Thursday, July 2, 2009

"GovernmentCareKilled My Uncle" 

By Grace-Marie Turner

Categories: Single-Payer Follies

Diane Furchtgott-Roth's first-hand experience with the National Health Service teaches us that a single-payer system would radically change the standards of American medicine -- for the worse.

Socialized medicine killed Furchtgott-Roth's uncle, she writes. He was allergic to penicillin but the doctor gave him a shot of it -- soon after he had told Furchtgott-Roth's aunt that he was on the road to recovery.

Or, consider Furchtgott-Roth's grandmother, who had the misfortune of having a stroke on a Friday.

Furchtgott-Roth asked when the doctor would see her and was told that the doctor would come on Tuesday. When asked if she could pay for someone to see her grandmother over the weekend, the answer was that no one was there to be paid.

The elderly are most likely to lose from rationed care, writes Furchtgott-Roth. Her father, a highway planner in England, was instructed to consider deaths of retired people in road accidents as "benefits," because their "consumption" was likely to exceed their "production."

With the examples of Britain's NHS, it's astounding that anyone would recommend a single-payer government plan for the United States, concludes Furchtgott-Roth.

• posted by Grace-Marie Turner
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Wednesday, July 1, 2009

Dressing up Flawed Ideas in New Language 

By Grace-Marie Turner

Joseph Antos of the American Enterprise Institute outlines fundamental principles that must guide health care reform. The "new vision" for American health care advanced by major reform proposals is actually an old one backed up by new regulations and restrictions, including mandates, tight insurance regulation, and the creation of a new public plan. These proposals are flawed and will not work as advertised.

Antos stresses five principles for real health reform:

1. Support those who need the help;
2. Promote effective competition;
3. Promote informed choice;
4. Create appropriate financial incentives; and
5. Look beyond the confines of medical care.

Neither a market-based reform nor a highly regulatory approach to reform will produce an instant cure for the problems facing the health care system, concludes Antos. Real health reform strengthens effective competition, rewards initiative, promotes innovation, and permits failure when poor business decisions are made; levels with the American people about what is possible and necessary and gives them the tools and support to do their part; and lays the foundation for an efficient health care system that is sustainable in the years to come.

• posted by Grace-Marie Turner
• 11:16 am
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Wednesday, July 1, 2009

Live in New Jersey? Pay 40% More 

By Grace-Marie Turner

Categories: New Jersey

New Jersey's laws and regulations have limited the selection of health care policies, driven insurers out of the market, caused premiums to soar, and significantly increased the number of people without health insurance in the state.

That's the conclusion of Assemblyman Jay Webber. New Jersey residents pay exorbitant rates for health care coverage -- an average annual health insurance premium of $10,398, or nearly twice the national average.

Not surprisingly, 40% fewer people buy their health insurance on New Jersey's individual health insurance market today than in 1992.

The climb of health care coverage costs has hit New Jersey small employers the hardest, with the average cost of providing health insurance doubling in the last six years. In 2007 alone, the average cost of an insurance policy for small companies rose by an average of 9.8%, to $7,251 per employee.

Allowing New Jerseyans to purchase regulated health insurance policies from other states would empower consumers to seek out and buy health insurance policies that best fit their needs and budgets, said Assemblyman Webber. For example, Pennsylvania residents can purchase health insurance policies for as little as 40% of the cost of comparable polices in New Jersey.

• posted by Grace-Marie Turner
• 9:11 am
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Wednesday, July 1, 2009

Roughly Half the Uninsured Can Afford Insurance 

By Grace-Marie Turner

The Census Bureau's estimate of 47 million uninsured dominates nearly all health care policy debates, but is unfortunately a relatively coarse measurement that provides little substantive information about the uninsured that can be used to craft effective policy solutions.

That's according to Drs. June and David O'Neill, of Baruch College and City University of New York, respectively.

A large fraction of the uninsured (43%) could likely afford health coverage. In addition, they say that the involuntarily uninsured -- those that lack health insurance because they are likely unable to afford it -- are demonstrably different from the privately insured.

A disproportionately large percentage of the involuntarily uninsured are young, a third are immigrants, close to half are single without children, and close to 40% did not work during the year.

Finally, the two scholars show that while the uninsured use fewer health services, they still receive a large amount of care, and there is little discernable difference in mortality based on insurance status.

