March 09, 2010
1:37 pm
In order to boost public support for its health reform push, the White House added a new wrinkle to the Senate-passed reform bill it has, by and large, embraced. The White House proposes to create a new federal agency with the power to review, regulate and, if it so wishes, block health insurance rate increases.
It’s not difficult to see the political strategy involved here. With health insurance premium increases in the news as of late, the health reform debate has been cast as a heroes-versus-villains morality play. A new federal rate commission will save vulnerable Americans from the health insurance industry and its, as one Administration spokesman termed them, “wildly excessive rate increases.”
But, as veteran health policy journalist Robert Pear writes in today’s New York Times, there are serious flaws with this populist initiative.
For one, health insurance premiums are already regulated by the states. As Sean Dilweg, Wisconsin’s insurance commissioner, said, “The federal proposal would be a huge pre-emption of decisions that states have made over their history.”
It’s important to note here the difference between what states actually do and the new federal responsibilities being proposed. When states analyze proposed insurance rate increases, they look at the entire picture. What are overall healthcare costs? How much of an increase can consumers reasonably absorb? What is essential to keep health insurers solvent?
In Pear’s story, Kansas insurance commissioner Sandy Praeger put it this way, “You are not necessarily helping the consumer if you keep rates artificially low. What’s worse for the consumer: having a premium increase or having to pay the full amount of a medical expense because the company is out of business?”
State insurance commissions work without fanfare, making their decisions on the basis of objective data and analysis. A federal rate commission would be under a harsher spotlight and under greater pressure to reject rate increases, regardless of their merit and necessity.
This issue is another indicator of how the health reform debate has lost its essential focus. When we should be discussing how to implement delivery reforms to improve both the quality and cost-effectiveness of care, as well as steps to expand the accessibility of private insurance, instead a disproportionate amount of attention is being devote to excessive hyperbole about insurance companies and proposed “solutions” that could make those companies less solvent and, thus, less available to those who need coverage. Consumers are not being well served by the direction of this debate.
March 03, 2010
10:17 am
The U.S. healthcare system takes no shortage of criticism. Often, these criticisms fall into two camps. There are those of us who believe that the United States has one of the strongest, most innovative health systems in the world, but we need delivery and payment reforms to increase value as well as insurance reforms and subsidies to strengthen accessibility. There are others who see the U.S. ranking well below dozens of other countries’ health systems and that we’re inherently condemned to this inferiority unless we begin taking steps to model ourselves after the government-run systems of Europe.
As we consider these two views, it’s good to get a little perspective. That perspective is brought to us from the Times of London.
The Times recently reported an appalling instance. Cost-cutting to meet government budget requirements took priority over providing hospital patients even basic, decent care. Doctors and nurses “stopped providing safe care because they were preoccupied with government targets and cutting costs.” This negligence and maltreatment led to the deaths of between 400 and 1,200 patients at this one hospital alone between 2005 and 2008. Read more
November 23, 2009
9:22 am
There was a great deal of hoopla Saturday night over the Senate Democratic leadership’s success in gaining the minimum 60 votes necessary to bring health reform legislation to the floor to begin debate after the Thanksgiving holiday. It’s perhaps a story in itself that there was so much drama over a procedural vote simply to allow debate on the President’s signature policy issue.
Despite Saturday’s successful vote, the road to health reform enactment seems more fraught with potholes than ever. The Capitol Hill newspaper, Politico, has a good summary story today on the current state of play, headlined, “How Health Reform Could Fall Apart.” Sunday’s news shows and interviews undermined any supposed momentum that was claimed on Saturday. Centrist senators made it clear that they will not vote for a bill that includes the current public option language. Senators on the left, like Bernie Sanders (I-VT) and Sherrod Brown (D-OH), said Sunday that they’ve compromised on the issue as much as they’re going to.
Adding to the difficulty of the task at hand, Rasmussen polling shows, for the first time, public support for Democratic health reform plans has dropped below 40%. Only 38% support the current legislation compared to 56% opposed. Read more
November 13, 2009
4:37 pm
A new Gallup poll released today shows that a small majority of Americans (51 percent) say it is not the government’s responsibility to make sure all Americans have health coverage. The survey shows 47 percent saying that government does indeed bear that responsibility.
Ordinarily, a margin this close wouldn’t warrant a tremendous amount of public attention. What makes this survey noteworthy, though, is how significantly these results vary from public opinion measured over the past decade.
This is the first time since Gallup began asking this question in 2001 that a majority of the public said that they don’t believe the responsibility for insurance coverage for all rests with the government. In previous years, the margin hasn’t even been close – but in the opposite direction.
Just three years ago, in 2007, 69 percent of Americans said it was government’s responsibility to make sure all Americans had health coverage, compared to just 28 percent that disagreed. In fact, the margin separating “yes” from “no” responses on this question has never been closer than 13 points, until now. Read more
November 03, 2009
4:02 pm
Senator Joe Lieberman (I-CT) has been absorbing a lot of criticism in the media and the blogosphere for his comments last week that he may have no choice but to oppose the Senate Democratic leadership’s health reform legislation if it includes a government-run health plan option.
There have been so many people trying to interpret the Senator’s statement and speculating as to his motivations that I was glad to see that Senator Lieberman took it upon himself to write an op-ed in the Hartford Courant explaining his decision. I was pleased to see the Senator, in spelling out his opposition to the government plan option, cite the cost-shifting factor that has received too little attention:
“A new public option will likely increase premiums for the 170 million Americans who already have private insurance, and let’s not forget the warning of the Congressional Budget Office: that the federal government will assume the financial risk that the premiums charged in a given year may not cover all of the public plan’s costs.”
Senator Lieberman also explained that he’s not against health reform, but rather he supports reform that will truly address the greatest needs of our healthcare system. Read more
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