Here's one for a Harvard Business School case study: A few months before voters in the state are going to decide the future of your industry get into a losing battle about retroactively canceling sick peoples' health insurance policies.A unanimous California Appeals Court decision has decided that California health insurers have a responsibility to check the accuracy of applications for health
The First Year For This Blog
This month marks the first anniversary for this blog.As of today, folks have visited 95,558 times. From less than a thousand visitors that first month, 14,000 a month now visit and that number continues to grow briskly.As long as you keep reading it, I'll keep writing it.
A November Ballot Initiative Over California Health Reform Would Be The Biggest Thing Ever To Happen In The Debate
With news that California Governor Arnold Schwarzenegger (R) and the Democratic controlled General Assembly have agreed on a health reform proposal we may be on the cusp of a huge referendum on the Democratic version of health care reform.The next step is for the State Senate to approve the plan. The Assembly approved it earlier this month on a party-line vote with Republicans in opposition. The
Why Couldn't CIGNA Make the Right Decision In the First Place?
The Christmas weekend was full of news stories about a 17 year-old girl who was denied a liver transplant by CIGNA.The insurer ultimately reversed its decision but the girl died a short time later.I have no idea if the outcome would have been different had CIGNA made the decision to approve the transplant in the first place.Health insurance contracts--and government plans like Medicare and
"Health Care Quote of the Year"
Brian Klepper joins us again today with his nomination for the "Health Care Quote of the Year."Health Care Quote of the Yearby Brian KlepperI was reading through some other peoples’ blog posts yesterday and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston. Paul made news by establishing a blog called "Running a Hospital."I think
Washington Post: McCain "Has Some Good Ideas on Health Care"
The Washington Post is not known for favoring Republican prescriptions for health care reform. That is why their editorial today calling the McCain health care reform proposal, "the most detailed and thoughtful of the Republican proposals," caught my eye.McCain has gone further in some respects than his Republican opponents on health care. Instead of providing people with a tax deduction, McCain
The State of Primary Care--How Much Responsibility Do Specialty Physicians Bear?
Our good friend Brian Klepper, posting over at "The Health Care Blog," has some provocative things to say about the state of primary care and the role the specialties, and even the American Medical Association, have had in getting us to where we are.Among Brian's points:"American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes
The Shadegg Bill––A “Health-Insurance Solution” That Is a Waste of Time
Merrill Mathews, writing on yesterday’s Wall Street Journal op-ed page, asks why Representative John Shadegg’s (R-AZ) “Health Care Choice Act” isn’t a “no-brainer” for the Congress to pass.Shadegg’s proposal would enable consumers to buy a health insurance policy in any state thereby bypassing the states with the most costly benefit mandates. At the top of his costly mandate list are state “
Health Wonk Review Is Up!
David Harlow over at the "HealthBlawg" has a particularly entertaining holiday edition of Health Wonk Review up. It covers some of the best posts in recent weeks from the world of health blogs.
Republican Candidates Wouldn't Have Been Able To Get Coverage Under Their Own Health Reform Plans
Republican presidential candidates have called for a greater reliance upon the individual health insurance market. But many of these same candidates have had cancer and wouldn't have been able to get individual coverage under their own health reform plans at the time of their treatment.Ricardo Alonso-Zaldivar had a great story in the Los Angeles Times recently.Ricardo points out that Rudy
Mike Huckabee's Health Care Plan
Mike Huckabee is now among the front runners for the Republican nomination. So, what is his health care plan?First, he doesn't have a plan so much as a set of principles that would have to be detailed. On the surface he seems to want a lot of it both ways--no more government but lots of new program ideas. For example, he calls for tax credits to help low-income people purchase health insurance
More People Think Health Care Is An Urgent Issue Than Think The Iraq War Is
A recent Wall Street Journal poll caught my eye.The poll found that 52% said the economy and health care are most important to them in choosing a new president compared to 34% that said terrorism and social and moral issues were most important.That is the opposite of what people thought at the time of the 2004 election.Here's the surprise for me. The poll also showed, "health care eclipsing the
Pete Stark Regrets the Stark "Self-Referral" Laws!
