Access to healthcare. Mandate coverage for everyone (sorry twenty-somethings, you are not invincible). The insurance industry has said for years that if everyone is required to have coverage, then they will drop pre-existing condition clauses. It also alleviates the costs associated with adverse selection. Allow people to purchase individual polices when an employer-sponsored plan is not available.

Drive out costs associated with health care. Many health plans, both employer-sponsored and individual, are loaded with mandated benefits, such as behavioral health, substance abuse, maternity, etc., but does everyone really need these benefits? Not necessarily. Further, it is very expensive, and often cost-prohibitive, to administer a different plan in each state. Reform should address this issue, either by allowing individual purchasers to select a plan from any state (like 529 plans), and/or allow insurers to offer plans that meet federal minimum guidelines (e.g., Medicare A and B). This drives out administrative costs from the carriers, and offers individuals more options from which to select a plan that truly meets their needs, both in terms of benefits and costs.

Affordability. If the pool of insureds increases, adverse selection decreases, which drives down premiums. If the costs of administering the plan decreases, so do premiums (assuming free markets are allowed to work). Further, if people have the option to only purchase what they need, and individual purchasers can deduct their health care premiums, thus receiving the same benefits as employee contributions processed through a Section 125 plan, affordability starts to become a reality.

So in conclusion, let’s keep it simple and focus on feasible solutions to the real issues. The individual market is the best place to start.

You already know about the big-ticket items: the public option, abortion, taxing Cadillac plans, prescriptions drugs, etc. One of the most interesting things about these big plans, though, is the little things that get added to win one vote or another.

So what are the seven interesting things?

1. Requiring employers to provide unpaid time to allow nursing mothers time to use a breast pump at work – now, 24 states (including the great employee-friendly state of California) already have laws that protect nursing mothers in the workplace; this new provision would require employers (over 50 employees) to provide a private location – other than a bathroom – to use a breast pump, and of course, the time to do so. Seems like such a common sense, decent thing to do for a returning mother, that it seems so sad that we require legislation to make it happen.
2. Personal Responsibility Education for Adulthood Training – I would actually be glad to have my taxes go towards this program. Besides “innovative youth pregnancy prevention strategies,” the program would provide education to help teenagers transition to adulthood – covering topics such as relationship dynamics, self-esteem, dating, marriage, family interaction, goal setting, decision-making, stress management, and my personal favorite, financial literacy. Unfortunately, many of our under-funded and overcrowded high schools just can’t seem to  reach the students that need this kind of training most. Wouldn’t it be nice to have young adults learn these things before they reach the workplace? Children are our future, my friends.
3. Retiree health benefits – both the House and Senate bills had similar provisions that would have the government paying for high-cost health claims for retirees who are under 65 and still get their insurance through their employers. Employers would then be required to use the savings to make the health plans more affordable for the retirees. This provision, which would cost $5 billion in the Senate bill and $10 billion in the House bill, gets big smiley faces all around from employer groups and labor unions. Sad faces abound, however, over another retiree provision – taxing companies on government subsidies for providing prescription coverage to Medicare-eligible retirees. The American Benefits Council and the AFL-CIO argue that companies may stop providing prescription drug coverage and will force retirees to get their coverage through Medicare, which would increase the cost for the government.
4. Increasing payments for bone density scans for Medicare patients – increasing the payments would make it easier for Medicare patients to get access to bone density scanning that would presumably reduce the effects of osteoporosis. Seems like a good thing to me.
5. Limiting cost of uninsured in the ER – seeing as how the health care bill is supposed to reduce the number of uninsured people to a negligible amount, it seems only fair that those who are uninsured not have to pay substantially more when they go to the ER. Doesn’t it?
6. Non-profit Blue Cross and Blue Shield Health plans would have to act like non-profit companies – sounds about right to me. If you want to have high revenues, then wouldn’t that make you a for-profit company?
7. Transparent drug pricing – the health bill wants pharmaceutical benefit managers – or PBMs to those in the know – to disclose all their hard work at getting discounts for drugs at retail pharmacies. PBMs don’t like it; they say that companies will now know what their competitors charge and will raise prices! It will decrease competition! In actuality, most companies already know what their competitors are charging. If they don’t, they will probably go out of business pretty quickly, unless they have a completely unique product that has hardly any competition, in which case they can charge whatever they want to for it *cough*iPod*cough*.

