29. April 2008 by Jon Moss.

by Libby Quaid

Republican presidential candidate John McCain wants health insurance companies to compete for your business on the open market.

He would offer families a $5,000 tax credit to help buy insurance policies.

“Millions of Americans would be making their own health care choices again,” McCain said in remarks prepared for delivery Tuesday at the H. Lee Moffitt Cancer Center & Research Institute in Tampa.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” he said. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

His campaign called the speech a major policy address, though McCain has talked about the same ideas for several months. What’s new, according to adviser Doug Holtz-Eakin, is that McCain will give more examples of how his policies would work.

Still missing: The total cost of the plan and an estimate of how many people it would help. There are more than 40 million people in the United States who don’t have health insurance.

“So, a little more detail, but remember, it is April, and the election’s in November, so not everything will happen tomorrow or this week,” Holtz-Eakin told reporters Monday.

Under McCain’s plan, anyone could get the credit, and those who like their company health care plan could choose to stay in it. The credit would be available as a rebate to people at lower income levels who have no tax liability, Holtz-Eakin said.

To pay for the tax credit, McCain would eliminate the tax exemption for people whose employers pay a portion of their coverage, raising an estimated $3.6 trillion in revenues, Holtz-Eakin said. Companies that provide coverage to workers still would get tax breaks. McCain would also cut costs by limiting health care lawsuits.

The goal is to move the health care industry away from job-based coverage toward competition among health insurance companies on the open market.

read more

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7. April 2008 by Jon Moss.

Hillary Clinton	Barack Obama	John McCain
	CLINTON Requires everyone to have insurance. Insurers must sell to all who apply. Large employers would offer coverage or pay a portion of workers’ costs. Small employers would be exempt but could get tax incentives to provide coverage. A new public plan, “Health Choices Menu,” similar to the federal employees’ program, would be designed. A refundable tax credit would help pay for coverage. Premiums’ cost would be limited to a percentage of income.	OBAMA Requires all parents to have coverage for their children. Insurers must sell to all who apply. Large employers would offer coverage or pay into a fund. Small employers would be exempt but could buy coverage in a new system with subsidies available to some businesses. Creates a new plan for the uninsured and businesses that is similar to the federal employees’ health program. For employers who offer insurance, the government would pay for very expensive care, if employers agree to pass savings to workers.	McCAIN Ends tax-free health benefits offered through employers and replaces with a tax credit of $2,500 for individuals and $5,000 for families to purchase health insurance. Allows consumers to buy insurance from sellers in any state, which could be cheaper. Allows businesses and the self-employed to band together to buy insurance through associations, which they cannot do now in some states. Sets limits on medical malpractice awards. Allows importing prescription drugs from other countries.
The cost	Estimated $110 billion a year when phased in. Would be offset by cost savings, such as limiting tax-free health benefits for those earning more than $250,000 and ending recent tax cuts that income group received under President Bush.	Estimated $50 billion to $65 billion a year, with much of the cost coming from savings in the health system and ending tax cuts for those making more than $250,000 a year.	The campaign has not estimated costs.
Sources: USA TODAY research and the Kaiser Family Foundation

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27. March 2008 by Jon Moss.

Washington Post
March 18, 2008

Between now and next month, Lou Bruhn, 65, of Fairfax County will have to make an important decision about his medical care: Should he pay $1,500 a year to stick with his primary care physician of three years — a doctor who he says has given him excellent care? Or should he resign himself to finding another doctor?

Some 5,000 Northern Virginia residents are mulling the same question after learning that their Franconia family practitioners, Brett Wohler and Andrew Wise, are switching to what’s sometimes called boutique, or concierge, care. On April 15, the pair will join a national doctors’ network and will charge each patient an annual retainer of $1,500. In return, the physicians say they will offer more attention, including round-the-clock cellphone access, same-day appointments and time to accompany their patients to specialists.

The move follows a nationwide trend that began nearly 12 years ago as a reaction to what some doctors see as the excesses of managed care. More than 1,000 doctors have switched to this mode of practice, according to the Society for Innovative Medical Practice Design, a trade group in Richmond.

Under concierge plans, doctors typically reduce the size of their practice so they can stretch patient visits to 30 minutes, compared with the seven to 16 minutes that various studies have found to be average under managed care. In addition to their annual retainers, doctors collect the usual fees for service or reimbursements from patients’ health insurance plans. The doctors also accept Medicare patients.

