In Senator Edward Kennedy’s absence, Senate Finance Committee Chairman Max Baucus has emerged as the Senate’s point man on healthcare reform—“prompting concern among some liberal senators,” according to The Hill. Why are they concerned? Because they “remember Baucus’s history of cutting deals with Republicans.”
Friday, Baucus gave a speech at the Campaign for American Progress (CAP) that suggests liberals have reason to be worried. Many consider a public-sector alternative to private health insurance key to reform. As I have argued, Medicare E ((Medicare for Everyone) would provide a standard of excellence for private insurers, and in President Obama’s words “keep them honest.” But at CAP, Senator Baucus suggested that there are several different ways of putting a “public option” into place. Such a system could either allow Americans to buy into Medicare, or, open up the Federal Employee Health Benefits(FEHB) program.
In truth, FEHB is just a menu of private insurance plans that the government offers to its employees. As Jerry Flanagan points out on consumerswatch.org: FEHB is “ a captive of private insurers. . . . program costs are higher than need be due to insurer overhead and profit demands.”
Medicare’s administrative costs are much lower than a for-profit insurer’s because Medicare doesn’t have to advertise, lobby Congress, paying executives exorbitant salaries or deliver profits to shaeholders. “ Medicare E would force private insurers to prove that they can be cost-effective while offering similarly comprehensive coverage,” Flanagan writes.
Moreover, Medicare E, plus Medicare, woudl have the clout needed to negotiate for significant discounts on drugs and devices, something that for-profit insurers haven’t done. Instead, they pay sky-high prices, and pass the costs along in the form of higher premiums. Medicare E also would be likely to cut fees and raise-copays for tests and treatments that are only marginally effective, while raising fees and lowering co-pays for servcies that provide the greatest benefit to the patient. In other words, a government plan would have the public good in mind; for-profit insurers have to put their shareholders’ concerns first. “To benefit from real savings, the ‘public’ in public option must mean ‘public program,’ observes Flanagan..
HealthBeat reader Jim Jaffe, who uses FEHB as his insurer, agrees. “People seem confused about FEHB,” he says. They think it is a governement health plan. In fact, the government has farmed FEHB out to private insuers, just as it farmed out Medicare Advantage—with similar results. Premiums keep rising twice as fast as inflation, and Jaffe reports, the plans are not user-friendly. “It makes no more sense to use FEHB as a template for a public option that it would to use the plan GE offers its employees,” Jaffe adds. Finally, it is important to remember that FEHB offers a range of plans—at arnage of prices. Postal workers and Senators don’t have the same plan. (See Jaffe’s post on FEHB below)
Perhaps it should come as no suprise that Baucus is less than commited to the private-sector option. Last week he signaled that he viewed it as no more than a “chip” in a political poker game. Talking to TIME Magazine’s Karen Tumulty about the public sector plan, “He strongly suggested that its main value, at this point, is as a bargaining chip to get the health insurance companies to agree to other things that reformers want to see.” Tumplty reported. She quoted Baucus:
Of course, most politicians don’t announce their poker strategy in TIME—unless they’re ready to to throw the chip under the bus.
In part 2 of this post, I will talk about what liberal Democrats remember about Baucus past compromises, Kennedy’s absence, why Baucus isn’t willing to protect the health care reform bill from a Republican filibuster, and his status as both the insurance industry’s and the drug industry’s favorite Democrat. Billy Tauzin says this isn’t a problem.
.
Can’t one of the DEM Senators on the HELP Comittee(like Barbara Mukulski)pick up where Ted Kennedy left off?
As far as I am concerned an endorsement by the venal Billy Tauzin is a kiss of death.
So I am looking foward to Part 2.
