The Downfall of AIG

Those of you outside of Washington, DC likely missed the Washington Post's three-part investigation of the events leading to the downfall of AIG.It makes for good holiday reading. I highly recommend the series to you.Knowing the culture at AIG from many years of activity with the company and its leadership, I can tell you the story certainly has the culture right.While this is not a health care

"A Handshake That Made Health Care History"--A Boston Globe Expose: A "Quiet Deal" Between Mass Blue Cross and Boston's Most Powerful Hospitals

In a lengthy expose entitled, "A Hand Shake That Made Health Care History," the Boston Globe details what it called a "gentleman's agreement that accelerated a health care cost crisis" in Massachusetts. The reported deal was between Partners Health Care, the state's biggest health care provider, and Massachusetts Blue Cross, the largest state insurer.The article charges that the agreement all but

CBO to Health Care Reformers: Naive Policy Makers Need Not Apply

The Congressional Budget Office (CBO) has released two comprehensive papers detailing the policy and financial options for health care reform: Key Issues in Analyzing Major Health Insurance Proposals and Budget Options, Volume I: Health Care.I can't overestimate the importance of these documents to health care reform.I recently did a post as sort of an open letter to the CBO: To the Congressional

Conservatives Need to Be Part of Health care Reform

Stuart Butler, Vice President of Domestic Policy at the conservative Heritage Foundation has an op-ed in Thursday’s Washington Times, “Four Steps Can Heal Health Care.”He makes some very valuable points and proposes four steps toward reforming the health care system most people—liberals and conservatives—could agree on:Making sure every working family has access to an affordable private health

“Irrational Exuberance” and Health Care Reform—Slow Down!!!

I think Pete Stark has it right. In a story in The Hill, Stark calls for waiting until later in 2009 or 2010 to move on a big health care reform proposal. The House Ways and Means Health Subcommittee Chair also points out that there are a number of "deferred maintenance" issues that will need to be dealt with sooner—SCHIP renewal, the upcoming Medicare physician fee cuts, and the pending health

"Expanding Coverage Without Increasing Health Care Spending: Dartmouth Institute White Paper Recommends Course for the Obama Administration"

Once again the Dartmouth Institute for Health Policy and Clinical Practice has provided a valuable contribution to our health care reform discussion with their new paper, "Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration."In my mind the authors made two critical points:We can insure everyone without dramatically increasing national

Who's The Guy Sitting Next to You? The Obama Health Care Reform Parties and Unexpected Guests

The incoming Obama administration is getting a quick start toward health care reform.By the end of the year, they anticipate having thousands of health care discussions in homes, businesses, coffee shops, and the like.About everyone, including the Obama health care team, believe Hillary Clinton's 1993 top-down health care reform process was a big mistake. The new folks don’t intend to make that

The Best Way to Spend the Coming Federal Health IT Money: An Open Letter to the Obama Health Team

An Open Letter to the Obama Health TeamBy David C. Kibbe & Brian KlepperIt seems likely that the Obama administration and Congress will spend a significant amount on health IT by attaching it as a first-order priority to the fiscal stimulus package. We take the President-elect at his word when he recently said:“...we must also ensure that our hospitals are connected to each other through the

How Can We Accomplish Health Care Reform If Everyone Ends Up Getting More?

I doubt anyone would disagree with the statement that America’s health care costs are too high, continue to grow at an unsustainable rate, and reform is critical to control costs, get everyone covered, and improve quality.In the wake of the election, I see one positive and magnanimous press release after another coming from the health care special interests. The press is full of daily stories

Likely Health Care Reform Will Not Reform the American Health Care System

Remember those Archway "Windmill Cookies?" They were a favorite when I was growing up.Robert Pear's article in the New York Times this weekend reminded me of that treat my mother used to buy for us kids. His article also illustrated the crisis many families are facing in what looks like it will be the worst recession of our lifetimes.Archway was a great American company--it was in business for 72

We Can Save 30% By Getting Rid of the Waste in the U.S. Health Care System—Sounds Like "Groundhog Day" To Me

As we begin the health care reform discussion in earnest, many are pointing out all of the waste in the system and the need to research what works best, provide the incentives to do it, manage the big spenders’ chronic care better, make better use of heath information technology, and encourage wellness and prevention.One of the disadvantages of being at this for more than 20 years is that I feel

Consensus on Health Care Reform Means More Than 70 Senate Votes

The Clintons have been criticized for agreeing to allow their 1993 health care reform plan to be subject to the Senate’s 60-vote rule. With the Democrats controlling what will end up to be 59 or 60 votes in the new Congress, some are arguing that the Democrats should move quickly and get their plan passed under the budget rules that would require only a simple majority.Trying to get legislation

Stimulus Spending and Health Care

Last week I was saying we were facing a $1 trillion budget deficit in the current fiscal year and that made health care reform problematic.This week, the operative number is $2 trillion.It was $1 trillion before reports that the President-Elect would be looking at a stimulus bill in the $700 billion range as well as reports his planned income tax cuts are on track and his planned income tax

"Two Girls Two Countries One Cancer"

David Whelan has an interesting article at Forbes.com following two girls through the same serious cancer diagnosis here and in Britain.As David put it, "When stories get specific, as in the cases of Zoe and Ellen, two kids from similar backgrounds with the same disease, the generalities [about the differences in our health care systems] start to break down."

Small Business Health Insurance Coverage: A Sobering Report From the Trenches

One of the things I enjoy the most about my travels across the country is meeting benefits brokers and health plan sales reps--they have the best feel for the real market and what their customers and their employees are up against.This very sobering and, from what I independently hear, accurate report about the small group health insurance market comes courtesy of Brian Klepper. Please note the

An Adult Conversation About Health Care Reform

Zeke Emanuel and Shannon Brownlee have an op-ed in Sunday’s Washington Post that should be required reading for anyone interested in health care reform.The title is, “5 Myths About Our Ailing Health Care System.”They suggest the “5 Myths” are:America has the best health care in the world.Somebody else is paying for your health insurance.We would save a lot if we could cut the administrative waste

The Healthy Americans Act--Wyden-Bennett Bill--Still in Play

A recent letter from 15 Senators to President-Elect Obama caught my eye.The letter was from Senators Ron Wyden (D-OR), Bob Bennett (R-UT), and the other 13 Senators on their health care reform bill--7 Democrats 7 Republicans, and one independent--to President-Elect Obama reminding him of the progress this bipartisan group has already made toward health care reform.As readers of this blog know, I

Insurance Industry Reform Proposal––Little Ado About Nothing

This week the health insurance industry trade association announced that its board had approved a new policy position. The industry has agreed to guarantee the insurability of everyone if the nation passes a health insurance plan that requires everyone is covered.That’s a no-brainer for the industry to offer and not much of a deal.If everyone is in the insurance pool—sick and healthy alike—there

Daschle for HHS?

