Bill Clinton on CNBC

Whether conservative, liberal, super left or super right, it was interesting to watch former President Bill Clinton this morning on CNBC. He articulated perfectly what is wrong with the healthcare system in the U.S. and it has NOTHING to do with not having a public option, or whether we pay17% or more of our GDP on healthcare spending....it is all about outcomes. He referenced Columbia where they spend 6% of GDP on healthcare and have a much higher outcomes rating than the U.S. The problem is on governance of the healthcare process, especially on physicians and hospitals, which can happen between government, insurance carriers and providers. A public plan is such a radical (far left) change to the current system, that most agree we do not need to be so radical, though we do need a big change. This can be done pushing providers, and insurance carriers, to be regulated and incented based on outcomes. The better a patient gets, and more efficiently, means better compensation to the provider and institution (read up on the Cleveland Clinic, and Mayo Clinic). Providers and institutions that do not have good outcomes, will go out of business - just like in the REAL world....poor business models fail and go bankrupt. Same should be true for healthcare.

Obamacare

Is Obamacare officially dead? As an internet insurance entrepreneur, I have mutliple news channels on all day every day, and they all say the same thing - what about Medical Malpractice tort and the costs of defensive medicine and unnecessary testing...these numbers are not small, they are as high as 30% of the healthcare spend! I will say one thing whether I support one side of the isle or the other "politically" I do not want uneducated (on healthcare anyway) politicians driving our healthcare system in an unhealthy direction in order to win their seats the next go-around, or to get happy lobbying/self-interest support. It is very scary to think one of my 4 kids could be denied care, as the Obamacare and House-supported model right now, does not focus on the core problem - our system does not have consumerism now...if I pay a 25$ copay for a service that is $400, or $400,000, what do I care as a consumer? Believe me, my employer cares. If I have a sick child or loved one, I do not want the government looking at statistics telling me what we can and cannot do. I am also fine with paying my fair share as we all should be in the U.S. Why does everyone come to these terrific institutions we have in the U.S. for their healthcare? Because it is the best.....we all do need to pay our fair share though, that is another problem...the healthly are not offsetting all of the sick in todays' system.

Why doesn't the government just backstop large claims and the chronically ill folks in the nation (5% of the population drives 49% of the spending) for the private insurance industry, and as a take back enforce stronger regulation, and profit restrictions? All medical records being electronic like the Mayo Clinic and Cleveland Clinics do respectively (arguably 2 of the best institutions in the world!)?

We need to get politicians out of the debate and start fixing the real problem here....let's have bipartisan, outside entities with expertise in this area assist reform, instead of politicians elbowing for votes please!

Healthcare Reform and some valid Statistics

Medicare passed in 1966, and at that point in time the private sector (the insurance we as Americas have state in 2009 that we like over 85% of the time - employer-sponsored or buy it ourselves, or if we own small businesses etc...) funded over 75% of total healthcare expenditures. Following that percentage began to pull back and fell to 63% by 1967. Since that time the private sector has continued to fund less of the national health expenditures.

As of 2007 that number was down to 53%. Why? Again, we reference the "health care wedge" which is the separation of the consumer and provider as there began to be more and more government intervention through this time period. What is amazing, if we compare this phenomenon to auto insurance, or other types of insurance (life etc..) which by definition is a tool to manage risk, and in exchange for premium payments, provides protection against large but uncertain risks. We have completely flopsided the way health care is purchased, and for what services. There is a great article now by Laffer & Moore that I am referencing (The Prognosis for National Health Insurance) and in it they compare auto insurance paying for oil changes, brakes, you name it. Even a layman can quickly state "wow, wouldn't that cost way more?" Answer is simple and yes.

As the government has already intervened, driven this wedge up, and taken control of the payment and funding methodology almost half of the time as of 2007, the spike in health care spending is actually more because of the existing system that has pulled away from the private sector funding versus the government. As an expert in this field, I quickly jump to, "well, go back to the 60's before the government destroyed the system with it's now bankrupt Medicare program, and completely reformed by whom and how Medicare is run and funded. Government already seems to be the obvious problem here."

