12/2001: The Pulse

Published December 1, 2001

I was in Maine recently debating single payer with John Ross, MD, president of Physicians for a National Health Program. The Maine legislature has established a commission to recommend whether and how to adopt single payer in that state, and there is a referendum on the ballot in Portland asking the City Council to do everything possible to influence this commission to favor the state take-over of health care. The debate was sponsored by the School of Social Work at the University of Southern Maine, so you can imagine what the crowd was like!

PNHP’s Extreme Rhetoric

The debate was instructive for learning how ideological the single payer crowd is. Most of us avoid using the term “socialist” to describe these folks, because it seems inflammatory. But after experiencing Dr. Ross, and studying the PNHP Web site, I would say “socialist” is too mild a term. These people are clearly Marxist in ideology, and don’t mind using extremist terminology.

Ross, for instance, kept equating “for-profit” with “right-wing.” There is a quotation at the head of the PNHP Web site that reads, “Rats and roaches live by competition under the laws of supply and demand. It is the privilege of human beings to live under the laws of justice and mercy.”

A presentation posted on the site by Karen Palmer includes this sentiment: “Whether we like it or not, we are going to have to deal with the persistence of the narrow vision of middle-class politics. Vincente Navarro says that the majority opinion of national health insurance has everything to do with repression and coercion by the capitalist corporate dominant class.”

Maybe it’s time to start calling a spade a spade.

Source: http://pnhp.org

MSA Paper Published by NCPA

I have just written a new paper on Medical Savings Accounts for NCPA. In it I try to debunk some of the myths that have been parroted about the concept, and explain how MSAs and other consumer-driven approaches to health care financing are superior to managed care. I also have fun recalling some of the more outlandish quotes from Ted Kennedy, Gail Shearer, etc., who promise the end of civilization if MSAs should be enacted.

Source: The publication will be mailed out in hard copy to a lot of folks, but you may also download it at: http://www.ncpa.org/pub/bg/bg157/

Chicago Tribune Likes MSAs

The Chicago Tribune suggests MSAs are a good solution for small employers facing large premium increases, many of whose workers can’t afford any more cost-shifting. The article quotes Allen Wishner of Flexible Benefit Service Corp. to explain the concept.

Source: http://chicagotribune.com/ Unfortunately, the Tribune charges for articles even when they are only a day old. If you still want it, search in the archives for recent mentions of medical savings accounts. The article appeared on November 1, 2001.

Consumer-Driven Health Care in Minnesota

Minnesota employers are also looking at MSAs and other consumer-driven health benefits, according to an article in the St. Paul Pioneer Press. The article cites one small employer who has seen 50 percent rate increases in the past two years and now is looking at another 32 percent hike for next year.

Source: http://www.pioneerplanet.com/seven-days/thu/news/docs/168704.htm

New York Looking at Defined Contribution

The same is happening in New York, according to Crain’s New York Business.

The article quotes one New York employer who is experiencing a rate hike of 20 percent on top of a 25 percent increase last year. “We can’t go on like this,” he says, especially with a slowing economy.

The article says some employers are raising copays and premium costs for workers, but others are “rethinking health care coverage altogether, opting for more consumer-driven plans that put a fixed amount of dollars into employee accounts and encourage workers to play a more active role in keeping their medical costs down.”

Source: http://www.crainsny.com There is a charge for accessing full-text articles. This one is by Samantha Marshall and is headlined, “Employers Run for Cover From Rising Insurance,” October 22, 2001.

Seattle Looking at Defined Contribution, Too

Across the continent in Seattle, employers are making similar moves, according to Peter Neurath in the Puget Sound Business Journal. He writes, “New high-deductible health insurance policies are coming to market—as employers struggle with ever-higher premiums for employee health coverage . . .”

The article quotes Dr. Vern Cherewatenko as saying, “Insure for the big stuff, pay cash for the small stuff, just like you do with your car.”

Source: http://seattle.bcentral.com/seattle/stories/2001/11/05/focus3.html

Mainstream Insurers Moving to D-C

Employee Benefit News is staying on top of this trend. Karen Lee writes in the current issue (November 1, 2001) that “mainstream insurers” are now rolling out products to compete with the newer companies like Sageo, Lumenos, and DefinityHealth. The article emphasizes Aetna’s new product, but adds that United Healthcare and Humana are about to offer similar consumer-driven products.

Lee also mentions a recent Watson Wyatt survey of 10,000 employees, which she says found that less than half are satisfied with their current health plans, and 39 percent said they want their employers to contribute a fixed amount, “even if it means workers would have to find their own health plans.”

Source: This article doesn’t appear to be included on EBN‘s Web site, but it was published in the November 1 edition, headlined, “Employers, Employees at Odds Over Fixes.” Contact Karen Lee through the EBN Web site http://www.benefitnews.com for a copy.

Employees Like Defined Contribution

Lee writes another article for EBN that expands on the Watson Wyatt results and also looks at a Kaiser Family Foundation (KFF) survey that found “40% of consumers insist that managed care plans actually do a ‘bad job’ serving participants.”

She notes that KFF is still insisting on a Patients’ Bill of Rights, even though the survey indicates consumers are willing to compromise on that issue. She quotes Bob Blendon as saying that, while the public supports the idea, it is not a top priority and they are not focused on the details. She adds, “employees have another solution to their health care woes: a defined contribution plan.”

Source: http://www.benefitnews.com/subscriber/Article.cfm?id=37880418

VEBAs May Be Answer, Says Wallach

The biggest limitation on moving to defined contribution and personal health accounts is not market interest, but the regulatory environment, including the federal tax code, HIPAA, ERISA and state insurance laws. These problems can be overcome by using VEBAs (Voluntary Employee Benefit Associations, Section 501-C-9 plans).

VEBAs are especially attractive for public employers, retiree benefits, and multiple employer situations. Lance Wallach has an article in Employee Benefit News explaining some of these benefits.

Source: http://www.benefitnews.com/subscriber/Article.cfm?id=37880416

AMNews Reports on Wye River Study

AMNews includes a nice write-up of the Wye River press conference in the current issue. Staff writer Amy Snow Landa lists the groups that have sponsored the Wye research, and adds comments from Mark McClellan of the President’s Council of Economic Advisors. McClellan says the Wye River paper “fits in very well with our overall direction.” The article highlights the need for an FSA rollover.

Source: http://www.ama-assn.org/sci-pubs/amnews/pick_01/gvsa1105.htm

Greg Scandlen is senior fellow in health policy at the National Center for Policy Analysis in Dallas, Texas. To sign up for his free weekly e-newsletter, Scandlen’s Helth Policy Comments, log on to www.ncpa.org/sub/. Scandlen can be contacted by email at [email protected].