David Whelan was kind to point out a great story he just did at Forbes.com on the Stark anti-kickback laws and the bans on provider "self-referral."David writes, "Yet in an interview today the Congressman lamented that he ever made this legislative intrusion into medical practices."Congressman Pete Stark (D-CA) went on to say the laws, "gave every shyster and promoter a loophole" and that he
If Grady Fails--The Crisis At Atlanta's Grady Health System Is A Symptom Of Bigger Problems In The U.S. Health Care System
Brian Klepper joins us again today this time with a post on Atlanta's Grady Health System. Grady is an inner city safety-net hospital now going to extraordinary lengths to remain open. Brian makes the point that the Grady situation is by no means unique but instead represents a national issue as safety net hospitals struggle to maintain health care for the uninsured while being underpaid by their
"Health Wonk Review" Is Up
The latest edition of "Health Wonk Review" is up over at "Health Care Renewal."I must say it is a very well done and interesting review of some of the best in recent health care posts--this time crafted by Dr. Roy Poses.
The Last One is Gone--CIGNA Buys Great West Life Health Insurance Business
The recent announcement that CIGNA has purchased the U.S. health insurance business of Great West Life for $1.5 billion in cash struck me as more than the minor headline it was back on page C5 of the Wall Street Journal.The last one is now history.Metropolitan, Prudential, John Hancock, Mass Mutual, Hartford, Pacific Life, Phoenix Mutual, and so many more, are all out of the medical business.I
One Heck Of A Budget Mess and Lots of Ugly Consequences--But Watch The Pork
With the Congress set to come back to attempt to break the budget impasse in the few weeks before the holidays, many in this town are ready to see the Congressional Democrats and President Bush agree to disagree and let the budget problems slide for a year under a series of lengthy continuing resolutions (CRs).The problem with CRs is that they only allow the agencies and programs to continue at
"Cavalcade of Risk" Is Up
The latest edition of the "Cavalcade of Risk" is up over at "Colorado Health Insurance Insider." This edition includes some of the best posts from the last couple of weeks in insurance, finance, and investing.
California Policy Cancellation Scandal Heats Up As Republican Candidates Propose Health Reform Based On An Individual Health Insurance System
All of the leading Republican candidates for president favor health reform based on the individual health insurance model instead of the more common employer-based system.Apparently, a number of health insurance companies would like to derail those Republican health reform plans by scaring the heck out of consumers and voters picking the year before the election to hold a policy cancellation
SCHIP, Medicare Physician Fee Cuts, and Medicare Advantage--We're Getting Down to Crunch Time
Since September of 2006, I have been pointing to this year-end as the time that would require some big budget decisions impacting SCHIP, the scheduled 10% Medicare physician fee cut, and corresponding Medicare Advantage cuts to health plans to pay for the doc fix.Guess what? New Year's is just over six weeks away.For now, each of these issues is bogged down in the overall budget stalemate between
VEBA's--The New Growth Opportunity
With word that Ford workers have followed those at GM and Chrysler in ratifying their new labor contracts we may be at the cusp of the next big growth opportunity in the health plan business.GM alone will transfer as much as $50 billion in long-term retiree health care liabilities to the Voluntary Employees Beneficiary's Association (VEBA) and Chrysler and Ford will also set up the structure over
Health Wonk Review Is Up
Maggie Mahar does a particularly good job this time of accumulating some very good posts from the best of the health care blog world.This is also an opportunity for you to check out her new and excellent health care blog, "Health Beat" which is "a project of the Century Foundation."
Part D Medicare Drug Plans See Major Price Increases--Why?
The Part D Medicare drug program's weighted average monthly premiums will increase 17% in 2008 and 23% since the program's January 2006 inception. The 2008 increase is well above basic pharmacy cost trend meaning the insurers are doing some rate catch-up. The average is weighted by actual enrollment.Premiums for the top two Part D Plans (PDPs) by enrollment are up dramatically. According to a
Giuliani Puts His Foot In It With the Claim He Would Have Only Gotten Quality Treatment For His Cancer in the U.S.
