With each passing day, I am becoming more convinced that a good many of the people who are engaging in the “debate” about healthcare reform have no clue about the issues that the Obama administration and Congress are wrestling with.
Last evening I logged on to a White House Forum on Healthcare Reform that was being conducted on Facebook. Not surprisingly, most of the participants in this chat room environment we posting comments favoring the Obama health plan. I don’t have a problem with people taking sides on an important issue like this, but most of the participants seem to lack knowledge of what is now being debated in Congress.
While I participated, a large number of the comments were directed at the sole person in the chat room who seemed to be challenging the need for reform, saying that he had a health savings account and it lowered his premiums and covered him for the unexpected and the catastrophic - a pretty good definition of insurance if you ask me.
However, this guy’s logic was met a myriad of slogans and catch phrases that indicated to me that the contributors were misinformed about the plans that are making their way through Congress. In fact they were making up their own version of what healthcare reform would look like.
Most comments, in my opinion, reflected a belief that there should to be a government-run single-payer system, and it ought to be free. One theme running through the posts was that of not wanting to have an insurance company telling them and their doctors what is, or is not, covered. I tried squaring that with having a government-run system, but my logic couldn’t take me there.
Thank goodness, that is not at all what the administration and Congress has been talking about. In fact, compared to where a lot of the people participating in the forum were, the bill being marked-up by the HELP Committee in the Senate sounds almost reasonable, despite its trillion dollar price tag and the threatened public plan option.
Having participated in this online experiment in democracy in action, I was not surprised when I read this morning that a new Rasmussen Reports national telephone survey found that 50% of U.S. voters at least somewhat favor the Democrats’ health care reform plan, while 45% are at least somewhat opposed.
This in response to a question that did not in any way describe the plan as it stands to date. It was simply presented as the health care reform proposed by President Obama and Congressional Democrats.
What was interesting about the survey results is that while the overall numbers favor the plan, those with strong opinions tilt the other way. Twenty-four percent (24%) strongly favor the plan, but 34% are strongly opposed.
This tells me that these are the people who have taken at least some time to study the issues and learn about what the administration and Congressional leaders are really proposing including the projected costs and the proposed means of covering those costs.
Congress will reconvene on July 6. Hopefully, over the upcoming long weekend, more Americans will take time to read a newspaper article or simply Google “healthcare reform” and read what comes up. I think most will be surprised when they learn the details of the product that Congress is producing, and the price they will pay for it.
There has been much chatter lately on Twitter and in the blogosphere about the use of social media in healthcare. According to a story written by Les Masterson and appearing in HealthLeaders Media, use of this new technology may be just what the doctor ordered.
It seems that The Microsoft Health Engagement Survey 2009, conducted by Kelton Research, shows that most people still don’t visit their health plans’ websites or believe their insurers support their health. Still, survey respondents say they are interested in their health plans connecting with them via e-mail and phone for electronic coaching. The key, they say is that they want those services integrated into their lives.
Masterson points out in his article that the consumerism movement with insurers and employers pushing more out-of-pocket costs onto members has led insurers to invest in online components in hopes of creating more educated consumers. However, nearly half of those surveyed think health plans only support them when they need a doctor.
According to Masterson, the disconnect occurs as a result of consumers simply not visiting their health insurers’ websites. Though 82% of insurers provide websites with health and wellness information, nearly three-quarters of respondents visited their insurers’ websites fewer than six times a year. That includes 16% who never visited their insurers’ sites and another 16% who only went on the sites one or two times in the past year.
The survey revealed that of those who actually visited the carrier’s website, nearly half went to find provider lists or coverage information. Only one-third checked out information on health and wellness and this was mostly after a diagnosis had occurred. In other words, they were not being proactive.
So with health plans and employers pushing to control chronic diseases, how do they communicate wellness messages to their members? There are some hints in the survey results. First, the vast majority of people surveyed said healthcare technological solutions are inviting, and secondly, most respondents said they were interested in communicating with their insurer through e-mail.
In fact, more than half of the respondents said they are interested in using e-mails to ask questions about benefits and coverage; receive feedback about their health; and get encouragement, reminders, and advice on diet and exercise.