Thanks
Dr. Rick Lippin
Southampton,Pa
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It is possible that you may miss the true value of the proposed federal health insurance option. To date, it has been an incredibly effective bargaining chip which has caused the insurance companies to make significant moves towards cleaning up their act. They have no publicly stated their willingness to adopt a community rated system for setting premium rates just as they have expressed their willingness to insure everyone, including those with pre-existing conditions. I don’t believe that this would have happened had they not been terrified by the creation of a public option with which they could never hope to compete. Now, if they go the third step – standardizing contracts, including nomenclature and codifications, they would play a major part in dramatically reducing physician and hospital overhead. If they are prepared to do all of this, then is the Medicare E really necessary?
Hi Maggie:
I posted on a thread that I think you had already stopped reading last week. What do you think about Bernie Sanders of Vermont forwarding a single payer bill in the Senate last week? Is the action useful right now or just divisive, in your opinion?
Following the response thread in your March 26 blog (on private insurers), Maggie, you inadvertently credited Pat S. for the catchy and clever phrase Medicare Plan E (E-for Everybody).
As I commented on that blog, the phrase originated with Dr. Rob Stone, an emergency room physician in Bloomington IN. It refers to Medicare for All–not to the Obama Team’s endangered “public option.”
If you can find a source earlier than Rob Stone, I would be happy to be corrected–but a Google search does not yield one.
I hope health care wonks saw the PBS documentary Sick in America last night. Did the audience notice the defensive stance of the insurers on rescissions, and the tragedy of the TennCare/Medicaid refusal to help a lupus patient?
The insurers are in the business of making money. As you have stated, “a government plan would have the public good in mind; for-profit insurers have to put their shareholders’ concerns first.” They make those profits by denying care. AHIP spokespersons keep saying they will “make nice” if we simply give them all the marbles–in essence our health, our lives and our pocketbooks.
Senator Baucus, along with his Republican allies, a few Blue Dog Dems, and their lobbyist pals will cave on the public option if the President doesn’t stop them. The behind-the- scenes Baucus-Kennedy discussions with selected “stakeholders” (see today’s 04/01 NY Times) do not give much credibility to the new administration’s promise of transparency.
I would like to dispute the comments about insurer overhead and profit demands adding to FEHB costs with some data. I used to work at one of the insurance companies that had a FEHB contract and I pull financial data for insurance companies in the state where I work (Oregon). In 2008, admin costs are 10% of premium and underwriting margin is about 0.3% across all lines of business. 10.3% in overhead for Medicare, Medicaid, FEBH, commercial, and individual is fairly efficient and I would question if there would be a more efficient way to administer claims, enrollment, etc. Additionally, FEHB has requirements that it get any rate discounts that the 10 largest account of any carrier. Carriers do not make profits on large groups like FEHB but use the large membership to contribute to fixed costs. Profits are made on mid-sized groups who don’t have the bargaining power.
Costs are rising on FEHB due to medical costs. Administrative costs in my state have risen below the rate of inflation. I understand the source of the argument that drivers of costs are insurer overhead and profit, but the data is not there. Insurance companies make money off investment income from their reserves and mid-size groups but not large ones like FEHB.
As an insurance company individual, I have no concerns about Medicare E. If we can’t compete with a government program than we shouldn’t be ins business. If we can’t offer a better alternative than government cutstomer service, provider network (they will likely pay very low rates and have lower provider participation like traditional Medicare and Medicaid), no experience in disease management (most pilot projects have produced poor results) to help reduce costs, and probably a very low to no marketing budget, than we (private insurance companies) offer no value and shouldn’t be in business.
Yes, Rick, Medicare E (for Everybody) is essential. Clearly, government regulations don’t work to keep the plethora of gamers/players honest… (plenty of evidence here!) They will always find loopholes and other ways around- they prove this to us every day. It is what Insurers do- it’s how they make money. The only realistic way forward with any True Health Reform is to get a real National Health Insurance Program, just like every other industrialized nation has… except US. Have a look at the new PBS FRONTLINE “Sick Around America”… that will convince you! It is not only heartbreaking what is happening, it is an absurd and costly violation of our morality and our human rights – and it’s happening right here under our own noses… to our families and in our communities. Think you’re covered? Think again. You or someone in your family could be next. These are our own lives and the lives of loved ones that we are at risk of losing to ignorance, cynicism, greed and corruption of our Health Care System.
