Why Only Business Can Save America From Health Care

Brian Klepper

Posted 3/24/13 on Medscape Connect’s Care and Cost Blog

For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.

Steven Brill’s recent Time cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, the hospital chargemaster, with pricing “devoid of any calculation related to cost,” facilitated US health care’s rise to become the nation’s largest and wealthiest industry. His recommendations, like Medicare for all with price controls, seem sensible and compelling.

But efforts to implement Brill’s ideas, on their own, would likely fail, just as many others have, because he does not fully acknowledge the deeper roots of health care’s power. He does not adequately follow the money, question how the industry came to operate a core social function in such a self-interested fashion or pursue why it has been so difficult to dislodge its abuses. For that, we need to turn our attention to a far more intractable and frightening problem: lobbying and the capture of regulation that dictates how American health care works.

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Day Three – The Wrap Up

Merrill Goozner

Posted 3/29/12 on Gooz News

This is what conservative justices will do if they strike down or cripple the health-care law … A court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology. now – E.J. Dionne, The Washington Post

The insurance mandate was effectively reduced to a bumper sticker by the opponents in their constitutional challenge, and the entire law reduced to little more than an appendage to the mandate. . . The fate of the mandate should not determine the survival of the other elements of the law — like prohibiting insurers from denying coverage to people with pre-existing conditions or charging them higher fees — which can operate without the mandate. – New York Times editorial

Overturning the whole law would be an act of judicial restraint. – The Wall Street Journal editorial

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Health Reform: An Amicus Brief for the Court of Public Opinion

C. Eugene Steuerle

Posted 3/23/12 on the The Government We Deserve

The Supreme Court will consider the constitutionality of the Affordable Care Act at the end of the month. We the public should be appalled.

It’s not that each side can’t come up with some good constitutional arguments. It’s that the suit is totally unnecessary, caused largely by the unwillingness of the major political parties to work together on anything. Like a divorce between two parties more invested in their fight than in the effect on those around them, it belongs in a domestic relations court that would refer the parties to a mediator.

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The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power

Brian Klepper and Shannon Brownlee

Published 3/29/12 in the New York Daily News

Obamacare had its days in the Supreme Court this week, and the justices’ decision could have sweeping consequences for the individual mandate provision in the Patient Protection and Affordable Care Act, and maybe even for the fate of the law itself.

Yet whatever the court decides, we will still be stuck with a problem that this contentious law was not likely to solve on its own: an out of control health care industry that threatens the stability of the U.S. economy and the federal government’s ability to deal with our long-term debt.

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The Legal Strategy To Defend Health Reform

Joe Paduda

Posted 3/15/11 on Managed Care Matter

There’s a seemingly intractable conflict facing the Obama Administration – how can they argue – simultaneously – that the mandate is crucial to the Affordable Care Act, while also arguing that the rest of the Act should and can survive if the Supreme Court rules the mandate is unconstitutional?

That’s the Hobson’s choice facing lawyers arguing for the Administration, and while the two positions seem irreconcilable, they may not be.

Merrill Goozner is convinced the two positions can comprise a reasonable and legally logical argument. He cites a recent article in the NEJM, to wit:

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Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators

Robert Laszewski

Posted 2/9/12 on Health Care Policy and Marketplace Review

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.

I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice Department argued that a finding by the Court that the individual mandate is unconstitutional should not jeopardize the vast majority of the new health law.

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Uwe on Premium Support and Vouchers

Matthew Holt

Posted 12/24/11 on The Health Care Blog

There’s a great post by Uwe Reinhardt on the NY Time Economix blog explaining the theoretical difference between premium support and voucher systems (and you thought they were the same thing!).

Unfortunately it skirts the real problem that those of us playing along at home know too well. Either a well constructed premium support (Ryan done right), or a well constructed voucher/managed competition (Enthoven) system, a mixed public/private system (Germany, Starr, Reinhardt) or even a decent Medicare for all /Single payer system (PNHP, McCanne) needs to be designed holistically to have a chance of working–especially to ensure that all people are in plans that treat them all equally.

Note that this very week HHS devolved the choice over plan benefits to the states–meaning that the very notion of Enthoven-like standard plan benefits required in a voucher system gets tossed out the window and even in the exchange plans will likely be able to alter their benefits to risk select. The sad facts of the matter are – speaking as a lefty who supports the concept of managed competition a la the Enthoven or Dutch model – that the 2009-10 debate shows that no holisitic system can emerge through our political process.

And worse, no cost containment device will be left alone by a future Congress, as this weeks extension of the now more than a decade old SGR cuts demonstrates.

So my non-cheery Christmas message is that the health care system will continue to promote over spending on the wrong types of people, and rational transformation of our 1950s designed insurance coverage and payment system will remain elusive for decades to come. What we get IF we keep the ACA will be the best we can hope for.

Meanwhile, back over at NY Times it’s great to see Uwe Reinhardt reacting to his commenters (even those not paying Princeton tuition fees!). Kudos from a health care blogger who doesn’t engage with his commenters enough.

Matthew Holt is the Founder of The Health Care Blog and the Health 2.0 conferences.