Proponents say concierge care lets doctors give patients the time and services they deserve, and allows them to focus more on preventive care. But critics say the development exacerbates inequities in the American health-care system by limiting access and increasing the workload of doctors who don’t join such networks.

Several years ago, only a handful of Washington area doctors listed themselves as members of MDVIP, the nation’s largest retainer health-care company and the one Wohler and Wise are joining. By June 1, the area will have nearly two dozen MDVIP doctors, according to company officials, with 15 in Northern Virginia, six in Maryland and one in the District.

“It’s not really about the money; I can afford it,” said Bruhn, a retired engineer and a patient of Wise’s. “I guess I’m still curious to see if it works as well as the doctors seem to believe, and if that would be worth the price for me.”

But some other patients are less sanguine.

To convert to the new plan, Wohler and Wise plan to drop about 4,000 of their 5,000 patients. Remaining patients, up to 1,000, will be selected on a first-come, first-served basis, they say, leaving the rest to find a new physician they can trust.

Lisa Zuber, 51, of Springfield, is one of them. A patient of Wohler’s since 2004, she said that she initially considered following him into his new plan. But the more she learned about concierge care, the more it made her uncomfortable.

“I guess what bugs me so much is that even if everyone wanted to join, they couldn’t,” said Zuber, an administrator for a national professional association. “It sets up this situation where people are competing against each other to get health care. I just didn’t want to be a part of that.”

Wohler voiced regret about the situation. “There are patients that I’ve seen for years that probably will not continue, and that’s hard,” he said in an interview last week. “Part of me asked myself, ‘Is this right?’ But I firmly believe I’ll be getting back to doing the things that I set out to do when I first became a doctor.”

MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don’t stop seeing them until they do.

Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. “I’m absolutely going to join,” said Arthur Smith of Fairfax County. “There doesn’t seem to be any drawback.”

Others were more cautious.

“It makes you wonder where we’re going as a health-care system,” said a patient of Wise’s, who identified himself only as Ray and declined to give his last name. “I understand where these doctors are coming from — all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you’re really not doing your job.”

Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.

In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, “they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.

A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.

“This really isn’t a solution to the chief problem in our health-care system, which is maldistribution,” said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn’t involved in the survey. “By giving more people an opportunity to opt out, they’re not addressing the problem of access to health care.”

Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.

“Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy,” said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. “But it’s unclear to me how viable the market is right now.”

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10. March 2008 by Jon Moss.

The State of Georgia has passed a bill to encourage insurance companies to offer cheap, affordable, and limited health insurance plans. The bill passed by Georgia’s Senate will give insurance companies an opportunity offer health insurance to Georgians who are unable to afford a comprehensive plan. The republican proposal passed 42-12 in the House. Now, individuals searching for affordable Georgia health insurance can pick a plan based on what they can afford. Although the coverage will be limited, the limited coverage is still better than no coverage at all. 

Democrats who apposed the plan are worried that individuals who obtain the limited plans will not truly understand the coverage of the plan and will only make their decision to purchase based solely on price. Democrats predict that the future of this plan is flawed because its popularity may grow tremendously in the future but coverage will not be sufficient for most.

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7. March 2008 by Jon Moss.

A growing number of business groups have embraced the idea of requiring individuals to purchase health insurance. Supporters of an individual mandate, including Democratic presidential candidate Hillary Clinton, contend it is necessary to achieve universal health care and spread the burden of health care costs more fairly.

Clinton’s rival, Barack Obama, says it is unfair to force people to buy insurance they can’t afford and argues that most people would buy insurance if the cost is reduced. In recent weeks, the National Small Business Association, the National Business Group on Health — representing large employers — and the National Retail Federation have endorsed an individual mandate. The National Federation of Independent Business has not taken a position. The NFIB helped kill Clinton’s 1993 health care plan because it required all employers to provide insurance.

The U.S. Chamber of Commerce opposes an individual mandate, as well as an employer mandate. Both Clinton and Obama would require employers to provide health insurance or contribute to their coverage by paying money to the federal government. Both would exempt small businesses from this mandate, but they haven’t specified what the size threshold for that exemption would be. They also would provide subsidies or tax breaks to low- and moderate-income individuals to help them buy insurance. Likely Republican nominee John McCain opposes mandates. His health care plan focuses on reducing health care costs

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27. February 2008 by Jon Moss.