You’ve got to admit, it’s going to be pretty interesting to see what other little “pet interests” creep up in the health bill. Which one has you scratching your head the most?

The Pentagon commissioned a report on smoking in the military and is urging the Department of Defense to ban smoking in the military. The report makes a lot of strong arguments, such as smoking causing $800 million a year on lost productivity and health care expenses, smoking causing mental health problems like mood disorders, schizophrenia, and substance abuse, and etc.

Now, don’t get me wrong. I hate smoking as much as the next person. I hate the smell, and I honestly cannot comprehend how someone can suck on a stick of carcinogens, knowing that the likelihood of dying from a painful disease directly caused by smoking is around 99.99%.

But the average person is not being asked to go into a war zone and put his or her life on the line, every day, for months and months at a time. The report suggested “enforcing equal work breaks for all employees to relieve the stress and boredom on duty.” Now, I’ve never been to a war zone, but I’m guessing that most of the men and women over there don’t have much of a chance to get bored or relieve stress. If taking a cigarette break helps them get through the day and calms them down before they have to get in a vehicle that may or not be blown up by a roadside bomb, then who are we to say that’s unhealthy? In the long run, yes. In the short run, though, the negative effects are outweighed.

Should the DOD spend more energy and effort on smoking cessation programs? Absolutely. The report indicates that neither the Pentagon nor the Department of Veterans Affairs has a “comprehensive tobacco-control program.” It’s definitely time to put one in place. Active duty military personnel, especially those in conflict zones, should not be the guinea pigs for these programs. They have more important things to worry about today than the possibility of lung cancer 10 or 20 years down the road. Target smoking-cessation programs at them either before they go off to war or when they get home safely, not while they’re in the middle of the action.

The report identifies a correlation between tobacco addiction and mental-health problems. While this is no doubt true, does it also mention the correlation between mental-health problems and being in an active war/conflict zone?

Anyone who has tried to implement any sort of wellness program in their workplace knows how challenging it can be. There has to be a readiness to change, and getting people to that point through whatever means you can is a daunting task (trust me, I know!). People who don’t want to change are not going to change, no matter how many taxes or increased health care costs you throw their way. The employees in our workplaces, though, are not at war. Our troops fighting for their lives need our support, not lectures on healthier lifestyles.

If the DOD can direct its focus on the new members of the military, eventually the problem will work itself out. It’s an uphill battle (no pun intended), but I think they can do it. They just have to provide the right tools and resources to the right people to set a successful course. Kudos for commissioning the report and looking to actually do something. Here’s hoping they do it right.

Never mind what’s said about the major contributors to the increasing health care costs such as pharmaceutical R&D, Technology, etc. What it comes down to is that there is great demand in the United States for our level of health care, and we “need” it. The more we need it, then the higher the price. Don’t you think that if we can reduce the demand we can resolve the bulk of our problems? Just think about the inelasticity of demand for health care, and how that impacts price. It would be far better to reduce the need for health care, rather than finding more money to pay for it, don’t you think?

So, indeed, health care reform is needed, but it actually starts with you. Ask yourself, “am I as healthy as I could be?” Chances are that you’ll answer no, but don’t be discouraged. There are several studies showing that we’re getting heavier as a nation, and generally don’t appear to be doing anything about it. Reality check, more and more of our children are becoming diabetic, and on average our belt size increased about two notches every five years within the last thirty. That doesn’t have an impact on health you say? Well then you should read about what happened to India after they incorporated the Western diet.

We know what we need to do, such as have a good diet and exercise, but most of us will put that off until we get a condition that has us going to the doctor when it is far more difficult to make that change. The reality is, the more we “need” the doctor, the more expensive it gets. Therefore, using that logic it’s less expensive to be proactive rather than reactive.

Our government can only do so much with regard to keeping health care affordable, accessible, etc. Unfortunately, it will take far more than their efforts to fix our problem. Yes, it’s very complex and confusing at times, causing most to turn away and not bother dealing with it. However, it will eventually catch up to all of us. So what should we do about it? Each and every one of us can contribute to being part of the solution by taking care of ourselves. If we all did that, imagine what would happen.

And now, the President of the United States: 

The White House, Washington

Good afternoon,

You are receiving this email because you signed up at WhiteHouse.gov. My staff and I plan to use these messages as a way to directly communicate about important issues and opportunities, and today I have some encouraging updates about health care reform. The Vice President and I just met with leaders from the House of Representatives and received their commitment to pass a comprehensive health care reform bill by July 31.

