A recent analysis from the Commonwealth Fund called Paying the Price: How Health Insurance Premiums Are Eating Up Middle-Class Incomes suggests that health insurance reform is the answer to solving the health care cost problems. The report lists certain reforms that should be implemented: (1) leveraging public purchasing power, (2) reducing administrative waste, (3) creating incentives for better health and cost outcomes, and (4) having insurance companies work in the public interest. The goals of this reform are touted as better access, better quality, and slower cost growth.
The idea of better access is intriguing. I suppose it depends on what you mean by “better” access. If you mean expanded access because more people are covered by some kind of insurance plan, then perhaps this may be true. In a minute we will explore the experience of Massachusetts, the first state to pass a health insurance mandate. If “better access” means enhanced access due to broad-based provider networks, then there could be an inherent struggle.
The problem with much of the recent discussion about health care reform is that folks seem to want things both ways. We want unlimited choice but we don't like the price tag it comes with. Heck, insurers would love to offer plans with scaled-down provider networks that focus on having an adequate number of high quality providers. They tried it back in the 1990s. But there were so many “health care reform” laws passed in a backlash against managed care that insurance companies are often prohibited from taking these simple steps by law.
For example, in Kentucky we have a law that says insurance companies must have a hospital and a primary care provider within 30 minutes or 30 miles of every single member of its health care plan. Specialists have to be available within 60 minutes or 60 miles of every single member of its health care plan. Insurers are required to run reports demonstrating that they meet this network “adequacy” requirement. This law was passed due to the barrage of consumer complaints about the tightly managed provider networks offered by their health insurers. People want to go to “their” doctor and “their” hospital, regardless of how much it costs or how good someone tells them the quality is (or isn’t). They want freedom of choice, baby.
In a mostly rural state like Kentucky, this means an insurer needs to have virtually every single community hospital in the state in order to meet this requirement. The reality is that some of these smaller hospitals are likely to be the ones left out in the cold if health care reforms that focus on high quality and low cost are implemented. Why? Because hospitals, by nature, have high fixed costs. They require a tremendous amount of infrastructure. These hospitals may only see a relatively small number of people per year. In order to cover their fixed costs when there isn’t a large patient volume to support it, their variable costs are higher. Because they may perform a significantly smaller number of procedures, their quality outcomes may not be as high as a hospital with a high volume. To add more fuel to the fire, hospitals are often one of the largest employers in small communities. Closing a hospital means more than closing a hospital and asking patients to drive further. It means a blow to the economy. A loss of jobs.
So back to the Commonwealth Fund report. One of the most interesting notes from the study was the state-by-state comparison of premium costs. The state with the highest premium costs in the country is….(drum roll please)….Massachusetts. Why is that interesting, you may ask? Because in 2006 Massachusetts passed landmark “health care reform” that required that everyone in the state have health insurance coverage. The goals of this reform were to provide high quality affordable health care to all citizens. To ensure access to coverage, Massachusetts (1) expanded Medicaid, (2) created a publicly subsidized private insurance plan called Commonwealth Care to cover those earning up to 300% FPL who didn’t qualify for Medicaid and didn’t have access to employer sponsored insurance, (3) required insurers to offer plans that meet a “seal of approval,” and (4) required insurers to offer a specific low-cost plan to residents 19 to 26 years old who don’t qualify for Medicaid and don’t have access to employer health coverage (either on their own or through their parents).
To ensure coverage, Massachusetts required employers with 11 or more FT employees to either offer health insurance or pay a penalty and required individuals to have health insurance or pay a penalty. To improve quality of care and control cost, Massachusetts created a Health Care Quality and Cost Council whose objective is to set cost and quality goals and provide consumers with comparative information about providers to help them make educated and informed treatment decisions, developed an infection control program, and implemented a wellness program. The reform model also included some efforts towards electronic record keeping. Sound familiar?