Rick Ungar, Martha, Dr. Rick,
Thanks for your comments.
Rick Ungar
First the industry’s “concessions”
aren’t really as big as them seem.
Guaranteed issue (meaning they have to cover everyone)and “community rating” (same price regardless or age or prior conditions)
is already the law in several states. (And it hasn’t driven insurers out of business, so it clearly is doable).
There is a general consensus in the country that insurers should not be able to shun the sick–or charge them prohibitlvely high premiums.
So everyone knew that this was almost certainly going to be part of heatlh reform.
More than six months ago, I was told that the insurance industry was gong to “concede” on both issues. They really didn’t have a choice.
More importantly, thers is a strong argument to be made that we simply cannot afford to have the cost of our health care premiums boosted by the amount the for-profit industry spends lobbying (essentially bribing our legilsators), paying executives $11 million dollar salaries (these salaire are a small part of their total budget, but
extravagant salaries set a tone that is not customer-friendly), advertising and
delivering profits to investors.
Many believe that because a public-sector plan doesn’t have these expenses, and because it would be willing to get tough with drug-makers that overcharge, hospitals that overcharge (like Partners in Boston, charging 30% more than other Boston hospitals for the same treatment) etc,
Medicare E could offer
Americans better coverage for less.
The only way we find out if that is true is if we have Medicare E compete on a level playing field with
private insurers.
Then Americans can see what they each offer, and make their choice.
IF it is true that Medicare E could offer better coverage for signficantly less money, we just cannot afford to let private insurers have a monopoly on the market.
Dr. Rick–
At this point, Ted Kennedy commands respect and affection that is unparalleled in Congress.
He really is the last
passionate lilberal.
I think Obama also could unite Democrats. I don’t see anyone else in Congress who could do it.
Martha- Since I don’t think there is any chance that Sanders’ bill will pass, it merely seems divisive.
No REpublican in the Senate is going to vote for single-payer. (I’m told no Republican in the Senate will even vote for a
public-sector option.) So that means it can’t pass.
So I’m afraid it will just divide Democrats . . .
making it that much harder for Obama’s bill to pass.
I don’t claim to be the originator of the phrase “Medicare Part E,” although I did arrive at it independently. It was used in exactly the sense I used it in a Brookings Institute paper by Gerard Anderson and Hugh Waters of Johns Hopkins in 2007, talking about the idea of a public insurance option incorporated into Medicare, but has not seemed to catch on from that.
It also had two other earlier incarnations, one the one mentioned in the post by Peter J, as synonym for “Medicare for All” as endorsed by PNHP.
The other was as the name of a relatively short-lived idea called “Medicare Extra,” which was a proposal to offer a public option to patients who wanted to buy insurance coverage for gaps in Medicare A and B.
The beauty of the English language is that it is flexible and evolving. I remain happy with the idea of referring to the public insurance option as conceived as a part of Medicare as Part E. PNHP seems to have abandoned their use of the term in favor of the more popular “Medicare for All,” and the other use has gone to that big dictionary in the sky, along with the idea it represented.
I plan to continue using the phrase, rather than the awkward “a public option insurance plan incorporated into Medicare as a part of the program.” Based on this research on Google, the Brookings paper seems to have the honor of conceiving it for this use. The letter “E,” however, remains in the public domain.
I am happy to stand corrected as to the original source of the expression “Medicare Plan E “.
I appreciate the fullsome and gracious response of Dr. Pat S. I must not have gone deep enough into the Google barrel. He/She opts to use it to denote the “public option.” I prefer to use it for our real need: “Medicare for Everybody!” Let’s hope the general public does not get confused.
Whoops — the person who pointed out the PNHP use of Medicare Part E was not Peter J, but rather Harriette Seiler. Sorry about that.