We also have an unprecedented commitment from health care industry leaders, many of whom opposed health reform in the past. Monday, I met with some of these health care stakeholders, and they pledged to do their part to reduce the health care spending growth rate, saving more than two trillion dollars over the next ten years — around $2,500 for each American family. Then on Tuesday, leaders from some of America’s top companies came to the White House to showcase innovative ways to reduce health care costs by improving the health of their workers.

Now the House and Senate are beginning a critical debate that will determine the health of our nation’s economy and its families. This process should be transparent and inclusive and its product must drive down costs, assure quality and affordable health care for everyone, and guarantee all of us a choice of doctors and plans.

Reforming health care should also involve you. Think of other people who may want to stay up to date on health care reform and other national issues and tell them to join us here:

http://www.whitehouse.gov/EmailUpdates

Health care reform can’t come soon enough. We spend more on health care than any country, but families continue to struggle with skyrocketing premiums and nearly 46 million are without insurance entirely. It is a priority for the American people and a pillar of the new foundation we are seeking to build for our economy.

We’ll continue to keep you posted about this and other important issues.

Thank you,

Barack Obama

P.S. If you’d like to get more in-depth information about health reform and how you can participate, be sure to visit http://www.HealthReform.gov 

County Clinics and Emergency Rooms have been carrying the burden of healthcare expenses for illegal immigrants in the state for many years. William Walker, director of Contra Costa Health Services, said the national ambivalence on immigration policy means that illegal immigrants are living here but without federal or state funding to provide essential medical services to them.

While Counties can take action to eliminate healthcare services to illegals, Emergency Rooms and hospitals cannot. They are required by law to provide care to all regardless of immigration or insured status. There is a fear amongst State health officials that this action will result in more Emergency Room visits by illegal immigrants and further inflate healthcare costs to legal citizens of the State and the insured. Others are concerned that lack of treatment will result in communicable diseases going untreated and put everyone at risk.

In light of the recent swine flu outbreak, how do you feel about treating non-citizens for communicable diseases? Should we treat them or not?

First off, I think the bigger question that needs to be addressed in relation to impoverished areas is why it costs more to eat healthy.  The sad fact is, while people may want healthier choices nearby, they may not necessarily be able to enjoy them, as the prices in the Whole Foods market in a poorer neighborhood are not going to be that much cheaper than those in an upscale area.  Placing a moratorium on new fast food places is not going to change this.  In fact, the community may feel alienated and frustrated because the choices they could afford are being held off in favor of places that are out of their budget.  The ban will merely serve to highlight the economic challenges that come with eating healthy, while doing nothing to lessen this burden, which probably has more to do with obesity in depressed community than the proliferation of fast food places.   

Another point of contention is in regards to the government regulating food in schools.  The rights of a child sequestered in a publicly funded educational institution are a completely different animal than the rights of an adult going to a place of business by their own volition.  Moreover, in order to get this argument to click, one would have to assume that an eight or nine year old has the same mental capacity to make the same kind of decisions relating to health that an adult can make, which is simply not the case.  A child that would eat unhealthy food without restrictions would not be able to fully grasp the consequences of their actions, whereas an adult does not have such an excuse.

Also, the drinking while driving analogy can make sense the moment that somebody eating one extra Big Mac could potentially lead to the tragic death of another person.  Until then, it is rather irresponsible to draw conclusions that overindulging in food equates to a regulatory level that is reserved for drunk driving.  DUI laws are strict because of the real possibility of damage that one can inflict on other people who would be affected by the intoxicated driver’s poor choice.  Since the same cannot be said in relation to what a person eats, such an analogy should not be made in this situation.

Finally, Lexi had mentioned that without laws, people could do anything they wanted without concern of the affects on other people.  I absolutely agree with this sentiment.  However, the L.A. City Council’s ruling does not stem from a concern on the affects of other people, because what one chooses to eat simply does not have an affect on those surrounding that individual.  Rather, the essence of the ruling is to protect people form themselves, which is not something that the law is designed to do.

Again, I think the issue that needs to be addressed in the wake of the L.A. City Council’s decision is the expensive cost of healthy food, and how a solution is needed to make healthier options more affordable.  Until then, however, limiting liberties in lieu of increased obesity rates is not the proper reaction.

