Michele Swenson, a Health Care for All Colorado board member, shared these notes on the July 23 meeting of Colorado's Blue Ribbon Commission for Health Care Reform, also known as the 208 Commission. The 24 commissioners, now 27 with three additional commissioners appointed by Colorado's new governor, were charged with soliciting reform proposals, getting independent financial analysis on the top four or five proposals, and then presenting their findings to the Colorado Legislature. The commission decided early on to create their own proposal, and to only submit one reform plan to the Legislature. The Lewin Group, the independent analyst, came back mid-July with number crunching that showed the single-payer plan to be by far the plan that would cover the most people (everyone), with better coverage than virtually any of us now has, for a savings of $1.6 billion. Commissioners weren't impressed. They're still looking to create their own plan, keeping the health insurance industry at the heart of financing health care. Michele took these notes at the commission's proposal committee's first meeting.
Key Questions considered for creating a 5th proposal
•Individual mandate;
•Role of employers;
•Role of government;
•Expansion/reform of Medicaid/CHP+;
•Portability;
•Government subsidies for those on a minimum benefit;
•Minimal benefits
Much of the discussion centered on individual mandate. Commissioner Arnold Salazar said the only question for him was whether an individual mandate would cut costs and increase coverage; otherwise, he would oppose it.
Commissioner Linda Gorman said that Massachusetts has just backed away from an individual mandate, which someone noted would prompt "public pushback." Gorman said that Lewin is not equipped to model individual mandate, which requires data on insurance take-up. It was noted that the mandate for motorists coverage is not working. She also said individuals are responsible to pay for their own health care; that health care is not a right, and providers do not have to provide care for all.
Commissioner Steve Erkenbrack questioned whether an individual mandate is enforceable.
Commissioner David Downs, MD, cited a RAND Corp. study demonstrating that take-up is not good, even with subsidies. He noted that Massachusetts has no defined care for which to provide access, and that their $380/month cost for coverage per individual is too high. Dr. Downs noted the high cost of fragmentation. He cited a government role of assuring adequate infrastructure - information technology, for instance. He said he thought that the Colorado Coalition for the Medically Underserved proposal [not one of the proposals modeled] had a default sign-up similar to a single payer option.
Commissioner Allen Jensen said that the Commission has not looked at the broad spectrum. He cited Medicaid and regulatory reform as two big costs. He said with or without individual mandate, uninsurance rates remain the same.
Commissioner Barbara Yondorf said that her idea of "voluntary single payer (a 2-track plan) would not work without an individual mandate. She suggested asking Lewin to model this both ways. She said that "single payer has a lot of problems." She expressed the desire of some to "fix Medicaid/CHP first."
Commissioner Mark Simon asked for a discussion of the responsibilities of insurers and providers.
Commissioner Don Kortz asked if immigrants would be covered. Commission Chair Bill Lindsay said that is a subject for later committee discussion.
Showing posts with label RAND. Show all posts
Showing posts with label RAND. Show all posts
27 July 2007
12 April 2007
Ezra on patient incentives
Maggie Mahar wrote yesterday on perverse incentives for physicians that drive up costs; Ezra Klein writes today in American Prospect about perverse incentives for patients.
This again offers Bush & co. an opportunity to take real facts and twist them so they'll become ammunition for their class warfare against the middle class. C'est la vie, I suppose. Iron can be used for good — plowshares, say — as well as being potential death dealers as swords. We shouldn't turn our backs on the stuff.
Klein writes that RAND's 15-year study showed that "gold-plated" healthcare coverage that gave 40 percent more care than basic coverage offered no better outcomes.
This is actually an argument in favor of single-payer. Denver Dave of HC Talk has mused that the average person, when thinking about single-payer, pictures U.S. healthcare being a finite entity that he or she has a part of through his or her insurance. If we split the pie differently in order to give some of that healthcare to people who have none now, that seems to mean that he or she would have less.
The RAND study shows that less can be better. What's more, the study also showed this: "The only exception was for the poor, whose health outcomes were hurt by cost-sharing and improved by more generous plans."
Further showing that denying healthcare to the poor (and increasingly to the middle class) is foolish, Klein links to this:
"One-size-fits-all high deductible policies associated with Health Savings Accounts (HSAs) require costly tax breaks for the most affluent while unnecessarily increasing financial and health risks for low- and moderate-income families," Klein writes. He instead likes a plan from his favorite economist, Jason Furman at the Hamilton Project, who has come up with a system that he claims could save 30 percent immediately by charging co-pays adjusted by income.
Of course the only realistic way to do that would be through a single-payer system.
This again offers Bush & co. an opportunity to take real facts and twist them so they'll become ammunition for their class warfare against the middle class. C'est la vie, I suppose. Iron can be used for good — plowshares, say — as well as being potential death dealers as swords. We shouldn't turn our backs on the stuff.
Klein writes that RAND's 15-year study showed that "gold-plated" healthcare coverage that gave 40 percent more care than basic coverage offered no better outcomes.
This is actually an argument in favor of single-payer. Denver Dave of HC Talk has mused that the average person, when thinking about single-payer, pictures U.S. healthcare being a finite entity that he or she has a part of through his or her insurance. If we split the pie differently in order to give some of that healthcare to people who have none now, that seems to mean that he or she would have less.
The RAND study shows that less can be better. What's more, the study also showed this: "The only exception was for the poor, whose health outcomes were hurt by cost-sharing and improved by more generous plans."
Further showing that denying healthcare to the poor (and increasingly to the middle class) is foolish, Klein links to this:
The New England Journal of Medicine... compared Medicare patients who faced heavy cost-sharing for pharmaceuticals with those who had nearly unlimited benefits. The seniors with cost-sharing cut back on pharmaceutical spending (and thus, use) by about 31 percent. The results? More visits to the emergency room, more hospitalizations, and higher rates of death. And the upshot of all this is that the costs incurred by the deterioration in health completely erased the savings from the cost-sharing.Klein agrees with cost-sharing by patients except for chronic conditions where generous care has been proven to pay for itself and more.
"One-size-fits-all high deductible policies associated with Health Savings Accounts (HSAs) require costly tax breaks for the most affluent while unnecessarily increasing financial and health risks for low- and moderate-income families," Klein writes. He instead likes a plan from his favorite economist, Jason Furman at the Hamilton Project, who has come up with a system that he claims could save 30 percent immediately by charging co-pays adjusted by income.
Of course the only realistic way to do that would be through a single-payer system.
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