Don Grunt, Harriette, Peter J. and Pat S.
Thanks for your comments.
Don Grunt–
What you say is intersting. Though I would point out that when it comes to insurance, Oregon is quite different from (and better than) most states.
Insurers are regulated — they must get permission from the state before raising premiums. Half of insurers are not-for-profit. Oregon’s insurers pay an averge of 88% of the premiums that they collect out in reimbursments. This is very high–they keep only 12% of premiums to cover administrative costs. National-wide the average insuer keeps 15% to as much as 20% to cover administrative costs.
I suspect that if you looked at insurers who had FEHB
contracts in other states, you would see higher overhead costs–and greater rate increases.
I very much appreciate the fact that, as someone in the industry, you realize that you should add value–or you shouldn’t be in the business. (Then again, you’re from Oregon. People in the Northwest tend to have a much more enlightened undertanding of the purpose of heatlhcare than the rest of us.)
And I think there are private-sector insurers who can add value through better disease-management, for instance, or putting together a better, more co-ordinated physician and hospital network.
I tend to think they are more likely to be non-profit insuers, but we’ll see. That is the point of allowing the competition–to see what happens.
Peter J.–
Thanks for your comment.
Yes, there are always loopholes. That’s why I think we really need a public sector option to compete with the private plans. All of the plans have to be as transparent as possible in terms of what they offer so that people can actually compare them. . .A law saying that the private plans must all offer everything the public plan offers–plus anything extra that they want to offer–should make the comparison relatively easy. For instance, some private plans might offer dentistry. I doubt the public plan will . . .
Harriette–
Pat S. was the first person I heard using Medicare E to refer to an altnerative to private insurance (rather than single-payer.)
See his comment– apparently someone else used it in that context before he did. It doesn’t really matter–as he notes: “the letter E remains in the public domain.”
btw, neither Baucus or Kennedy are in the administration. Congressmen routinely listen to lobbyists and let them make their pitch. Lobbyists have every right to make their concerns known. They just don’t have a right to vote.
Pat S.-
Good for Gerard Anderson.
I too like Medicare E and plan to keep using it–for the time being, I have to explain it in the first reference, but if enough people keep using it, eventually it may catch on. (I remember Geroge Lundberg telling me how long it took for “JAMA” to catch on as the name of the journal. But it did.)
Harriette Seiler —
Maggie, I, and others have been using “Part E” all along as well. Plan E is something else.
The Part E is because Medicare is already composed of various “Parts” — Part A, Part B, Part C (now better known as Medicare Advantage,) and Part D (the Bush drug insurance plan.)
Part E would be the next letter up, and fortuitously stands for Everyone, which struck me (and apparently the guys from Hopkins) as a nice touch.
Harriette Seiler —
Also, for the record, I think in an ideal world that a single payer or social insurance program like most advanced countries would be best for the US. However, in the world we actually live in, that is not going to pass congress, so I advocate working as hard as possible to see that certain features, especially a federal insurance option run through Medicare – Medicare Part E — are part of the new policy.
BTW — I am Patrick, not Patricia (and curses to Saturday Night Live.)
Pat and Maggie,
I don’t think raising the wage cap to which Social Security taxes apply as President Obama proposed it is a good idea. First, it would further exacerbate the differential between the taxes on high income wage earners vs. high income taxpayers whose income is mainly from capital gains and qualified dividends. The federal tax rate on the latter is currently only 15% and even Obama has only proposed raising it to 20% whereas he wants to raise the top ordinary income tax rate back to 39.6% which was the top rate during the Clinton administration.
