UNHCR
In response to a post by Jay Parkinson:
Today the average health insurance premium is $11,000 a year per employee. In 2020 it will be $29,000. Health insurance reform spreads the cost of premiums across three entities— employers, individuals, and the government. Costs are being redistributed to land less on employers and individuals and more on the government.
The health reform bill begins to address these concerns through taxing employer-based “Cadillac” insurance plans which encourage wasteful spending. This will raise revenues to pay for expanding coverage as well as provide greater incentive for employers to choose insurance plans that hold down cost. Other strategies such as bundling and health insurance exchanges will also help.
The cost of healthcare in America is still doubling every 8 years because our population is getting older and sicker and we pay for healthcare based on sickness. Again, the cost is still doubling. The only difference is who pays the checks.
Rising costs and demographic changes only provide an even stronger argument that the status quo is unacceptable and that reform needs to happen. The Congressional Budget Office, the non-partisan budget scorekeeper agreed upon by both parties, reports that the current reconciliation bill, HR 4872, will reduce the federal deficit by $124 billion dollars over the next ten years (link). It accomplishes this while extending coverage to 32 million people and providing federal subsidies to those who cannot afford to purchase insurance on their own.
This is why I support the bill. It’s not perfect, but it improves the status quo and lays a foundation for future health reform.
These three components effectively create a closed loop of finite money in and out with all three stakeholders having skin in the game. The question is this…what’s the demographics of the smallest group for which this financially works? And how can this group thrive as a private, profit-driven, competitive wellness company?
Here is the question I ask: “How can we set up a system to provide affordable, equitable, and quality care to the largest group of people possible?” I believe this bill moves us in that direction.
Previously undisclosed records from Mitchell’s case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
Read the whole story here
This a really cool example of how data visualization makes complex issues much more simple. The current healthcare debate needs to focus on straight forward critiques of the current system and ways in future systems might improve these issues (such as this one), rather than giving voice to the more outrageous claims to garner shock value and ratings.
My only issue with the above presentation was the direct comparison between life-expectancy and healthcare spending per capita might be somewhat misleading. I can easily think of many confounding issues — lifestyle choices, health-seeking behaviors, environmental factors, etc — that could be messing with the numbers. I’ve seen a pie graph of factors which influence an individual’s health, but I can’t remember exactly where I ran across it. It basically showed that genetic predisposition, lifestyle, and environmental factors all contributed more to overall health than the quality of healthcare received. Anyway, it’s something to keep in minding while enjoying the presentation.
Slate published an interesting article today on how medicare determines the cost of various procedures. They use a system which assigns “relative value units” to every procedure based upon the mental effort and stress required of the doctor. This fancy-schmancy procedures like CT scans are worth many RVUs whereas more simple procedures are worth less. Every RVU is worth about $40 right now, so RVUs*$40 how much medicare doles out.
Who determines how many RVUs the procedure is worth? A panel of doctors made up of mostly specialists — those people who profit most by charging more for big fancy procedures. Two things strike me immediately —
1. Is the cost of the equipment or time required for the procedure factored in at all?
2. What about the patient’s need for the treatment? Is a simple life-saving treatment worth less than a complicated yet less important treatment?
It seems like the RVU system sets up a perverse incentive scheme that rewards big fancy procedures performed by specialists over more simple care provided by a family practice doctor. I could easily see how this contributes to the current healthcare mess we’re in.
