Healthcare Letter

September29th

10 Comments

This week the Senate Finance Committee continues its work on its healthcare bill. As the intensity of the discussion heats up I would like to offer some recent articles that I thought were insightful and/or informative.

To start I thought both the Washington Post article by Ezra Klein and the Wall Street Journal article “Doubling Down on a Flawed Insurance Model” by John Cogan, Glenn Hubbard and Daniel Kessler were very good at getting at some of the nuts and bolts of the healthcare industry and what drives costs, prices, offerings and behavior. To me the articles are successful at educating, not just advocating.

Then there is the recent article by former Senator Bill Frist of Tennessee (R) in US News & World Report in which he looks at the costs/benefits of a mandate for healthcare insurance and provides a very concrete yet manageable first step for reform. To me, this article is important not so much for a policy he is advocating but for the rational measured approach, the examination of historical experiences, and the transparent review of costs/benefits that he brings to the discussion. It is this type of thinking that I believe is lacking in our politically charged debate.

Finally I would like to offer an editorial by David Brooks in the New York Times. It has nothing to do yet everything with healthcare. He advocates a move away from consumption and towards economic self-restraint. What Brooks identifies is actually one of the root causes I believe of our healthcare system failings. We have an industry of significant consumption but the consumer isn’t tied to the immediate paying of the bill. It is as if someone said I could eat all the chocolate I wanted for a week and not gain weight. (I’d bring chocolate to bed.)

In my Healthcare Letter, I put forth that healthcare reform is much more than “payment” and “coverage” reform. It should be about the transformation of 17% of our economy in a methodical, deliberate way that begins to unwind the interwoven complexities of a system that is expensive and cumbersome but still offers brilliant innovation, life-saving treatments and comfort to many.

I hope these articles help illuminate some of the critical issues we are facing in this transformation. I know they did for me. It seems as if these authors had an opportunity for lucid thought in contrast to the constrained environment in the windowless Senate Finance Committee room.

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10 Comments

  • Comment by Susan Kishner — September 29, 2009 @ 4:22 pm

    A friend of mine just emailed me one of your articles from a while back. I read that one a few more. Really enjoy your blog. Thanks

  • Comment by Shannon Kennedy — October 1, 2009 @ 9:23 am

    Good stuff Oakleigh… So many reasons for Government to deregulate rather than increase regulation. A simple solution to decrease health insurance cost – remove state regulation (mandates) of health insurance plans. We are the divided states of America, each state has its own rules and fees on how health insurance can be offered; therefore limiting companies from entering every state. Even the largest insurance companies do not have product available in every state. Everyone agrees that competition is good; so allow all insurance companies to compete nationally at same level.

  • Comment by Rob Plamondon — October 2, 2009 @ 1:26 pm

    There is something I am trying to understand. I would appreciate any thoughts from readers of this forum. Healthcare insurance is fundamentally different from other types of insurace (Home, Auto, etc.) in that we bill our Healthcare insurance company for any healthcare related need including routine office visits, check ups, dental cleanings, etc. We do not bill our auto insurance company for an oil change, nor our homeowners insurance company if our furnace fails. These are costs we bear ourselves. Coverage on our homes and automobiles is designed to protect against more catostrophic losses and the potential financial impact associated with these events. Imagine what our auto and homeowners policies would cost if we billed insurance companies for all our maintenance and repairs in addition to what is currently covered.

    So, my question is this: What percentage of claims are associated with routine doctor’s visits such as check ups, physicals, a minor cough, etc. (basically things that probably lead to a claim of less than $200)? I would also be curious to understand what the costs are to admininster and pay these claims. How much of the administrative costs of overall claims is associated with these types of claims? I have no basis to make a guess, but would assume it is fairly high. What would eliminating these from Healthcare insurance models do to premiums and the overall cost of healthcare to families? I am not in a position to say this is a good or bad course of action, but was interested in views others may have.

  • Comment by Steve — October 5, 2009 @ 6:47 am

    This is a great site and you are doing a wonderful service putting the government gobbletygook in language the majority of people can read and understand and use that knowledge to challenge the issues. I have been to Town Hall meetings and the one recurring theme is that no one is Washington is using any “common sense” in dealing with this or any other major issues facing our country right now. It is all about government taking control of more and more of our lives.