Medicare’s “Rationers” – the IPAB

Joe Paduda

Posted 12/19/11 on Managed Care Matters

Among the howls of indignation coming from anti-health reform legislators and more strident Presidential aspirants one can often hear the outrage about “faceless government bureaucrats” rationing medical care to our elderly.

(we’ll leave aside that many of the howlers are the same ones screaming about out of control Federal entitlement spending…for now).

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Implementing Health Reform: A Bulletin on Essential Health Benefits

Timothy Jost

Posted 12/16/11 on the Health Affairs Blog

On December 16, 2011, HHS released a “bulletin” describing the approach that it intends to take to establishing the “essential health benefits” under the Affordable Care Act. A bulletin is a form of guidance that lacks the legal stature of a rule. HHS believed, however, that the states, insurers, consumer advocates, and the public needed some indication as to the direction HHS was intending to take in defining the EHB, and the Bulletin was intended to serve this purpose until an actual rule is issued.

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How Health Reform Will Affect You

Joe Paduda

Posted 12/16/11 on Managed Care Matters

There’s been one consistent finding among all the polls and surveys seeking opinions on health reform: most respondents don’t know much about it and there are many misperceptions and misconceptions about reform.

The good folk at Kaiser Family Foundation have put together an interactive tool to help remedy that situation. The YouToon application shows how reform will impact employers – large, small, and mid-sized; individuals and families, the well-off, middle class, and poor.

It’s easy to understand and a quick read too.

There’s a more “you-specific” tool here that is focused on individuals and families, not employers.

And the Washington Post has an interactive site where you can plug in details on income, family size, source of insurance, and marriage status and get specific info on how reform affects you – specifically – and what, if any, tax impact it has.

Implementing Health Care Reform: Coops, MEWAs and Medicare Data

Timothy Jost

Posted 12/12/11 on The Health Affairs Blog

The week of December 5 was a particularly busy week in health care reform implementation. After a lull over the Thanksgiving holiday, new regulations, proposed regulations, guidance, and grant announcements have poured out of the agencies. This post will briefly summarize three of these issuances: the final rule on the Establishment of Consumer Operated and Oriented (CO-OP) program; the final rule on the Availability of Medicare Data for Performance Measurement to qualified entities; and a series of proposed rules and forms issued by the Department of Labor to implement new provisions of the ACA intended to address Multiple Employer Welfare Association (MEWA) fraud and abusive practices.

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Implementing Health Care Reform: Fine Tuning the Medical Loss Ratio Rules

Timothy Jost

Posted 12/02/11 on The Health Affairs Blog

On December 2, 2011, the Department of Health and Human Services released both a final rule and an interim final rule updating the medical loss ratio rule that it issued almost exactly a year ago. The Department of Labor simultaneously issued a technical release giving direction to employer-sponsored health plans governed by the Employee Retirement Income Security Act (ERISA) as to how to handle rebates provided by insurers who fail to meet the targets established under the MLR rule.

The MLR rule has been one of the most controversial provisions of the Affordable Care Act (ACA). The MLR provision of the Affordable Care Act (section 2718 of the Public Health Services Act) requires health insurers in the individual and small group market to spend 80 percent of their premiums, after subtracting taxes and regulatory fees (85 percent for large groups), on payment for medical services or on activities that improve health care quality. Insurers must report their medical loss ratios annually and insurers that fall short of the target must rebate to their enrollees an amount equal to the product of the difference between their actual medical ratio and the statutory target multiplied by their premium revenues. According to a recent Kaiser tracking poll, 60 percent of the public views the MLR concept favorably, although only 38 percent was aware that the provision is in the ACA.

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Half of Americans Don’t Realize There’s No-Cost Preventive Care in the Affordable Care Act

Jane Sarasohn-Kahn

Posted 11/30/11 on Health Populi

The U.S. public’s views on health reform — remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health Tracking Poll from the Kaiser Family Foundation.

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High Court to Review ACA’s Minimum Coverage Requirement, Medicaid Expansion

Timothy Jost

Posted 11/14/11 on the Health Affairs Blog

Today, November 14, 2011, the Supreme Court decided to review a decision of the Eleventh Circuit Court of Appeals striking down the minimum coverage requirement of the Affordable Care Act (ACA) as unconstitutional. The case will probably be argued before the Court in March and decided in the early summer.

Procedurally, the Court “granted certiorari.” This means that it agreed to review certain questions raised by the certiorari petitions presented by the various parties in the Florida case, including the plaintiffs who challenged the constitutionality of the Affordable Care Act — 26 states, the National Federation of Independent Business, and two private individuals — and the federal government, which defended the Act’s constitutionality. The Eleventh Circuit had ruled against the federal government on the question of whether the minimum coverage requirement of the ACA is constitutional, but had ruled against the plaintiffs on all other issues.

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Plan B: If The Mandate Is Overturned

Roger Collier

First posted 9/12/11 on Health Care Reform Update

Kaiser Health News has an interesting piece in which it quotes the answers of six health care system “experts” to what happens if the Affordable Care Act’s individual mandate is found unconstitutional. (The GAO posed a similar question to a wider group earlier this year, and published its much more extensive findings in a February 25 letter to a Senate Appropriations subcommittee.)

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