Back to my example above, again referencing Laffer & Moore, now the private sector funds just above 50% of health care expenditures, with only slighltly more than $1 out of ever $10 coming out of the consumer's pocket (no consumerism here either). Where was that number in 1960? It was about 47%, or $4.70 out of every $10. So today, and back to the automotive example, if we overlayed (apply?) this to the auto industry, pricing would be fixed whether you crash all the time or not, or whether you are 21 years of age or 50, and the "reckless" would be funding the "safe."

This does not appear to be a fair system, and does not promote any type of "thinking" before we research or spend. If I can go to a $400 dollar a visit cardiologist 5 times a month just to check in, and it does not cost me very much (but is killing the overall system), why wouldn't I?

I can go on and on, but my point is straight-forward and simple. The private industry NEEDS to control more of health care funding and expenditures, and we as Americans also need good tools to use to research, examine, and compare doctor's and hospitals to see their outcomes, infection rates, readmission rates, etc. If I choose a doctor that my mother says is incredible - "we all go to her" - but that doctor readmits patients to the hospital for the same services over and over because their health immediately deteriorates after they are released, does it seem like a problem? Yes, maybe I would like more information on this physician and her practice patterns? It is a proven fact that most American's spend more time researching the purchase of their new SUV than they do gathering information before having a hip replacement. Amazing isn't it? We need more of this valuable information to help American's see that what most politicians say on TV is self-motivated by lobbying interests and perhaps not always with an eye on the common good of us as tax-payers. I can beat up on both Republicans and Democrats on this very point, for they are the government. Private insurers, if regulated differently, and if their cost structures change to bring down the enormous profits they make at the expense of consumers in this country solves two problems. First, it would make affordability radically increase and coverage availability soar. Second, it would place the profit mechanism for businesses that want to sell health insurance under much greater scrutiny and management.

Enough for now...please provide comments.

Obamacare?

It was been a while since I blogged on this subject, but the Obama plan seems to have lost most of it's muster and it's steam. Most economists, and folks from both sides of the isle seems to think we will see insurance reform, but perhaps this turns more in to insurance carriers being reformed in the private market. Seems to us that if pre-existing condition exclusions are removed, and guaranteed issue coverage takes a national state (like they have in NY, NJ, CT, MD for example) that would certainly be a piece of the pie. But there will invariably need to be business tax credits for folks that offer group coverage to their employees, and tax penalties if folks do not, which would in turn offset the internal cost structure to insurance carriers in order to be able to have bigger pools of people (both healthy and sick) to bring down premiums. What seems to have sunk the Obama plan is the fact that an already bankrupt Medicare and Medicaid government run program, if given the opportunity to bring in a government plan for all (the Public Option) would then force hospitals and private physicians to take drastically lower reimbursements, hence forcing them to drive up their charges to the privately-insured - this in turn would radically push private insurance higher, and also force providers to increase the already staggering 29% of Medicare covered senior (and then now also non-seniors with a public option) to run in to access issues - this 29% has been referenced many times in all forms of media, as the percentage of people covered under Medicare that can't get treatment because physicians prefer to not treat for such low reimbursements when they can see privately-covered patients and more reasonable reimbursements.... I have not even starting talking about Medical Malpractice tort etc...another huge piece of the pie.

That brings us to the place we are today, we need everyone in a room together, insurance companies, doctors, hospitals, and legislators, working out a better private system to continue to give Americans access to the best healthcare in the world. We have lots of work to do -

Best priced NYC area health plans 2009

It almost seems an oxymoron to say "best priced" with where premiums for health insurance plans have risen in the last 5 years. Having said that, if small businesses are looking for the lowest premium on the market, Health Net and Emblem Health have the best community rated products right now. Empire BCBS has introduced some new EPO plans as well that are also quite competitive. If employers are looking for high-deductible health plans to couple with HSA or HRAs, Emblem Health has plans are that below 200/person.

