Ezra has a great post on the logic of Walmart-directed outrage. Responding to this:
Just out of curiousity, why should taxpayers be outraged? This is after all, precisely what the Democratic party has been arguing for for decades. For a half-century, Democrats have been arguing that what America really needs is a universal health-care system, funded by taxes. Indeed, the only reason why Wal-Mart employees are eligible for Medicaid in the first place is because Democrats made a push to amend Medicaid so that the working poor could get Medicaid benefits, even though they are employed.
So, it's a little silly to be complaining that Wal-Mart employees are using Medicaid benefits when the goal of the Democratic Party is ensure that everyone gets taxpayer-funded benefits.
Yep. In fact, it's probably a helluva lot more efficient for the government to be picking up the tab. What taxpayers should be outraged by is that Wal-Mart isn't following their ethos to its logical conclusion and loudly advocating for a universal health care system. They should be angry at the hypocrisy, not the usage of federal/state health programs.
Bingo. What's bad here is that people can work full time and still be unable to afford health insurance. It's not that Wal-Mart isn't spending enough on health insurance; they don't spend enough on wages. Higher wages, more than anything, would make a huge difference. Piddling over whether Wal-Mart spends 7% or 9% on health insurance is pointless.
The Washington Senate just passed a hodge-podge medical malpractice reform bill unlikely to make a difference.
Breaking down the main provisions:
• Changes that would prevent apologies to patients from health care providers from being used in court, as well as a requirement that lawyers would have to file certificates of merit when filing suit against health care professionals
Y'know, it's really fun to play this game, but unmerited lawsuits pretty much never make it to court. It's exceedingly difficult to sue, and lawyers have no incentive to go after cases with a high risk of failure. This change is purely symbolic.
• the bill would place a $1 million cap on non-economic damage awards in malpractice cases that go to arbitration instead of trial
I'm trying to find the stat, but I imagine there aren't many arbitrations that involve over $1 million for non-economic damages, so it's unclear how much this would do.
• The malpractice bill also would enable the insurance commissioner to reject increases in doctors' insurance premiums and collect data on malpractice payouts for analysis
This just isn't the government's place. Why? Because the "data analysis" will end up in a vault (or hard-drive) somewhere and is unlikely to be used for anything.
• Members of the public would be added to the doctor disciplinary board
This one is the strangest of all -- what do they mean by "members of the public"? Is it John Q. Patient or someone with actual knowledge about medical practice and licensure?
There's no caps on damages or efforts to make it more difficult to sue, but this amalgam of ineffective measures is a sorry excuse for reform. Mandatory reporting of injury, initiatives to set up more arbitration, and stricter punishment for doctors (i.e. license revocation) would be much sounder ways to proceed.
Update: Reader Public Health Press points out the more pernicious aspects of the certificate of merit: "Requiring a certificate of merit is a real change, but the devil is in the details (I don't have the bill in front of me, but that won't stop me from posting my thoughts!). Illinois requires such certificates, and recently made changes to their process. Generally, certificates are filed by the plaintiff's attorney with an attached Affidavit of Merit by a licensed medical practitioner, who must review the record and state there is a meritorious claim. That, in and of itself, is an additional administrative hurdle and cost incurred by the attorney and the patient/victim up front, and the burden goes up depending on the qualifications required of the expert (for example, do they have to be in the same or a similar specialty, or can it be just any physician with some working knowledge of the area in question?). But here's the way they can make a big difference in the number of suits filed: if the affidavit of merit requires details about the reviewing physician be disclosed (e .g., physician's names, addresses, etc.), it can create a tremendous amount of peer pressure to prevent physicians from signing on to these cases, and therefore make it significantly more difficult to get over the hurdles needed to file the claim."
Via Matt Holt, a Chicago couple has started a non-profit tee-shirt biz for patients with serious or chronic illness to help them feel the lighter side. They feature shirts like: "Death: Been there, done that", "Chicks dig scars," and "Warning: High Voltage (defibrillator)".
My personal favorite is, "Think I look bad? You should have seen the other guy," because I like to mess with people when I go out on my crutches and tell them I was in a knife fight (punchline: I might have a brace, but the other guy has no leg).
It's a great project, so pass it on to friends/family who would enjoy.
From the Great Ideas in Technology Bin:
The New York Times on Thursday examined how WebMD Health, "one of the most-visited medical information sites on the Internet," hopes to "tap into the growing corporate trend of having employees pay more ... of their own health costs" by "helping people enrolled in employer health plans compile personal health information online." WebMD has signed multiyear licensing contracts with health insurers Aetna, Cigna and WellPoint and almost three dozen large U.S. employers -- such as Bank of America, Cisco Systems, Dell Computer, IBM, Pfizer and Shell Oil -- to operate private-access Web sites that allow employees to track their medical records, as well as find information about diseases and compare cost and quality ratings for physicians and hospitals.
I would love to participate in this program, if only because I'm so tired of filling out 5 million forms every time I go to the doctor. Continuing the cycle of inefficiency, the nurse asks me every single time what medications I'm taking (especially because I take more than one).
But I also get very curious about what they write down about me in my medical record. Don't you always want to grab your record when the doctor leaves the room for a second and thumb through it? Now you can.
The doomsday predictions have arrived:
U.S. health care spending will increase by an average of 7.2% annually until 2015, when spending will reach $4 trillion and account for 20% of the gross domestic product, according to a report released on Tuesday by the National Health Statistics Group at CMS
Health spending the previous four years increased at rates much higher than 7.2%, and most of the recent decrease was due to a lower utilization of prescriptions. With the Medicare drug benefit now implemented, much of those savings will be erased. It's also unclear exactly how much the benefit will cost, so those predictions are volatile. As every sector of health care spending almost doubles, premiums will sky rocket. Unless substantial reform is enacted, expect the number of uninsured to sky rocket as well.