It should, considering it is the basis for the national health care reform we’ve been talking so much about. So how did Massachusetts fare? We have to go back to the beginning. Massachusetts actually started from a better place than the rest of the U.S. Even before reform, the state had a history of a relatively low number of uninsured citizens (only about 6%) and a relatively high rate of employer sponsored insurance. So when reform began, 94% of Massachusetts residents had coverage. Not too shabby.
So where are they now? Three years after reform, 97% have a coverage, a gain of 3%. Again, not too shabby. But perhaps less than expected, especially considering that “reform” has been a budget buster for the state. Massachusetts expects to spend a whopping $595 million more on its health insurance programs in 2009 than it did in 2006 when reform was passed, an increase of 42%. So to get a gain in coverage of 3% = cost increase of 42%. Yikes!
What’s a state to do? Well, in 2008 Massachusetts was forced to raise health insurance premiums and increase copayments to help stabilize the program. Before anyone squawks, notice I said “Massachusetts” had to raise premiums and copayments. For their publically funded plan. They also increased the state tobacco tax to increase revenue to help pay for the struggling plan.
In December Massachusetts reported that a majority of the approximately 200,000 citizens who were still uninsured were the “young and healthy.” These are the very adults that a universal system most needs to have in the mix because they are typically inexpensive, so they help balance out the higher costs of the older and sicker. The end result of Massachusetts’ reform is that premium costs in the state are about two to three times the level of inflation, much higher than anticipated, and available funds to support the public plan options are dwindling dramatically, so much so that discussions are brewing over whether or not to exclude legal immigrants who haven’t yet obtained permanent status from the public plan in order to trim costs.
So what’s next for the program? Some health policy analysts say that simply changing payment methods won’t be enough to slow the growth in cost, even when efforts are combined with other cost-cutting mechanisms. They say the only way to truly control costs is to stop spending, and that could mean…rationing of care. Just like they already do in many of the countries that provide universal coverage. Get ready to pick your poison, America.
Saturday, August 22, 2009
Tuesday, August 18, 2009
Is America ready for a culture shift? Societal mores can't be ignored in the health care reform debate
In 2007 the Commonwealth Fund ranked the United Kingdom’s health care system as number one amongst six countries, including the U.S. The study ranked the systems using six measures: quality care, access, efficiency, equity, healthy lives, and health expenditures per capita. The quality care measure was further broken down into four areas: right care, safe care, coordinated care, and patient-centered care.
The U.S. ranked last in nearly every measure. We managed to just squeak ahead of Canada and take 5th place for quality care, coordinated care, and patient-centered care. We actually ranked 1st for right care because of our success in ensuring folks get preventive care.
Not surprisingly, access was one of the key issues that worked against the U.S. Americans were the most likely of those surveyed to say they had problems accessing care because of cost, except for those with insurance. Insured patients in the U.S. have some of the best and most rapid access to services in the world. In other countries that provide universal coverage, the cost of care wasn’t a barrier to access – but long waiting times to receive care were a problem.
One of the most interesting things about the study is the way in which the information was collected. The rankings are based on national mortality data and the perceptions and experiences of patients and physicians. The rankings do NOT consider objective data available in medical records or administrative findings. The study authors note, “Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.”
Cross-cultural studies have repeatedly demonstrated that the national culture is the main factor in determining human behavior in all aspects of social life, including business. The world may be getting smaller, but cultural differences between countries still run very deep. I am not trying to say that everyone within each country is the same, or even that all the many countries that comprise Europe can be placed in one uniform bucket (yes, Miss Teen South Carolina – Europe is a CONTINENT, not a COUNTRY). The point is that differences within a country are much less significant than the differences between countries.
The impression that globalization is making us a unified world may be mistaken. Yes, most of the world eats at McDonalds and watches MTV. But these are superficial cultural artificats that are more a reflection of prosperity than a shift in cultural norms. According to a World Value Survey that was conducted in more than sixty countries throughout the world, as much as 85% of the variation between countries can be explained by cultural plus economic factors. This seemingly would include health care.