• posted by Grace-Marie Turner
• 9:06 am
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Friday, June 26, 2009

Massachusetts: Significant Subsidies, Physician Shortages 

By Grace-Marie Turner

Categories: Massachusetts

Tara Persico and I have a major new paper out this week (which we have been working on for months) entitled "Massachusetts' Health Reform Plan: Miracle or Muddle?"

It is so very important to study Massachusetts' efforts to achieve universal coverage because the state uses many of the same tools that Congress is considering to overhaul the nation's health sector. Massachusetts even had a head start with a low uninsured rate, broad bi-partisan support for the reform plan, and billions of dollars in subsidies from the federal government.

Well over half of those newly enrolled in health coverage in Massachusetts are in free or heavily subsidized plans, causing significant budget pressures for the state. Physician and medical workforce shortages have been exacerbated, with half of the state's internists and family physicians closing their practices to new patients. And rising costs for health insurance and health care continue to pose the biggest challenge to the success of the reform effort.

The state is facing growing opposition from businesses and individuals to the mandates. Citizens are also frustrated that they are required to have expensive health insurance but have difficulty finding physicians who will see them. Further, the promise has not been fulfilled that hospital costs would go down as fewer uninsured people have sought care in emergency rooms.

Among the Massachusetts reform initiatives that are being considered by Congress: an individual mandate, employer play-or-pay mandate, a national health insurance exchange, strict regulation of private health insurance, expansion of Medicaid, and a government-mandated health benefits package.

Before proceeding to implement this experiment on a nationwide scale, it would be wise to learn more about how the reform plan in this sophisticated, highly-motivated state is developing.

• posted by Grace-Marie Turner
• 4:10 pm
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Wednesday, June 24, 2009

GMT on ABC & CNN 

By Grace-Marie Turner

I've been invited to the White House this evening to participate in the ABC News special "Questions for the President: Prescription for America."

Charlie Gibson and Diane Sawyer will moderate the discussion as President Obama answers questions from the audience about health reform. The program airs tonight from 10:00-11:00pm Eastern on ABC, with a follow up broadcast later this evening on Nightline.

I also have been invited to appear on CNN's "Your $$$$$" to discuss health care reform with host Ali Velshi, which airs this Saturday at 1:00pm ET and again Sunday at 3:00pm ET.

We hope you can join us in watching these broadcasts and send us your thoughts. Please join the conversation online at the Galen website. 

• posted by Grace-Marie Turner
• 2:17 pm
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Friday, June 19, 2009

The Bombshell Week 

By Grace-Marie Turner

The bombshells started dropping on the health reform front this week:

 

• Soaring costs: The Congressional Budget Office told the Senate health committee its bill would cost $1 trillion over the next 10 years and would only provide health insurance for a net 16 million more people. It said 15 million would lose their coverage at work and eight million would lose coverage from other sources, leaving 36 million uninsured. Since the goal is to have virtually everyone covered with no deficit spending, this was a double whammy, especially since there is even more spending in the bill that the CBO hasn't yet scored.

   

• Delay: The Senate Finance Committee was forced to delay its work on developing its bill when the CBO offered a preliminary cost estimate of $1.6 trillion over 10 years. Somehow in the hall of budget mirrors in the U.S. Congress, the most they are willing to spend of future generations' money is $1 trillion.

   

• No agreement: President Obama traveled to Chicago to speak at the annual meeting of the American Medical Association, hoping to sway them to support his health reform plan. He again faced protest signs outside the hall. Inside, there were boos when he said he wouldn't go along with their proposal to cap malpractice awards.

   

• AMA rebuffs: Worse, when a resolution came to the floor of the AMA which would have endorsed Mr. Obama's idea of a new government health plan, the language he had hoped for was stripped out, and it became a mere restatement of the AMA's long-standing goals supporting "pluralism, freedom of choice, freedom of practice, and universal access for patients."

   

• More cost-shifting: The CBO also says that congressional plans to rein in federal spending through public plans could end up shifting more of the costs to private insurers, employers, and people with private medical coverage. While there are many efficient providers currently practicing, experts don't yet know how to spread that efficiency throughout the system, and policy makers won't be able to do so "through fiat or good intentions," the CBO said.
  
  "I think there's definitely risk that a portion of the reduction in hospital payments from Medicare will wind up as increased payments by private insurers," said Paul B. Ginsburg, president of the Center for Studying Health System Change. Hospitals may have the motive and means to "transfer those charges to somebody else," and "we'll see costs increasing on the private side and not necessarily falling everywhere," said Harold S. Luft, director of the Palo Alto Medical Foundation Research Institute.