Word around town is that Tom Daschle, the former Democratic Senate Majority Leader, is going to be named HHS Secretary.That would mean that President-Elect Obama is going with a political and health care policy heavyweight.With word yesterday that Senator Kennedy has appointed Hillary Clinton (presuming she stays in the Senate) to take the lead on the health insurance reform portion of his health

Health Care Reform a "Longer Term Goal" For the Obama Administration?

Under the headline in today's Washington Post, "Kennedy Announces Plan to Submit Bill For Universal Care" was this:"Some Democrats, including members of President-elect Barack Obama's circle, have begun to view expanded [health care] coverage as a longer-term goal."Is the new administration trying to send a message to its health care eager constituencies that given the economy and all of the

"The Changes We Need"

The Changes We Needby Brian KlepperThese are, as the Chinese curse reputedly called them, interesting times.If the burst of new Democratic health care reform proposals is any indication, the fresh breeze of the Obama campaign's "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee

Medicare Advantage Payments to Insurers--Baucus Zeroing In!

Senate Finance Chair Max Baucus (D-MT) released his health plan white paper last week.Buried in it was this regarding how private Medicare payments to HMOs should be changed:“Congress must act to level the playing field between traditional Medicare and Medicare Advantage payments and the Baucus plan would do so. Enacted in July 2008, MIPPA [the July physician fee fix that will end PFFS] took

Market Capitalism and Health Care--It Will Never Be the Same

Washington Post business page columnist Steven Pearlstein's Friday column, "Toward a New International Capitalism," caught my eye.Here's a snippet:"From the Latin American debt crisis of the 1980s to the Asian financial crisis of the 1990s to the Internet craze at the turn of the century to today's economic conflagration, the past 20 years have provided ample evidence that uncontrolled flows of

To the Congressional Budget Office: Please Keep Playing it Straight!

I guess this is an open letter to CBO Director Peter Orszag and his colleagues at the Congressional Budget Office (CBO).I have great respect for the CBO and that has been the case under different majorities--Democratic and Republican. Never more than now.The CBO is intended to be non-partisan and objective. They provide the information and estimates the Congress needs to complete the budget

The Baucus Health Plan Proposal--Evidence There Is No Consensus on the Key Health Reform Issues

Max Baucus will be a key player in the health care debate the next two years. As chairman of the Senate Finance Committee he has jurisdiction on many of the key issues including Medicare and provider payment reform.He is also a leader in the true bipartisan spirit--something crucial to actually getting reform done.Yesterday, he released a 98-page white paper, "Call to Action--Health Reform 2009."

There is Now a Real Bipartisan Opportunity in Health Care

President-Elect Obama, and about every candidate for Congress, has said he wants to change the partisan tone in Washington. Obama, the Democratic Congressional leadership, and the Republicans have a terrific opportunity to do just that on health care when they all come to Washington early next year.As I posted earlier, I do not believe there is any chance we can see the enactment of the

The Morning After: Obama and the Dems Win Big--What It Means For Health Care

258 House and 57 Senate Democrats make it almost certain that major health reform will be passed. Right?Actually, that was the number of Democrats Bill Clinton started off with in 1993 and we know what happened to health care reform in that Congress.With similar Democratic majorities, I do not expect a major health care reform bill like the one President-Elect Barack Obama called for during the

High Costs for the Massachusetts Health Law--Sustainability is Now the Question

The Center for Studying Health System Change has just released a study examining the state of the important health reform law in Massachusetts.As one of the co-author's put it, "Improving access to heath care coverage has been a clear emphasis of the reform, but little has been done to address rapidly rising health care costs, raising questions about the longer-term viability of the reform."I can

Can Health Plans Explain Why They Aren't Re-Empowering Primary Care?

Brian Klepper and David Kibbe offer a post today on the issue of primary care and the role they believe health plans should be taking to encourage greater involvement with PCPs. They ask why health plans are not being more proactive in partnering with PCPs to control costs.Can Health Plans Explain Why They Aren't Re-Empowering Primary Care?By Brian Klepper & David KibbeSometimes a whisper is more

Health Wonk Review is UP!

David Harlow hosts this week's edition of Health Wonk Review over at his, "HealthBlawg."It is a very comprehensive sample of some of the best recent posts from the world of health blogs.

The McCain Health Plan's Good Idea for Health Care Reform--Likely Going Down With the Candidate

John McCain would reform the American health care system by providing big tax incentives for it to transition from being employer-based to one built on a system of individual responsibility. He would do this by eliminating the longtime personal tax exemption on employer-provided health insurance and replacing it with a $2,500 individual, and $5,000 family, tax credit for those who have health

Coventry Health Care Stock Down 48%--"Sort of" No Surprise

Readers of this blog will not be surprised to see Coventry Health Care's stock down 48% this afternoon after its earnings call this morning.That is a 77% drop from their 52-week high.Last July I commented on their earnings call where senior management used the precise financial term "sort of" 63 times to explain their then earnings and operations situation: Required Reading for Health Care

What Impact Do Medical Costs Have on Home Mortgage Foreclosures?

