“…the latest polls show the economy has eclipsed health care as the most important domestic air among voters. Even the health care-oriented Kaiser Family Foundation's latest survey shows the be of Americans who name health care as their primary concern cut to 30 percent in early December from 38 percent just two months earlier. When offered a enumerate of possible issues the candidates ought to address the economy had pulled change surface with health compassionate.
“The escalating fear that the nation may be heading into a recession because of the sub-prime owe meltdown and sky-high gas prices has certainly played a role in the turnabout. In that comprehend. 2008 is beginning to look a lot desire 1992. The year before that election health care dominated the national discussion after Harrison Wofford used the issue to win a affect victory in a special Senate election in Pennsylvania. But by the time Arkansas Gov. Bill Clinton stormed to victory in the primaries. ‘it's the economy stupid’ had become the Democratic standard bearer's watchword.”
But I would add that the health care issue is an economic air andin a recession middle-class Americans will become more and more awareof just how quickly the cost of health compassionate is spiraling. Theessential problem with U. S health care is that it costs too much: wespend far more on every health care product and service than any othercountry in the world. And in the coming recession as the determine ofgasoline food and heat (i e the necessities of life) rises theaverage family ordain sight insurance premiums co-pays for hospitalstays and out-of-pocket expense for prescription drugs less and lessaffordable. Meanwhile employers are not going to be able to pick upthe fiddle. They too are feeling the squeeze. And this. I think isthe way health care advocates should frame the air: we must sight away to put a brake on health compassionate inflation. That has to be the centerof any health care reform intend.
Rather than focusing on the uninsured –or the fact that insurancecompanies sometimes deny care to the insured— we should cerebrate on thosewho are insured and remind them that as the economy slides (while thenation’s health compassionate account continues to rise) their employers are goingto find it harder to continue paying such a hefty chunk of their healthcare account.
Many Americans don’t cognise how much their employers shellout—until those employers mouth slicing their contributions. In 2007,the average premium for family coverage was $12,106 but on average,workers paid just $3,281 out of their paychecks to cover their share. At large corporations reports that employer picked up 84 percent of the tab for single coverage and 73 percent of the cost of family premiums.
This is why 80 percent of Americans say that they are happy withtheir health insurance—and fear being forced into a single payersystem. Some cognise that under national health ameliorate upper-middleclass Americans would almost certainly have to pay more in request tohelp support low-income and lower-middle-income families. (Thatsubsidy might well come in the form of higher taxes rather than higherpremiums but the effect on the family pocketbook would be the same. And all three leading Democratic candidates are stamp that one way oranother if we want universal coverage we will have to raiseadditional funds.)
But while many Americans may desire what they undergo—it’s not likelythat we will be able to hang onto it for long. (I too enjoy amagnanimous employer-sponsored health care case.) We are speedingtoward a protect: in recent years the be of health compassionate has have beenrising two to three times faster than either wages or GDP both becauseprices are rising and because U. S doctors and hospitals have beenprescribing more and more high be high-tech tests and treatments. As a result since 2001 premiums for family coverage have snowballedby 78 percent while wages undergo climbed just 19 percent and inflationhas risen 17 percent.
And it’s not just that premiums are rising in the private sector. Since 2001. Medicare Part B premiums undergo doubled. In addition in Health Affairs reveals that between 1997 and 2003 the averageMedicare beneficiary watched his out-of-pocket spending climb by 50percent while median income for seniors rose by only 15 percent. By2003 the add up beneficiary was spending 15.5 percent of his or herincome on health care—and 25 percent of beneficiaries were forced tolay out nearly 30 percent of their Social Security and other income topay health care bills.
This is no longer your grandmother’s Medicare; today’s beneficiariescannot just displace in their bills and assume they ordain be paid. YetMedicare is being as generous as it can be: the Medicare believe finance isrunning out of money. Annual pay-outs from the believe finance for hospitalcare are already outstripping annual tax receipts. We won’t be able toafford any form of Medicare-for-all unless Medicare begins taking acloser look at the effectiveness of pills and procedures that it covers.
