A recent New York Times highlighted Maine’s attempts at comprehensive healthcare reform. Their experiences serve as a cautionary tale for Congress.   The state established a public health insurance plan, expanded Medicare and Medicaid eligibility, and banned insurers from refusing to cover people with pre-existing conditions, but those actions have done  little to insure more of its residents.  Contrary to the promises of public option supporters, health care costs have only continued to rise in the state.

Reasons for the high health care costs range from the state-specific to the general. Unlike the bill that recently passed the House of Representatives, Maine’s healthcare reform legislation didn’t include a mandate to buy health insurance plans. It’s a vicious cycle: forcing health insurance companies to offer policies to unhealthy people with pre-existing conditions raises the rates for younger people; young adults will be even less likely to buy health insurance if their premiums go up, which results in the insurer’s risk being spread among less people. In the end, the older, unhealthier population remains in the pool and must contend with less affordable health insurance. Therefore, there is a larger uninsured population.

Granted, Maine is a market dominated by just one private health insurance company (which, with its effective monopoly, can increase premiums to their liking); and its population is older, sicker, and poorer than the U.S. in general. Senator Olympia Snowe points to her state as a cautionary tale of what may happen if drastic changes are made too fast. Snowe is a Republican that supports healthcare reform but is against the public option. Budgeting problems have caused Maine to cap enrollment of its own public option health insurance plan at under 9,000. The federal government, unlike most states, is allowed to run a deficit. However, it isn’t exactly rolling in the money right now either.

I look at healthcare reform as a football field. It’s separated by a virtual, high-res 50-yard line controlled by the commentators at ESPN.

On one side of the yard line, there are politicians shouting at their quarterback about a health plan run by the U.S. government; one that would force private health insurance companies to compete with a presumably cheaper public plan (“GO PUBLIC PLAN!”). On the other side of the 50-yard line, there are politicians shouting at their quarterback about a health plan run by the U.S. government; one that would choke  private insurance company CEOs until they raised their premiums or be forced out of business (“GO PRIVATE ENTERPRISE!”).

Outside the stadium, insurance companies are having an awesome tailgate party in the parking lot.

The smell of hot dogs and hamburgers are filling the air, beer is flowing as fast as the crude jokes about the game going on behind them. If you look at recent public statements from some of these companies, it’s clear they couldn’t care less who wins this one. Because they know they’re going to be the ultimate winners, no matter who makes the last field goal.

After President Obama established healthcare reform as a top priority almost immediately after saying “I Will” on January 20, most major insurance carriers went into the locker room. Their public silence  was about as deafening as the Super Bowl at half-time.

But insurance industry analysts knew it was only a matter of time before the position papers, talking points and customer Q&A scripts started to trickle down, ready for public consumption. Company leaders just needed to huddle up and come up with a contingency plan. After the House won their own marathon Pro-Public Option showdown in overtime on Saturday night, it’s as if the coach for the insurance plans threw a cooler of Gatorade on themselves in victory.

Here’s a look at some of the not-so-partisan statements that have come across the newswires about the vote:

“…(we are) deeply disappointed with the legislation progressing in Congress. Both the bill proposed by the House of Representatives and the bill passed by the Senate HELP Committee miss the opportunity to address the underlying cost drivers in our health care system.” – WellPoint, nation’s largest health benefit company, with approximately 35 million policy holders.

“A government-run program would threaten employer-based coverage…An independent analysis by the Lewin Group found that millions of employees would lose their private coverage and be forced to join a new government-run health plan. People will reject proposals that could put at risk their employer-sponsored coverage.” – CIGNA Corporation, one of the largest investor-owned health care providers in the U.S., the bulk of which is employer-based.

“We support reforms that make the market work for everyone, by bringing more people in rather than creating a new government-run health plan that would cause millions of Americans to lose their private coverage.” – BlueCross and BlueShield Association, covers 1-in-3 Americans, approximately 100 million policy holders.

It’s no shock that none of the commercial insurers are behind the public option. But what’s a little surprising to me is  they’re not hanging out in the parking lot waiting for the post-game traffic to die down.

By making these dire threats about how people will lose their coverage; pay more for what they’ve got; or even lose access to insurance altogether (as in the odd assessments of CIGNA and BlueCross), it’s insulting to the American public.

If Uncle Sam were to open up shop down the street, private insurers only make their industry look like a bunch of spoiled sports  in a game where the ones who are crying foul are the ones the Fed will be counting on to administer their plan. It’s not like the U.S. Government has some kind of top-secret, underground insurance company waiting to jump out after the Senate vote and take over like King Kong in Times Square.

Bottom line: The insurance companies are going to be just fine no matter what happens in D.C. Public option or not. You know it, I know it and they most certainly know it. For the sake of public perception at least, insurance companies need to throw their full support behind health insurance reform (or at least pretend to, in an intelligent way) because the game’s  in overtime and nobody is injured on the field.

Reform is going to happen. They may not have wanted to be in the game, but  it’s now time to be gentlemen at the end and shake the winning coach’s hand on the way off the field.

