Consumer Power Report #165

Published February 17, 2009

The House and Senate have agreed on a massive stimulus package, and it’s on its way to the White House. Like most of the Members of Congress, I have no idea yet what is in the bill. But we’ll be finding out for months to come, I’m sure.



Betsy McCaughey has done it again. Fifteen years ago she published an article that galvanized opposition to the Clinton health reform proposal simply by going through the bill and highlighting some of the consequences. Now she has performed the same service for the stimulus package.

As we reported last issue, the stimulus package includes $20 billion for health IT and $1.1 billion for “comparative effectiveness research.” It’s basically a one-two punch for federal control of the health care system. First, get all the docs and hospitals wired up with electronic medical records, and then have a federal agency tap into those records to make sure they are practicing medicine the way the Feds think they should.

This is all pretty alarming, but Ms. McCaughey has the magical touch to convey that alarm to a much wider audience. She wrote a fairly short column in Bloomberg News that spread like wildfire. At least a dozen people sent it to me. People all over America posted it on blogs and used it as the basis for their own opinion pieces. She has been on television discussing it.

The article says, “Tragically, no one from either party is objecting to the health provisions slipped in (to the stimulus package) without discussion. Senators should read these provisions and vote against them because they are dangerous to your health.”

Ms. McCaughey is no troglodyte. She agrees there is value in having electronic medical records and informing physicians of the best thinking in medical practice, “but enforcing uniformity goes too far.” She says the elderly will be especially targeted– “Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council.” A similar effort in the UK “approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit.”

She adds, “Hiding health legislation in a stimulus bill is intentional. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. ‘If that means attaching a health-care plan to the federal budget, so be it,’ he said. ‘The issue is too important to be stalled by Senate protocol.'”

SOURCE: Bloomberg News


Ms. McCaughey’s little op-ed has set off a firestorm. House Minority Leader John Boehner (R-OH) sent out a “Leader Alert” accusing the Democrats of “attempting to take advantage of the crisis in our economy to enact a series of liberal policy proposals that have nothing to do with economic recovery.” He adds, “One of those proposals–dubbed ‘comparative effectiveness’– would lay the groundwork for a government takeover of America’s health care system by creating an organization to decide how to ration medical treatments.” He says, “this proposal is opposed by many of America’s leading health care research organizations, like the AIDS Institute, the Alzheimer’s Foundation of America, American Association for Cancer Research, Easter Seals, and the American College of Obstetricians and Gynecologists,” because it would lead to “restrictions on patients’ access to treatments and physicians’ and other providers’ ability to deliver care that best meets the needs of the individual patient.”

SOURCE: House Leader Site

CNS reports on an interview Fox News had with Senators Arlen Specter (R-PA) and Jon Tester (D-MT) based specifically on Ms. McCaughey’s op-ed. Mr. Specter, who was one of only three Republican senators to vote for the package, said, “We are not going to let the federal government monitor what doctors do.” And Mr. Tester said, “If–that’s a big if–if there’s language in there that says the government’s going to make my health care decisions, we’ll get it out.”


Steven West, MD, president of the Florida Medical Society, weighs in with an op-ed of his own in the Tallahassee paper. He writes, “As Congress rushes its economic stimulus plan to the desk of President Obama, its grand vision of health reform has been secretly buried inside: rationing patient care and dispensing cookbook medicine.”

He adds, “That vision involves using large government bureaucracy and computer technology to tell patients what kind of care they can receive from their doctors. The congressional rationing plan will make doctors supplicants to big government and big insurance, rather than independent advocates for their patients. In the system that Congress envisions, the doctor serves the payer and not the patient.”

He then gives a list of better approaches, including:

  • Tax rebates should be given to all Americans to create tax-free health savings accounts and to buy insurance for health catastrophes.
  • Insurance prices can be driven down if the government would remove politically motivated mandated benefits that most people don’t want or use.
  • Patients should be allowed to purchase less-expensive and higher-quality insurance from another state, a ban now imposed by Congress.
  • Reducing government regulation and interference in patients’ financial decisions will help lower costs and drive up quality.
  • National reform of the legal system will provide the fastest path to cost containment.

SOURCE: Tallahassee Paper

The Chicago Tribune is also concerned, publishing an editorial that says, “We’ve been skeptical about this whole process. The mantra on this page has been that if the U.S. has to do this, the spending has to be timely, targeted and temporary.” But it balks at slipping health reform into a massive bill like this, saying, “Many Americans want health care reform. And there’s plenty of room to improve the system, to cut costs and deliver better care and coverage. But the Senate is right to recognize this is a debate for another day. Its stimulus package does not attempt this massive growth in health spending.”

SOURCE: Chicago Tribune

Meanwhile, the House and Senate are divided over the patient privacy protections that go with the health IT spending, with the House much stronger on privacy than the Senate is. An article in the Washington Post sums up the in-fighting in Congress. It says, “At the heart of the debate is how to strike a balance between protecting patient privacy and expanding the health industry’s access to vast and growing databases of information on the health status and medical care of every American.”

But, like all Washington battles, a lot depends on how much money the warring sides can put into lobbying: “The effort to speed adoption of health information technology has become the focus of an intense lobbying battle fueled by health care and drug-industry interests that have spent hundreds of millions of dollars on lobbying and tens of millions more on campaign contributions over the past two years, much of it shifting to the Democrats since they took control of Congress.”

And so it goes in the New Utopia. All decisions become political ones, all power goes to the best-funded lobbyists. And you wonder why Congress wants to get more involved in health care? Just wait until it starts deciding what will be covered in a “universal” health scheme.

SOURCE: Washington Post

Former AMA president Donald Palmisano, MD has been making the rounds talking about the importance of patient privacy. It’s nice to have the AMA weigh-in–finally–about preserving the patient/physician relationship. Unfortunately, the organization still officially supports the health IT and comparative effectiveness provisions in the stimulus package.