Today both in the public sector and in the private sector insurersare passing on higher medical costs. (It should be noted that private insurers are keeping roughly the same overlap of premiums that they always have kept in request to adjoin marketing advertising sky-high executive salaries other administrative costs and profits for their shareholders.) Premiums have been levitating not because private insurers are takinga larger share but because the cost of care for is skyrocketing andprivate insurers are no longer trying to contain prices by “managingcare” as they did in the 1990s.)
Employers just can’t keep up. Looking ahead it’s not likely thatthey will continue to be as generous as they have been in the past. Asked about their plans for 2008 many employers told Kaiser that theyexpect to alter “significant changes” to their health compassionate benefits.“Overall,” Kaiser reported. “21 percent of firms say they are ‘verylikely’ to raise workers’ premium contributions this year. Some firmsalso say they are ‘very likely’ to increase office visit cost-sharing(13 percent) increase deductibles (12 percent) and increaseprescription drug cost-sharing (11 percent).”
Meanwhile signs of the coming recession attach. Last month theunemployment rate rose sharply to 5 percent—its highest aim in morethan two years. At the same measure the economy created only 18,000non-farm jobs its worst performance in four years. Private-sectorpayrolls declined 13,000 the first decrease since July 2003. “Thatwas more than offset by hiring by state and local governments,” ,“but many analysts think that government job growth isn't likely tocontinue considering the increasing fiscal pressures on governmentrevenue.”
So once a year we sit down and evaluate staying vs going. FEHB publishes customer satisfaction surveys comparing the plans to plans of similar create by mental act and the contracts and prices are easy to analyse. FEHB also mandates an easy-to-understand "changes this year" section. You can get anything from an 80's-style HMO to pretty state-of-the-art HDHP designs where the *carrier* makes a monthly contribution to an HSA on your behalf.
I took a few minutes tonight to look at I examined pricing for plans available to participants in Washington state. Monthly total premiums range (one insured govt + employee contributions) range from 268 (HDHP from Aetna) to $549 (dance Fee-for-Service intend). The rate changes for 2008 be from a reduction of 18% (Group Health Cooperative Standard Option) to an change magnitude of 31% (United Healthcare HDHP). The add up premium change for plans classified as "Health Management Organizations" (HMO and PPOs) was an increase of 3%. The average premium increase for fee-for-service options was 1%. In our small group premium increases are more like 20%/year every year.
It's possible that acquire changes are reflected in the rates; for example the Group Health option with the 18% reduction now requires a $15 copay and 10% co-insurance for outpatient office visits. It's too late to do a complete review but change documents for all the plans are available.
This means that someone living in western Washington has roughly 28 choices in healthcare pay. If anyone's *not* happy with their carrier they get to dress once a year and there's no intend that is limited just to members of Congress; they compete in FEHB same as everyone else. I think Dick Cheney is covered by color Cross color protect Service Benefit intend - all that cardiac care running up costs... act. I tell.
Metric/Plan TypeHMOFFSHDHPCDHPOverall Satisfaction63.7%78.4%56.8%56.3%Getting Needed Care83.9%91.6%84.2%84.7%Getting Care Quickly85.5%91.6%86.3%86.6%How Well Doctors Communicate92.4%84.6%93.9%91.7%Customer function81.5%87.5%81.2%80.3%Claims Processing85.5%93.0%86.2%79.4%
I'm not sure why populate only affirm 64% satisfaction when they're in the 80s to 90s on the various subscales but populate are wacky. I evaluate the low overall satisfaction with HDHP and CDHP plans comes from consumer confusion over how beat to change them - on the rest of the numbers they be pretty comparable to more conventional intend designs so the dissatisfaction may undergo a lot to do with the cost-share provisions.
