November 28th, 2009
When a 2,000 page piece of legislation traverses the legislative sausage making process, it is a large target for those who want to take pot shots.
When you are trying to fix a system that is broken in lots of places, it is not an easy process.
Let’s remember what we are trying to fix.
The system does not cover everybody. Estimates on the number of uninsured range from 30 million to 70 million depending on whom and how you are counting.
It’s expensive. Our economy already sets aside more resources per person than any other country on the planet. We pay more in taxes for health care than any other country on the planet.
We are not a healthy country. Relative to other industrial countries, we don’t live long. Our babies die before they reach their first birthday. Our pregnant mothers die in child birth.
That’s a lot of fixes.
In fact, the 2,000 pages is a pretty mediocre start. If either the House or the Senate version survives intact, it still will not cover everybody. It still will be expensive. And there isn’t much reason to believe that we will be any healthier as a result.
But it is a start.
And let’s not forget that simple in the form of single payer (HR 676) was taken off the table very early in the process.
February 28th, 2009
A letter to Senator Thomas McLain (Mac) Middleton
Chairman, Senate Finance Committee
Maryland State Senate
In one way or another I have been associated with labor management benefit funds throughout my working career. For years, the multiemployer funds were my model of how a health care system based on employment could work.
But I have become convinced that the health care system is broken at its core.
I understand that the Maryland State Senate will be considering SB 881 in committee hearings on Wednesday, March 4th. I am asking you to join the effort to lead Maryland to a single payer solution to health care in Maryland and the nation.
Who should the system serve?
First, I ask you to pay attention to who is complaining the loudest that the current system is broken. It is patients and doctors. If all of the other stakeholders aren’t facilitating patient access to care and physician delivery of care, then their role in the process needs to be reexamined. A single payer approach begins a fundamental realignment of those roles. It does not need to eliminate their roles. It needs to make them secondary.
Just about every health care reform proposal includes payment reform as an important part of its platform. Most of the proposals come from organizations representing providers. Not much is heard form the other side of the exchange.
Two stories recently highlight the need for payment reform from the consumer point of view.
Number one. My son recently visited friends in New York City. An unfortunate accident landed him in the New York University hospital for two days. He is 23 years old and has his own very good insurance.
Several weeks after he returned home, he received a bill from one of the doctors that treated him in the hospital. Apparently the insurance only paid him a bit more than $200 of the $800 bill. Because he was an out of network doctor, he could and did bill for the balance.
Number two. A Participant called our plan recently. His daughter was travelling with her mother to visit her grandmother in a southern state. She too wound up in the hospital. The family belongs to an HMO and so the HMO paid the Emergency Room bills and the follow on hospital stay. But they are having difficulty with the follow up care. HMOs routinely do not pay for services provided by out of network providers.
These examples represent the most frequent type of complaints that we hear from members and why payment reform should matter to consumers.
Before I explore these two stories more detail, I wanted to outline why providers, academics and some large purchasers are advocating for payment reform.