SOURCE: The Today Show; Good Morning America


Our friend Bill Boyles, publisher of the Consumer Driven Market Report, does a fabulous job keeping track of the market. I learned a lot from reading his latest, CDMR #1, 2009. Here are just a few of the gems:

  • Wellpoint’s products such as Lumenos are helping keep enrollment growing–a recent broker quote in southern California showed a Lumenos $3,000 deductible plan costing $683 versus $1,273 for a comparable Blues PPO.
  • CIGNA is seeing premiums fall by more than 3 percent in some markets for CDH accounts. In Tennessee employers told local media their premiums fell by 3.3 percent, versus a 10.6 percent increase in the old PPO.
  • Our review of local news coverage of HSAs shows local unions are major backers of HSAs, with both local and county workers swarming in and local unions approving of the changes.
  • The top HSA banks will beat their HSA targets or more in the first quarter, several told CDMR in the past week. That means account growth of 30-40 percent and national growth of more than 3 million new HSA covered lives in a single year.
  • HSAs are considered hands-off in Congress and will not be addressed this year, former Democratic Party leader Terry Mcauliffe told a World Congress event February 4 in DC. A top Republican staffer to former President Bush agreed.
  • HSA Bank reported that a shocking 97 percent of its accounts showed a rollover last year and the rollover amount is up 25 percent. The average HSA balance rose 11 percent to $2,400.
  • A shocking 90 percent of the news stories appearing in a Google search for the term “consumer-driven health care” were positive in our test analysis, up sharply from 2008. Only four of 40 recent news items contained what can be classified as negative import.

SOURCE: For subscription information, contact Mr. Boyles at 202-277-1994, or [email protected]


But, some people never change their tune, regardless of the evidence. A new report by Linda Blumberg and Lisa Clemens-Cope of the Urban Institute and funded by the Robert Wood Johnson Foundation repeats the tired old mantras we’ve been hearing for 15 years.

They argue HSAs are okay for the healthy and wealthy, that the sick and the poor can’t afford to pay the higher deductibles, that people can’t effectively shop for health care services, that HSAs are ripe for tax cheating, and that they aren’t very popular in any case. They support these views by relying on old information and discredited sources and by ignoring any research that runs counter to their predetermined views.

Once again into the fray, my friends.

First, for the easy stuff. This report relies a great deal on a GAO report that came out last year. That is how it concludes market penetration is only 2 percent and that HSA account holders are much wealthier than others. The GAO report was using very old data. Its enrollment numbers were from 2006, and its wealth estimates were even older–2005–when HSAs were still brand new. Further, it measured “wealth” by comparing HSA account holders to all tax filers, including the uninsured, people on Medicaid, people in the military, etc. Honest researchers would not have relied exclusively on this information, especially when much more robust and contemporary data are readily available.

The paper also discusses at length the problem low-income and high-consuming users will have in paying their deductibles. But it completely ignores how the same people will manage to afford the premiums required to avoid the deductible. Any honest measure of financial impact has got to include all the elements of covering health care costs–premiums, deductibles, coinsurance, and non-covered out-of-pocket expenses. People with special needs (high costs or low incomes) obviously must be subsidized, but that subsidy can be just as well directed at covering their HSA contribution as at covering their premium payments.

Further, the paper assumes “the sick” are disadvantaged by HSAs because of their greater out-of-pocket responsibility. But because there is a limit on out-of-pocket spending with an HSA program, high utilizers actually spend less than they would with another kind of coverage. This point was made in a Health Affairs article by Dahlia Remler and Sherry Glied, who report, “We find that many HSA/high-deductible arrangements would actually reduce cost sharing for many groups. In particular, the group responsible for half of all medical spending would see no change or a decline in cost sharing at the margin and on average.” Remler and Glied considered this a weakness of HSAs, that they would fail to restrain high-cost spending. Maybe so, but you can’t have it both ways. Either HSAs hurt high-spenders or they help high-spenders. It is irresponsible of Blumberg and Clemens-Cope to ignore the available evidence.

The authors also make the argument that HSAs will have little effect on high-cost expenses that are above the deductible. Theoretically that argument has merit, and the response has usually been that HSAs are not a silver bullet that will solve all the problems in health care. But they are a good start. But more recently, there is evidence that HSAs are indeed reducing expenses across the board. We’re not yet sure why that should be true. Perhaps people with HSAs or other high-deductible plans learn habits of frugality that do not disappear once they break through the deductible. Or perhaps being “invested” in their own care means they are doing things that lead to better health generally. It is something that needs to be explored, but the old argument is out-of-date.

The authors also are concerned that the tax advantages of HSAs accrue only to those consumers who pay taxes. Because of progressive taxation, people with higher incomes pay more taxes and thus get a larger tax benefit. This is all true, but it is not confined to HSAs. The exact same argument can be made about employer-sponsored coverage of any kind–there are great tax advantages for the wealthy, very little for the non-wealthy. That is why HSAs are tax advantaged. They must compete with tax-advantaged employer-sponsored comprehensive coverage. It would be dishonest to remove the tax advantage of one without removing it from the other as well.

Finally, the authors argue that consumers are incapable of shopping for health care services. This might have been a valid concern 15 years ago when the whole thing was just theoretical, but no longer. Today there is empirical evidence aplenty that empowered consumers are very capable of shopping and making cost-effective decisions about the health care services they choose to buy. But once again, the authors completely disregard any evidence that does not suit their predisposition.

So let’s put the question out there again–why is the Urban Institute sponsoring, and the Robert Wood Johnson Foundation financing, such disreputable and dishonest “research?” And what does that say about the credibility of those organizations?

SOURCE: Urban Institute