There is this myth that all of the extra money we spend on health care at least gets us the best care in the world. Study after study debunked that long ago and the fact that someone running for president doesn't understand that claim is a myth is inexcusable.But Rudy Giuliani actually has a radio ad in New Hampshire that repeats the myth.All Giuliani's remark did was give opponents of a market
Report: "Health Insurer Tied Bonuses to Dropping Sick Policyholders"
It's hard to imagine a worse headline for the health insurance industry just as we are heading into what will be a fundamental debate over who should run our health care system.It is even harder to imagine a dumber thing for the insurance industry to do than continue to argue and litigate the notion that an insurer can cancel--or rescind--an insurance policy for a misstatement of fact on an
Sometimes It's the Little Things--The NCQA Announces an Agreement Between Providers and Payers to Better Pay for the Quality of Care
Particularly in this election season we tend to focus on the big health care reform plans. It is natural to want to see a big fix to a big problem. But everyday things are going on in the market that can make a difference. Make no mistake, these good works will not replace the need for systemic health care reform but it would be wrong to think just big policy changes are the only answer.A case in
What Will It Take to Get a SCHIP Bill This Year? The Budget Outlook Deteriorates Even More
Democratic and Republican negotiators are hard at work to get an agreement on the State Children's Health Insurance Program (SCHIP) extension.The current SCHIP bill failed to get a veto-proof majority in the House.President Bush has said there is no way he will sign a SCHIP bill with a tax increase in it--the current bill would increase the per pack cigarette tax by 61 cents.The only way the
The Best Places To Get the Inside On the Workers' Compensation Market
Workers' Comp has always been a unique niche in the health care business.If WC is on your mind, I was reminded again today how important it is for you to be a regular visitor on Joe Paduda's "Managed Care Matters." While Joe is also a great source on all things health care, his perspective on WC is a must for those in that business. It's the real insider view that I always enjoy. His recent post
Romney Says There Are Already "Pots of Money" in the States to Pay For Health Care Reform---Where?
Mitt Romney says states could implement comprehensive health care reform without having to raise taxes.However, states trying to replicate the Massachusetts health plan would likely have to raise taxes in order to pay for it. That is the conclusion of a November 3rd Boston Globe article. Here are some points:Massachusetts had something other states don't have--a $610 million uncompensated care
Medicare Buy-In For Retirees--Private Options Make It an Even Better Idea
"We should act now to let companies and unions buy their early retirees into Medicare." That's the point of a Washington Post op-ed today by Democratic Congressman Rahm Emanuel and the president of the Democratic Leadership Council, Bruce Reed.These two former Clinton aides are arguing that:"The troubles at GM and Chrysler--and Ford, which reached a tentative labor agreement this weekend --
"Medicare Advantage: Wrong Way to Spend $54 Billion"--The AMA Goes After the Medicare HMO's Money
The American Medical Association (AMA) in an editorial in its journal, American Medical News, has pulled no punches in its argument that Medicare HMO plans (Medicare Advantage) need to be cut in order to find the money to fix the upcoming Medicare physician fee cuts--10% in 2008 and another 5% in 2009.Without a doubt their attack on "excess payments" to insurers is self serving--as about all
Why Consumers’ Checkbook v CMS is a Sideshow--Bush Administration Refuses to Release Provider Data
Brian Klepper joins us again today with another one of his welcome posts. This time he points out the hypocrisy in CMS, which has been calling for market transparency, refusing to provide provider data to a consumer group.Why Consumers’ Checkbook v CMS is a Sideshowby Brian KlepperThere are people who call for market solutions as the answer to every societal problem, but who then work to restrict
A Good Idea and Bad Leadership--A Way Out of the Entitlement Crisis Meets Partisan Politics
I call your attention to a column this morning by the Washington Post's David Broder.He tells us that there will be an important Senate hearing tomorrow on the issue of Social Security and Medicare entitlement costs.It seems that two Senators, one a Republican and one a Democrat, are trying to create a bipartisan task force that would have the power to fast track a solution to this huge emerging
Bush Ups the Budget Pressure--Shows No Sign of Compromising on SCHIP