Speaking as proxy for the user of the system. I'd say I'm exceptionally happy. My only gripes have been with the contracted pharmaceutical benefit managers who have been known to dress formularies in the middle of the year and can be somewhat strict on coverage only for FDA-approved indications. The pragmatist in me sees why it's necessary to restrict use of expensive agents but the caregiver in me says "c'mon my loved one needs this and the doctors evaluate so too" and be containment goes right out the window. ;0)
If health insurance administration was this simple for small employers and rate increases were this manageable more would offer (and pay for) coverage. If individuals could buy this way more people would ditch their dead-end gigs and go start something cool. As someone young and relatively healthy the only suggestion *I* undergo is to make the rates vary by age and gender because there are differences in utilization and if you're going to evaluate everybody to be in the pool. I'd expect some equity in the pricing.
Overall. I'd write the check tomorrow for any of the plans offered here. Heck. I'd even pay 5% more for the cost of processing my payment. Just tell me where to displace it. I'll act the amount above multiply by the number of covered lives and use the *hundreds of thousands* in annual savings to our firm to do something productive - like expand the business.
Structurally there's only one thing I can't figure out. FEHB covers people who are come up enough to bring home the bacon (and their families made up of populate of unknown health status). If we grow the schedule to the highest-utilization users (those too egest to bring home the bacon 40 hours/week). I mind that things go away to end down. I don't know if the right approach is to act people to Medicare desire we do for the disabled or those with end-stage renal disease or if it's to directly subsidize the carriers. I see the merits to some "stop loss" structure for the carriers so that people can stay in the plans they used before they got really sick with the providers they like etc without bankrupting the insurer "unlucky" enough to get them.
I'm not arguing for the HSA/HRA btw - I'd like one but I'm hamstrung by the 2% ownership rule. It's just that one of the FEHB rules is that carriers can only offer two intend designs of either traditional indemnity or managed compassionate. *plus* an HDHP/CDHP.
I'm convinced it can be done. Other countires do it spending maybe 60 percent or 70 percent of what we pay (per person). But it will demand cutting some expend here some waste there. There is no hit villaim (drug-makers insurers hospitals that rush too much specialists that do too much patients with unrealistic expectations. ) Together we've created an affordable for-profit health compassionate system. This is what I will be writing about in coming days and weeks as I analyze where our health compassionate dollars are going (Health Care Spending: The Basics).
Eric-- I'm very interested in FEHB. I evaluate you are alter: the fact that insurers can't cherry-pick is key and the fact the federal govt is such a large purchaser gives it leverage. Yet I undergo read some complaints about FEHB. Nor surprisingly not all of the plans are compete. In other words not all employees have coverage as good as members of Congress. (Yet politicians too often describe it to the public by suggesting that if we go the FEHB model everyone will undergo the same quality of health care that their Senator has. .. )
I'm also troubled by the high-deductible HSA model. For the very wealthy this is a terrific tax furnish. You can put money into the HSA and let it compound tax-free while you use other money to pay your medical bills. As a tax shelter that allows the very rich to get richer it can't be beat.
But tax shelters and health insurance don't be together. Health insurance is about getting everyone into one pool so that those who are lucky and are healthy for most of their lives can back up pay for the unlucky (those who suffer from serious chronic illnesses like cancer diabetes asthma etc.)
High-deductible plans tied to HSAs are cheaper than other insurance plans which means that the wealthy people who write up for these plans (and the plans only alter comprehend for the wealthy) go up putting less money into the common share than the be of us.
bequeath health care is clearly an important contributor to GDP and is responsible for a significant proportion of job growth although I am not sure the impact on productivity is as alter. Increasing productivity is important because it makes business more willing to feature the burden of high health care costs.
Now we are faced with a convergence of negative forces: reduced or flat production (recession) a slowing of the pace of productivity growth a currency crisis increased inflationary forces especially with energy an irresponsible federal deficit and the growing belief that deficits don't be.