Moreover, as I’ve written before, most economists will tell you that the employee really pays the employer’s share of FICA taxes as well as his or her own. So, if we count the employer’s share both as a tax paid by the employee and as income to the employee, the nominal 12.4% Social Security portion of the 15.3% FICA tax is really an 11.67% tax on the employee. Think of $100,000 of salary on which $12,400 of Social Security tax is due with half nominally paid by the employer. Economists tell us that the employee is actually paying the entire $12,400 but on a gross salary of $106,200. In a high tax jurisdiction like NYC, the top NY state level income tax rate is about to go to 8.97% from 6.85% while NYC levies its own 3.6% tax rate. Add all these together and you get 63.84% less approximately five percentage points of gross benefits from being able to deduct state and local taxes on the federal tax return, but even that is subject to the itemized deduction phaseout for high earners. It doesn’t take long if each taxing jurisdiction decides to soak the high income wage earner without regard to what other levels of government are doing before the aggregate effect borders on the confiscatory and adverse (for the economy) behavioral effects are likely to set in.
If I understand the Obama proposal correctly, high income people who are subject to these additional payroll taxes would not be eligible to collect additional benefits. The Social Security benefit structure is already quite progressive with three so-called bend points in an individual’s earnings record that determines benefits. The initial and comparatively small piece of annual earnings would be eligible for a benefit of 90% of wages – the replacement ratio. There is a larger middle piece that is replaced at 28% while wages in the highest tier are only eligible for 15% replacement. While this progressivity is partly offset by lower life expectancy, on average, of lower wage beneficiaries, the current benefit structure is already a comparatively poor deal, from a return on investment standpoint, for high wage earners, especially when you take into account the half of the tax nominally paid by the employer.
In the mid-1980’s, about 90% of all wages were subject to Social Security taxes. As wages for high earners rose faster than for the population overall in the last 15 years or so, that percentage declined to the mid-80’s. To move it back up to 90%, which I would find acceptable, notwithstanding my comments above, the wage base would need to rise to $160-$175K from its actual 2009 level of $106,800. I think it would be better to go back to taxing dividends as ordinary income like they were prior to 2003 and raise the capital gains tax back to the 28% rate that was in place from 1986-1993.
If we ultimately opt for a payroll tax to finance taxpayer funded health insurance via vouchers, we would need to integrate the payroll tax and the income tax to ensure that those who earn significant income from sources other than wages – interest, dividends, capital gains, rent, etc. pay their fair share.
Whoops. I meant to post the prior comment on the March 19th Public Option Part 2 thread. Sorry.
Thanks Maggie,
Your compliments about the northwest are part of the reasons that I evangelize Oregon so much to my midwest-based family and east coast school colleagues. Our CEO does comment that about our strong tradition of managing care in this state and everything that you said makes sense. I didn’t realize that the statistics around admin expense or premiums paid were so strikingly different than the rest of the country.
Part of the health care reform discussion that doesn’t come up is how to keep practices that work decently (like Oregon’s) while stopping practice that don’t. There has not been a lot of talk about best practice (probably because it would be more like pretty good practice).
As far as Medicare E, while I don’t think that we can try to stop new entrants regardless of their source but it would be a powerful new competitor which does cause some concern. However, I think that people are overly excited about Medicare E without thinking about what it would really entail. It would probably something like Traditional Medicare plus a Part D plan (with the doughnut hole) at best. Traditional Medicare pays 80% but with vagueries about what is covered and what is not and not out of pocket maximum (so someone would pay $200 K for that $1 million neonate). Providers would receive low reimbursement so probably 25% would not accept it. There’s no care management component so it would continue to promote fee for service. It would come with government instructions and help. Insurers at least spend some money trying to explain what we sell while I can’t imagine the government would make the most user friendly product.
I just don’t see what value a Medicare E would really offer for the implementation cost compared to other reform efforts other than giving people an opportunity to give the middle finger to private plans (which might be worth it for some). Again, I’m not against the idea for competition sake, I just don’t think it’s a real solution.
Don–
Medicare has been working on changing the way it reimburses doctors and hospitals in recent years, and launching pilot projcts aimed at paying for value, not volume of care.