In other words, people seem to want to communicate with their health plans using technology, but it must be done as part of their normal use of the media.
Does this mean that I am going to “Friend” my health plan on Facebook so I can receive a reminder to have my annual checkup while I am checking out what my friends and family are up to? Why not? Should I “Follow” my health plan on Twitter so that I can get tips on dealing with the summer heat? Sure. Would I read an e-mail message from my health plan and click to a link containing my latest EOB and tips on how to save money on my next prescription. Definitely.
Hopefully, health plans will use this research as an incentive to continue to push forward on the use of e-mail and social media to better communicate with their members and to help them control chronic illnesses that can become so expensive when they go unmanaged. Sure, there are privacy challenges, but it is worth working to overcome these challenges to reach members with pertinent and timely messages.
According to a press release issued by the Kaiser Family Foundation, a solid majority of the American people (61%) continue to believe that health reform is more important than ever given the country’s economic problems; sizeable majorities support key elements of reform currently being debated such as employer mandates (69%), individual mandates (71%), and a public plan option (65-67% depending on wording).
However, as seen in previous polls less than half of the public (41%) say they are willing to pay more for health reform, with a similar number supporting changing the tax treatment of employer based health insurance (40%), one of the major revenue raisers being discussed. Overall opinion, according to the release, remains highly moveable, with support for many elements of reform susceptible to arguments pro and con and often moving by as much as 40 percentage points when arguments are tested.
These poll results speak volumes about the complexity and the emotions of this issue. Sure, everyone can agree on the conceptual issues of access, affordability and quality, but when it comes to the harder questions of figuring out who will pay, and for how much, there is still a tremendous amount of disagreement. Special interest groups are now closing ranks to protect their piece of the healthcare pie.
More casual supporters of the concept are likely to cast a skeptical eye on healthcare reform efforts after they read about today’s announcement from the Congressional Budget Office that said the Senate Health, Education, Labor and Pensions Committee health reform legislation would cost the government an estimated $1 trillion over the next 10 years while reducing the number of uninsured U.S. residents by about one-third, or 16 million people.
This has sent the powerful tax-writing House of Representatives Ways and Means Committee looking for more money and their Chairman Charles Rangel, D-N.Y. aims to have proposals by Friday to help pay the trillion dollar tab.
According to a Reuters report, among the proposals Rep. Rangel is expected to announce by Friday are cuts to private plans that operate in the Medicare Advantage health program for seniors. Rep. Rangel also said the panel was weighing the “depth” of the subsidies that low-income people might get under any health reform legislation.
I am still confused about why this discussion centers so much on buying health insurance coverage instead of the real issue which is providing opportunities for Americans to achieve better health. Would it really cost a trillion dollars to make us all healthier and less dependent on expensive medical treatments? Isn’t that what we are really trying to do here? If we just focus on devising ways to pay for care once we get sick - mostly because of lifestyle choices - we had better have a lot of money to throw at this problem and the last time I checked, we didn’t.
It is far too easy sometimes to get ourselves bogged down in the intricacies of a debate. Take healthcare for instance. We can talk about the merits of having a public health plan versus the benefits of having the private sector use its innovation to show us the way out of the growing financial woes being caused by our current healthcare system.
Once in a while we need a slap in the face, a cold shower, that Americano with no room for cream. That is exactly what John A. Kitzhaber, MD, Governor of Oregon 1995-2003, delivered to those gathered to hear the keynote address this morning at AHIP Institute in San Diego, CA.
The third wheel on a panel that featured Jeb Bush, the former Governor of the State of Florida and Howard Dean, MD, Chairman, Democratic National Committee, 2005-2009; Founder, Democracy for America, and the former Governor of Vermont, Kitzhaber stole the show.
Dressed in a jacket, white shirt, tie, pressed blue jeans and cowboy boots, Kitzharber made no bones about the fact that we are borrowing from our kids to pay for health care today. But, rather than dwelling of the finer details of how to fix the current system to provide coverage to more people, Kitzharber told the representatives of America’s health insurance plans that they were missing the point and needed to change their business model.