Regardless, 2015 is now only nine years away. And nothing we have right now is going to slow spending enough in nine years time. Paul Ginsberg thinks there's another reason that spending will increase more than 7.5% a year:
Ginsburg also said that the report was "optimistic" because the authors are "only following current laws on the books, which means they assume there will be continued physician payment cuts in Medicare," adding, "But people don't expect that to happen".
Bush refused to push through with Medicare fee cuts this year. It really depends on the political climate of the next presidency on whether or not those fee cuts will proceed. They're substantial -- 26% over 6 years. In the place of reform, legislators might go ahead and push through, but it will be an uphill battle. Doctors will take on a massive PR campaign claiming they won't be able to see any new Medicare patients. With so many baby boomers on the verge of retirement, you can be sure that won't sit well.
The percentage of growth might be higher or lower than 7.5%, but doomsday is coming. Employer and employee alike will feel the financial pain as industry attempts to adjust to these costs. It's an unprecedented amount of growth, and we can't underestimate its effects on the economy.
Via Kaiser, Medicare has agreed to pay for three types of weight loss surgeries:
Three of the most commonly performed bariatric procedures -- Roux-en-Y gastric bypass, gastric banding and biliopancreatic diversion with a duodenal switch -- will be covered as long as beneficiaries obtain the services at centers that have been certified as well qualified by the American College of Surgeons or the American Society for Bariatric Surgery, the Post reports (Stein, Washington Post, 2/22). To qualify for the surgeries, beneficiaries must have a body mass index of more than 35 and one or more weight-related health problems, including diabetes, heart disease or sleep apnea, according to CMS. In addition, beneficiaries must have tried other treatments unsuccessfully, USA Today reports. CMS officials said they do not know how the new coverage will affect costs, though they believe the costs will be significantly less than what Medicare spends on coronary bypass or heart defibrillators.
Far from the UK's recent bias towards those with obesity, Medicare is going where many private insurers refuse to. It's good to see they've added some qualifiers like trying other treatments and suffering at least one obesity-related disease, although I wonder how strictly those guidelines will be adhered to. Unfortunately, when you get over 65, it's fairly difficult to lose weight through exercise and diet has to pick up much of the slack, so surgical options might be more appropriate for this age group.
I'm quite surprised that weight loss surgeries are only $20,000 -40,000, as my own minor leg surgery was $23,000. One frustrating insurance practice is their inability to recognize that denying treatment for current illness will end up costing them a lot more down the road. Maybe they think they can get away with it in our shifting employment market because there's a fairly good chance that a claimant will be on another plan down the road when they incur these costs. But with Medicare, you can be fairly sure an enrollee will stay a Medicare enrollee, so the trade-off of paying for surgery versus not paying and later being responsible for cardiac care is easier to predict.
I'm also curious to know how many people over 65 would qualify for this. It seems most people needing this kind of surgery are between 20 -- 40, and can recognize the long-term impact of such a drastic procedure.
One more thing -- how much higher is the death rate over age 65 for these procedures? That's worth looking into, because it's major surgery with a fairly high risk of death, and being over 65 surely increases that risk. It probably depends on the patient's BMI.
HSA's are a relatively new idea in the U.S., so it may come as a surprise that another industrialized nation has several years experience with the accounts. But they have enjoyed good market penetration in South Africa for long enough to examine some of the results, and yesterday the Wall Street Journal took a look. The majority of the population has publicly funded insurance, mostly due to ability to pay. About 15% have private insurance, most of which are HSA-style plans. Discovery Health, the key HSA provider, has had extensive success with HSA plans and seen its stock price double in a year.
As President Bush proposes changes to make HSA's easier to purchase, it's important to look at other nation's experience with them. And South Africa serves as a troublesome teacher.
The introduction HSAs had some unexpected effects which have wreaked havoc on the country's insurance system. For one, plans are keeping costs low by competing over the healthiest customers. David Adler of the New Republic explored the effect of HSAs in South Africa and wrote:
The South African story, then, is a move from a noncompetitive insurance environment to a competitive one, but the competition wasn't by hospitals to provide the best or cheapest care, but rather among insurers to get the healthiest patients. Consumer-driven plans are central to this process, because they are ideal for "risk-selecting" the young and fit, who have flocked to the new plans. Not in need of expensive medical care, the healthy could watch their account balances grow, leaving the truly sick behind in traditional plans.
Fortunately, South Africa is stepping in to keep insurance companies from this practice. As the Wall Street Journal noted,
Starting in about a year, companies whose insured populations are disproportionately filled with the young and healthy will have to pay a penalty.
The strategy has gotten so out of hand that South Africa, a nation that has in the past accepted very little insurance regulation, is intervening.
Unfortunately, it gets worse. Not only has have the plans stratified the sick versus the elderly, they haven't contained costs at all. In fact, costs have risen.
Between 1996 and 2001, the cost of specialty care increased 43 percent, and the cost of hospital care rose 65 percent. This represents a marked increase from the inflation rates for the five years prior. There have also been substantial increases in plans' administrative costs (which include profits).
So there you have it. The two things that U.S. policy makers fear (decimation of insurance and inability to restrain costs) have already played out in South Africa. HSA backers make a lot of promises, but there's little evidence that all of their lofty goals will play out in the actual U.S. insurance market. South Africa's experience alone is reason to be very skeptical.
I'm sorry I'm majorly slacking today. I couldn't sleep last night, so I got up a bit later than usual, then I had a conference call with an unnamed Governor, followed by completing an application for a job at Kaiser!
So it's been a busy afternoon. All good stuff except for the not being able to sleep thing. Regular posting will now resume.