In an effort to increase the funding and efficiency of health care for Native Americans, the Senate voted 83-10 to approve legislation intended to provide the group with greater access to health care services — including screening and mental health programs.

Native Americans typically experience higher death rates due to alcoholism, drug use, diabetes, cardiovascular disease and suicide rates, according to reports.

In addition to expanding tribal access to Medicare and Medicaid, the bill — which would authorize approximately $35 billion for Indian health care programs over the next 10 years — would also enhance programs at the Indian Health Service, help construct and revamp health clinics on reservations, and attempt to recruit more Native Americans into the health care industry, according to reports.

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27. February 2008 by Jon Moss.

Aetna announced today that it has launched a secure, provider Web site with NaviMedix, a leading innovator in automating health care provider communications.

Through NaviNet, NaviMedix’ s multi-sponsor health care communication platform, health care providers have easy, one-stop access to most major payers and select regional carriers, improved security options and improved electronic administrative transaction capabilities, according to reports.

Aetna’s secure provider Web site via NaviNet offers many easy-to-use features to both participating and nonparticipating physicians, hospitals and other health care professionals, the company says.

Free, real-time transactions are available with Aetna as well as other payers including major health plans and the Medicare program and enhanced administrative options provide one-stop service, as only one user name and password is needed to interact with Aetna or other health plans.

Meanwhile, health care providers can check eligibility and benefits in real time, submit or inquire about claims, review claim payment policies, view and print explanation of payments online within 24 hours of claims processing, obtain electronic remittance advices, access Aetna’ s education site and conduct many other activities, according to Aetna.

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27. February 2008 by Jon Moss.

Last Sunday the Wichita Eagle published a story on how a local Kansas hospital has discounted  slashed their price on a common type of heart surgery.  They did it to be more competitive in the marketplace.  Apparently they felt strongly about gaining more share of the market.  They’re even advertising in Canada and the UK (for people who don’t want to wait for their government-provided medical plans to schedule procedures, and are willing to pay)  Here’s the story in it’s entirety:

Galichia Heart Hospital says it will begin charging a flat fee of $10,000 for one of the most common types of open heart surgery — undercutting hospital charges by at least $25,000.

The discounted fee is the latest plan by the physician-owned hospital to attract more patients. The hospital also promises a 15-minute wait time and a $50 co-pay in its emergency room.

Galichia officials say the discounted rate applies to standard coronary artery bypass graft surgery, but only for cases where there is little chance for complications. Patients with risky health issues such as diabetes or who have had the surgery before are not eligible.

Hospital officials are frank about their motives: They want a bigger piece of the patient base in Wichita and beyond.

“We’re very serious about presenting cost-effective products and options for our community and for the region and nationally,” Galichia hospital chief executive Steve Harris said.

“I think it will turn some heads. This isn’t just a good rate. It’s a world-class rate.”

Getting patients

About five of every 1,000 people need open-heart surgery every year, so a community this size produces roughly 2,000 procedures annually, Harris said.

Surgeons at Galichia Heart Hospital perform about 200 open-heart surgeries a year. Harris said he would like to see that increase by 100 this year.

The idea behind the rate cut is threefold, he said. The hospital wants to attract cash-paying uninsured workers, get the attention of insurance providers and cost-conscious employers in Wichita, and tap into medical tourism — the trend of patients going out of the country to purchase affordable surgery.

“We’re making money at this rate,” Harris said. “We’re challenging our colleagues to really square off against rising health care costs.”

Physician-owned hospitals in Wichita have historically struggled for market share in a city where the two major hospital systems — Via Christi Regional Medical Center and Wesley Medical Center — contract exclusively with insurance providers.

Galichia officials are hoping their new rate causes the area’s largest insurers — Blue Cross and Blue Shield of Kansas and Via Christi-owned Preferred Health Systems — to consider steering some of their client base to Galichia.

“This is a much better rate than anybody else is giving Blue Cross or Preferred Health,” Harris said. “We’re not an in-network provider. We’re sort of challenging (them) to rethink their contracting strategies.”

Blue Cross, at least, is intrigued, although the state’s largest insurer said it would abide by its contractual obligations.

“Blue Cross… members are free to receive services from any hospital they choose with the understanding that their benefits will be applied differently when they use non-contracting facilities,” spokeswoman Mary Beth Chambers said.

“We direct members to the hospitals where we have contracts because of the discounts we receive from those contracting providers. If one hospital is charging less than others in the area then that is good for the community and could help lower overall health care costs for everyone.”

