charge the uninsured.
I’d add that we don’t need single-payer to negotiate with providers and bring rates down. Medicare can begin doing this—especially if, as the Senate bill proposes, Medicare spending is overseen by an independent panel that is protected from Congress (under the proposal Congress has a limited amount of time to object to changes in Medicare spending, and can only say “yea” or “nay” to the whole package. It can’t pick in choose.) This means that lobbyists would have much, much less influence in trying to block specific cuts. And if the pubic option also is negotiating with providers, the combined strength of Medicare and the public plan could begin to set market rates. In many cases, private insurers would follow their example.
Maggie:
You wrote about Medicare and the public plan influencing reimbursements by the private insurers.
Would you support Medicare establishing the reimbursements for all providers, with the proviso they can balance bill?
It seems to me that the better providers could charge higher rates, due to their increased value.
In addition, the savings incurred from no further negotiations by private insurers could be substantial.
Smaller insurers would not be at a disadvantage for not being able to leverage their size as larger insurers do.
Don Levit
Don —
You write: “It seems to me that the better providers could charge higher rates, due to their increased value.”
I have two responess.
First, when it comes to individual doctors, we really don’t know who the “better providers” are.
I have lived in Manhattan for more than 25 years. Here, New York Magazine rates the “best doctors”–a total joke. These are the doctors who have very nice offices, charge high fees– and may or may not have any diagnostic or clinical skills.
Secondly, even if patients were in a postiion to figure out who the “best physicians” are, and pay them more, this would mean that the wealthy would be able to afford the best doctors, the middle class could not.
Precisely what we do NOT want to do is to create a two-tier system –that’s just continuing one of the current problems: ratiioning care based on ability to pay.
Finally, and perhaps most importantly, we want to move away from fee-for-service payment and want doctors on salaries.
The model is the Mayo Clinic where after the first three years ALL DOCTORS EARN THE SAME SALARY IN A GIVEN SPECIALTY.
We don’t want doctors competing with each other to see who can bring in a higher income. We want doctors COLLABORATING with each other, sharing their knowledge.
This is part of what makes care better at places like Intermountain.
Maggie wrote:
“We don’t want doctors competing with each other to see who can bring in a higher income. We want doctors COLLABORATING with each other, sharing their knowledge.”
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Maggie, this is one of the best posts you have written. The only suggestion/addition that I have to this reply going forward would be to change the word doctors above to providers! If we are to have just/good/fair access to care down the road, the traditional idea/training/numbers of today’s doctors will have to change.
NG–
Thanks.