The Single-Payer Debate

Bernie Sanders raised the profile for a single-payer health care system when he released an outline for his plan on January 17th. Sanders essentially advocates a “Medicare for All” plan. Rival Hillary Clinton criticized the plan not only for the timing of the release, 2 hours before their debate, but because the she said it is not realistic to pass in today’s political climate. Clinton noted that when the Affordable Care Act was being considered, the Democrats were not able to get a “single-payer option” passed in the healthcare reform bill. She also thinks it is ill-advised to consume the country and our politics in another healthcare reform debate. We have Obamacare, it’s better than what we had, and we can work to make it better.

So, pragmatism versus idealism. I have to admit, that although I support a universal coverage as a right of citizenship, Clinton makes a lot of sense. The politics, let alone the implementation of essentially replacing and entire industry (health insurance), are incredibly daunting. Not very realistic or practical.

The health insurance industry, like the overall health care industry, has experienced exponential growth. In 2014, there were an estimated 490,000 people employed in the health insurance industry. In 1980, there were $141,000. Let’s put that into perspective. In 1980, there were 225 million people in the U.S. and in 2014, 320 million. So, during a time when the U.S. population increased by less than a third, the number of workers in health insurance increased 3.5 times!

One of the biggest arguments for a single-payer/Medicare for all system has been that it would be more cost efficient. I’m seeing things all over the map here, from Medicare being much more efficient, to the exact opposite.  If the Sanders plan would wipe out an entire industry, it darn well better be replacing it with something far superior. Perhaps our goal can be to provide coverage for all, do it more efficiently, and do it through the insurance industry.

 

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Up From the Canvass(ing)

I had the opportunity to do some political canvassing last Friday. One of our tasks was to ask voters what issue was most important to them. Exactly half of those I was able to ask this question stated that the rising cost of health care and health insurance was #1 on their list. One gentleman said his he and his wife’s health insurance premium went up 50% in the past year. Not surprising to me, health care was not on the list of options to select for issues of primary concern. I think this omission demonstrates a few things: #1 – Politicians and political parties aren’t aware, or don’t care that health care continues to eat up a larger and larger share of the family budget (they don’t seem to care that it is eating up our public budget either). #2 – The rising cost of Health Care doesn’t pass the political hot button test (unless they blame Obamacare!) #3 – Neither the Republicans nor the Democrats are highly motivated to take this issue on. I mean, look at the constituencies: medicare recipients or those baby boomers that are quickly approaching 65, the health insurance industry, the pharmaceutical industry, the hospital industry, the medical device industry, trial lawyers, and so on.  Lots of votes and lots of money to risk disappointing. It’s an uphill fight to achieve Health Care reform that legitimately takes on the issue of costs, but it isn’t down for the count!

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Colorado Launches New Commission on Controlling Health Care Costs

The Colorado legislators approved the formation of a new commission to study and make recommendations on ways to better contain the growing costs of health care. I applaud our political leaders to act in non-partisan ways in this regard. The commission will be represented by a breadth of interest groups and members of Republican and Democratic parties.

The commission will run for 3 years and make policy recommendations to the State legislature. Comments from the article suggest that Colorado is pretty unique in having an environment where diverse groups on health care have worked successfully together. We wish them success! For more information, go to the story at Health News Colorado here: http://www.healthnewscolorado.org/2014/08/22/hopes-for-health-cost-cuts-high-as-commission-launches/

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Healthcare – The driver of debt

Going to link to another great post by Ezekiel Chang that describes why our debt problem cannot be solved by cutting spending for (non-healthcare) programs, or by raising taxes, or even a combination of both. We won’t solve our debt problem, or the problem of diminishing resources for other important needs without putting the breaks on the runaway train that is healthcare spending. Thanks Ezekiel for permission to share!

https://m.facebook.com/notes/ezekiel-chang/the-driver-of-debt/10151485697474349/?ref=bookmark

 

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There’s Upselling, and then there’s Upcharging

A new Propublica report sheds some light on some Medicare physicians who routinely charge Medicare the highest rate of reimbursement for office visits. When 90-100% of patient visits to your office are so complex that they warrant the highest level of care and reimbursement, something is going on there. Fortunately, the abusers don’t appear to be in the majority, but they are costing taxpayers lots of money. Here’s the scoop:

http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits

 

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Actuarily Speaking…

Went to my good friend Chris’ wedding in Pasadena last weekend and received a surprise gift (or 10) for my blog. Chris is an actuary in the health care industry. One of his good friends, Ezekiel Chang, is also a health insurance actuary, and has put a lot of thought into not just the what of health care costs, but the why, and the how do we fix this mess.

I have linked the first of Ezekiel’s blog posts (click on title), and I encourage you to read it. Lots of material to digest. It was insightful to distinguish between cost factors and cost drivers. Addressing the cost driver of medical technologies is an imperative. We also need to incentivize prevention and overall health outcomes, as opposed to incentivizing expensive treatments.

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Not Can We, But Should We?

Blogging time was taken up with planning and facilitating time as I coordinated a health care series at Arvada United Methodist Church this March. We had 3 great presenters from Kaiser, the Colorado Department of Health Care Policy and Finance and the Bell Policy Institute. There is an appetite out there to delve into our health care system and understand why it costs so much. Our congregation is “mature,” and the most mature ones are those that tend to participate in the adult education offerings.

One thing I wondered was whether people were open to discussing end of life issues as it relates to health care costs. At least in our groups, they were. There is an understanding that an inordinate amount of money is spent on medical interventions at the very end of life and that there is something wrong with that. We’ve hosted presentations on “The 5 Wishes” and palliative care. More palliative and less curative interventions for the very sick and the very old is a motto I believe many would embrace.

It’s remarkable honestly, given the dominant messaging that we hear from the medical industry. “Do this, do that. Take this, take that.” One individual in the group phrased it well. “We need to start asking the question, “It’s not can we, but should we?” It’s a hopeful sign to me. One that recognizes a responsibility to future generations and a less fearful approach to death and dying. I would call it faith-full.

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