Ah, and while the Glibertarians and 'Left of Penultimate Perfection' continued their chorus of ineffective moaning, the working Dems moved the ball a little further down the field -

http://www.politico.com/news/stories/0810/41179.html

Commissioners OK health rate plan

The National Association of Insurance Commissioners approved Tuesday morning a preliminary outline of what insurers will be able to count as medical costs, a document necessitated by the health reform bill’s requirement that insurers spend at least 85 percent of subscriber premiums on medical costs in the large group market and 80 percent for small group and individual plans.

Despite divided political views on the health reform law, all commissioners voted together to approve the document, [b]a move forward that drew the ire of insurers.[b]

“It’s extremely noteworthy that you heard … very diverse perspectives on the bill and the impact of the bill, but the vote was unanimous,” NAIC CEO Terri Vaughan told POLITICO after the vote. “That’s a very powerful statement on the hard work this organization did.”

The commissioners moved forward with a proposed “blank,” NAIC terminology for an insurers’ filing document, as well as 10 of 11 proposed amendments. They approved amendments that narrow inclusions of utilization review in the calculation and expand the definition of "wellness and health promotion activities" to include "public health marketing campaigns that are performed in conjunction with state or local health departments."

The one rejected amendment would have allowed insurers to count accreditation fees as a “quality improvement” cost, thus making it a part of medical spending.

While insurance commissioners moved forward unanimously, familiar fault lines emerged between consumer advocates and industry over the document and how it categorizes medical spending.

Ah, but who liked the outcome, you ask -

“In general, we are very pleased,” said NAIC consumer advocate Timothy Jost, a professor of health policy at Washington & Lee University. “The process has been very open and participatory. We feel like our concerns have been listened to.”

Ah, and who didn't like it so much, you ask -

America’s Health Insurance Plans, the trade organization that represents health insurers, was unenthused about the document and warned of dire consequences. AHIP circulated a letter detailing its concerns with what will be counted as a quality improvement, urging that spending on complying with new "ICD-10" coding requirements, which require upgrading systems tailored to ICD-9 specifications, and anti-fraud efforts ought to make the cut.

“The NAIC is conducting a transparent and thorough process as it develops the [medical loss ratio] MLR definition, but the current proposal could have the unintended consequence of turning back the clock on efforts to improve patient safety, enhance the quality of care and fight fraud,” AHIP president Karen Ignagni said in a statement. “Preserving patients’ access to high-quality health care services is essential if the key goals of health care reform are to be achieved.”

Ah, but I'm sure our friends from Glibertarian land and the 'Left of Penultimate Perfection,' those stalwarts against corporate greed, would have been there to support this latest working Dems' HCR milestone --- well, except they were too busy with that chorus moaning thingee - something about Obama is about to destroy Social Security and scaremongering about doing that. I'm sure you got those evil insurers on the ropes with your siren calls! Keep up the good work guys, I'm sure it will win you big points with the GOP when they get back in power!

This is a disgrace for the most powerful country in the world.

http://www.reuters.com/article/idUSTRE65M0SU20100623

Originally Posted by Deb C

This is a disgrace for the most powerful country in the world.

"Dead last" when compared to a whopping six other prosperous, highly industrialized countries:

The United States ranked last when compared to six other countries -- Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.

In other words, this is probably a biased study with an agenda. We know the U.S. health care system has problems but this seems like a rather disingenuous way to point them out. I mean, I'm "dead last" in terms of personal net worth in a list of 103 people that also includes Bill Gates, Warren Buffett and the members of the U.S. Senate, but that hardly means I'm poor.

Originally Posted by ziggyX65

"Dead last" when compared to a whopping six other prosperous, highly industrialized countries:

In other words, this is probably a biased study with an agenda. We know the U.S. health care system has problems but this seems like a rather disingenuous way to point them out.

I'm curious as to why you might think that this is a biased study.

Originally Posted by Deb C

This is a disgrace for the most powerful country in the world.

http://www.reuters.com/article/idUSTRE65M0SU20100623

And from that report -

"The findings demonstrate the need to quickly implement provisions in the new health reform law," the report reads

Yep, and you can thank working Dems for at least that possibility.

Ziggy, we come out pretty badly compared to other prosperous, industrialized countries as a whole, not just those five. I notice France wasn't on the list, and France is highly rated by most estimates, so the list doesn't appear to be biased. There are countries with worse overall health care performance than ours, but they are without exception poor developing countries, to which the comparison isn't appropriate. In the advanced world, we suck.

Originally Posted by Deb C

I'm curious as to why you might think that this is a biased study.

Because they only include first world, highly developed health care systems but the headline -- U.S. scores dead last again in healthcare study -- makes it sound like it's the worst in the entire world. Only by digging in do you see that they are not including (say) Zimbabwe or Haiti or Laos in this list. See my example above (added after an edit) to see why this can be extremely misleading.