Making waves

Galichia’s new rate could threaten larger community hospitals, although executives at each declined to comment.

Administrators at Kansas Heart Hospital, of which Via Christi is a minority owner, said the Galichia plan is “very interesting” but unlikely to make a dent in their business, which is based largely on physician referrals.

“I’m not sure what impact it could have,” said Lynn Jeane, chief operating officer. “And I’m not sure how many people needing heart surgery are going to be out shopping for the lowest price.”

Supporters say physician-owned hospitals are extremely efficient, making such cost-cutting strategies possible.

“It’s a gutsy move, but I understand what they’re trying to get done,” said Jim Sergeant, past president of the Kansas Surgical Hospital Association and chief executive of Salina Surgical Hospital. “If you take a hard look at costs, you can do premier services at a very good price.”

Galichia hospital also is running ads this weekend in Canada and the United Kingdom, targeting countries where government health plans have created long waits for elective surgeries. Such environments have fostered medical tourism to such places as India, where patients can get procedures done inexpensively.

“The price… is absolutely stunning,” said Rick Baker, a Canadian who founded Timely Medical Alternatives and North American Surgery. His companies connect clients with specialty hospitals that agree to perform certain surgeries at low, contracted rates.

“The solution to America’s health care problems is (for) people to find a way to negotiate very good prices,” he said.

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26. February 2008 by Jon Moss.

Post-primary polling shows small business owners and their employees are a significant voting segment equal to, and larger than, well-established voting blocs like veterans and union members.The National Federation of Independent Business, the nation’s leading small business advocacy association, conducted one national survey and six state-specific surveys Tuesday, polling Democrats in California, Missouri and Arizona, and Republicans in California, Missouri and Georgia. Not only did the results illustrate this voting bloc’s significant presence, it showed health care to be one of the most important issues to small businesses.

Polling data from the four states show the impressive strength and bandwidth of small business owners and their employees:

• In California, small business owners and employees made up 28 percent of the Democrats who voted on Super Tuesday, versus union members who were 24 percent.
• In Missouri, small business owners and employees comprised 32 percent of the Republicans who voted, versus 21 percent¹ who were veterans. On the Democratic side in Missouri, small business owners and employees were 28 percent, versus 16 percent who were union members.
• In Georgia, small business owners and employees were 38 percent of the Republicans who voted, versus 19 percent² who were veterans.
• In Arizona, small business owners and employees made up 31 percent of the Democrats who voted, versus 13 percent who were union members.

“More than ever before, small business men and women made up a significant voting bloc on Super Tuesday. It is clear they are a voting segment that should receive the same attention from candidates as other groups, including veterans and union members,” said Todd Stottlemyer, NFIB president and CEO. 

Despite their significant presence, the issues that matter to small business owners and their employees have been overlooked by the presidential candidates. In fact, the national survey found that 81 percent of owners and 52 percent of employees do not feel the candidates are adequately addressing issues that are important to them, especially health care. Presidential candidates are not effectively considering and reaching this significant voting segment, a group that grows each year as corporate downsizing impacts large employers.  

The rising cost of health care is a major concern for small business owners and their employees who continue to be squeezed by premium increases and state mandates. Nationally, 51 percent of small business owners and 47 percent of their employees say they have had difficulty keeping up with the cost of health care. And both groups feel that the presidential candidates are not saying enough about health care on the campaign trail.     
 
“The research shows that health-care reform is a top concern for America’s job creators, and they are desperately seeking help from the next president,” continued Stottlemyer. “Small business owners and employees are bearing the overwhelming burden of a broken health-care system that needs real reform. Candidates from both parties need to address this crisis head on. Because when you fix health care for small business, you fix it for America.”

-NFIB survey results

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26. February 2008 by Jon Moss.

A slew of bills proposed in the current session of the Kentucky General Assembly would require health insurers to expand services they must cover.  The proposed mandates have sparked opposition from Kentucky doctors and health insurance providers.  The proposed legislation includes bills that would require health benefit plans to cover services such as colorectal cancer screenings and mammograms. Other proposals address terms of the relationships between health care providers and health insurance companies.

Melodie Shrader, executive director of the Kentucky Association of Health Plans, said many of the proposals are “unnecessary regulation.” The association represents six insurance providers, including Humana, Anthem. and Aetna.

If the past is any indication, whenever government mandates benefits rates usually go up.

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