Oxford Health Plans and Aetna are priced similarly to each other, as such, their products and prices are the next tier up. Cigna now has also introduced an EPO plan that is also quite competitive.

For folks over the river in to New Jersey, Horizon BCBS has the best price/product mix right now, followed by Health Net and others including Oxford and Aetna as well.

For free quotes, visit www.healthinsurancegeeks.com, for New York companies there is a real time quote engine, for NJ, folks must submit a census document to get a quote right back as the carriers rate based on census.

The New Landscape of Health Insurance: Reform?

It has been a few weeks, and we have seen lots and lots of new ideas, perhaps rhetoric about the new system that will be employed in the U.S. for health insurance. The Obama Administration continues to be front and center with its ideas, and they circle around many of their original plans. The government wants desperately to offer a public option to both the uninsured population, which hovers over 40 million Americans, and anyone else in the market, whether with or without coverge. Obama continues to tell employers and employees covered by group plans that they can keep their plan if they so chose, but would like to increase competition through the public option. Many defenders of private insurance point to the ineffective Medicaid and Medicare plans currently in force in the U.S. These plans just like private insurance have not kept costs in line, and get steady push-back especially from private physicians and hospitals.

Regardless of political opinion, many things about reform are front and center - controlling treatable illnesses and conditions such as obesity, smoking, a Asthma, with wellness and prevention. These conditions alone account for plenty of the spending in the current system, and are coupled with the fact that electronic medical records are not the norm in 2009. As such many tests are duplicated along with multiple visits and procedures that could be eliminated if records were more coordinated. Approximately 30% of the spending in the U.S. is attributed to this waste alone.

The private insurers are going to need to budge if the wish to remain in business and many point to the medical underwriting around pre-existing conditions. Private insurers urge a mandate for every American to be required to have coverage similar to car insurance, in order to bring more healthy Americans in to the system to offset the claims that would be incurred by sick members. In general that is the problem, private insurers can have more "lax" underwriting and in fact offer more affordable coverage if these massive insurance pools have a better mix of healthy and sick members. Perhaps that is where we will find ourselves after all, with a private system augmented with Congress enacting stronger legislation around mandates for coverage, some for of government subsidy for coverage (for certain income levels etc...) and perhaps a revamped Medicare system to pick up some of the costs for the very low income population currently uninsured. Regardless one thing must be done, all Americans should be required to have health insurance, though our reformed system must offer a suite of affordable products, and places through which one can secure it.

One thing is for sure as mentioned recently on Good Morning America by Michelle Obama, and that is the debate is strong, and reform will be no easy task. Years of out-of-date legislation that governs the current private system, and Medicare/Medicaid as well, needs to be brought up to speed with 2009. After all, we have not had any major reform for years and years.

Healthcare Reform

New Law will help inform consumers about health insurance
Many consumers have health insurance plans and don’t even understand what half of the policy even means. Health insurance consumers are often challenged when trying to understand their coverage options. Trying to obtain information in order to make an informed decision is hard when a consumer doesn’t understand any of the terms of the policy.
A survey released early this year reports that coverage is beyond comprehension for most consumers. Approximately 75% of consumers don’t understand their coverage or how it works. Because of this, Sen. Jay Rockefeller of West Virginia and U.S. Representative Rosa DeLauro of Connecticut have introduced the informed Consumer Choices in Health Care Act of 2009. This act requires the development of information resources and consistent standards for insurance definitions. Many insurance policies have the same key terms but may mean something different to each carrier or plan. The development of information resources will coverage facts labels that will provide data to consumers and providers on everything needed to know and understand a policy.
This law will help to create an office within the Department of Health and Human Services called the Office of Health Insurance Oversight. This office will collect key data about health insurance as well as improve the transparency of private health insurance carriers.
Due to the amount of money consumers spend each year on health insurance coverage, the least they should receive in return is the resources needed to make an informed decision about the future of their health.
For more resources to make an informed decision about your healthcare, go to http://affordablehealth-insurance.org.