“Healthcare is a means to an end,” he said. “The end is health.”
Kitzharber noted that most of the factors that contribute to poor health in this country have nothing to do with access to health insurance coverage. They are lifestyle choices, environmental issues and so fourth.
If we really want to address health, we need to work on developing a system that promotes health and not one that is not geared towards spending massive amounts of money on people after they have reached a health crisis that could have been prevented with the proper emphasis in prevention and wellness.
I think that slap in the face was exactly what this audience needed, and I think they knew it too judging by the amount of applause Kizthaber received for his comments.
Tomorrow is the official kick-off the America’s Health Insurance Plans (AHIP) annual meting called Institute being held here in San Diego, CA.
The morning’s keynote speakers include Jeb Bush, the former Governor of the State of Florida, Howard Dean, MD, Chairman, Democratic National Committee, 2005-2009; Founder, Democracy for America; Governor of Vermont, 1991-2003 and John A. Kitzhaber, MD, Governor of Oregon 1995-2003; Director, Center for Evidence Based Policy, Oregon Health & Science University. That should make for an interesting discussion.
A rally of supporters of a public health plan are expected to convene outside the San Diego Convention Center as they did in San Francisco last year. This will make for an interesting mix as attendees try to make they way from area hotels to the Convention Center.
I will be Tweeting live from AHIP and hope to to post a few blogs about the day.
The Washington Post is reporting this morning that Sen. Edward M. Kennedy (D-Mass.) is circulating the outlines of sweeping health-care legislation that would require every American to have insurance and would mandate that employers contribute to workers’ coverage.
The newspaper noted that in many respects the plan being circulated adopts the most liberal approaches to health reform being discussed in Washington citing as an example the fact that the plan embraces a proposal to create a government-sponsored insurance program to compete directly with existing private insurance plans.
The draft summary, according to the Post, also calls for opening Medicaid to those whose incomes are 500 percent of the federal poverty level, or $110,250 a year for a family of four.
The post also reported that a top administration official said the White House expects Kennedy to unveil his bill Monday. A timetable released by Kennedy’s office calls for Democrats on the Senate health committee to meet Tuesday, with a bipartisan session scheduled for Friday. Committee markups could begin June 16.
If Kennedy keeps to that ambitious schedule, it would put him ahead of several other Democratic leaders crafting health bills.
Could this bill, with its proposed expansion of an already unsustainable entitlement program, just be a way of softening up the opposition for what appears to be a bit tamer bill that is expected to emerge from the Senate Finance Committee? In contrast to Kennedy’s bill, the legislation being crafted by Sen. Max Baucus (D - MT) will probably come across to lawmakers as a much easier to pass alternative.
With this activity going on in Washington next week, it should make for interesting discussion at the meeting of America’s Health Insurance Plans (AHIP) scheduled to kick-off Tuesday in San Diego. I will be there and will be blogging about what I am hearing.
Well, the data is out, and for the second consecutive year, Washington D.C. has been declared to be the “fittest City” in America. In the second annual American Fitness Index (AFI), a publication released by the American College of Sports Medicine, Washington, D.C., edged out Minneapolis-St. Paul, Minn., Denver, Boston and San Francisco.
The index ranks 45 metropolitan statistical areas (MSAs)–a geographical measurement defined by the U.S. Census Bureau used by federal agencies in collecting, tabulating and publishing federal statistics–that include the city and surrounding suburban area. It measures each city’s performance on 30 indicators, including acres of parkland, death rate from cardiovascular disease, the number of primary care physicians per capita and the percent of residents who bicycle or walk to work. The metrics were gathered from government and non-profit organizations. (For the complete methodology, visit www.americanfitnessindex.org.)
According to the index, Washington, D.C., residents are healthier than other Americans for a number of reasons. They have increased access to farmers’ markets, at 13 per 1 million residents, compared to a national average of 11. Fewer residents smoke and have diabetes, and nearly 90% have health insurance compared to a national average of 86%.
I have always wondered who all those people are I see riding bikes along he Potomac and jogging around the National Mall when I am visiting the nation’s capital. I always thought they were tourists. But, now I must assume that they are local residents doing what D.C. residents do best - staying fit. Way to go Washington!
