Winning Medicare for All? 'I Like Our Chances'
Despite insights, Time magazine's cover story falls short on remedy
By James KahnCommonDreams.org, February 28, 2013
In his recent Time magazine article, Steven Brill paints a vivid and rather depressing picture of the perverse malfunctioning of our health care system – overpriced and technology-addicted – and he acknowledges some of the advantages of Medicare.
Sadly, however, he shies away from an endorsement of the obvious solution: an improved Medicare for all, i.e. single-payer national health insurance.
I’ll come back to that a little later. However, let me first say that Brill masterfully illuminates much of what’s wrong with U.S. health care.
Take, for example, the “chargemaster” list: an archival, bizarrely hyper-inflated price list in each hospital based on some long-lost secret formulas and automatically inflated over time.
As a physician and health policy researcher, I’ve long known about the massive charges offered to non-contract payers (read: individuals not covered by a public or private insurer), charges that are completely meaningless for costing studies because they’re almost never paid in full and don’t represent the real resources used to provide care. However, what Brill lays out brilliantly (pun intended) is the following:
• Some very poor (lower-middle income) people actually do pay the sky-high chargemaster rates.
• There is a cottage industry (growing, I’m sure, if nothing else due to this article) to help those hapless souls negotiate steep discounts on these ridiculous bills.
• Hospital administrators either refuse to discuss the chargemaster list or offer up the most heinous, transparently nonsensical justifications for using it.
• Perhaps worst of all, the CEOs of large not-for-profit providers are paid literally millions of dollars (OK, not tens of millions like big for-profit companies, but still …), thereby introducing into a supposedly public-good-oriented setting the compensation (and marketing) tone of for-profit industry.
• When these not-for-profits list their “charity” care they value it at the price levels in the chargemaster, even though the cost to produce those services is less than 10 percent of the chargemaster price.
In these and other instances, Brill performs an outstanding public service. However, he regrettably stops short (or his editors stopped him short) of explaining why a single-payer health care system is the only effective remedy for the mess we find ourselves in today. This despite the fact that much of what he says would lead you directly to that conclusion.
http://www.pnhp.org/print/news/2013/march/winning-medicare-for-all-i-like-our-chances
U.S. hospital chain exec: All GOP governors eventually expand Medicaid under new health law
Posted Feb. 28, 2013, at 11:33 a.m.
Chris Christie of New Jersey and Rick Scott of Florida won’t be the last Republican governors to expand Medicaid under the 2010 health-care law, said Trevor Fetter of Tenet Healthcare: All will do so eventually.
Maine Gov Paul LePage is one of those Republican governors who continues to oppose expansion of Medicaid in the state.
Governors face increasing pressure to expand the program from hospitals that provide millions of dollars in unpaid care to the uninsured, and from businesses struggling with rising premiums, said Fetter, CEO of the nation’s third biggest publicly traded hospital chain, which provides about $450 million in unpaid medical care annually.
“The biggest impact from the expansion for us would be in Texas,” Fetter said Tuesday. About 20 percent of Dallas-based Tenet’s patient beds are in the state, where a quarter of the population is uninsured — and where Republican Gov. Rick Perry has vowed to oppose all aspects of the 2010 health-care law.
“If tomorrow the Texas Legislature and governor were to devise a way to expand Medicaid, investors would think that is a very good thing for the company. There isn’t a scenario I can envision that is worse than the status quo in Texas,” Fetter said.
The decisions within the past week by Scott and Christie bring to 25 the number of states participating in the expansion of Medicaid, the federal-state health program for the poor, according to a tally by Advisory Board Co., a technology, research and consulting company based in Washington. Fourteen other Republican governors, including Perry, oppose the expansion.
Perry announced in July that he won’t expand the Texas Medicaid program, saying the Affordable Care Act signed by President Obama in 2010 represents “brazen intrusions into the sovereignty of our state.”
Obama’s health law, which passed Congress without a single Republican vote, may extend insurance over the next decade to about 27 million people now uninsured. The Congressional Budget Office estimates that 8 million more people will enroll in Medicaid programs next year because of the expansion, which raises the income eligibility limits.
