The Convalescing Orphan

What worries me most about the article linked in that last post is the response of the AHIP.

A curt “no”?

Without some form of push back on private insurers, be it vigorous competition, regulation, or DEcreased tort reform (yes), and placing them back in the arena of antitrust regulation, they are going to continue to be the insurance version of soldier ants, eating anything that crosses it’s path, and endlessly hungry for more.

The great irony is, the public option isn’t going to be terribly cheap. What it will be is fair, and even-handed, and free of market corruptions. Most people don’t see the doctor very often, and don’t need that kind of access to specialists.

What a robust (but somewhat spendy) public option will do is likely SAVE insurers money. The very few really sick people would choose the public option. Some of them will work for employers who themselves like to have access to good care and have excellent private coverage. The rest will be folks who overall aren’t terribly expensive to insure. Given the rates they’ve been charging due to covering all these chronically ill folks, they could drop premiums AND see a vast increase in profits.

So why are they sulking?

They had visions of eating the whole pie (via mandated coverage) so now having to share isn’t such an appealing option.

That is something to think about further, isn’t it? Why would insurers want to insure sick people? Altruism?

More likely they had a game plan. They figured out a way to game the rules that they were hoping Congress would pass. In fact, given the millions they’ve spent lobbying Congress on this issue, they likely wrote much of what they were hoping Congress would pass.

So what if they had to cover everyone via mandated coverage? What if there were no threshold on how much they could charge, and no limit at which you could opt out?

That would mean some folks were paying 30, 40 or 50 thousand dollars a year. Or more.

By my estimation, we could charge every working human in this country an additional 10% in taxes, and provide Cadillac care to all of them. I don’t know about you, but the version the AHIP was dreaming of seems like a scam.

So what happens when people realize they’ve been roped in to mandatory insurance coverage, and they have no outside option, and the unexpected happens and they are roped into paying the vast majority of their income in insurance premiums?

Given the power the AHIP has been able to buy with their ill-gotten gains, what happens when they have that much more gold to rule with? If they have a guaranteed source of more income, how do we fend off their advances when we realize they are the corporate Medusa? What then?

“Tom Bodenheimer caught the managed care dilemna neatly: “cost, quality, access — pick any two”. It was a sign he saw hanging on a wall in a West coast Medicaid HMO.”

My intent was to document the current state of Oregon Health Plan, the parallel between it health systems in Canada and the UK. I suspect a cautionary note could be gained from OHP’s struggles as this debate rages on.

In trying to find some recent articles, I came across something else.

I’ve been on the road again, and visiting friends as I head home from our nation’s capital. I’m leaving in a few short hours, so this will have to suffice for now.

It’s a worthwhile read, and highlights better than I managed the dangers of making health care too cheap.

It also highlights the problem with OHP, a quick Google search is quite edifying, but the gist is this: Oregon attempted to cover fewer (services), and cover more (people). It worked beautifully for a while (unless you were the one who’s life was risked with rationing). Now it’s failing on both counts.

Canada and UK both beat us coming and going on most measures of health care, and yet the costs there are also unsustainable. What is the commonality between our “private” system, and their “public” systems?

Ineffective funding.

Consumer driven plans are a good start. When patients have a limit of real money, and have to pay for the day to day stuff out of pocket, they are more careful with their health care dollars, they demand better quality care, and in a more affordable manner. They become more engaged in their health care, ask more questions, do more research, and don’t blindly follow the doctor’s orders. They are more invested in staying well.

The way I see it, we have very few options: the government can try to rein in costs by limiting access or limiting reimbursement. Neither model works particularly well.

Private insurance companies can try to manage cost… That’s not working well either.

We can have patients take on more responsibility for day to day costs, so they are more selective with health care utilization.

Frankly, my preference is always to empower the patient. I simply don’t trust the impact of either of the two other options.

My concern is the elderly (the proposed cuts to an already struggling Medicare and already struggling seniors in the worst recession in my lifetime worries me), the chronically ill, the poor.

Personally, I think consumer driven health plans are really the only way you get to pick all three. But they leave the most vulnerable folks even more vulnerable.

My suspicion is through tax incentives or other means, you could lessen the impact on those vulnerable groups, ensure them better access to care, and fair reimbursement to providers. That still leaves us with Fee for Service, but the suggestion of a federally-sponsored website where patients could track costs and quality might be quite useful, particularly if it incorporated a Health Grades type feature.

Whatever reform we get, we have to remember what it means to be a consumer. We have to remember the first thing we saved and strived for, the first thing important enough for us to delay gratification. Consumers need to be that vested in their health, and their health care, but not so invested in the overall cost that they delay care altogether.

I find the quandary Baucus is now in to be more than a little ironic.

He seemed so confident in his monumental success as he attempted to serve up a load of tripe to the American public all the while shilling for the insurance industry under the guise of working hard for John Q.

He must now be wondering if he’s been selling his… ahem, “wares” to Jack the Ripper.

I could take a swipe at the political prostitution he’s been engaging in, but why aim for the low hanging fruit?

Really, there are bigger issues to tackle, such as the ludicrous claims made by the AHIP in this fundamentally flawed study.

If prior trends are the best predictor of future trends, then what does this say about the future cost of premiums, with or without insurance reform? At least with insurance reform, we get more Americans covered, and hospitals and providers aren’t forced to resort to padding the bill of the insured to pay for the uninsured.

I will say once again, the more we learn about Baucus’s bill, the more it seems to argue for a comprehensive public option. This bill as it stands now scares the living $4!# out of me. All I can see is greater expenditures, and no means of reining in cost. Maintaining the status quo, and amping it up on speed by insuring more people under the same broken system without any checks or balances, no increased regulation or enforcement, is the definition of a recipe for disaster.

It’s a bit scary, the lengths the insurance industry will go to manipulate us. More frightening is that we seem to believe them. They played on our fears with Harry and Louise, and then proceeded to steal every last chicken from every last hen house. They seem to have realized hens require hen houses and are hoping to distract us long enough to steal those too. How do we go from a majority of  Americans being in favor of a public option to the heated melee the many Town Hall meetings became? It couldn’t possibly be the work of the AHIP, right? Nah. Crazy conspiracy theories…

At this point all I can do is foresee a future where the insurance industry coffers are overflowing with all this mandated coverage, that much wealthier, and able to funnel more of our premiums into fending off any legislation in the future that might require them to behave in an ethical manner.

It’s not a pleasant future to contemplate. All those fiscal conservatives, on either side of the aisle, when we’re spending most of our GDP on health care, how will we fund the military? Infrastructure? Reduce the debt? Balance the budget? Pay for education?

Wake up, America. We’re losing our edge. One only needs a cursory look at world history to know that’s a dangerous position. We can be the promise that lures people from around the globe to our shores, in search of a brighter future. We won’t get there by being the school-yard bully. Our only hope is to remember the qualities that have driven the greatest moments in our young history: compassion, innovation, negotiation. It’s time to stop special interests from derailing our country for the sake of flooding their coffers.

I saw this article, and couldn’t help but wonder, if the discussion were purely one based on realities, and not lobbying or political pandering, where insurance reform movement would stand right now.

It is interesting to me, the ebb and flow of political opinion from outsiders, insiders, and former insiders.

I really want to believe our elected officials have the best intentions, but this whole health care debate smacks of leadership by lobby, not leadership by principle.

I can’t say I’ve ever been a huge fan of Mr. Dole, but I admire his courage. That was a risky stance to take.

Thank you, Bob Dole. Speaking out for what you believe in always earns my respect.