09/2002: The Pulse

Published August 30, 2002

Scott Holleran publishes “The Pulse,” a weekly email newsletter sort of like this one, on behalf of Americans for Free Choice in Medicine. His current edition includes a wonderful little “blast from the past” in the form of President Richard M. Nixon’s statement on signing the federal HMO Act on December 29, 1973.

The statement is filled with ironies. For example, Nixon says, “The establishment of HMOs will allow people to select for themselves either a prepaid system for obtaining health services or the more traditional approach that has served the American people so well over the years.” He goes on to say the Act will allow “both the provider and the consumer of health services to exercise the widest possible freedom of choice.” He also calls on Congress to enact “an appropriate and responsive national health insurance act.”

To find out more about AFCM or to sign up for its “The Pulse” newsletter, go to http://www.acfm.org.

Source: http://www.nixonlibrary.org/Research_Center/1973_pdf_files1973_0376.pdf

Survey: Texans Want Single Payer (?)

A new survey conducted by the University of Houston concludes a majority of Texans “favor a publicly funded national health care plan in which all Americans would receive their insurance from a single government source,” according to the Houston Chronicle.

The article says 52 percent of Texans support such a plan, while 43 percent oppose it. Five percent did not answer the question. The article doesn’t say how the question was worded, but it concludes the high level of non-insurance among Hispanic Texans is a major contributor to the survey findings. Sixty-four percent of Hispanics favored the idea, and only 57 percent of Hispanics are covered by insurance.

The story also says, “a majority of Texans think government politics has a negative effect on health care.” According to the article, majorities of Texans surveyed favor “requiring businesses to offer private insurance for their employees; income tax deductions, tax credits, or financial assistance to help uninsured Americans purchase private insurance; expanding programs like Medicaid and CHIP; and expanding neighborhood clinics.”

It sounds like a majority favors doing something … anything … to reduce the numbers of uninsured. They don’t seem to be too fussy about what it is.

Source: The Houston Chronicle is one of the more expensive daily archives. The story ran on July 14, 2002; you can find it at http://www.chron.com/archives. You might also want to search the University of Houston for the source material.

New Canadian Survey on Waiting Times

Those Texans may want to reconsider the single payer idea.

A recent survey of 14,000 Canadians by Statistics Canada finds that, “Almost one in five Canadians who accessed health care for themselves or a family member in 2001 encountered some form of difficulty….”

The survey offers separate results for “first contact services” and “specialized services.” About 94 percent of the population used first contact services, of which 18 percent (4.3 million people) had problems, with “long waits” and “problems contacting a health care provider” topping the list.

Of the 6.1 million people who needed specialized services, 23 percent had difficulty, with long waits being the biggest. Of those who needed non-emergency surgery, 40 percent waited less than a month (60 percent waited more), and of those who needed diagnostic tests, 55 percent waited less than a month (45 percent waited a month or more). Five percent waited six months or more for diagnostic tests, and 10 percent waited six months or more for non-emergency surgery.

Nine hundred thousand people said the waiting times “affected their lives,” with 59 percent saying the wait induced “worry, anxiety or stress” and 37 percent saying they experienced pain.

Source: http://www.statcan.ca/Daily/English/020715/d020715a.htm

Maine: MSAs, Tax Credits Better than Single Payer

An editorial in the Portland (Maine) Press-Herald contends new entitlement programs—like the prescription drug benefit Congress is considering for Medicare and the single payer push before the Maine legislature—risk runaway costs and denied access to needed care.

Far better, says M.D. Harmon, to adopt a program like what The Heritage Foundation has long promoted with tax credits, risk pools, and FEHBP-type choice of plans. He likes MSAs as part of the mix.

Harmon also cites an article in the Wall Street Journal by CAHI’s Merrill Matthews, who wrote about the Canadians who took a bus to Maine in search of better health care because what they needed wasn’t available back home. “We can do better than this,” writes Harmon. “But as the current debate in Maine and Washington shows, we can also do worse. Sadly, it looks like that’s the direction we’re headed.”

Source: http://www.pressherald.com/viewpoints/harmon/020715harmon.shtml

Rhode Island Town to Offer MSAs to Residents

Down the coast, in Scituate, Rhode Island, the town is developing an MSA plan that will be available to all of the town’s 10,000 residents, according to AMNews. The effort has been led by long-time health activist and family physician, Dr. Michael Fine.

In addition to an MSA/high-deductible health plan, participants would pay $200/year to support a “population-based primary care practice,” which would actively service plan members (sounds a tad like “concierge medicine,” doesn’t it?).

The town council began looking for answers two years ago when the Harvard Pilgrim health plan left Rhode Island, leaving the Blues and UnitedHealthcare the only remaining carriers. The plan will start by being offered to municipal employees in 2003. The state legislature has enacted a $200 tax credit for all participants.

Source: http://www.ama-assn.org/scipubs/amnews/pick_02/bil20722.htm

Herzlinger: Time for Employer Risk Adjustments

While we’re in New England, the Boston Globe ran a story by Charles Stein that is mostly an interview with Regina Herzlinger of the Harvard Business School, prompted by an article she wrote for the Harvard Business Review.

Stein sums up Dr. Herzlinger’s views by saying, “Health care needs to work like other markets. … We need to put the dollars and the decision-making power into the hands of the people who actually use the service. … The result will be more choices, happier consumers, and moderating prices.”

Stein says the argument isn’t new, but, “for the first time, the world seems to be paying attention. Some of America’s biggest companies and biggest insurers have embraced the concept of consumer-driven health care.”

Herzlinger wants employers to go further than they have, however, to use “risk-adjusted policies.” Stein gets an alternative point of view from Richard Kronick, a health policy specialist at the University of California at San Diego. Kronick is quoted as saying, “It’s a fantasy.” Markets only work when there is good information available, and in health care there isn’t. Kronick concedes, however, that “right now these consumer policies seem to be the only thing left on the menu.”

Source: The Globe charges to access articles. The article ran on July 9, 2002. To find it go to http://www.boston.com/globe/#search

“Unleashing the Tremendous Power” in Milwaukee

The Milwaukee Business Journal reports efforts by Richard Blomquist, former CEO of Associates for Health Care, a PPO, who is now working on a health plan design to enhance consumerism.

“The key to controlling health care costs is unleashing the tremendous power of consumers,” he is quoted as saying. His plan design is based on publishing fee schedules for hospital and physician services.

Employees can compare those schedules to actual provider charges and shop accordingly. The article says, “The concept of attaching a price to a service has been absent on health care.” It adds the plan design can be used with an MSA or as a stand-alone product.

Source: http://milwaukee.bizjournals.com/milwaukee/stories/2002/07/15/story4.html

Greg Scandlen is senior fellow in health policy at the National Center for Policy Analysis in Dallas, Texas and assistant editor for Health Care News. To sign up for his free weekly e-newsletter, Scandlen’s Health Policy Comments, log on to http://www.ncpa.org/sub. Email Scandlen at [email protected].