President Bush just made a statement on the SCHIP bill and the upcoming 2008 budget votes. Standing in front of the White House with the Republican leaders behind him, he blasted the Democratic Congress, the recent SCHIP bill passed by the House, and rumored efforts on the part of Democratic leaders to couple defense and Iraq spending bills with domestic budget bills.The bottom line is that the
House SCHIP Vote Fails to Attract Veto-Proof Majority
Yesterday evening, the House passed a slightly modified version of the SCHIP bill President Bush vetoed last week, this time by a vote of 267-142. That is still likely at least 7 votes short of the two-thirds needed to overturn the expected Bush veto.The bill now goes to the Senate.It is possible that both sides will try to work out a compromise--but not likely.Expect the Senate to pass it, Bush
Poll Shows Democratic Presidential Candidates Attracting Independents and Moderates With Their Health Reform Plans
I was struck by this conclusion in today's Los Angeles Times regarding their recent voter survey:"In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate."The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" -- the
Discussions Regarding Scheduled Physician Fee Cuts and Possible Reductions in Medicare Advantage Payments Getting Serious
As the year winds down, the Congress must deal with the scheduled January 2008 9.9% Medicare physicians fee cut. Both Democrats and Republicans want to fix it.To fix the physician fee cut, proposed cuts to Medicare Advantage have been on the table.Senate Finance Chair Max Baucus (D-MT) has been working on a package that would cost $25 to $30 billion and fix the physician fee problem not only for
New Study Shows Lower Costs in Consumer-Driven Plans--But the Findings Won't Settle the Debate Over Just How Effective C-D Plans Are
HealthPartners, a highly regarded not-for-profit Minnesota health plan, has issued an important report on its consumer-driven care book of business. It includes Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).Their findings include:After adjusting for "illness burden," HealthPartners found that heath care costs were 4.4% lower for members in a consumer-driven plan compared
Democrats Pushing to Vote on New SCHIP Bill This Week--Bush Starting to Give
Democratic attempts to modify the SCHIP bill just enough to pick off the seven more Republicans they need are intensifying.The House failed to override Bush's veto by 13 votes last week.Yesterday, Bush's lead person on the SCHIP issue, HHS Secretary Leavitt, said the administration is now willing to consider covering kids up to 300% of poverty--they had said they would not go above 200%. Leavitt
The Fight Over SCHIP Tells Us This Budget Season is Going To Be One Big Food Fight--Medicare Payments to HMOs and Physicians Are in the Middle of It
Now that the House has failed to overturn President Bush's veto of the SCHIP bill by just 13 votes, Democrats are looking to tweak the $35 billion expansion of SCHIP just enough to get the extra Republican votes they need to get their bill passed.The House Democratic leadership is now in discussions with Republican House members who voted with their President last week and who might be persuaded
A Detailed Analysis of Rudy Giuliani's Health Care Plan
A Detailed Analysis of Rudy Giuliani's Health Care PlanRudy Giuliani's health care reform plan generally follows the Republican health care reform template that places the emphasis on making the health care market more effective in controlling health care costs and thereby enabling more people to be covered.Giuliani would remodel the income tax system to help people buy coverage and encourage
Health Wonk Review is Up
Jason Shafrin is hosting this edition of "Health Wonk Review" over at the "Healthcare Economist."
SCHIP Veto Override Fails in the House--Now What?
As expected, the SCHIP veto override effort in the House failed by a vote of 273-156--thirteen short of the two-thirds necessary.Now what?First, SCHIP will not expire. A continuing resolution funds the program at current levels until mid-November and that can likely be extended indefinitely. However, at current levels hundreds of thousands of kids will eventually fall off the program.The
Why Bush is So Ready to Use the Veto Now When He Never Did When Republicans Were "Spending Like Drunken Sailors"
This from an article in today's Washington Post stood out for me:"President Bush declared yesterday that he remains 'relevant' despite his political troubles, and he derided Democrats for running a do-nothing Congress that has failed to address critical domestic, economic and security issues in the nine months since they took control of Capitol Hill."Back on August 2nd, I did a post, Why Is
Kaiser Family Foundation Creates a Great Tool to Compare Presidential Candidate's Health Care Plans
The Kaiser Family Foundation interactive comparison tool for the presidential candidates' health care plans can be found here.You can find my evaluation of each candidate's plan in the index on the right side of this blog.