Under the Bush administration, the head of CMS expressed frustration that he wasn’t allowed to move forward with modernizing Medicare –the administration as primarily focused on privatizing Medicare, and making sure that it didn’t try to negotiate for discounts on drugs.
But now the work that Medicare has been doing will be implemented–along with many of the excellent recommendations that MedPac has been making over recent years as well as recommendations that CBO’s Peter Orszag has been
making. (Orszag is now White House Budget director.)
In addition, Medicare will be adjusting its fee schedule this year – most likely hiking fees at teh bottom and slicing some at the top for services that are only marginally effective.
Already, this year, Medicare has sent out a letter to all hospitals saying that it no longer views giving beta-blockers to heart attack victims within a certain time period as a sign of “qualtiy care” (We have no medical evidnece that beta-blockers work. And there are risks.)
This is something that Medicare probably couldn’t have done last year . . . It is also now refusing to pay extra for
virtual colonoscopy. This is causing protests, but so far, no one is telling Medicare: “You can’t do this.”
I wonder how much the letter will reduce the use of beta-blockers? IN terms of savings, it will be a drop in the bucket, but that, combined with refusing to pay more for the virtual colonoscopies, and about 200 other small changes will control costs–remove unncessary treatments, and so lift hte qualtiy of care under
Medicare.
Some of the money saved may well be used to cover things that Medicare doesn’t cover today (vision checks?) and to keep a lid on co-pays and deductibles.
In terms of physicians refusing Medicare: On average, Medicare does pay less than private insurers (depends to some degree on location), but hte difference tends to run 5% to 15% . . . Meanwhile, Medicare pays on time.
In many states for-profit insurers drag ou payment to a point that some doctors would rather work with Medicare. The cost to the doctor of refiling for reimbursemnt, hiring people to follow up to get reimubrsed can et up that extra 10% in fees pretty quickly.
Right now in NYC primary care doctors are reluctant to take Medicare patients because the fees are so low. Those fees are all but certain to be hiked this year.
It’s still relatively easy to find well-paid specialists who take Medicare–they’re not hurting trying to make their overhead.
If Medicare adjusts its fee schedule–and begins moving away from fee-for-service by paying for outcomes, I think fewer doctors will be inclined
to reject Medicare or Medicare E.
Finally, many patients prefer Medicare to the private insurance they had with their employer because their is significantly less uncertaintly about what it will and won’t cover.
Aggressive private insurers are constantly springing suprises on their customers; this makers people very nervous.
Again, private insurance in Oregon is very, very different from private insurance in, say Texas. . .
I will be very interesting to see how the compeittion between Medicare E and private insurers works out (assuming there is a Medicare E)
As long as insurers are forced to compete on quality (not price) the best private insurers will keep Medicare E on its toes, and Medicare E will set standards for the worst private insurers (or drive them out of the business.)
Competition on quality was what Paul Ellwood had in mind when he and others invented “managed care”.
Perhpas at long last we can have that, though we need another name. (I vote for “the right care for the right patient at the right time.” )
Barry–
On taxes– see the post that I will be putting up Monday.
Since 1980 both effective and marginal tax rates for the wealthy have been historically very, very low.
Prior to 1980, the wealthy paid much higher taxes, and the gap between the rich and the rest of the population was much narrow.
Low tax rates have led to condolidation of wealth at the top which, in turn , has led to too much money at the top chasing too few things, speculation, bubbles and the collapse that we are now enduring.
Widening gaps between the rich , the upper-middle class, the statistical middle-class, the working poor and the poor have underminded both the economy and the society.
Reagonmics was based on a theory that tax hikes would undermine productivity– people wouldnt’ have an incentive to work as hard.
We now know this is not true. Graphs show no correlation between higher taxes and lower productiivity. (And many of the measures of “productivity” used in the 1990s were simply bogus–see Bull!)
I am afraid that the notion that tax increases would undermine productivity is just one of the many lies that Reagan so cheerfully told (probably not knowing it was untrue–he was not an economist.)