Some of these variances can be significant. For example, the level of individualism (versus collectivism) in Europe varies from moderate to high. But Americans hold the top position in individualism among all other countries. This attitude translates into a difference in attitude towards goods and services. Europeans have a very egalitarian attitude. When the French were surveyed, they said they preferred for everyone to have the same access to healthcare, even if the quality of the healthcare were lower, rather than having a society in which the quality of healthcare was higher but access was uneven.
This sort of thinking doesn’t seem to be as prominent in the U.S. Americans want the highest quality of everything and the focus on quality may come at the expense of other aspects that may be deemed less important, like access. Thus it seems then that the expectations of Europeans and Americans are different. This could certainly color the lens through which the healthcare system, as well as everything else, is viewed. Let’s start with the most basic of activities – having a meal. In Europe a meal is expected to take a leisurely hour and a half, even two or three hours. Waiters seem in no hurry. In the U.S., many folks have ordered, consumed, and paid for a meal in under 30 minutes.
Housing and personal space is another good example. Today the average size of a new home in the U.S. is 2400 sq ft. In Europe, the average size is only about half that. Oftentimes the “master” bedroom won’t accommodate a king-sized bed. The hot water heater is a small box that fits on the wall, whereas most of us have gigantic 50-gallon behemoths to house our water. And what about the differences in our cars?! Not to mention that many Europeans get around by bicycle or walking. The point I am making is, Europeans and Americans are different.
One statistic that is often cited as being representative of failure of the U.S. healthcare system is infant mortality. According to the CIA World Factbook, the U.S. has 6.26 deaths per live births, a high rate for a developed country. Contrast that to Canada at 5.04, Britain 4.85, France 3.33 and Germany 3.99 deaths per live births. Startling, right?
But I don’t think this statistic can be fully understood without considering another - the abortion rate. In 1995, the total number of abortions performed in Europe was 7.7 million. In Northern America (which includes both the U.S. and Canada), there were 1.5 million abortions. This translates to an abortion rate of 48 per 1000 women in Europe versus 22 abortions per 1000 women in Northern America. In other words, the abortion rate is 118% higher in Europe than in Northern America. Why is this relevant? Because it may reveal an important cultural difference at play here as well. If American women are more likely to continue with a pregnancy, even when the fetus is discovered to have an incurable or devastating disease, then we may be delivering significantly more very sick babies that can’t be expected to live as long.
A closer look at attitudes toward abortion is in order to help better understand what may be happening. A 2007 CBS News poll about abortion in the U.S. asked, “What is your personal feeling about abortion?” 30% said that it should be “permitted only in cases such as rape, incest or to save the woman's life”, 31% said that abortion should be “permitted in all cases”, 16% that it should be “permitted, but subject to greater restrictions than it is now”, 12% said that it should “only be permitted to save the woman's life”, and 5% said that it should “never” be permitted.
Contrast that to a 2005 Euro RSCG/TNS Sofres poll that examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, “If a woman doesn't want children, she should be able to have an abortion.” Some of the results are as follows:
“Very much” “A little” “Not really” “Not at all”
France 55% 23% 8% 13%
Germany 40% 24% 10% 24%
Italy 29% 24% 16% 25%
Netherlands 37% 22% 11% 26%
Spain 41% 18% 8% 27%
U.K. 43% 23% 10% 19%
Clearly attitudes towards abortion are very different in the U.S. and Canada from those in Europe, where abortion is much more common. These kinds of cultural biases and preferences have not been taken into consideration in the Commonwealth Fund survey or most other surveys on healthcare systems. We will continue to examine these underlying cultural norms and values that shape an individual’s perspective on what is important in life and society.
The U.S. ranked last in nearly every measure. We managed to just squeak ahead of Canada and take 5th place for quality care, coordinated care, and patient-centered care. We actually ranked 1st for right care because of our success in ensuring folks get preventive care.
Not surprisingly, access was one of the key issues that worked against the U.S. Americans were the most likely of those surveyed to say they had problems accessing care because of cost, except for those with insurance. Insured patients in the U.S. have some of the best and most rapid access to services in the world. In other countries that provide universal coverage, the cost of care wasn’t a barrier to access – but long waiting times to receive care were a problem.