That is the subject of a recent paper by Christopher T. Robertson, Richard Egelhof, & Michael Hoke.The authors studied homeowners going through foreclosure in four states and found a big impact on their being able to stay in their house because of the health care cost issues these families had to deal with.Here is an excerpt from their work:"This preliminary study reveals that the standard

Demystifying U.S. Health Care Spending--Some Surprising Information

Paul Ginsburg, of the Center for Studying Health System Change, has just authored a new report, "High and Rising Health Care Costs: Demystifying U.S. Health Care Spending." The report is part of the Robert Wood Johnson Foundation's Synthesis Project.This paper reviews existing literature in search of a more clear understanding of U.S. health care costs, the drivers, and the trends.It is an

HIGH AND RISING COSTS: DEMYSTIFYING U.S. HEALTH CARE SPENDING

I have seen an advance copy of this very comprehensive report on the growth in health care spending. If you are in DC next week, I highly recommend this event to you:HIGH AND RISING COSTS: DEMYSTIFYING U.S. HEALTH CARE SPENDINGNew Report Synthesizes the Literature on the Growth of Health Care SpendingConcern about high and rising health care costs in the United States has increased sharply in

Time to Get Real--On the Economy and Health Care Reform

I just got a call from a reporter at one of the major news organizations to talk about the chances for health care reform.We both commented on the almost surreal environment we are all in. I'm not sure if my friends and neighbors are in denial or just numbed by the recent cascade of events in the financial world. Up on the Hill and in the presidential campaigns it's business as usual when it

The Big Elephant in the Room During the Presidential Debate

Last night Tom Brokaw asked Barack Obama and John McCain to prioritize health care, Medicare/Social Security, and energy. Neither of them backed down from their promises to deal with all of them.When Jim Lehrer tried to challenge them at the last debate on their ability to do all of the expensive things they want to do he got pretty much the same answer.About the only two people in America that

What I'm Telling the Health Care Business About the Future

Last week I did a post, The Chance for Major Health Care Reform in Either 2009 or 2010 Is Now Zero.I made the point that the bailout the Congress is now voting on is on top of a 2009 projected federal budget deficit that the White House has already estimated to be $500 billion. Add to that the $300 billion in deals the feds have done for the likes of Freddie, Fannie, and AIG. Then we have the $

Health 2.0 in San Francisco October 22-23

Matt Holt is getting ready for his upcoming Health 2.0 conference and asked that I pass along his personal invitation:The next Health 2.0 conference will be held in San Francisco, California from October 22nd - 23rd at the San Francisco Marriott. The theme will be a return to the focus that made our first conference a resounding success: Web 2.0 technologies, healthcare and all points between.

The Chance for Major Health Care Reform in Either 2009 or 2010 Is Now Zero

A couple of weeks ago I did a post, The Pretend Presidential Debate on Health Care--The Health Care Press Needs to Force the Presidential Candidates to Get Real on Health Care "Change".In it I made the point that facing a $500 billion budget deficit next year, the sunset of the Bush tax cuts in 2010, fixing the alternative minimum tax problem once again, and the cost of the Freddie and Fannie

AIG and Regulation Versus Deregulation

As I posted earlier today, I believe the feds did the right thing in making sure AIG did not fall.But as the dust settles, that takes us to another big question--the question of more or less regulation generally and, more specifically for readers here, more or less regulation for the health insurance industry.The first thing to note is that the existing state regulation of the insurance industry

AIG--The Feds Did the Right Thing and Only They Could Have Done It!

There is that old saying: "There are the bears, the bulls, and the pigs--and the pigs get slaughtered."This past weekend I witnessed the most incredible thing I had ever seen in the insurance industry with the demise of the world's largest insurer--AIG. AIG was not just a company--it was a legend in the industry.Now, a couple of days later, that has been trumped--in spades--by the United States

The Pretend Presidential Debate on Health Care--The Health Care Press Needs to Force the Presidential Candidates to Get Real on Health Care "Change"

Let's pretend that either Senator Obama or Senator McCain will be able to implement their respective health care reform plans if elected. Should be easy--we've been doing it for months now.Or, we can get real and expect them to do the same.For all the arguments both are making that they are change agents, including over the candidates' competing health care reform proposals, is this dirty little

"Lipstick on a Pig"--The McCain Campaign is Defining the Fight

The quickest route to a political loss is to let the oppostion define the fight.Anyone who listened to just 10 seconds of the Obama "lipstick on a pig" sound bite knows he wasn't talking about the Alaska governor.But what this whole dust-up tells us is that the McCain campaign is defining the debate and the Obama side can't get their message out.Not that long ago the Obama campaign was

Comparing John McCain's Health Care Plan to Barack Obama's Health Care Plan

Now that the political conventions are over we are in the final weeks of the presidential campaign. Here is my primer on both of the candidates' health care reform plans and the the big idea difference between them.Comparing Barack Obama's Health care plan to John McCain's health care plan:What's the Big Idea Difference?A Detailed Analysis of Senator John McCain's Health Care Reform PlanA

The Long-Term Viability of Medicare Advantage--Why Aren't the Analysts Asking for the Numbers to Add-Up?

I have been struck by the optimism regarding private Medicare presented by health plan executives during the recent earnings season and the analysts failure to press them on just how their numbers will add-up to sustain the long-term viability of a private Medicare strategy.The typical private Medicare health plan operates on a medical cost ratio in the mid-80s. Let's assume 86% for medical costs

The Cost of the Massachusetts Health Insurance Law is "Less Than Expected"

That was the conclusion in a recent New York Times editorial, not to mention the growing spin coming out of Massachusetts, regarding the state's new health plan.As I have said before on this blog:Massachusetts finally took a first big step in health care reform--something no one else has been able to do in Washington, DC or elsewhere and that is to be commended.The Massachusetts Health Insurance

Do Certificate of Need Programs Reduce Costs? Governor Palin Says "No" But Lots of Data Say "Yes"

Republican vice presidential candidate Sarah Palin hasn't done a lot on the health care policy front during her short time as Governor but one thing she has called for is an end to Alaska's Certificate of Need (CON) program requiring preapproval for any new health care facility.CON programs are about government management of health care capacity and it should be no surprise that a conservative

Sarah Palin on Health Care--A Free Market Republican

Republican vice-presidential candidate Sarah Palin has very little on her health care policy resume from her short time in office as Alaska's Governor but what she does have fits right in with Senator McCain's strategy to use the market more effectively in bringing down America's health care costs and improving access to the system.Her health care efforts have focused on two things in

"US Healthcare on the Edge: A Prescription for Cure"

Jonathan Lorch and Victor Pollak, two physicians with plenty of experience and accomplishments in America's health care system, have suggested the steps they think will go a long way toward making our system work.I am pleased to post a brief description of their plan and a link to the full proposal.US Healthcare on the Edge:A Prescription for Cureby Jonathan Lorch and Victor PollakThe US

McCain-Palin

Who?Well the self-described maverick surprised everyone this morning.While many kept saying it would be Romney, I never believed it. First, they don't like each other. Second, a Romney pick would have flown in the face of the McCain health care strategy ( If McCain Picks Romney He Will Never Again Be Able to Criticize Obama's Health Plan).Governor Palin would seem to be a conservative Republican

Health Wonk Review is Up

Julie Ferguson hosts the latest edition of Health Wonk Review over at the "Workers' Comp Insider."She has a great list of recent posts from the world of health blogs suitable for beach reading. Just turn up the brightness on that screen!