But if you say something long enough, with confidence, people begin to believe it–especially if they have never studied economic history.
Many people just assume that the way things have been since the 1980s is the way they have always been; this is all they remember.
But we don’t have to tolerate such extremes of wealth and poverty. And while there will always be cycles, we don’t have to endure bubbles that grow so large for so long that their collapse leaves us in a 1980s-style Depression.
I’m afraid that is where we are headed. If you analyze the employment numbers and factor in the people who have given up looking for work (who are not counted as unemployed) as well as the people who want a full-time job and are instead working a couple of days a week (who are counted as “employed”), you find that unemplooyment is already over 10 percent– and rising.
Finally, a story in today’s NYT about the number of parents who had been planning on sending their kids to private schools, and are now trying to get them into public schools with waiting lists was impressive.
Some people are moving (selling in a down market) just to get to public schools.
In NYC, as you know, sending your child to private school is a big deal-many people consider it a necessity. This is one of the last things they would give up. So this tells you how much even very affluent people are hurting . . .
Is the goal to reduce cost or just cover everyone while cost continue unabated?
As I have said many times before, Claim Costs drive insurance rates.
Any insurance company can waive pre-existing conditions and provide guaranteed issue coverage and even charge everyone the same rate no matter what age, sex or geographic location. This isn’t new and different.
And, it doesn’t change how much is paid for the services rendered (i.e. doctors charges, hospital charges, other providers charges) which equals Cost of Claims.
To have a single payer or government sponsored Medicare E, doesn’t resolved the cost problem, either.
Competition and transparency will drive costs down as long as consumers/patients get engaged instead of relying on third parties.
To eliminate private companies from competition will allow insurance premium costs to rise while masking the cost of providers services to the insured patients.
Scott– the goal is to contain costs and cover everyone.
Unless we contain costs we cannot possibly cover everyone.
Morever, we know that lower costs and higher quality often go hand in hand.
But unfortuantely, consumers are not in a position to bring down costs even if they had lists of what every hospital and doctor charges for every procedure.
Health care bills are so high in large part because
there is so much unnecessary overtreatment.
WE have close to three decades of research showing that 1/3 of our health care dollars are spent on unncesary, ineffective, often unproven drugs, devices adn procedures.
But as a consumer, how can you know which ones are unncessary?
Medicare recently sent a letter to all hospitals saying that it will no longer give them points for “higher quality” if they give beta blockers to heart attack victims within the first hour.
Why? Because we have no solid medical evidence that beta blockers work.
For years, the consensus has been that it is very important to give beta-blockers. But it appears that the consenus was wrong.
If you had a heart attack, and got to the hospital in time would you tell them: “Don’t give me the beta-blockers. There is no evidnece that they work and I’m not willing to pay for them.”
Probably not. You would be afraid of dying. And since you’re not an M.D. or a scientist you wouldn’t be in a position to study the medical reserach and decide. (Even if someone could hand you the relevant reserach and you could read it while you lay on the stretcher).
There are literally thousands of unncessary treatments out there, but as one Masschusetts health exectuive put it– the fat isn’t hanging out on the edges of the steak–it’ marbled into the meat.
To excise that fat, you need to use a scalpel, and you need to knwo what yo are doing. In other words, you need to be a physician on Prsident Obama’s “comparative effectiveness” panel. They are the folks who are in a position to make the jugments about what is mot effective for patients who fit a particular medical profile..
In additon, keep in mind that roughly 80% of our health care dollars are spent when we are really sick–not when we have the flu or a sprained ankle, but when we have cancer, congestive heart failure, etc.
When you are really sick, you are not likely to be bargain hunting. So, even if you have a transparent price list, what are you going to do with it?
Say you need heart surgery, and the price lists tell you that at hospital A, you can get the surgery for 30% less.
The first thing you want to know is “how are outcomes at Hopsital A?”
You’re told that about the same number of people die at hopsital A as at ohter hospitals. On the other hand, hospital A has a reputation for getting easier cases. People with more complicated cases tend to go to other hospitals . .