One of the most interesting things about the study is the way in which the information was collected. The rankings are based on national mortality data and the perceptions and experiences of patients and physicians. The rankings do NOT consider objective data available in medical records or administrative findings. The study authors note, “Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.”
Cross-cultural studies have repeatedly demonstrated that the national culture is the main factor in determining human behavior in all aspects of social life, including business. The world may be getting smaller, but cultural differences between countries still run very deep. I am not trying to say that everyone within each country is the same, or even that all the many countries that comprise Europe can be placed in one uniform bucket (yes, Miss Teen South Carolina – Europe is a CONTINENT, not a COUNTRY). The point is that differences within a country are much less significant than the differences between countries.
The impression that globalization is making us a unified world may be mistaken. Yes, most of the world eats at McDonalds and watches MTV. But these are superficial cultural artificats that are more a reflection of prosperity than a shift in cultural norms. According to a World Value Survey that was conducted in more than sixty countries throughout the world, as much as 85% of the variation between countries can be explained by cultural plus economic factors. This seemingly would include health care.
Some of these variances can be significant. For example, the level of individualism (versus collectivism) in Europe varies from moderate to high. But Americans hold the top position in individualism among all other countries. This attitude translates into a difference in attitude towards goods and services. Europeans have a very egalitarian attitude. When the French were surveyed, they said they preferred for everyone to have the same access to healthcare, even if the quality of the healthcare were lower, rather than having a society in which the quality of healthcare was higher but access was uneven.
This sort of thinking doesn’t seem to be as prominent in the U.S. Americans want the highest quality of everything and the focus on quality may come at the expense of other aspects that may be deemed less important, like access. Thus it seems then that the expectations of Europeans and Americans are different. This could certainly color the lens through which the healthcare system, as well as everything else, is viewed. Let’s start with the most basic of activities – having a meal. In Europe a meal is expected to take a leisurely hour and a half, even two or three hours. Waiters seem in no hurry. In the U.S., many folks have ordered, consumed, and paid for a meal in under 30 minutes.
Housing and personal space is another good example. Today the average size of a new home in the U.S. is 2400 sq ft. In Europe, the average size is only about half that. Oftentimes the “master” bedroom won’t accommodate a king-sized bed. The hot water heater is a small box that fits on the wall, whereas most of us have gigantic 50-gallon behemoths to house our water. And what about the differences in our cars?! Not to mention that many Europeans get around by bicycle or walking. The point I am making is, Europeans and Americans are different.
One statistic that is often cited as being representative of failure of the U.S. healthcare system is infant mortality. According to the CIA World Factbook, the U.S. has 6.26 deaths per live births, a high rate for a developed country. Contrast that to Canada at 5.04, Britain 4.85, France 3.33 and Germany 3.99 deaths per live births. Startling, right?
But I don’t think this statistic can be fully understood without considering another - the abortion rate. In 1995, the total number of abortions performed in Europe was 7.7 million. In Northern America (which includes both the U.S. and Canada), there were 1.5 million abortions. This translates to an abortion rate of 48 per 1000 women in Europe versus 22 abortions per 1000 women in Northern America. In other words, the abortion rate is 118% higher in Europe than in Northern America. Why is this relevant? Because it may reveal an important cultural difference at play here as well. If American women are more likely to continue with a pregnancy, even when the fetus is discovered to have an incurable or devastating disease, then we may be delivering significantly more very sick babies that can’t be expected to live as long.
A closer look at attitudes toward abortion is in order to help better understand what may be happening. A 2007 CBS News poll about abortion in the U.S. asked, “What is your personal feeling about abortion?” 30% said that it should be “permitted only in cases such as rape, incest or to save the woman's life”, 31% said that abortion should be “permitted in all cases”, 16% that it should be “permitted, but subject to greater restrictions than it is now”, 12% said that it should “only be permitted to save the woman's life”, and 5% said that it should “never” be permitted.