In short, I think it was written with the explicit intent to make U.S. health care look as bad as possible.

Originally Posted by ziggyX65

"Dead last" when compared to a whopping six other prosperous, highly industrialized countries:

In other words, this is probably a biased study with an agenda. We know the U.S. health care system has problems but this seems like a rather disingenuous way to point them out. I mean, I'm "dead last" in terms of personal net worth in a list of 103 people that also includes Bill Gates, Warren Buffett and the members of the U.S. Senate, but that hardly means I'm poor.

I looked up the Common Wealth Fund that did this study and they appear very legitimate. Here's their URL. On the right side of the page is their mission statement.

http://www.commonwealthfund.org/About-Us.aspx

Originally Posted by ziggyX65

Because they only include first world, highly developed health care systems but the headline -- U.S. scores dead last again in healthcare study -- makes it sound like it's the worst in the entire world. Only by digging in do you see that they are not including (say) Zimbabwe or Haiti or Laos in this list. See my example above (added after an edit) to see why this can be extremely misleading.

In short, I think it was written with the explicit intent to make U.S. health care look as bad as possible.

Seems to me, they were comparing industrialized nations.

Originally Posted by Deb C

Seems to me, they were comparing industrialized nations.

Agreed, but you wouldn't know that by the headline. But that's on Reuters, not the folks who did the study.

Originally Posted by Brian Rush

Ziggy, we come out pretty badly compared to other prosperous, industrialized countries as a whole, not just those five. I notice France wasn't on the list, and France is highly rated by most estimates, so the list doesn't appear to be biased. There are countries with worse overall health care performance than ours, but they are without exception poor developing countries, to which the comparison isn't appropriate. In the advanced world, we suck.

Exactly. You said it better than I.

The WHO last published a complete international comparison in 2000, and they say they probably won't do it again because it is incredibly expensive to undertake something like that.

Anyway, at that time, U.S. healthcare ranked 37 - right between Costa Rica & Slovenia. Since then, prices have gone up significantly as a share of GDP, and patient & doctor satisfaction are both facing news lows. We're definitely #1 when it comes to total per capita spending... but... we don't really have that much to show for it in relative terms.

Faced with skyrocketing healthcare costs and new insurance rules under healthcare reform, more of the nation's biggest businesses are planning to hike premiums and cost-sharing measures on their employees next year, according to a survey of those companies released Wednesday.
Seventy percent of large employers said they will eliminate lifetime dollar caps on overall benefits, according to the latest annual survey conducted by the National Business Group on Health (NBGH), while 63 percent plan to increase premium rates in 2011, up from 57 percent this year.

Forty-six percent intend to hike maximum out-of-pocket costs for workers next year, up from 36 percent in 2010. Forty-four percent intend to increase in-network deductibles.

An additional 5 percent plan to drop retiree healthcare coverage in 2011, while another 60 percent are eyeing that strategy for the future, the survey found. That trend, NBGH said, is based on healthcare reform's gradual move to close the doughnut hole in Medicare's prescription drug benefit — a provision "making Medicare Part D benefits richer," the group said.

http://thehill.com/blogs/healthwatch...en-to-workers-

Originally Posted by Deb C

Faced with skyrocketing healthcare costs and new insurance rules under healthcare reform, more of the nation's biggest businesses are planning to hike premiums and cost-sharing measures on their employees next year, according to a survey of those companies released Wednesday.

So they plan to continue increasing costs as they have been doing for some time now, but now they intend to blame it on the partially implemented healthcare plan. Not much surprising about that! I'd take their claims more seriously if it weren't for the trend to this point...

An additional 5 percent plan to drop retiree healthcare coverage in 2011, while another 60 percent are eyeing that strategy for the future, the survey found. That trend, NBGH said, is based on healthcare reform's gradual move to close the doughnut hole in Medicare's prescription drug benefit — a provision "making Medicare Part D benefits richer," the group said.

This sounds potentially like a good thing! Companies could save money by not providing a benefit that the increased Medicare part D provides.

Originally Posted by scotths

So they plan to continue increasing costs as they have been doing for some time now, but now they intend to blame it on the partially implemented healthcare plan. Not much surprising about that! I'd take their claims more seriously if it weren't for the trend to this point...



This sounds potentially like a good thing! Companies could save money by not providing a benefit that the increased Medicare part D provides.

My intention was not to blame the reform. It is my intention to continue working for a workable health care for all. The rising costs of insurance is not new, and neither is the fact that they continue to have us by the testicles and ovaries.

Health insurance costs have always, and will always rise, because of the insurance industry's out of this world profits. They will continue to be beholding to their stock holders and pay their CEOs sinful salaries. To me, it's just another reason to continue working for single payer. Keeping the insurance giants in charge is sure not going to cut costs.