  • Comment by Diane — October 5, 2009 @ 8:08 am

    Rob Plamond brings up some good points. Health care, unlike any other insurance we buy, has too many variables to be a one size fits all policy. Preventative medicine and cost of care for illness is important here but also abuse and fraud is important. How many people go to the ER rather than make a doctor’s appointment? How many in the healthcare field overcharge or say they perform services that were not done? I’ve seen both happen when I worked in the medical profession. I pay for my insurance. If I abuse it I get stuck with the bill. If someone doesn’t pay for their insurance and abuses it what are they stuck with?

  • Comment by granny02 — October 5, 2009 @ 8:39 am

    Has anyone looked at a hospital bill account summary lately? A friend on Medicare and insurance was in the hospital recently for a quick surgery (went in one morning and out at noon next day). This person had about 5 pills during the whole time and the pharmacy bill was $8,423.58. The other parts of this summary were just as ridiculous. Now Medicare will knock that amount down and pay some and then the insurance company will knock it down more and pay some. Luckily the patient will not have to pay but here is at least one place where some adjustment needs to be made. It seems to me that Government is not willing to give up their political contribution money from lobbyists in order to lower the cost to Medicare.

  • Comment by Philip Tympanick — October 5, 2009 @ 8:43 am

    Please read my health care proposal. It’s only 5 pages long and emphasises many of the most important points articulated in Oakleigh’s letter.

    Download your copy at:
    http://tympsnet.com/TympsNet/PDF/HR3200CS.pdf

    and get me your feedback. My hope is that WE THE PEOPLE can come up with THE PLAN, and our representatives in Congress can PASS OUR PLAN!

    Thanks,
    Phil Tympanick
    Millville, MA
    philt@tympsnet.com

  • Comment by Rudi Schnur — October 5, 2009 @ 1:37 pm

    I applaud you for your effort to promote understanding. Profound understanding of the processes underlying the complex system we call “healthcare” is the only way to hope for improvement by way of improving those processes.
    I actually share your view about the excellent article by David Goldhill in the September 2009 issue of The Atlantic under its title page headline “WHAT WASHINGTON DOESN’T GET ABOUT HEALTHCARE-HERE’S HOW TO FIX IT”. It should be “Must Reading” for politicians looking for a quick fix and in all likelihood will just make it worse.
    Keep up the good work.

  • Comment by Rob — October 5, 2009 @ 4:37 pm

    Think the whole thing is as simple as this:

    A. Let me be able to buy my own health care services at a reasonable cost (or not).
    B. I am fundamentally “self insured” so, let me be able to buy insurance for the cost of health care services at a reasonable cost (or not).
    C. Don’t charge me, or my insurance company, for someone else’s heath care expenses.
    D. The State to provide a minimum level of indigent health care for their citizens who can’t pay for their own.
    E. Services cannot be sold at a premium or discount to anyone. Everyone pays the same.
    F. Providers are allowed to charge actual cost, plus overhead and profit. Set a maximum profit allowable.
    G. Let me have opportunity to save money and pocket the difference.
    H. Proof of citizenship is required. If no proof, stop the bleeding and deport.
    I. Don’t charge me to cover high-risk behavior of others. If that behavior is job related, charge the employer. If that behavior is chosen by the individual, let them pay for it.
    J. If any of these provisions are not followed by the individual States, seek a Constitutional Amendment to allow the Federal Government to provide. Otherwise, stay out of it.

    This last point is crucial though. Past Congresses did Social Security, Medicare, Medicaid, Prescription Drug Benefit and the Cash For Clunkers as well, all without a Constitutional Amendment, and all are or will be bankrupt.

  • Comment by Ron — October 6, 2009 @ 9:15 am

    Oakleigh, I appreciate you’re helping me (and many others)to gain a better understanding of just what is going on with the healthcare debacle. Unfortuneately I feel the root problem is far deeper than just healthcare. I think the ‘war’ between politcal parties is far more important to most politicians than any thing else. I also feel the good of the people is not one of the concerns they care about. I think a far more important concern is MONEY, both in pocket and for future polictal backing. I think you’re points are the most logical and intelligent way to work on this problem, paricularly utilizing the minds and common sense of the people who first handedly deal with the complexities of the system on a daily basis. I think instead of reading the current plan our elected officials should be required to read your letter. Maybe some of them would actually decide to think about the people who they represent and what’s best for their interests. Thank you for your dedication to healthcare and my well being.

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