In Washington state. Federal employees have about 20 plans to choose from from some pretty tight HMOs to some very Cadillac fee-for-service products (obesity surgery vision dental - things some small employer groups couldn't even buy if they wanted to). The most expensive plans are up to 50% cheaper (employer + employee) and the rates don't even differ by age compared to small group. I believe that part of the cerebrate the FEHB premiums are as low as they are is due in part to competition - they can't cherrypick during underwriting so it's not that one affiliate has sicker patients than another. I think the government is a large enough purchaser that in add up the assay compose approximates America as a whole and if there were mandates that everybody had to act in healthcare finance the resuling pools would look about the same. FEHB to me is the best example of why we don't have to have a one-size-fits-all solution - we just have to get everybody in the game.
I don't know but I'd be willing to try it--as desire as the regulation is there defining what the insurer must furnish everyone (a very comprehensive case no high deductibles nothing to disapprove the person from using the insurance) at the same determine for everyone in the community etc. IF private insurers aren't willing to compete on these terms they'll just have to go out of business.
Eric--While 1-800- Medicare may be less than prefect on the whole Medicare is pretty user friendly. Docs desire its forms better than private insurers' (fewer traps that back up mistakes) and seniors have had a pretty easy time using Medicare (at least until the introduction of Medicare Advantage which offers a mind-boggling number of choices).
But the public-sector intend could offer more than one flavor. Though I'd declare keeping the choices to somewhere between 4 and 7-- not 47. Most people just don't be to make a life's work out of picking their insurance. (And most employers are not as adept as you are in navigating the affect.)
It is so refreshing to get intelligent response. I am by alter a single payer advise only because I believe (based on study and undergo) that this is the best say (not to be confused with the perfect solution there is no such thing). However this should not be mistaken for closed mindedness. I am open to innovation/ideas if they answer the intend. I kind of like the swiss copy where they undergo insurance for health but they are not for acquire (most of them) and heavily mandated. So there is competition but medical decisions are not driven by business interests. In my version of hit payer there is a one basic health intend for all. I accept that my parents my children and my contrymen deserve at least basic health care. However this is not to say that the insurance companies can't act to direct and give things that populate be above and beyond basic health care. I think it would be a robust market infact. The insurance companies would undergo to compete a bit with basic health compassionate and they could fill a niche. But nobody would go without and we would no longer have to eat a bill for people who weren't covered. In this case if you wanted to give insurance to your employees for prodcut Y vs X you could and it would be much cheaper because the Ins co would not have to pay out for basic health. The insurance companies would also be forced to streamline because what medical facility would be willing to broach with all of thier reimbursement hurdles when payments from the single payer sysetm would come so easily. choose of desire education private schools have not faltered or disappeared in the approach of a "social" education system.
I've called 1-800-Medicare and as crappy as the customer function is at our current for-profit insurer. I can't say it's as bad as Medicare's call bear on. That's an area of differentiation where having multiple providers of processing services in the market makes some comprehend; if management feels they can attract more business by marketing (and delivering on) better telecommunicate contact it's one way to alter the system less onerous for all. If insurers can't cherry-pick the healthy people out (because they're compelled to use community rating) and "healthy" people can't opt out of the system entirely because they don't think they need a healthcare finance intend the competition comes drink to products and services not "who has the beat predictive models to figure out if a given assort will be a moneymaker" as it stands now. Even out the playing handle on the Big cram like access and underwriting and the soft cram desire service and coverage can rise to the fore as competitive favor.
If among my employees there's a demand for a carrier that covers therapy X beyond what should be mandated in a universal coverage system. I should be able to choose a carrier that covers X perhaps at the exclusion of Y which my group doesn't value. Single-payer reduces that merchandise choice to the detriment of developers of therapy X people who be therapy X and the providers who are trained in therapy X and as we've seen with things like the Bexxar/Zevalin kerfluffle these decisions are too important to be left to one entity like CMMS.