The CED Health Reform Plan Gets It Right Until They Have to Make the Tough Decision
The Committee for Economic Development (CED) has released its report, "Quality, Affordable Care for All."A few days ago I asked a number of questions about just how far the CED would go toward creating a better health care system.While I think the group has made a number of very valuable suggestions, when it comes to cost containment they don't offer more than the long list of incremental and
Upcoming "Common Good" Forum: Health Courts, Administrative Compensation & Patient Safety: Research, Policy & Practice
For years we have debated reforming the medical malpractice system. But, most of that debate has focused on capping a system most people believe just doesn't work when it comes to improving the quality of our medical care. To me, that has always begged the question, Why cap a system that is fundamentally flawed?Common Good has been doing good work on that more fundamental question and will have
Committee for Economic Development (CED) to Release Its Health Plan This Week--The Questions to Ask Them
David Broder gave us a preview of the Committee for Economic Development's (CED) upcoming health care reform plan. With the likes of Alain Enthoven and "a high powered business group" involved, we all need to pay attention.Key points the report will make according to David's column:Business can no longer afford afford to pay for health care.Five years ago the group laid out a strategy for
Health 2.0 and the Promise of Market-Based Health Care Reform
"The ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technologyinfrastructure, evidence-based best practices, transparency and decision-support, and
SCHIP Veto Override Vote on Thursday--The Ragged Line Between Those Who Need Assistance and Those Who Don't
The House is scheduled to vote on overriding President Bush's veto of the State Children's Health Insurance Program (SCHIP) expansion.As I said last week, I believe the Democrats will come up about ten votes short in their attempt to override. I would be surprised, but not shocked, if they can find the two-thirds necessary to override the President.One of the arguments opponents of the SCHIP
When It Comes To Drug Prices the Europeans Are Better Health Care Capitalists Than We Are!
Sometimes I think the government-run European health care systems do a better job of using market tools to control their drug prices than we do in the U.S. market.For example, some government-run systems in Europe, France for example, are not afraid to take a drug off their official formulary if they don't get a competitive price.In January, the Democratic House passed a bill requiring Medicare
Cavalcade of Risk--Recent Posts From the World of Risk Management
Today, it's my turn to host the "Cavalcade of Risk." Every two weeks the Cavalcade offers insights into efforts to manage risk.Having spent substantial time at a main line property and casualty company, when I hear the term "risk management" my thoughts go to the things that corporate insurance managers do to limit their "loss costs."The popular notion of individual responsibility, and the
Aetna to Provide Managed Care Services to the British National Health Service--Say What?
Aetna has been approved by the British National Health Service (NHS) as one of the suppliers who can provide local Primary Care Trust (PCT) managers "a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services."Where's Michael Moore? He needs to do an addendum to "
Means Testing for Medicare--It's Unavoidable If Politically Problematic
Means testing is politically problematic but necessary and probably unavoidable if we are to shore-up Medicare.The Bush administration is pushing a proposal to begin means testing on the new Medicare Part D drug benefit. They would increase deductibles and premiums on single seniors with incomes over $82,000 a year and couples with incomes over $164,000 a year.We already have a means test on
An Important and Disciplined Review of the Health Care Marketplace--The Latest Site Visit Report From 12 Markets
Good health care market intelligence is hard to come by. Information tends to come in the form of detailed and narrow, often backward looking, surveys that give us little texture for what key players are thinking. Or, at the other extreme, market information is often based on a relatively few almost random anecdotal impressions by "experts" as they do their work in the market.The highly respected
Health Wonk Review is Up
Jane-Hiebert-White has the latest Health Wonk Review up over at the Health Affairs blog.This sample of some of the best recent posts in the health blog world not surprisingly has lots to say about the SCHIP debate and other timely health reform issues.I wonder what 1993 would have been like if we'd had the blog world?
SCHIP Supporters Are At Least Ten Votes Short to Override a Bush Veto
The Democrats are now going to take two weeks to try to change some minds before they attempt to override the Bush veto of the SCHIP bill--scheduling a vote for October 18th. If nothing else they will continue to hammer on the President and his Republican supporters over what is turning out to be a very unpopular stand by the President.The Senate approved the SCHIP compromise by a vote of 67-29.
