Looks like some interesting debates on health care 3rd party payers are
coming this year in the USA. Full article below.
Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
4301 West Markham St. Mail Slot #563
--
DuBoseTerryJ@UAMS.edu
http://www.uams.edu/chrp/sonography/
http://www.obgyn.net/us/panel/panel.htm
http://www.io.com/~dubose/
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-----Original Message-----
From: Betty [mailto:bhamilt@valornet.com]
Sent: Monday, February 06, 2006 7:30 AM
To: DuBose, Terry
Subject: AWOL from the healthcare debate
Did you happen to see this?
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The following appeared on Boston.com:
Headline: AWOL from the healthcare debate
Date: February 6, 2006
"GOVERNOR Mitt Romney's $200 million healthcare proposal no doubt
will create some heated debates. To be fully productive, these debates
must address five issues that no one has wanted to discuss so far."
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To see this recommendation, click on the link below or cut and paste it
into a Web browser:
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/02
/06/awol_from_the_healthcare_debate?p1=email_to_a_friend
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This message was sent by Betty [mailto:bhamilt@valornet.com]
through Boston.com's email recommendation service. If you have questions
or comments about this free service, please email us at
feedback@boston.com.
THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
<http://www.boston.com/news/globe/> <http://www.boston.com/news/globe/>
DAVID W. YOUNG
AWOL from the healthcare debate
By David W. Young | February 6, 2006
GOVERNOR Mitt Romney's $200 million healthcare proposal no doubt will
create some heated debates. To be fully productive, these debates must
address five issues that no one has wanted to discuss so far.
Preventable illness
Should people who maintain their weight subsidize those who do not?
Should nonsmokers subsidize smokers?
According to the Centers for Disease Control, in 1991 there were 49
states that had fewer than 15 percent of their citizens overweight. In
2000, there was only one such state (Colorado).
This obesity epidemic and the resulting high-cost medical conditions are
caused entirely by preventable factors, such as diet and lifestyle.
Similarly, smoking is associated with many high-cost forms of illness.
The solution: Use body-mass indexes and smoking habits to adjust
healthcare premiums.
Family size
Most health plans have two premium levels -- one for single people and
one for married couples. Some include a third level to distinguish
between couples with and without children. In effect, childless couples
and small families subsidize large families.
It's hard to understand the rationale for this pricing policy.
Automobile insurers don't charge one premium for a family with one car
and another for a family with multiple cars. Life insurance companies
charge by the life, not by the family.
There are no economies of scale based on family size -- as it increases,
so, too, does the cost of providing healthcare.
The solution: Charge a separate premium for each individual.
Nonprofit hospitals
Massachusetts, by exempting nonprofit hospitals from property, sales,
excise, and income taxes, provides them with multimillion-dollar annual
subsidies. Although these hospitals complain about the financial burdens
they face in meeting the healthcare needs of the uninsured, they in fact
should be providing such care in exchange for their subsidies.
The solution: Require nonprofit hospitals to pay their tax forgiveness
into a fund to help pay insurance premiums for the uninsured. Hospitals
that provide a great deal of care to the uninsured will receive payments
from the fund in excess of the amount they pay into it; those that
provide little such care will not. The fund will lessen the burden that
otherwise would be placed on the state's taxpayers, and assure everyone
that the new legislation does not create multimillion-dollar annual
windfall gains for nonprofit hospitals.
Physician training
Each of the state's teaching hospitals spends several million dollars a
year on graduate medical education. Yet, only Medicare helps pay for it
from its financially precarious Trust Fund. All other health insurers
are free-riders: They receive the benefit of a cadre of well-trained
physicians at no cost.
The solution: Require health insurers to pay a percentage of their
premiums into a fund for graduate medical education, and reduce
Medicare's medical education payments accordingly.
Pharmaceutical copayments
The substantial cost difference between generic and brand-name drugs is
addressed only minimally by copayments. Copayments also force low-income
patients to choose between filling (or refilling) a prescription and
spending their limited resources on food, clothing, or shelter.
The solution: Eliminate copayments for pharmaceuticals. Instead, when
there is a generic equivalent for a brand-name drug, require patients
who wish to use the brand-name drug to pay the cost difference (rather
than a copayment).
When a Fortune 10 company instituted such a plan, the number of
employees using generic drugs increased from 50 percent to 99 percent.
It should be relatively easy to implement the first two solutions.
Overweight people and smokers have little political clout, and large
families will have a difficult time mobilizing any opposition.
By contrast, the presence of powerful lobbies means that implementing
the last three solutions will require considerable political will.
However, with health insurance premiums and pharmaceutical costs
skyrocketing, the time is ripe for change.
An effort to structure premiums and supplemental payments more fairly
should be welcomed.
If the political will can be mustered to move ahead on these solutions,
each would be relatively easy to implement.
Clearly, some analysis and debate would be required, but in each
instance the overarching premise is to avoid cross-subsidization when
there is no societal benefit to justify it.
If this premise is accepted, the debate can become clearly focused, and
the resulting legislation can eliminate many of the free riders and
opportunists whose self interests underlie much of healthcare inflation.
Perhaps it's time for employers, patients, families, and taxpayers who
currently financially support the vested interests of hospitals,
insurers, and pharmaceutical companies to open their windows and scream
''I'm fed up and won't take it anymore!"
David W. Young is a professor of healthcare management at the Boston
University School of Management.
(c) Copyright <http://www.boston.com/help/bostoncom_info/copyright>
2005 The New York Times Company
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