Admittedly, it may be a little tough to take a hard line stance on the government on this issue.  After all, the endgame of this decision is to increase health by decreasing unhealthy choices, and it is very difficult to view the motive behind the decisions in a negative light.  That being said, it does not grant the rulings themselves the same exemption.  Laws like the ones put forth by the state and local governments the past few weeks ultimately intrude upon important ideas such as personal choice and responsibility.  Granted, from a big picture perspective, the laws are not too unreasonable – menus are not going to suddenly resemble a health food store; it’s not like this week’s Los Angeles ruling is ordering that a wrecking ball be taken to existing fast food places in the designated areas.  However, both decisions at its core boil down to the government making choices on behalf of its people.  If a person wants to eat unhealthy, isn’t it his or her right to do so?  And even though we should rightly be discouraging people from making poor dietary choices, there is a fine line between discouragement and force, and these laws squarely cross into the latter camp. 

Again, the rationale behind these decisions is a worthy one.  There is nothing wrong with desiring better health for people.  However, there has to be a better way to see such a goal come to fruition without the government stepping in to essentially protect people from themselves.

First and foremost, why should the government penalize Medicare beneficiaries who have successfully planned for their retirement?  Our government should encourage people to save for their future – not charge them more for a benefit for which they have been making contributions for more than 40 years.  

Second, the process for managing Medicare D deductions is already inefficient; so inefficient and just plain bad that according the Medicare Advocacy website (medicareadvocacy.org), there are 3 pending lawsuits resulting from the government’s inability to properly process the deductions and fix errors in a timely matter.  Part of the problem is that there are 3 separate government agencies involved in the process – the Centers for Medicare & Medicaid Services (CMS), the Social Security Administration (SSA) and the Internal Revenue Services (IRS).  The other part is that, unlike Part B which has a single deduction option, there are multiple deductions for Part D, depending on the selected plan.  Add another layer to the matrix, namely income, and the problems will only get worse.

Finally, I doubt this is even cost-effective.  There are time and resources involved in working through the process, updating and testing systems, as well as trouble-shooting once in place.  Further, if the government is already in court as a result of their inability to handle the current matrix, I am fairly confident that by adding complexity and therefore increasing the likelihood for errors, more court cases are bound to follow.  In addition, according to the US Census Bureau, only 10.8% of households 65 or older earn over $100,000.   The percent of earners over $160,000 would be even less.  So Senator McCain’s proposal is to add complexity to an already inefficient process for less than 10% of the eligible population.  That fact alone speaks for itself.

What other options are there?  Well, if this process was taken over by a private entity, the first order of business would be to drive costs out of the process – what can be automated, simplified, eliminated?  Next, private enterprise would look for ways to reduce the costs of goods sold – in this case, the cost of the prescriptions.  Finally, the consumer pricing model would be reviewed, looking at both hard costs and soft costs.

There is no doubt that there is a need for the “modernization and improvement of Medicare”.  However, implementing a program that creates administrative burden, lawsuits, and penalizes Americans who successfully plan for retirement is not the answer. 

We’re in presidential election season and the so-called health care crisis is a primary topic among the three remaining candidates.  I’ll leave the industry diagnosis to others, but I thought a reasoned study of their positions would be helpful.

After carefully reading the health care policy positions of all three presidential candidates, it is clear that at least one major difference separates Senators Hillary Clinton and Barack Obama from their Republican Party opponent Senator John McCain – a government mandate that all Americans be required to purchase a health insurance plan.

Senator Clinton proposes a sweeping mandate that “every American (be) required to have coverage,” while Senator Obama only requires that “all children have health coverage,” apparently leaving adults with the option of going uncovered.  He does, however, require that “all employers offer ‘meaningful’ coverage” for their employees.  An in-depth search yielded nothing on how to define “meaningful coverage.”  So, though he doesn’t require individuals to acquire coverage on their own, he does require all employers to provide it.  Both candidates propose tax credits to those who purchase their own health insurance.

Senator McCain opposes any mandate for coverage, preferring to allow Americans their constitutional right to choose for themselves.  However, he does support federal funding to states that allow government programs like Medicaid and State Children’s Health Insurance Program (SCHIP) to be used to purchase private insurance.  And, like his opponents, he also proposes tax credits for those families who purchase their own health insurance.

As a believer in free markets and private – not government – solutions to big problems, John McCain’s commitment to keeping government from further intrusion into the health care industry is aligned with my personal philosophy.  However, the entirety of his proposal isn’t a win-win solution either.  I’m concerned about his proposed elimination of tax-favored employer insurance and how that will affect my livelihood.