Contrast that to a 2005 Euro RSCG/TNS Sofres poll that examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, “If a woman doesn't want children, she should be able to have an abortion.” Some of the results are as follows:
“Very much” “A little” “Not really” “Not at all”
France 55% 23% 8% 13%
Germany 40% 24% 10% 24%
Italy 29% 24% 16% 25%
Netherlands 37% 22% 11% 26%
Spain 41% 18% 8% 27%
U.K. 43% 23% 10% 19%
Clearly attitudes towards abortion are very different in the U.S. and Canada from those in Europe, where abortion is much more common. These kinds of cultural biases and preferences have not been taken into consideration in the Commonwealth Fund survey or most other surveys on healthcare systems. We will continue to examine these underlying cultural norms and values that shape an individual’s perspective on what is important in life and society.
Monday, August 17, 2009
The one thing that is TRULY universal – health care dissatisfaction
We may not have agreed on the best way to achieve universal health care yet, but we Americans can seem to agree on one thing: unhappiness with the current system. A 2007 Commonwealth Fund survey showed that 82% of us believe that our current health care system either needs fundamental change or should be completely rebuilt. We’ve heard arguments about the high cost and inferior quality of care in the U.S. from critics who point to Canada, Germany, Great Britain, etc. as models for reform. Interestingly enough, the same survey from the Commonwealth Fund reveals that a majority of the citizens of those countries share our feelings -- 72% of Canadians, 78% of Germans, and 72% of Brittons believe their health care systems need fundamental change or should be completely rebuilt. WTF?
We already know the problems within our system: rising costs, varying quality, and barriers to access. But what’s going on in these faraway lands where the access problems have been solved and everyone’s supposed to be covered?
A case study of these countries reveals some serious problems. Some of these problems – like rising costs – they share with us. Other problems are ones we haven’t experienced yet, like rationing of care, waiting lists, and lack of access to medical technology. So what “magic bullets” are being considered to address their problems?
Surprisingly, it seems that they have taken a lesson from the managed care playbook. When you get right down to it, there are really only two basic ways of dealing with rising costs – (1) pass them on or (2) reduce utilization. Our European neighbors are doing some of both by increasing taxes and restricting benefits. Sound familiar? Like rising premium costs and decreased benefits?
So what other options are being considered? Higher copayments. Physician “gatekeepers” who control access to specialists. Reduced reimbursement to doctors and hospitals. Removing high-cost drugs from the formulary and replacing them with low-cost generics. This is beginning to sound very familiar indeed…
So we’ve all got problems and it seems we’ve all got similar solutions –namely market-oriented forces, many of which we’ve already put in place here in the U.S. So as we debate whether or not to adopt some sort of government-run health care system, those countries that have some sort of government-run system are debating about how to make their health care systems look more like us!!
In upcoming blogs I will be exploring the health care systems of other countries, focusing on those that are being touted as models for our own health care reform. We will examine the triumphs and pitfalls of each and take a closer look at the societies and cultures behind them.
We already know the problems within our system: rising costs, varying quality, and barriers to access. But what’s going on in these faraway lands where the access problems have been solved and everyone’s supposed to be covered?
A case study of these countries reveals some serious problems. Some of these problems – like rising costs – they share with us. Other problems are ones we haven’t experienced yet, like rationing of care, waiting lists, and lack of access to medical technology. So what “magic bullets” are being considered to address their problems?
Surprisingly, it seems that they have taken a lesson from the managed care playbook. When you get right down to it, there are really only two basic ways of dealing with rising costs – (1) pass them on or (2) reduce utilization. Our European neighbors are doing some of both by increasing taxes and restricting benefits. Sound familiar? Like rising premium costs and decreased benefits?