Now That The UAW Is On The Hot Seat to Manage Its Retiree Health Costs Will Their View of Health Care Management Change?
Brian Klepper joins us again today this time with an astute analysis of the UAW/GM deal. Now that the UAW owns their GM retiree plan will they look at health care management differently?The Hot Seatby Brian KlepperI agree with Bob that the GM-UAW deal is a turning point for American health care. In a stroke – OK, it was a 456 page stroke – GM agreed to turn over as much as $35 billion, about 70
Reforming Our Health Care Financing System Won't Mean Anything if Americans Don't Start Taking Better Care of Themselves
Ken Thorpe, along with associates David Howard and Katya Galactionova, of Emory University has expanded on his earlier work on chronic disease in the U.S. and its impact on our health care costs in a web article for the journal Health Affairs. He compares chronic disease in the U.S. and Europe and looks at the difference as a means to help explain our higher health care costs.As all of the
The Country's Political Center is Shifting and With it the Health Care Reform Debate
I always thought it was shortsighted for the Republicans to avoid comprehensive health care reform in the six years they controlled the White House and the Congress (2001-2006). Instead they just added $8 trillion in unfunded liability (Part D) to a Medicare system they've been telling us from the beginning is unsustainable as it is.Eventually the political pendulum swings to the other side.
The GM-UAW Deal--If UAW Workers Can No Longer Count on Employer-Provided Health Care Then Neither Can Harry and Louise
I'm not the first one to suggest the GM-UAW deal to set up a VEBA is a watershed event. Most observers are focusing on the trend it will accelerate in the employee benefits market--and it will.I will suggest another dramatic impact that it will have--on voters.The polls already tell us that health care is by far the top domestic policy issue and second overall only to Iraq.This deal is also going
If the $35 Billion Expansion of SCHIP is About Moving to Government-Run Health Care Why Does the Insurance Industry Support It?
Both the House and Senate have now passed the $35 billion expansion of SCHIP. The House by 265-159 and the Senate by a vote of 67-29. The Senate bill got exactly the two-thirds it needs to override the expected Bush veto and the House fell 25 votes short of the 290 it will need.Opponents of the bipartisan compromise to renew and expand the State Children's Health Insurance Program primarily
Who's More Frustrated With Bush Over His SCHIP Veto Threat--Republicans or Democrats?
These days its hard to get Democrats and Republicans to agree on anything. But there is one bipartisan bill that has incredible support in both parties--the $35 billion expansion and renewal of the State Children's Health Insurance Program (SCHIP).By any measure SCHIP has been an incredibly good success--covering 6 million kids. There have been some legitimate questions about it growing beyond
Health Wonk Review is Up!
Joe Paduda is hosting Health Wonk Review over at "Managed Care Matters."Not surprisingly he's got lots of blog entries regarding Senator Clinton's new health plan and lots of other samples of some of the best blog posts from the past couple of weeks.Also making the big time this week was our good friend, Brian Klepper, who had the following letter published in the New York Times regarding Senator
Medicare Advantage Cuts Still on the Table to Offset the Medicare Physician Fee Fix
The House/Senate deal to renew the State Children's Health Insurance Program (SCHIP) does not include a fix to the January 2008 10% Medicare physician fee cut. It also doesn't include the $51 billion in cuts to the Medicare Advantage (MA) program the House had in their bill to pay for that fix and other Medicare improvements.As I have said many times before, that only means that the Medicare
Hillary Clinton's Health Plan
Here is an excerpt from the Clinton campaign's press release outlining her $110 billion a year health care reform plan:FOR IMMEDIATE RELEASESeptember 17, 2007The American Health Choices Plan:Ensuring Affordable, Quality Health Care for All AmericansHillary Clinton unveiled the third part of her plan today to ensure that all Americans have affordable, quality health insurance. Building on her
SCHIP Agreement "Near"
There are a number of published reports indicating that the House and Senate have reached an agreement to extend SCHIP along the lines of the earlier bi-partisan Senate agreement.That would mean a $35 billion SCHIP expansion paid for entirely be a new 61 cent tobacco tax.Bush says he would veto such a deal. While the Senate seems veto proof on this one, the House is another matter.If Bush is