Drew Altman, president and CEO of the Kaiser Family Foundation has published a column that points out the stark differences between what experts believe and what the public believes about some of the key issues in health reform.
Using data collected from numerous Kaiser polls, Altman points out that there is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform, especially delivery reform.
For example, experts believe the health care system is full of unnecessary care and troubling variations in care, and they are committed to the long-term reform of the health care delivery system to make it more efficient, smooth out variations and produce greater value for the health care dollar. On the other hand, the polls show that the public has a very different world view: People think that underservice is a bigger problem than overservice.
Altman’s article includes a chart that shows a number of the areas where the experts and the public are at odds on basic beliefs about underlying problems, delivery reform, and health care costs.
Starting with “Basic Beliefs,” the chart compares the thinking of experts with that of the public on the issue of why healthcare costs so much. The experts say it is because of costly advances in medical technology, and that consumers do not have enough “skin in the game.” The public, however blame the drug and insurance companies for making too much money. As for having more skin in the game, they say they are already paying too much.
You can see Altman’s article and the full chart by clicking here.
Altman’s concludes is that more needs to be done to educate the public about why health costs are rising as fast as they are in the U.S. “As long as people think we can solve the problem of rising health care costs simply by eliminating waste, fraud and profiteering, the hard choices they hear experts and leaders talking about will not make much sense to them,” he writes.
But, Altman admits that this educational process will not be easy, saying that we probably need to produce Ross Perot-like charts and graphs, with basic facts about why we have the problems we do in the health care system.
I wouldn’t mind seeing some of those charts myself.
| The Internal Revenue Service (IRS) has announced the 2010 inflation adjusted amounts for health savings accounts (HSAs) in Revenue Procedure 2009-29.
Annual contribution limitation. For calendar year 2010, the annual limitation on deductions under a high deductible health plan is $3,050 for an individual with self-only coverage, and $6,150 for an individual with family coverage. High deductible health plan. For calendar year 2010, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,200 for self-only coverage or $2,400 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $5,950 for self-only coverage or $11,900 for family coverage This revenue procedure is effective for calendar year 2010. |
An annual census by America’s Health Insurance Plans (AHIP) of U.S. health insurance carriers released this week shows that the number of people covered by health savings accounts/high-deductible health plans (HSA/HDHPs) totaled 8.0 million in January 2009. This is up from 6.1 million in January 2008, 4.5 million in January 2007, and 3.2 million in January 2006.
The survey, which polled virtually all private health insurance carriers in the HSA/HDHP market, not only continued showed robust growth but growth within all segments of the market. Between January 2008 and January 2009, the fastest growing market for HSA/HDHP products was large-group coverage which rose by approximately 35 percent, followed by small-group coverage which similarly rose at 34 percent.
Likewise the gender of those adopting this form of coverage was evenly split with fifty-two (52) percent male and forty-eight (48) percent female participants.
Enrollment in the individual market also rose. As of January 1.8 million individuals were covered by HSA/HDHPs, up from 1.5 million covered lives in January 2008, and fifty-three (53) percent of all individual market enrollees-including dependents covered under family plans-were aged 40 or older.
The states with the highest levels of HSA/HDHP enrollment were California (854,000),
Florida (524,000), Illinois (497,000), Texas (476,000), Ohio (464,000), and Minnesota
(388,000).The highest premiums for HSA/HDHPs were reported in Massachusetts where they averaged $361 for single coverage and $925 for family coverage. The lowest priced plans were found in North Dakota where they averaged $210 for single coverage and $461 for family coverage.
Health savings account (HSA) plans give consumers incentives to manage their own health care costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan (HDHP) that meets certain requirements for deductibles and out-of-pocket expense limits. Most HDHPs cover preventive care services (e.g., routine medical exams, immunizations, well-baby visits) without requiring the enrollee to first meet the deductible. The funds in the HSA are owned by the individual and may be rolled over from year to year. HSAs were authorized starting in January 2004.
Read the entire report here: http://www.ahipresearch.org/pdfs/2009hsacensus.pdf