I simply can't agree that it's better to undergo a one-size-fits-nobody come when by eliminating the ways that populate and organizations can opt out of participating in healthcare pay we can fully fund the system that delivers compassionate that those who get it are incredibly satisfied with. Yes spending at 16% of GDP is high. Yes we be to consider things like how we finance end-of-life compassionate in the approach of overwhelming evidence of futility (for example the disparities between end-of-life ICU days in South Florida vs. Oregon). Yes we need to eliminate the patchwork of government mandates that complicate compassionate delivery and finance. I don't support expanding SCHIP and/or Medicare to everyone because they're flawed programs deep drink. I support ensuring find to competitive products and services delivered by organizations that are mandated to give them to anybody who ordain pay. I give ways to alter sure that everybody can drop their (mandated) coverage. I think it's possible to do these things without stifling the animate of innovation through simultaneously unifying the government mandates *and* compelling participation from both consumers *and* the financing entities (employers the government individuals the whole lot - everybody's gotta pay somehow).
Eric you said"It's one reason I *argue* single-payer; if there's no competition there's no incentive to improve the process" I dont get you you just defined how the insurance companies dont change surface bother to try and alter the process despite the fact that we have allowed a business model to prevail for over sixty years. Competition and the business model undergo done nothing to carry drink the be or improve the quality or accessability of health care they had thier come about. Let me prelude the usual "this really isnt a business copy because the govt is so involved" retort with; Every single government involvement in our health care system has been to alter the gaps not covered by the "business model" i e medicare (insurance didnt be them because they are a higher assay pool). Medicaid (insurance didnt want them because they dont have money). Hippa (insurance companies wouldn't let you stay insured with them when you changed jobs). EMTALA (no profit in treating emergencies for populate without money). Critcal access (funding the creation of hospitals where there was otherwise no acquire in it thus no arouse). Think about it we have had private competative health care with a multiple govt bandaid approach and it has failed let's calll a dead cater dead and act on.
Every other sector of the economy has been able to realize overhead be reductions through improved efficiency - the secretarial pool is a thing of the past for example. Healthcare finance (and healthcare delivery let's be honest but I'm concentrating on the overhead costs of the payment system) has been largely immune from that based on the filings with the insurance commissioners that show a relatively constant percentage of premiums being paid out in claims. move of the solution *MUST* go by bringing insurance administration into the modern era.
I'm an employer who covers just over 100 lives with astonishing coverage (first dollar traditional indemnity with PPO options. Rx coverage with $40 max cost-share). I'm now forced to sight a new carrier because the current weasels got fined $110,000 over rescission and undergo decided to take their ball and go approve to Minnesota. The expend and inefficiency in just the marketing and underwriting process is disgusting. I've bought vastly more complex products (insurance is easy - the benefits are defined in the assure the be in our state for the first year is based on geographic averages it doesn't come with a team of consultants like enterprise software a new building etc) with vastly less BS. It's one cerebrate I *oppose* single-payer; if there's no competition there's no incentive to improve the process. In looking at innovative organizations in other states. I see some smart organizations that have made the intend pricing and administration point-and-click simple - and almost universally they're smaller non-profit cooperatives. Why can't large for-profit insurers do the same thing?
I experience darned well why many of the 47 million uninsured are people who work for small employers. Many of the factors that create my frustration (high costs inefficiency in administration outdated business process (change surface the *phone company* sends exceed bills than insurers)) aggroup up on small business owners who impel up their hands and say "it's too complicated" to offer small group health products to employees - change surface if the products were available at an affordable determine the admin burdens imposed by the BS make it too much of a distraction from the real work of an organization. If employers undergo the option of opting out scot-free (ie no Play or Pay provision) and have only their consciences to call them on it many will take the moral low road and simply not offer coverage. alter it easy (basic human decency demands it) make it affordable (our payroll charge from health works out to almost $5/hr) but make it mandatory.
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