Is that really true? Well no one really has an accurate way to measure “more complicated” or “how much more complicated”
Then there is the fact that while mortalities are ho higher at hospital A, more patients seem to pick up infections in Hospital A–though that may or may not be the hospital’s fault. (They get more poorer Medicaid patients and they are more likely to come in with infections.)
It’s very hard to tell.
Also, more patients who have heart surgery in hospital A wind up in a nursing home afterward. But that may be because they get more poorer older patients . . .
I could go on.
Oh, and recent reserach has been suggesting that mammograms may not be a good idea. The number of women who don’t die from breast cancer because they had a mammorgram is actually pretty small—Meanwhile, a fair number of women who have mammograms wind up having unncessary lumpetctomies and mastectomies. (It turns out that some breast cances go away on their own–if you hadn’t known you had it, you wouldn’t have had surgery–and it never would have hurt you.)
As a layman, how do you decide what to do? Do you tell your wife– the cost of annual mammograms is adding up, let’s forget about them?
The bottom line: when you are very sick you probably aren’t going to want the doctor who is a “bargain”; and you probably are not going to be in a position to know which product or procedure would be best.
Keep in mind that every human body is unique. What worked for your neighbor next door may not work for you.
This is not like comparing notes with other
consumers on the best
refrigerator.
Hi Maggie…
We know any government option expanding coverage will not necessarily be the cheapest option, especially if those choosing it are the highest utilizers of services.
So why not let the government compete with its lower admin cost structure and see what they can do for the cost and care management for likely a more chronic population. They will have to compete on largest part of the health care expenditure, care costs, not just admin costs, and I think this is overlooked when all the fear mongers say the public play will crowd out the private ones.
When Billy Tousen lauds Max Baucus it is past time for the Democrats to give “Raucus Baucus” as a neo con gift to the Republican party free of charge- or possibly before an accident befalls him, he may wish to quit the Senate and get a job as a Corporate C.E.O. The Demopublic party is a bad joke on the people of our country.
There is no ONE insurance coamnpy that is right for everyone everyone is rated individually and all companies have different likes and dis-likes , different credit tiers, different business models, and many other factors that can vary your rate and a QUOTE is ONLY a quote until the policy is issued.Typically, insurance rates will vary from State to State and can even vary by ZIPCODE! It also will depend on the type of car/truck, coverages, limits of liability, and driving record. Some companies run credit scores and MOST run a motor vehicle report and CLUE (Comprehensive Loss Underwriting Exchange) report to see about undisclosed accident involvement. A lot of these reports might get a BETTER finding with your SSN BUT we CAN get this info WITHOUT your SSN.The best thing to do is call a LOCAL independent agent or broker. Don’t go across town, or to some other city look for someone CLOSE. Just look in the phone book for the PIA or Big I (Trusted Choice) logos and you will find a professional licensed agent that will be able to help you solve your insurance problems, and give you rate comparisons of several different companies. An independent insurance agent will normally have a dozen different companies and if he cannot help you, he should be networked with other local agents that can. In my agency, we have companies that do NOT run a credit score and welcome drivers with less than perfect driving records and specialize in youthful operators!Most of the replies on this site say go to this on-line carrier or that on-line carrier or that 1-800 number but I’m sure that when you do, you will find some impersonal computer user with a script to work from and you won’t be able to talk with the same person every time you have a problem!Good luck, drive RESPONSIBLY and I hope this helps!
loan–
The only problem is that insurance agents are paid by insurance companies. Even most “independent” agents have companies that they favor (generally companies that pay them better than others).
Like most “agents” or “brokers” (real estate agents, etc.) many (most?) insurance agents are representing their own best interest.
Caveat emptor. (If you are eligible to shop in the Exchanges you may be better off getting advice from the “Navigators” who work for these
Exchanges. They are paid by the govt, not insurance companies, and so there’s no conflict of interest.)