What Happened to the Health Care Issue?

An interesting article in today's Chicago Tribune.Readers of this blog know we've been having a spirited debate recently on the question of just how likely health reform will be in 2009. Brian Klepper and Maggie Mahar have added to this discussion with some interesting posts and comments.The Trib headline:Health care no longer primary ailmentEconomy, price of gas, war in Iraq have surpassed

"Chastened and More Sober, Harry and Louise Return"

Brian Klepper joins us again today on the subject of just how realistic health care reform will be in the coming year.Chastened and More Sober, Harry and Louise Returnby Brian KlepperYesterday Ron Pollack of Families USA led a call with bloggers - unfortunately, I couldn't be on it - to discuss a new health care reform campaign sponsored by 5 prominent organizations: the American Cancer Society's

This is What a Real Cost/Quality Decision Looks Like

The UK's National Institute for Health and Clinical Excellence (NICE) has decided in a preliminary ruling that four drugs used for the treatment of advanced kidney cancer are not effective enough and they won't be paid for by the National Health Service.Now before someone just claims this is what single-payer health care plans do all the time, let me be clear that NICE is an organization that has

The Voters Aren't Upset Enough About Health Care--And Why Should They Be?

The health care issue has a history of being named by voters as one of the biggest problems we face--until the problem de jour comes along and pushes it off the list. In 2008, that seems to be happening again with the economic downturn, the mortgage mess, and $4 gas surpassing health care as the big issues.When asked to name the most important financial problem facing families today by the Gallup

Health Wonk Review

It's my turn to host Health Wonk Review--a synopsis of some of the best recent posts from the world of health blogs.HWR founder Joe Paduda starts things off with a post critical of investment analysts handling of a recent Coventry Health earnings conference call with his assertion that "the analysts blew it." First the analysts helped HMO stocks hit historic lows this year and now seem to be

Health Care Reform, the Federal Deficit, and the Bush Tax Cuts--A Very Counter Productive Combination

Readers of this blog have been very fortunate this week to hear from Brian Klepper and Maggie Mahar on the subject of just how realistic is it to expect any kind of meaningful heath care reform in the next year or two.They have both made excellent points--and both hope real health care reform will happen.But there is a big bucket of cold water we all have to factor into such a discussion.While

Will the Lobbyists Make Meaningful Health Care Reform Impossible?

Maggie Mahar joins us today. She responds to a recent post here by Brian Klepper. Brian argued that health care reform will be a very difficult thing to do in the near term. At the top of Brian's concerns is the the impact lobbying money has on the ability of the Congress to achieve real reform. While Maggie agrees that special interest money is a big factor, she argues there are other reasons to

State High Risk Pools For the Uninsured--Who Would Want To Be In Them?

What do we do with people who are uninsurable because they have a pre-existing medical condition?That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.One of the solutions being discussed--by McCain among others--is to use state-based risk pools. Under McCain's plan heavily dependent on an

Required Reading for Health Care Analysts and Coventry Health's "Sort of" Informative Conference Call

Joe Paduda, writing over at Managed Care Matters, has a post any health plan investor should read.He laments that the analysts just weren't asking the right questions and weren't tough enough during last week's Coventry Health earnings call.With my 35 years in the health insurance business, I have to agree with him. He's dead on.Beyond Joe's comments, I noted that management used the precise term

If McCain Picks Romney He Will Never Again Be Able to Criticize Obama's Health Plan

Mitt Romney seems to be at the top of the list when it comes to speculation over who John McCain will pick for his vice presidential running mate. I am not sure if that is what John McCain is thinking as much as the Romney people, trying to boost their guy, want us to think.But if McCain picks Romney, it will make for an interesting health care debate this fall.The Obama Health Plan is a virtual

The End of Medicare Private Fee-For-Service--the Questions to Ask the Health Plans During Earnings Season

Now that we know private fee-for-service (PFFS) is dead on January 1, 2011 in all but the most rural markets, how will the health plans who have significant PFFS business respond?UnitedHealth is the first health plan to report earnings this quarter and I thought they had the right answer. From their earnings call transcript (Ovations CEO commenting):We have had a strategy of deliberately

Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?

Our good friend Brian Klepper joins us after a bit of a summer break. This time he examines the dynamics of health care reform and questions just how optimistic we should be that progress will be made.Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?By Brian KlepperThose who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few

Health Insurance Industry Stupidity—It’s a Rout From Here On Out

Why the health insurance industry allowed itself to be put in the place they were put by the Democrats yesterday is beyond me.With the Senate voting 70-26, and the House 383-41, to override President Bush’s veto of the bill to erase the 10.6% Medicare physician fee cut and pay for it with changes that will end the Medicare private fee-for-service program in 2011, the health insurance industry’s

The National Coalition On Benefits' Oppostion to the Wyden-Bennett "Healthy Americans Act"--Maybe They Like It After All?

The National Coalition on Benefits is a group of more than 150 of America's biggest corporations as well as the U.S. Chamber of Commerce and the Business Roundtable.They wrote a letter to Senators Ron Wyden (D-OR) and Bob Bennett (R-UT), cosponsors of the bipartisan "Healthy Americans Act," telling them that their bill was a non-starter because it dared to mess with ERISA. The Wyden-Bennett bill

Underwriting Cycle or Medical Trend Rate Cycle?

Analysts trying to predict the future of the health plan business who are looking for an underwriting cycle will miss the real turns in the market.Recent health plan earnings issues have once again raised the question, do we still have an underwriting cycle, and are we entering one?In my mind, anyone trying to understand the profitability of the health plan business who concentrates on whether or

"Wall Street Comes to Washington"

The event I look forward to every year is "Wall Street Comes to Washington," Paul Ginsburg's (Center for Studying Health System Change) annual merging of Wall Street and policymakers in a lively discussion of health care from both perspectives.The last few years I have gotten to participate on the health insurance market panel. The session also had a panel concentrating on hospital, physician,

The Next Medicare Physician Fee Cut--17 Months, 20 Days, and 13 Hours to Go

The "Medical Home"--A real Solution?Now that this year's fight over Medicare physician fees is all but over, it is important to turn to real solutions.The recent Senate and House vote to kill the 10.6% physician fee cut only defers the problem for 18 months.On January 1, 2010, the Medicare physicians are slated to get an automatic 21% fee cut!More importantly, the Medicare physician fee structure

Senate Votes 69-30 To Rescind Medicare Physician Fee Cuts and Cut Medicare Advantage to Pay For It

Ted Kennedy came to the Senate floor and led Senate Democrats to an amazing victory in their first real attempt to rein-in private Medicare spending and rescind the 10.6% physician fee cuts.The veto-proof margin puts President Bush's threat to veto the Senate bill, that was approved by the House on another veto-proof 354-59 vote just before the holiday, in doubt. Why bother?I was not surprised to

So I Guess the HMOs, U.S. Chamber of Commerce, Business Round Table, and Over 150 Big Corporations Are Opposed to McCain's Health Plan?