Under the law, the U.S. government will pay the cost of covering people made newly eligible for the program until 2017. Thereafter, states don’t have to pay more than 10 percent of the cost. Christie said his decision to expand Medicaid will save New Jersey taxpayers $227 million in fiscal 2014.
Tenet, which operates 49 hospitals in 10 states, has centers located near the New Jersey border in Pennsylvania that will benefit from having fewer New Jersey residents coming without insurance, Fetter said. Tenet also will gain from Scott’s decision in Florida, where the company has more patient beds than in any other state.
An estimated 3.35 million of Florida’s 19.1 million residents will receive Medicaid this year, according to the state legislature’s Office of Economic and Democratic Research. An expansion under the federal law would increase that by 1.28 million during the next 10 years, according to a November 2012 report from the Kaiser Commission on Medicaid and the Uninsured, a program of the nonprofit Kaiser Family Foundation, a health- care research group based in Menlo Park, Calif.
While Texas eventually will follow the other states, Fetter said, it won’t happen quickly.
“Personally, I think it is only a matter of time and a matter of finding a face-saving opportunity out, but I’m not a politician,” Fetter said.
Some policyholders could see 47 percent hike when health insurance rate increase kicks in March 1
By Jackie Farwell, BDN Staff
Posted Feb. 28, 2013, at 5:37 p.m.
About 7,000 Maine customers of Mega Life and Health Insurance Co. will be affected by a rate change set to take effect March 1.
While some policyholders will see their health premium costs drop by nearly 33 percent, others will be hit with rate hikes of up to 47 percent, according to Mega’s filing with the Maine Bureau of Insurance. The average rate increase across all policyholders amounts to 6.5 percent.
The rate change affects Mega’s individual policyholders, or people who purchase health coverage on their own rather than through an employer. The 6,990 policies involved provide coverage to about 12,600 people, including the policyholders’ dependents.
Richard Barclay, 67, of Holden said he received a letter from the company last week stating that his wife’s individual policy would jump from $323 to $449 a month, a nearly 40 percent increase. He looked into a similar plan offered by Anthem, but it carried hefty costs for visiting medical providers outside the insurer’s network, he said.
Faced with paying the higher Mega rate for another 19 months, after which his wife will qualify for Medicare at age 65, Barclay said the couple may drop her coverage.
“If there are no [health] issues come January, we’re probably going to go with no insurance,” he said.
The letter from Mega about his wife’s policy, a $7,500 deductible plan, cites rising “health care-related costs” as the reason for the rate increase, Barclay said.
“Somebody’s going to make an awful lot of money off this, if they don’t lose all their customers,” he said.
According to Mega’s filing, the company expects to earn about $24.4 million annually with the rate increase, while paying out $17.2 million in claims. That translates to a nearly 30 percent gross profit margin, or $7.2 million annually, not including expenses such as state and federal taxes.
Mega ultimately will net an estimated profit margin of 3 percent, according to the insurance bureau. That’s after several types of costs are subtracted from the remaining $7.2 million, including taxes, administrative expenses, commissions paid to agents, and “cost containment measures.” That method of calculating profit margin has been used by insurers for a number of years, said Doug Dunbar, a spokesman for the Maine Department of Professional and Financial Regulation, which oversees the insurance bureau.
Mega last filed for a rate change in July 2011, seeking an average 8 percent increase for new policies.
“The Maine Bureau of Insurance recently implemented several changes to their regulations that impact how insurance companies operating in the state calculate premium rates for different categories of business, member ages and geographic locations,” Mega’s parent company, HealthMarkets Inc., said in a statement on Wednesday. “As a result of these changes, some policyholders may experience higher rate increases than others.”
In May 2011, Gov. Paul LePage signed into law a statewide health insurance overhaul known as PL 90. The controversial legislation was backed by Republicans who said it would make health insurance more affordable and decried by Democrats who labeled it “reckless.”
Blue Cross to pay board again, though at reduced level
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