Massachusetts’ health reform plan is going to cost far more than projected – $1.35 billion annually within three years. That’s compared to the original estimate of $725 million.
That’s bad, right?
Actually, it’s not all bad.
Projected costs are increasing primarily because enrollment is much higher than anticipated – and ultimately will likely be more than two times projections. It appears officials significantly underestimated the number of residents without health insurance, and those without coverage have signed up faster than expected.
I’ll admit to being one of the naysayers – my take was the per-employee penalty of $295 was not going to be enough to encourage employers to offer coverage – and I’m happy to be wrong. The other related criticism (but not from me) had to do with ‘crowd out’ – employers might drop coverage if their workers could obtain it from the Connector (Mass’ name for the health plan buying entity). That doesn’t appear to be a problem either, at least not yet. A relatively small percentage of employers are going to drop coverage this year – a percentage not materially different from employers in other states.
So far, it looks like the reform plan is succeeding in getting more folks covered. But, the program has not met its goals for cost reduction or reduced payouts for indigent care. While the strong enrollment numbers are great, the tough part now starts – and controlling costs is going to be a lot tougher than enrolling members.

I’ve been meaning to get to this for weeks now – while I (and others) have reviewed and compared the two plans and parts thereof, I’ve yet to see a brief but (reasonably) comprehensive comparison.
First, what these plans are not. They are not ‘socialized medicine”, single payer, or any version thereof. Both Obama and Clinton rely on private insurers to provide coverage, and make no changes to the health care provider community – they do not become government employees.
We’ll start with what others have said is the only real difference between the two – mandated universal coverage – Clinton’s plan requires a mandate; Obama’s doesn’t. I disagree- there are several other key differences, issues that we’ll highlight here and address in detail in future posts. The issues may seem picayune but the devil is in the details, and details in health care add up to half a trillion bucks or so.
From reading Obama’s campaign literature or speeches, it seems like the Senator is in favor of mandated universal coverage. Unfortunately, Obama’s rhetoric is inconsistent with his plan, leading me to suspect he wants to have his cake, eat it too, and not get fat. Obama does have a mandate, but it is specific to children – he requires all kids to have coverage, but his plan does not require working-age people obtain coverage.
(disclaimer – this is not all-encompassing, but rather meant to hit the high and medium points without getting down to the molecular level)

Continue reading How the Clinton and Obama health plans differ

Randall Hoven’s piece in “American Thinker” is admirable; Hoven is outraged that we don’t get what we pay for, and thinks we can do better.
He’s also speaking as one with a daughter that needed a heart transplant; this experience evidently informed his thinking, as Hoven appears to understand the need for insurance.
His views are remarkably consistent with other Republicans, even some of those who consider themselves staunch conservatives.

Increasing tax breaks for health insurance will not materially increase the number of folks with insurance. Yes, there are several studies that purport the Bush plan will result in more folks buying coverage, but there are a number of studies that show it would result in a very small increase, or actually decrease the number of folks with insurance.
What is puzzling is the schizophrenia embodied in conservatives’ view on health insurance and taxation thereof. Bush, an avowed conservative, touts tax breaks as the way to get more people to buy coverage, an idea also central to the platform planks of Mssrs. McCain, Giuliani, and Romney (Huckabee’s ‘fair tax’ is, well, rather different).
Doesn’t this amount to a government subsidy of health insurance, one that will distort consumer behavior by reducing the cost of coverage, and therefore of health care? Bush et al try to address this via high deductibles, but isn’t that fixing a problem caused by their own tax policy? If conservatives have so much confidence in the consumer, why do they need to offer them a tax break to buy something that logically, it is in the consumer’s best interests to purchase?
Conservative policy types have suggested chopping the proverbial baby in two, by limiting tax breaks to those plans that provide a minimum level of benefits. The idea is to encourage coverage without subsidizing plans with excessive levels of benefits; those “Cadillac” plans. What parts of the plan make it a “cadillac”?
– Hospital coverage?
– Physician visit coverage?
– Drug coverage?
– Diagnostic test and imaging coverage?
– Behavioral and mental health coverage?
– Physical therapy?
Where’s the bling? Where’s the fine Corinthian leather, the Bose 29 speaker stereo, the gold-embossed hood ornament?
Where’s the ‘excessive’ insurance? If there is any, it is small potatoes.
I applaud the folks who are trying to square their philosophies with the realities of politics, economics, and health care. Their ability to tie themselves in knots in an effort to remain true to their ideology while fixing a problem is painful to watch.
I’m just now sure how that solution is ‘conservative’.

Single-payer advocates have won another skirmish in the battle over health care reform, while those in favor of reform based on the existing insurance marketplace (that would include your author) are once again trying to explain why big insurance companies screw up so badly so often.
An audit by the California Insurance Department and Department of Managed Health Care found that Pacificare routinely mishandled claims and customer inquiries, with ‘routinely’ defined as about one-third of the time.
For those (including me) forever excoriating health systems and hospitals for their outrageous error rates, the debacle at Pacificare, the recently-acquired division of United Healthcare (one of my past employers) make the delivery sector look like a paragon of performance. I’m not overly surprised, as mergers involve systems conversions, the amalgamation of provider networks and contracts, and the shifting of work around to different call centers and processing locations. Duplicate staff positions are identified and people laid off, and when they walk out the door so does the expertise and understanding that enabled the operation to run smoothly.
Some will argue that this is a temporary hiccup, that any merger of this type and size will inevitably result in problems. All true, as is the point that they could not be screwing up at a worse time – during an election year wherein the future of their business will be determined.
So far, the private sector is not making much of a case.
Thanks to California Healthline for the tip.

What does the Florida GOP primary say about voters’ views on health care?
At first blush, they aren’t concerned.

Continue reading Florida GOP results – implications for health care reform