So what other options are being considered? Higher copayments. Physician “gatekeepers” who control access to specialists. Reduced reimbursement to doctors and hospitals. Removing high-cost drugs from the formulary and replacing them with low-cost generics. This is beginning to sound very familiar indeed…
So we’ve all got problems and it seems we’ve all got similar solutions –namely market-oriented forces, many of which we’ve already put in place here in the U.S. So as we debate whether or not to adopt some sort of government-run health care system, those countries that have some sort of government-run system are debating about how to make their health care systems look more like us!!
In upcoming blogs I will be exploring the health care systems of other countries, focusing on those that are being touted as models for our own health care reform. We will examine the triumphs and pitfalls of each and take a closer look at the societies and cultures behind them.
Thursday, August 13, 2009
Planes, Trains & Automobiles - Algae can run them all
The Community College in Henderson Kentucky hosted the Ohio River Algae Symposium this week organized by the University of Kentucky Center For Applied Energy and Ohio University. One of the most fascinating and motivating presentations was from Brian Goodall, Vice President of Sapphire Energy. While much of what he said was so new to me it took a bit for me to grasp it, I knew I was listening to something that was cutting edge and could radically change the way we think about Algae and transportation fuels. Apparently, under the right conditions, you can grow algae in large amounts and turn it into diesel fuel, gasoline, & jet fuel and do so in a way that makes them environmentally friendly products. Um? See already this was different.
Sapphire Energy, a California based company, was started by a group of scientist and business people that thought there was an out of the box solution to our carbon-based fuel problem. Sapphire’s goal is to be the world’s leading producer of renewable petrochemical products. And it appears that they are well on their way. The fuel they produced from algae powered a commercial Continental flight in January of this year. This got the attention of the air force, a large consumer of jet fuel. If Sapphire Energy can take their demonstration project, which has a production capacity of 100 barrels a day, to say 5000 barrels a day at a competitive price then we could see algae based fuels replace oil entirely.
Sapphire says that the company’s final products will have the same chemical composition as gasoline and will be completely compatible with the existing refining, distribution and fleet infrastructure. So their product is not ethanol or biodiesel, but a source of renewable gasoline. Broad scale adoption will not require a new infrastructure because it can be refined to the exact standards for petroleum based fuels and can be distributed in a similar manner.
The process to grow this fuel requires water, CO2 and sunlight. A cutting edge process that is being developed will allow the capture of CO2 from coal-fueled power plants that can be consumed in the algae growth process. This makes the use of the fuel-produced carbon neutral. That’s a plus. Another plus, algae is not consumed as a food product, therefore, unlike corn, large-scale commercial use will not drive up food costs.
So what are the problems? The technology is still being developed. Speakers throughout the day talked about new ways being developed to grow algae commercially and on a large scale. It’s more than a concept, but not much past demonstration projects yet, albeit successful demonstration projects. The key is to bring down production cost by locating near abundant water and carbon sources, developing a more efficient process to remove the water, identifying the best species for the growing environment and end use, and developing viable low cost growth containers.
Sapphire Energy says they are on their way and believe they will have the capacity to produce a million barrels of renewable algae based petrochemical products in 2011. Stay Tuned.
For more information on Sapphire Energy see them online at http://www.sapphireenergy.com/
The event was sponsored locally by the Kentucky Department of Energy Development & Independence, the Henderson Chamber of Commerce and the Henderson Fiscal Court.
Monday, August 10, 2009
The Media Coverage of the Fancy Farm - Conway Issue Continues
Senator Jim Bunning announced the week leading up to the Fancy Farm picnic that he would not be seeking another term in 2010. This created the opening that the major contenders had been seeking. Two Democrats, Attorney General Jack Conway and Lt. Governor Dan Mongiardo had already announced their intentions to run. Republican Secretary of State Trey Greyson had formed an exploratory committee, which he turned into a full-blown campaign immediately after Bunning's announcement.
Without a fall election this year, all political eyes turned to next year’s race at Kentucky’s premier political event, the Fancy Farm Picnic. The candidates were out working the crowd and perfecting their talking points. Jack Conway, Kentucky’s Attorney General announced that he was “one tough SOB”, creating interest from the media, YouTube enthusiast and the Colbert Report on Comedy Central.
