As presently conceived, health reform will fail. I’m talking not about the chances of a bill being signed into law but rather what happens when that happy day arrives.
I say this with deep regret, as I am an ardent advocate for health reform and a strong supporter of the President.
But we cannot force people of limited means to buy coverage they can’t afford, and we cannot force insurers to take all comers if people can opt out whenever they wish.
Without cost control, insurance costs won’t moderate, and without lower health insurance costs, many Americans can’t afford coverage. Despite the efforts of many, this seemingly-obvious conclusion hasn’t affected legislative efforts. Democrats are desperately trying to ram thru a huge entitlement expansion during a deep recession, while Republicans gleefully distort and demagogue, much more interested in helping the Dems commit political suicide than actually solve the health insurance crisis.
Over the last decade health insurance costs went up 131%; an annual rate of 8.7%.
If we are able to keep inflation to only 8.7% (doubtful in my mind), a family will pay $30,800 for insurance in 2019,
That inflation rate will moderate somewhat if everyone is covered (less need for cost shifting), but we’re still stuck with the prospect of forcing nursing aides making $12 an hour to buy coverage that they can’t afford.
To date private insurers have shown no ability to control costs; they’re too worried about on a reprise of the ‘managed care backlash’ of the nineteen-nineties when they should be thinking about the prospect of single-payer, a prospect that will look increasingly likely as health insurance costs approach $30,000 per family.
What does this mean for you?
There’s a lot of opportunities here for innovative, intelligent, creative approaches to coverage. Insurers and employers will have to leave their comfort zones and try solutions that will make them nervous, but the ones who do stand a much better chance of surviving than their conservative competitors.

Yesterday the Senate passed a bill extending unemployment and other benefits and subsidies for another month; one of the less well known provisions prevented imposition of a 21% cut in Meducare physician reimbursement.
‘Prevented’ isn’t exactly correct; the bill merely delayed implementation of the cuts till the end of March.
For years Congress has avoided implementing Medicare reimbursement decreases, bowing to intense lobbying by physian groups and other parties outraged at the very idea that their income will be reduced. I can’t really blame the docs; as I’ve reported here in the past physician income, especially generalist physician income, has not kept pace with inflation for several years.
What I’m less impressed with is the failure of physician advocacy groups to offer a reasonable alternative to the present fee-for-service system. Anyone with a clue acknowledges that FFS is one of the biggest problems in our health care system, rewarding providers for doing things to patients and not for keeping them healthy.
At some point we have to – must – adopt reimbursement methodologies that reward results not activity.
Don’t expect this to happen before the end of March. No, we’re much more likely to see the Senate boot this can once again, and with it the chance to fix a fundamental problem with our health care system.

The political grandstanding and point scoring on Capitol Hill will have significant repercussions for work comp, with some states directly – and quickly – affected and others feeling the impact later and more subtly.
I’m refering to the inability of the Senate to pass
legislation preventing the 21% cut in Medicare physician reimbursement that went into effect yesterday.
The Senate is trying to pass legislation to (temporarily) prevent the cut but Sen Bunning (R TN) is holding up passage. I’m a bit conflicted over Bunning’s move: he’s a bit of a wild card and rather erratic, but his stated rationale isn’t unreasonable; he wants to know where the money’s going to come from.
Regardless, several states base their WC fee schedules directly on Medicare: the cut will theoretically impact physician bills for services rendered beginning yesterday and cotinuing until the impasse is resolved.
I’m actually in DC now, if nothing’s changed before I get back to the office I’ll dig out my files and report on which states are directly affected.