Also, I'm wondering about the people, say teachers and others, who can retire at earlier ages than 65? They aren't covered by Medicare at that point and many get the benefit of continued health care coverage when they retire. If more employers stop those benefits because of cost, wouldn't that cause a concern for those employees, especially if any have a pre-existing condition?

Even 2014 will not halt the same principles of business that the industry practices today.

Originally Posted by Deb C

Health insurance costs have always, and will always rise, because of the insurance industry's out of this world profits. They will continue to be beholding to their stock holders and pay their CEOs sinful salaries. To me, it's just another reason to continue working for single payer. Keeping the insurance giants in charge is sure not going to cut costs.

This is a part of it, but in reality, as long as the people who consume health care are not cost-sensitive because of our current insurance model, they have no incentive to become better consumers. And as long as insurers can just pass along higher costs, they don't do all that much to stop the runaway inflation.

Any sustainable health care reform *must* tackle the cost issue. That's the 800 pound gorilla in the room. Solve it and the rest is comparatively easy.

Originally Posted by ziggyX65

This is a part of it, but in reality, as long as the people who consume health care are not cost-sensitive because of our current insurance model, they have no incentive to become better consumers. And as long as insurers can just pass along higher costs, they don't do all that much to stop the runaway inflation.

Any sustainable health care reform *must* tackle the cost issue. That's the 800 pound gorilla in the room. Solve it and the rest is comparatively easy.

Isn't this part of what the exchange should help with? People using the exchange will have much more flexibility in plan selection than they do today and the ability to change plans if a cheaper alternative presents itself or their current plan offers questionable service. Doesn't this offer incentive for the insurance companies to push down costs?

Originally Posted by scotths

Isn't this part of what the exchange should help with? People using the exchange will have much more flexibility in plan selection than they do today and the ability to change plans if a cheaper alternative presents itself or their current plan offers questionable service. Doesn't this offer incentive for the insurance companies to push down costs?

We can hope, but it remains to be seen. The main thing is, some of the plans in the exchange will need to do so. If they all simply accept and pass on higher costs without some pushback, it won't help at all. And if it makes the consumer even less sensitive to the cost of various procedures from different providers, it could be counterproductive on that front.

Originally Posted by ziggyX65

We can hope, but it remains to be seen. The main thing is, some of the plans in the exchange will need to do so. If they all simply accept and pass on higher costs without some pushback, it won't help at all. And if it makes the consumer even less sensitive to the cost of various procedures from different providers, it could be counterproductive on that front.

How often does an individual have a real choice anyhow? People tend not to have the knowledge to know what is needed and what is not needed in terms of medical tests and procedures. Passing costs along in a token sort of way could be helpful (for instance a slightly higher copay for non-generic drugs could lead some consumers to choose the generic version, but doesn't force those who really need the non-generic drug from using it). However, I can't see how passing the actual costs difference of drugs, procedures etc to patients wouldn't lead to a significant disparity in the quality of care and perhaps a decline in the average quality of care as patients make bad decisions. Further, the system might incur additional costs as those bad decisions lead to more need for emergency care.

Pushing the insurance companies to lower costs through competition while providing information about the quality of care provided and allowing flexibility of choice seems to me to allow the consumer a choice between options that are understandable to the patients.

Originally Posted by scotths

How often does an individual have a real choice anyhow? People tend not to have the knowledge to know what is needed and what is not needed in terms of medical tests and procedures. Passing costs along in a token sort of way could be helpful (for instance a slightly higher copay for non-generic drugs could lead some consumers to choose the generic version, but doesn't force those who really need the non-generic drug from using it). However, I can't see how passing the actual costs difference of drugs, procedures etc to patients wouldn't lead to a significant disparity in the quality of care and perhaps a decline in the average quality of care as patients make bad decisions. Further, the system might incur additional costs as those bad decisions lead to more need for emergency care.

It doesn't *have* to be on the patient but someone paying the bills needs to care. Right now it's too easy for all the insurers to just pass on the 20% annual inflation to the insureds (or their employers).

We also have a problem with different pricing depending on your insurance (or lack of it). If a procedure costs $500, it should cost $500 -- not $1,100 if you are uninsured, $350 if you have private insurance and $300 if you're on Medicare. Again, this transparency in pricing doesn't need to be at the consumer level, but should be in place for those paying the bills at a minimum.

The problem with that under today's insurance model is that as soon as they put their foot down on a provider's excessive costs and price increases, if they eliminate that provider from their list it makes them less competitive than the plans that say you can "see any doctor." People want cost control but they seem to want unlimited choice even more. So something really does have to give. Expecting unlimited, immediate highest quality care with no limitations and reasonable cost is an unattainable ideal.