WHAS11 in Louisville ran another story this past weekend summarizing the controversy, replaying the Colbert Report and adding a link to the YouTube video. If you are interested check out this link, http://www.whas11.com/topstories/stories/whas11-politics-090807-conway-backlash.b9d975c6.html.
Sunday, August 9, 2009
Opening the Dialogue of True Reform
Tonight on his Fox News show, Governor Huckabee talked about several aspects of health care reform and had a variety of experts on to give their take. Whether you support the President's plan or not, I recommend that you take the time to hear various points of view. I am very impressed with Governor Huckabee's knowledge of the health care reform issues. I was particularly pleased when he brought up the true number of uninsured Americans and posed the question of "which problem are we trying to solve?" My partners can attest to my rants on these very issues.
I don't think that the American people want to turn our health care system on its ear in a mad rush. I, for one, do not want to plow forward without knowing what the problem is that we are "solving." Having worked in private health insurance, served as Medicaid Commissioner for the Commonwealth of Kentucky, and now as executive vice president of a provider sponsored Medicaid and Medicare managed care plan in Kentucky, I have been on all sides of this equation. In my opinion, we must first clean up the ills of Medicaid and Medicare before we add yet another government program. I was very disappointed to see that these programs remain virtually unchanged in the the proposed reform, and in fact are expanded. Our current government programs are largely behind our health care system shortfalls, both financially and in terms of promoting positive health outcomes. President Obama has said himself that Medicaid and Medicare are simply unsustainable. Adding another government program and expecting a different result seems illogical.
I hope that other media figures take the opportunity to get the issues with health care reform out into the light of day. Health care is a bipartisan issue. There is no silver bullet, so only through a thorough discussion of all aspects of the problem, as well as the proposed solution can we craft any reasonable approach to health care reform.
New HHS State Specific Health Care Reform Reports
On Friday HHS Secretary Sebelius released the second round of state-by-state benefits from health care reform. The reports are supposed to show clearly how all Americans will benefit from reform. Frankly, I found several major errors of omission in the Kentucky report, so I imagine other state reports are likely flawed as well. Carefully read through the sources "cited" and you will find that lots of the "facts" are extrapolations or based on very limited reference points.
The report shows that premiums for Kentuckians have risen 61% since 2000. This is provided as a "shocking" number to illustrate that the current system is simply out of control. What the report leaves out is that Kentucky has been struggling since the last attempt at health care reform which was made by former Kentucky Governor Brereton Jones. During the time of "Hillary Care," Kentucky decided to move forward with many of the health care reform initiatives and like Congress seemed to attempt, he pushed it all through the legislature in a special session that was touted as solving a crisis that could not wait. The result is an insurance system where people in Kentucky pay higher premiums than those in surrounding states.
This leads to my second "shocking" number in the Kentucky report. The report states that 51% of Kentucky's insurance market belongs to one company. The report adds that under reform Kentuckians will have many more choices. The omission is that prior to the Jones reform effort, Kentucky had a much more robust market with hundreds of insurers serving the state. The reform effort forced them to leave Kentucky because they could no longer afford to do business here. It is true that we have very few insurance options in our state "post-reform," so I and many Americans remain concerned about the impact of national reform.
I think everyone agrees that there are some changes that could be made to our system. It is certainly far from perfect. However, when have we completely turned a system on its ear and labeled it is as a disaster when 85% of the people being served are satisfied?
Here is the quote from Sebelius on the release of the reports:
"These reports show how health insurance reform will help Americans save money, get better care, strengthen their insurance if they already have coverage, and afford it if they don't. Every American will benefit when we pass health insurance reform."
I hope everyone notices that we are no longer pursuing "health care reform" but rather "health insurance reform." As someone who has worked in a state where "health insurance reform" has happened, we need to tread cautiously or the nation will end up with the high costs and lack of choices that have plagued Kentucky since we drank the "reform" kool-aid the last go around.
The reports are available at http://www.healthreform.gov/healthcarestatus.html.
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