   

• Don't take it to the bank: The CBO also says that it can't give credit for most of the $2 trillion in savings that were announced with great fanfare in May. You will recall the brouhaha between the White House and six industry groups over whether they had or had not pledged to reduce health spending by 1.5% a year over 10 years through disease management, information technology, coordinated care, etc.
  
  "What was originally offered up as a down payment on healthcare reform simply can't be accurately estimated by the CBO and will result in far less savings than the originally promised $2 trillion," said Republican senator Mike Enzi of Wyoming, the ranking member of the Senate health committee. "The administration will need to come up with far greater savings proposals -- savings that Congress can take to the bank -- to achieve the massive healthcare bill Democrats are proposing."

The Senate Finance committee still offers the best prospects of a bi-partisan bill. It has gone back to the drawing board and is not expected to release its bill until after the July 4 recess -- missing its first deadline of committee action by the end of June. Here is an outline of the bill as of last evening. The goal for final action is now expected to be closer to Christmas. The longer it slips, the more difficult it will be to pass the sweeping reform the White House and congressional liberals envision.

• posted by Grace-Marie Turner
• 3:16 pm
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Friday, June 12, 2009

Private-Sector Care Gaining Ground in Single-Payer Countries 

By Grace-Marie Turner

As the U.S. is on the verge of rushing toward government health care, Canada is reforming its system in the opposite direction, wrote Dr. David Gratzer in the June 9 WSJ.

For example, Dr. Brian Day, an orthopedic surgeon, grew increasingly frustrated by government cutbacks that reduced his access to an operating room and increased the number of patients on his hospital waiting list. He built a private hospital in Vancouver in the 1990s. Dr. Day estimates that 50,000 people are seen at private clinics every year in British Columbia.

According to The New York Times, a private clinic opens at a rate of about one a week across the country. Public-private partnerships, once a taboo topic, are embraced by provincial governments, said Gratzer, himself originally from Canada.

And in the United Kingdom, the present Labour government has introduced a choice in surgeries by allowing patients to choose among facilities, often including private ones.

Even in Sweden, the government has turned over services to the private sector. Americans need to ask a basic question, said Gratzer: Why are they rushing into a system of government-dominated health care when the very countries that have experienced it for so long are backing away?

• posted by Grace-Marie Turner
• 2:36 pm
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Tuesday, June 9, 2009

State Employee Plans as a "Public Option" Model 

By Grace-Marie Turner

Some analysts have suggested that the experience of state governments in fielding a "public plan" for employees that competes with private health plans for the premium dollars of state employees is the proof that public plans can compete fairly and effectively.

But the experience of the states provides a good example of a "public plan" only if one is willing to stretch the meaning of a public plan well beyond all recognition, writes Robert E. Moffit, writing for The Heritage Foundation.

State employee health plans are really private health plans under contract with state government, and the simple fact that they are self-insured (like many private plans) does not make them public entities.

• posted by Grace-Marie Turner
• 7:54 am
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Monday, June 8, 2009

The French and Swiss Models 

By Grace-Marie Turner

Categories: Single-Payer Follies

Although many U.S. reformers praise the health systems of France, Switzerland, and other European nations, these systems are fraught with problems. They are burdened by cost overruns, and yet they still deny patients the latest care and the choices we take for granted.

In France, for example, the government now dictates which doctors and specialists a patient can see. And strict reimbursement schedules can penalize doctors for performing costly procedures, even when those procedures are clinically determined to be best for the patient. Consequently, many doctors are refusing to treat patients with certain illnesses.

Government efforts have done little to control costs. In 1996, the French government established health spending targets. That was the only year it met them. In every year since, the French health system has run a deficit.

Things aren't much better in neighboring Switzerland.

In response to soaring medical costs, Swiss officials started forcing hospitals and specialty units to close. Between 1998 and 2000, the number of hospital beds dropped by six percent nationally. Not surprisingly, patients have experienced diminished access to care and are routinely shuffled from one facility to another.

Alphonse Crespo, a Swiss surgeon and think tank researcher, traces his nation's shift from a focus on choice and quality care to emphasizing cost reduction to 1994, when his country adopted a compulsory insurance system.

The Swiss have since put severe restrictions on private health options. In 2002, the Swiss government placed a limit on private medical offices. Doctors are now prohibited from setting up new practices unless another doctor's office in the area closes. Although unpopular, this rule may be extended through 2011.

• posted by Grace-Marie Turner
• 8:11 am
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