Originally Posted by scotths

Companies could save money by not providing a benefit that the increased Medicare part D provides.

I found this statistic at the Physicians for National Health Care; Very few employers offer retiree health benefits for new hires, with 18% offering coverage to pre-65 retirees and 11% offering post-65 supplemental coverage to new hires.

Originally Posted by Deb C

I found this statistic at the Physicians for National Health Care; Very few employers offer retiree health benefits for new hires, with 18% offering coverage to pre-65 retirees and 11% offering post-65 supplemental coverage to new hires.

When I was hired at my first (career-oriented) employer, we had retiree health insurance for pensioners. They eliminated it several years later for *all* employees, not just new hires. Then they eliminated "85 point" retirement with no benefit penalty and set a minimum retirement age of 55 (and a penalty for all retiring under 65). And a couple years after that, my pension was frozen.

Yeah, you see why I didn't have the loyalty to stay there...

"To us, it symbolized everything," said Annette Read, a tea party participant from suburban St. Louis who quit her online retail job to lead a yearlong campaign for the Missouri ballot measure. "The entire frustration in the country ... how our government has misspent, how they haven't listened to the people, this measure in general encompassed all of that."

Yknow it must be nice to be able to quit your job in this economy to follow a passion...
Does it seem as though those who don't need health insurance are the ones most against this?

Originally Posted by ziggyX65

When I was hired at my first (career-oriented) employer, we had retiree health insurance for pensioners. They eliminated it several years later for *all* employees, not just new hires. Then they eliminated "85 point" retirement with no benefit penalty and set a minimum retirement age of 55 (and a penalty for all retiring under 65). And a couple years after that, my pension was frozen.

Yeah, you see why I didn't have the loyalty to stay there...

This is happening more often than not, and we will continue to see these practices multiply.

The following is a concrete explanation of why our multi-payer system will continue to be a risk and problematic situation for employers, and subsequently, for most people in the U.S. .
Just becaus eyou have decent insurance now, doesn't mean that you will have it in the future. At least not under our current system.

By Don McCanne, MD

The National Business Group on Health represents primarily Fortune 500 companies and large public-sector employers with self-insured health benefit programs. Because of their market power and their ability to eliminate the risk pooling function of private insurer intermediaries, you would think that these large employers would be immune from the high health care costs inflicted on the rest of us by our dysfunctional system of financing health care, but you would be wrong.

This report shows that escalating health care costs continue to plague our nation's largest employers, so much so they they are turning to some of the same ill-advised cost containment measures used throughout our system. Amongst the most perverse is that they are shifting ever more costs to those individuals who most need to be protected by the benefit programs - their employees and family members who have health care needs. It is bad enough to have health problems, but it is even worse to be financially penalized for having them.

Why is it that these large employers, with their tremendous purchasing power and ability to bypass the extortion of risk-bearing private insurers, have been unable to control their health care costs? The reason is quite simple. Our fragmented, dysfunctional, multi-payer system permeates the entire health care delivery system, and these employers are unable to function in an isolated delivery system that has not been damaged by the financing perversities.

Let's look at some of the excess costs that they face. First, U.S. health care prices are the highest in the world. Even with their purchasing clout, the employers are not able to slow the unrelenting escalation in health care prices; they still have to pay prices close to those negotiated by the private insurance industry. In fact, most of them use private insurers for administrative functions such as claims processing, so they're playing the same ball game.

Second, and most importantly, the health care delivery system has built into it very high administrative costs due to the necessity of interacting with a multitude of payers, each with different contract requirements. There is no way that large employers can avoid paying these excess costs because they are fixed costs built into the delivery system.

It is true that large employers escape some of the costs of private insurance, such as the expense of marketing health plans, or the necessity of paying profits to investor-owned insurance companies. However they are exposed not only to the massive indirect administrative costs imposed on the health care delivery system, they also have their own excessive administrative costs.

More at this site: http://www.pnhp.org/news/2010/august...ol-their-costs Just scroll down to Doctor McCannes' comment section.

Originally Posted by Yorick's Skull

"To us, it symbolized everything," said Annette Read, a tea party participant from suburban St. Louis who quit her online retail job to lead a yearlong campaign for the Missouri ballot measure. "The entire frustration in the country ... how our government has misspent, how they haven't listened to the people, this measure in general encompassed all of that."

Yknow it must be nice to be able to quit your job in this economy to follow a passion...
Does it seem as though those who don't need health insurance are the ones most against this?

So, what happens here... The bill goes into effect and MO refuses to enforce the mandate or allow it to be enforced. (Assuming they are some how able to do this, it isn't clear to me how!). This could be a good test case actually. If the health care exchanges are much more expensive than neighboring states people will see why the mandate was needed. If they aren't significantly more expensive, it will become evident that perhaps the mandate wasn't needed and perhaps could be reconsidered.