That's the only conclusion I can come to after having read the letter the National Coalition on Benefits has written to the authors of the Wyden-Bennett Healthy Americans Act.Wyden-Bennett is a comprehensive health care reform proposal that would largely replace the existing employer-based system of health insurance with one based on individual responsibility and individuals purchasing coverage.

State of California "Fearful" of Enforcing $1 Million Fine Against Wellpoint/Anthem Blue Cross for "Illegal" Health Insurance Policy Rescissions

Crazy as it sounds an AP story on Thursday reported that the California Department of Managed Care "didn't even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they feared they would be outgunned in court."Last year the department announced that it would fine the insurer for improperly rescinding individual heath insurance policies in the midst of the

What Do We Need to Do to Fix the Medicare Physician Payment Problem?

Whenever the subject of Medicare physician fee payments comes up on this blog, the reaction from physicians, particularly primary care docs, is predictable: "You can't cut us, we haven't had a Medicare raise in years, we are already dramatically underpaid, and if Medicare cuts our payments we are going to stop taking Medicare patients."There is no doubt that doctors have a point--particularly the

Run For the Hills, the Doctors Are Coming, the Doctors Are Coming!!!!

What is the one thing no human being should want to be next week?A Republican Senator at a Fourth of July Picnic.In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, DC, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts

A Flawed Defense of Medicare Advantage

If private Medicare is to be continued proponents had better make better arguments than Scott Gottlieb made on Tuesday's Wall Street Journal op-ed page.Gottlieb is a former Bush Administration CMS official and is currently at the American Enterprise Institute.The context of his arguments is that this week Congress is debating making cuts to the private Medicare Advantage program in order to pay

Coventry Health--Another Reminder That This Isn't an Easy Business

Here are some comments from a first quarter earnings call Coventry management would sure like to take back.Yesterday, Coventry reported that its Medicare private fee-for-service business will miss its second quarter medical cost ratio projections by more than 300 basis points and that it will miss its prior second quarter estimates for its commercial medial cost ratio by a whopping 200 basis

Coventry Health Care--What the Heck Is Going On?

When WellPoint, Humana, United, and others had earnings warnings this spring I pointed out their issues were largely unrelated and amounted to more rounding errors as the helpful five year deceleration in health care trend came to an end and the business just wasn't as easy.But today, Coventry hit us with a 300 - 340 basis point adjustment in their expected Medicare Advantage medical loss ratio

Transparency and Accountability: The Door Swings Both Ways--AMA Releases Its "National Health Insurer Report Card"

You have to wonder what they're thinking about over at AHP--the health insurance trade association that called for more transparency and accountability for the provider community a few days ago--now that the American Medical Association's (AMA) detailed report card on insurer claim processing performance is out.And, it's a fascinating read.How often do health plans pay at the contracted payment

Wall Street Relieved Democrats Unable to Cut Private Medicare Advantage Payments This Week--Why?

Congressional Democrats tried to take a big bite out of private Medicare this past week in an attempt to pay for an 18 month fix to the upcoming July 1st 10.6% reduction in Medicare physician payments.The effort, led by Senate Finance Chair Max Baucus (D-MT) got only 54 of the 60 votes he needed to end debate and move the issue to a floor vote. While getting that floor vote would almost have

"I Hear the Train a Comin"--What Does That Johnny Cash Refrain and the Employer-Based Health Care System Have in Common?

OK, maybe it's a stretch but bear with me.I heard a senior exec from a big health plan say the other day that it's hard to believe we will ever see the end of health insurance distributed primarily through the workplace in favor of an individual-based health insurance system. In fact, much of the health insurance industry is lining up behind staying with the system we know best and the one who

Health Wonk Review is Up

This time Jane Hiebert-White does a great job of selecting some of the most thoughtful posts from the world of health blogs over at the Health Affairs Blog.Topics include federal health reform, health information technology, consumer and patient rights, the business of health care, research-based policymaking, and others.

Comparing John McCain's Health Care Plan to Barack Obama's Health Care Plan--What's the Big Idea Difference?

This election is different than any other on the issue of health care because both candidates are giving us serious blueprints to reorganize America's health care system and those blueprints are very very different.As voters, you have a huge and critically important choice on health care.There are dozens of details upon which they differ and for those I would point you to my comprehensive posts

A Detailed Analysis of Barack Obama's Health Care Reform Plan

March 8, 2010Any big health care bill will be full of compromises—political or otherwise. But the Democratic health care bill doesn’t even come close to deserving to be called “health care reform.” As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do

A Detailed Analysis of Senator John McCain's Health Care Reform Plan

A Detailed Review of Senator John McCain's Health Care Reform PlanMcCain’s thinking on health care couldn’t be more different from Democrat Barack Obama.McCain very rightly points to health care costs as the biggest health care issue, "We are approaching a 'perfect storm' of problems that if not addressed by the next president will cause our health care system to implode."Therefore, his focus is

Would Either Barack Obama's Health Plan or John McCain's Health Plan Contain Costs?

With the health care reform efforts in Massachusetts presenting us with an incomplete result for an unsustainable cost, just how the presidential candidates' health care plans will contain costs is an even more important issue.The short answer is neither offer any kind of silver bullet solution to controlling America's health care costs. Both Obama and McCain propose similar generally good cost

Comprehensive Health Care Reform and Massachusetts--Are We On Our Way To a Very Different Debate?

The Massachusetts health care reform law appears on its way to:Covering two-thirds of those who did not have health insurance on the day it was enacted--about 400,000 people by the end of 2009.Covering most of those who were uninsured in households with incomes below 300% of the federal poverty level--below which the plan pays all or most health insurance premiums.Offering health insurance plans

"Healthcare Guaranteed"--A Health Care "Solution" Offered Dr. Ezekiel Emanuel

I just received a copy of Dr. Ezekiel Emanuel's new book "Health Care Guaranteed."I am anxious to get into it as Dr. Emmanuel's health plan has received considerable attention.In the meantime, Maggie Mahar over at "Health Beat" has put together two posts on the plan, "A Fresh Look at Health Care Reform" you might find useful.Dr. Emmanuel creates a voucher system enabling everyone to buy a private

AHP Announces a Health Care Reform Initiative and Tells All of the Other Stakeholders What They Ought to Do

I'd like to propose a new health care reform rule.You can't announce health care reform proposals unless Part 1 of your plan first tells us just what it is your side is going to sacrifice for the effort.I don't know about you, but I am getting tired of one vested interest after another in the health care system telling the others what it is they have to do to fix the system. Everyone has to

Childhood Obesity--The Washington Post's Five Part Series on an Important Issue

Last week, the Washington Post gave us a five part series on childhood obesity.It made the point, which has been made here a number of times, that for the first time in our history American children are on their way to a shorter life span than their parents.This comes on the heels of a report last month that 20% of American women have already seen a decline in their life expectancy largely

First Year Results in Massachusetts' Health Care Reform Undercut Barack Obama's Health Care Reform Strategy

The Massachusetts health care reform plan is coming up on its first anniversary.Its costs are now officially out of control.Those of you who regularly read this blog know that I have been particularly critical lately of what I see as a lack of sophistication in McCain's market-based health insurance proposals.But with this news, Obama will have some big health care policy questions of his own to

The CMS Website Comparing Hospital Performance Is a Good Step Forward

With much fanfare, Medicare (CMS) has stepped up the publicity for its website enabling consumers to compare their local hospitals' quality of care and cost data.So, I went to it and put in the necessary info for my neighborhood. While a number of hospitals came up, I was able to create a side-by-side analysis for three choices. (I suggest you simply ask for all hospitals within a certain

Administrative Costs and the Individual Health Insurance Platform for Health Care Reform

A new study by the "Center for American Progress Action Fund" says that Senator McCain's health reform plan based upon individually owned and controlled health insurance would increase administrative expenses by $20 billion.The Center is an organization headed by former Clinton chief of staff, John Podesta. So, they clearly have an agenda.But they also have a point.As I have said many times

McCain's Lost Opportunity

Joe Paduda has a great post today over at "Managed Care Matters" on the McCain health plan.Barack Obama is vulnerable over health care because his plan will cost a lot more than the $50 to $65 billion a year he has estimated--maybe twice as much.McCain rightly points that out regularly on the campaign trail.But what McCain and his advisers are missing is that his plan scares people in its own

Senator Kennedy's Illness

News that Ted Kennedy is seriously ill sent shock waves through the capital and the country yesterday.Many think of him as the "liberal lion"--and that is true.Less well known outside the beltway are his incredible instincts and skills for "cutting a deal."I know the notion of liberals and conservatives finding a way to come together drives some people on the far right and left nuts but it is in

"Blendon, Laszewski, And Rovner On Health Care Reform In The Election"

Earlier this week I was part of conference call organized by the new Health Affairs editor-in-chief, Susan Dentzer, on the topic of health reform in the presidential election.The call, and subsequent posting of the transcript by Chris Fleming on the Health Affairs blog, was in connection with the thematic issue of health reform in the May/June Health Affairs.First, congratulations to Susan on

Against Obama, McCain Has a Lot of Ground To Make Up on Health Care

The latest Washington Post-ABC News poll on health care should give John McCain reason to be concerned.The early May poll asked voters, "Regardless of whom you may support, whom do you trust more to handle health care?"The answer was Obama by 55% and McCain by 31%.And this poll was done a few days after his much-publicized week long health care tour.McCain also did poorly on the other economic

Watch the Wyden-Bennett "Healthy Americans Act"--It Could Be the Place Health Care Reform Compromise Takes Place in 2009

Health care reform will be hard to do after the November election. I've even called it a long-shot.Polls clearly show the voters split evenly between the Democratic and Republican approach to health care reform. I can't tell you who will win the presidency but I am willing to make the bold statement that it will be a close election and neither very different approach to health care reform will

There Won't Be Any Health Care Reform Without Physician Payment Reform and There Won't Be Any Physician Payment Reform Unless the Docs Lead The Way

Physicians are facing a 10% Medicare fee cut on July 1st, a total of 15% in cuts on January 1, 2009, a cumulative total of 20% on January 1, 2010, and more each year thereafter.This spring the Senate Finance Committee is trying to solve the problem. In the short term, the idea is to reach out to future years, when they are betting the Congress would finally fundamentally reform the Medicare

John McCain's Health Care Plan and the Uninsurable--There Are Better Fixes Than the Ones He's Proposed

John McCain spoke about health care in Tampa on Tuesday and tried to answer many of the questions that have been raised about his health care reform plan.The most pressing question is how would people with preexisting conditions get health care coverage in his plan? The worry is that his plan emphasizes tax incentives for consumers to purchase coverage in the individual health insurance market

HMO Executive Earnings Are the Subject of Criticism--37 Execs Paid $277 Million in 2007

I have had two different emails today on the subject of health plan executive compensation.The first cited a link to an article in the Baltimore Sun that reports the $17.65 million severance settlement with the former CEO of CareFirst (Maryland Blue Cross) is under scrutiny by the State of Maryland.The second was a reference to an Industry Radar post that compares HMO executive compensation from

The Genetic Discrimination Bill Shows Us Just How Hard Health Care Reform Can Be

About 1990, I was a member of something called the Task Force on Genetic Testing at the then Health Insurance Association of America (HIAA). The health insurance industry realized that, with the Human Genome Project in its early stages, we weren't far away from genetics being a part of everyday health care and the Orwellian implications on us as insurance underwriters were not lost.The task was

What Good Has Private Medicare Done for Shareholders?

Wall Street seems to have lost faith in publicly traded HMOs.When the Medicare Modernization Act was passed in late 2003, it was seen as a major boon to the health plan business. Without a doubt the revenue and profits that have accrued from the privatization of Medicare have been more than substantial.But what good has Medicare privatization done for shareholders?The first week of January 2005,

Health Care Reform Will Be a Long Shot in 2009

Many people, me included, have compared the recent resurgence in calls for health care reform with the big debate we had in 1993 and 1994 and the expectation back then that we would see major health care reform. Of course, all of that focus on the issue ended with the failed Clinton Health Care Plan derailing health reform for at least 15 years--and counting.Each of the remaining candidates for

Wall Street Continues to Be Disappointed in Managed Care--Just Where Did They Think It Was Headed in the First Place?

United Health's earnings and revenue grew by 7% this quarter year over year and the stock fell by almost 10% yesterday.I'd hate to see them really screw up.United is the first to admit that they have some service and persistency issues but the fundamentals of their business continue on track.Wellpoint followed with another disappointing report today.Wall Street finally seems to be figuring out

Obesity and Smoking--One Step Forward and Two Steps Back

Young Americans risk being the first generation whose health status will be worse off then the last.I have repeated that prediction many times but today it looks like tomorrow is here.A study by the Harvard School of Public Health and the University of Washington and published in the journal PLoS Medicine now tells us that the overall of life expectancy of many Americans has actually been in

Is the Bush Administration in Favor of Provider Transparency and Accountability or Aren't They?

Brian Klepper has shared an open letter he and Michael Millenson have written to HHS Secretary Leavitt regarding the issue of provider information transparency and the Department of HHS's apparent contradiction with its own policies.An Open Response To HHS Secretary Michael Leavittby Brian Klepper and Michael MillensonA few months ago, the two of us – both long-time advocates for transparency and

Provider Payment "Food Fight"

For some time I have been saying that we are about to have a "food fight" between health care providers over who will sustain Medicare payment cuts--HMOs, docs, hospitals, nursing homes, durable medical equipment, and others.But even I was surprised by a recent email from the AMA that included this connection between provider payments and food:“While it’s unusual to think of farmers and hospitals

The "Frontline" Report on International Health Care, "Sick Around the World," is Worth an Hour of Your Time

Last night the PBS program, "Frontline" gave us an hour long tour of the health care systems in Great Britain, Japan, Germany, Taiwan, and Switzerland and asked what can we Americans learn from them.When I heard about the program, I was dubious that an hour long report covering five different systems could possibly be helpful. But this hour long tour de force accomplished a great deal and I came

McCain Would Increase Medicare Part D Premiums for High Income Seniors--A Small Step in the Right Direction

As part of his broader speech on economic issues John McCain today called for high income seniors to pay more for their Part D drug coverage. Couples making more than $160,000 a year would pay higher premiums.This is a good idea and a down payment on something I believe is ultimately unavoidable--means testing for entitlement programs.It isn't news that the cost of senior programs--Medicare,

Nonprofit Hospitals Hardly Unprofitable––A Bad Time to Find Out Hospitals Are Making Big Money

Senator Charles Grassley (R-IA) has for years been complaining that non-profit hospitals have lost their way--that the tax benefits they get, originally intended to help pay for their charity care, simply aren't going to charity care anymore.Last Friday, the Wall Street Journal ran a front page story on the enormous profits many of the nonprofit hospitals are recording. The article made a number

Elizabeth Edwards Criticizes John McCain's Health Plan--He Needs to Fill in Some Important Gaps

In my detailed analysis of John McCain's health care reform plan, I said that he needs to fill in some very important gaps in order that voters have confidence that his market-based solution will cover them.During the Republican primaries it was important for McCain to present a conservative and traditional Republican approach to health care reform. His outline for a health care system controlled

Health Plan Stock Prices Hard Hit Recently--Then There is John McCain

The recent hit HMO stocks have taken in the market has come because Wall Street has the jitters over revised earnings outlooks. Many health plan stocks have fallen by 50% in recent weeks.The Street is right to worry that the health plans are going to have difficulty pumping out more of the great and predictable earnings we've seen from them in recent years. But they also continue to miss a very

Brian Klepper's recent post, "What Walgreens Surely Sees" got Health Beat's Maggie Mahar thinking and the result is one of her usually insightful comments. While Brian sees the for-profit model as a useful tool in making the primary care system more effective and vibrant, Maggie sees things differently.Their discussion represents the classic difference between those who believe the market needs

What Worksite and Retail Clinics Mean for the Primary Care Crisis

Today, Brian Klepper returns with one of the more intriguing posts we have seen from him.This time he looks at a relatively unnoticed acquisition of two worksite clinic firms in the broader context of the challenge primary care faces in out health care system.What Walgreens Surely Seesby Brian KlepperThough it probably went mostly unnoticed in the cacophony of health care stories, last week's

Democrats Ask GAO to Study the Individual Health Insurance Market--They Are Really Trying to Set Up McCain and Cast Doubt on His Health Reform Plan

There is an old salesman's axiom, "Don't ever ask a question you don't already know the answer to."Key House Democrats have asked the Government Accountability Office (GAO) to take a look at the current state of the individual health insurance market. They also want the GAO to review the operation of the state high risk pools designed to provide a safety net for those who can't get coverage in

Today's HMO Carnage on Wall Street

Maybe times have been just too good for so long that people have forgotten just what a challenging business this can be.After easy profits for the industry during a multi-year period when trend rates fell, today Wellpoint let us know nothing can be taken for granted.When the trend rate is steadily falling a monkey can make money. If an employer sees their claims go up by 9% the year before, it's

The Higher the Price the Better It Works--Placebo Drugs That Cost More Found to "Work Better"

That was the somewhat humorous--but nonetheless valuable--conclusion from a study sponsored by MIT and led by a Duke behavioral economist.It seems that researchers told one group that a medication cost $2.50 per pill and told another group that it cost ten cents per pill. Both were identical placebos.85% of those who took the "$2.50 pill" reported pain relief.61% of those who took the "10 cent

Drug Prices Rise 7% For Drugs Most Commonly Prescribed For Seniors--Two-and-A-Half Times the Rate of Overall Inflation

Many health care experts point to the creation of Medicare as the time that the American health care system's costs began to explode at an unsustainable rate. Simply, they believe that a huge infusion of government money drove both the supply and the demand for services setting the stage for today's cost problems.That has made many wonder what impact the new Medicare Part D drug benefit, which

A Slowing Economy--What Impact Will It Have On The Health Care Sector?

Health care is considered a business that tends to be resistant to economic downturns. Brian Klepper returns with a post asking just what the impact of a slowing economy will have on the health care sector. He specifically points to changes in real wages and home prices.Health Care and The Gathering Stormby Brian KlepperHere are two very interesting and frightening charts that my good friend

Another Government Study Questions the Medicare Advantage Business

You can now add the Government Accountability Office (GAO) to MedPAC and the CBO as highly respected government agencies who have issued reports questioning the cost effectiveness of the private Medicare program.This time, the GAO said:Insurers will receive $86 billion this year for the private Medicare plan--Medicare Advantage.Last year the government paid the private plans $8.3 billion more

Drug Patents and "Pay-For-Delay"--Drug Industry Payoffs That Need To End

I call your attention to a recent op-ed by a member of the Federal Trade Commission, Jon Leibowitz, in the Washington Post.Commissioner Leibowitz writes about the growing practice of "colluding with competitors to keep lower-cost generic alternatives to prescription drugs off the market."The Hatch-Waxman Act made it easier for generic drugs to enter the market once a name brand drug's patent has

Health Insurance Industry "Racing to Defuse a Growing Furor Over Retroactive Policy Cancellations"

That was the lead line in a Wall Street Journal story on the recent health insurance policy rescission controversy. The controversy is over a health insurance company's right to cancel a health insurance policy when the insured made a misstatement on the original application.Some insurers have held they can cancel a policy even when the misstatement was not material. For example, forgetting a

Give Cuomo and the Physicians What They Say They Want--Show the Patient Just What the Doc Is Accepting From Everyone Else

New York Attorney General Andrew Cuomo says that health plans are using the "Prevailing Healthcare Charges System" to "defraud" consumers and "manipulate" the system.He points to the example of an insurer refusing to pay a physician's $200 bill--the insurer said that $77 was more appropriate.In an earlier post, I pointed out that an examination of my own family's health insurance "explanation of

How Profitable is Medicare Advantage? The United/Humana Deal in Las Vegas Says a Lot

UnitedHealth and Humana have announced that Humana will acquire UnitedHealth's Las Vegas Medicare Advantage business for $185 million.The transaction was important for United in order to get Justice Department approval of UnitedHealth's acquisition of Sierra Health Systems.That $185 million gets Humana only another 25,000 seniors--at a price of $7,400 a customer.

The Argument for Specialty Hospitals

The growth of specialty hospitals has always concerned me. Too often these niche players looked to be siphoning off the most profitable parts of the business leaving the big hospital to charge payers more for their less profitable services--creating higher prices overall.David Whelan recently called my attention to an article he just did at Forbes making a strong argument in favor of

Hillary Clinton Criticizes Barack Obama's Health Care Plan Saying It Would Not Cover Everyone--Is She Right?

This is a repost of an original that addresses Hillary Clinton's claim, repeated in this week's Texas debate, that only her health plan accomplishes universal coverage because it has a individual mandate and Barak Obama's does not. Senator Clinton goes so far as to say she would garnish wages to enforce her mandate that everyone buy health insurance.Hillary Clinton has gone on the attack in

A "Health Care Fed" and Obama

An idea that has been floating around for some time is that a "Health Care Fed" needs to be created as a means to control health care costs.I first heard of the concept in a conversation I had with former Surgeon General C. Everett Koop a few years ago. Later, the idea showed up as a centerpiece in the National Coalition's plan to reform the health care system.And in both cases, I have supported

Health Wonk Review Is UP

This week's review of the best health care blog posts is up over at Merrill Goozner's, "Gooznews.com." The former foreign correspondent, economics writer, investigative reporter for the Chicago Tribune, as well as teacher and researcher, always has interesting things to say on his blog.

The Usual and Customary Controversy--Who's Cheating Whom?

New York AG Andrew Cuomo recently announced an investigation into how insurers pay for out-of-network services. He charged that consumers were being "defrauded" by insurers who were "manipulating reimbursement rates."Cuomo used the example of a charge for an office visit of $200 that the insurer cut back to $77--the insurer claimed the lower amount was reasonable and the maximum that should be

Bush Administration Now Willing to Increase SCHIP Spending by $19 Billion Only Weeks After Vetoing a Bipartisan Compromise

At a February 7th Senate Finance Committee hearing, HHS Secretary Leavitt testified about the 2009 Bush budget request.This time, the Bush Administration is asking for $19.3 billion more for SCHIP over the next five years.Just a few weeks ago, President Bush vetoed the $35 billion bipartisan SCHIP extension yet again. Bush and Leavitt maintained all of last year that the program should be

Lifetime Health Care Costs For the Obese and Smokers Lower Because They're Dead Sooner

This was the impressive conclusion of a study published by the Public Library of Science Medicine. The study was sponsored by the Dutch Ministry of Health Welfare and Sport.Obese people had the highest health care costs between the ages of 20 and 56. Obese folks and smokers were found to have a higher rate of heart disease than others.However, the authors found that the obese and those who smoke

Mom, Dad, the Kids and Medicare––Would an Obama Presidency Energize Young Adults to Demand Entitlement Reform?

Barack Obama has made this election-year different. Not since the 1960s have young voters been so energized. One college town after another has voted big for him.On entitlement issues like Social Security and Medicare, the political debate has always been dominated by what senior voters want. They have been the big and effective voter block that have managed to insulate these programs from any

Haley Barbour or Hillary Clinton?

Here's a test.Who just proposed the following, Hillary Clinton or Haley Barbour:A government authorized health insurance purchasing exchange program for the purpose of marketing health insuranceRun as a not-for-profit clearing house from which consumers could purchase health insuranceTarget the uninsuredAvailable to workers in small businessesDesigned to reduce the overhead costs of small group

Employers Finally Figuring Out They Can Shift Retiree Costs to Medicare

Employers are finally showing signs that they have figured out they can take advantage of the generous Medicare payments to Medicare Advantage plans.With Medicare Advantage plans paid 13% more than for the same beneficiary under traditional Medicare, many seniors have figured out the benefits are better in the private plans. Private Fee-For-Service (PFFS) plans even get more than that.What is

No One Ever Did Understand "Customary and Reasonable"

New York Attorney General Andrew Cuomo is suing Ingenix over its operation of the longtime "customary and reasonable" database.In the days before provider networks, insurers relied on this survey of insurance company claim data to determine an appropriate payment level. It was a survey of what all participating insurers paid by service in a particular market thereby ensuring that any one payer

Bush Budget Dead On Arrival But It Underscores the Trouble With Entitlements and The Choices That Must Be Made

President Bush is calling for $560 billion in cuts from Medicare over the next decade.He would make these cuts by reducing the payments doctors and hospitals would have received.What is amazing about the Bush budget numbers is that the administration is only trying to cut Medicare's annual growth rate from 7% to 5%. At one level, that ought to be easy. After all we aren't talking about reductions