Marilyn Wann never bought into professional modeling marketing-speak proclaiming that “Thin is In.” It’s not because her physique doesn’t fit the phrase. For her, it’s a widely-held bullying tactic for the current authors of health insurance reform. Marilyn tells New York Times reporter Susan Saulny that an increasing number of slender Americans blame fat people — not Medicare, nor pharmaceutical company profits — for the most historic overhaul of our healthcare delivery system since the U.S. Government started Medicare itself.

“We’re kind of a popular punching bag,” says Wann, author of the book, “Fat! So?”

Physicians, dieticians and the scientific community have proven that there is a common link between obesity and a slew of chronic and terminal illnesses, from diabetes to heart disease. Healthcare bean counters claim that fat people increase the entire cost of healthcare for everyone, since they are more often diagnosed with long-term disease.

We’re all aware of the doomsday, sky-is-falling stats that apparently prove we’re all eating funnel cakes, Twinkies and potato chips all while sitting in front of the couch watching The Biggest Loser every night. It’s the stuff that sensational television and reality series’ feed off of. To be sure, the Robert Wood Foundation (a think-tank on healthcare issues) just published a study showing that two-thirds of us are fat. In four states alone, Tennessee, Alabama, Mississippi and West Virginia, more than 30 percent of its residents are statistically obese.

But Wann thinks it is somewhat discriminatory that corporate America is suddenly offering sums of money, free stays at fat camps and other incentives to overweight Americans in a thinly-disguised campaign to cut group insurance coverage costs while marketing the move as a gesture toward caring about the wellness of their employees.

On the flip-side, Wann and other obesity fairness champions say the efforts for reform are energizing opportunities to cultivate what she calls, Fat Pride. “Basically, we want to be treated with respect the same as everyone else.”

Who knows. Wann and her followers might start a movement toward true health insurance portability and help prove that individual health insurance is still affordable.

On the eve of the historic House Congressional vote on the wobbly healthcare reform bill, President Obama managed one last pull at the AARP, but may not have saved its members from falling into the verbal mud pit in the long tug-of-war over the Affordable Healthcare for Americans Act. By his own admission, AARP CEO Barry Rand knows his 40 million members are still very much split down the middle in their support. This leaves the President wiping his brow while leaving Rand in the awkward position of posing for the photo-op while crossing his fingers behind his back. The near-finalized bill will hit the House floor on Saturday night for a vote.

“As members of the House gear up for this historic vote, they will hear from older Americans,” said Rand, in a prepared statement announcing the endorsement. Although Rand said this marks the first time the AARP has put its “full weight behind a comprehensive health care reform package,” he’s likely to find more raucous town hall style debates swarming around retirement homes after the vote and regardless of the outcome. That’s because by all accounts on Capitol Hill, the Senate and the House are miles apart on the road to reform. Somehow, some way, there’s got to be another lane built on the highway to accommodate both parties’ differences.

“It is not enough in our eyes just to say we endorse a particular piece of legislation and expect that all the dominos will fall into place as a result,” Sam Wilson, the chief AARP rep in South Dakota tells the Daily Republic today.

Right now, the ropes in this tug-of-war are wearing thin. Parties on both sides are gonna need gloves to avoid further rope burns. Whether or not the holy grail of health reform — the so-called Public Option — remains in the final bill is sitting squarely in the mud pit.

One of the identifying features of terrorism is the intent to cause a feeling of terror in a population.  Many may disagree with Nancy Pelosi’s plans of healthcare reform that include a public option, but keep in mind that congresspersons of both parties genuinely believe that what they are doing will help America. They may be wrong–and their policies might have disastrous results–but neither Democrats nor Republicans are purposely trying to destroy the United States. Therefore, comparisons to the likes of Osama bin Laden are off-base.  The worst thing about her comments is that they serve to cheapen the legitimate concerns people have. Foxx doesn’t like the bill because she believes it will allow the government to force people to buy health insurance, raise taxes, and and give bureaucrats more power. These are all valid arguments that deserve to be debated, but some people may tune them out due to her inflammatory statements.

Our infamously long-winded Vice President once said that he tried to never question a person’s motives, no matter how much he disagrees with their policies. All of our politicians would do well to take that advice. Both parties are striving to achieve what they think is best for America. Their varied opinions on healthcare reform deserve to be discussed civilly, without resorting to the modern equivalent of Godwin’s Law. In my opinion, that would be best for us all.

(Image: U.S. Army under CC 2.0)

1. The Comprehensive Health Care Reform Act of 2009 would give Americans a 100% tax credit on their health care costs (e.g. prescriptions, hospital stays, doctor visits). Health Savings Accounts (HSAs) with high-deductible health insurance plans would also be tax-free. Low-wage employees who don’t file tax returns can have the credit refunded against their payroll taxes, so the bill would help those who need it most afford healthcare. Currently, only medical expenses that reach over 7.5% of an individual’s income can be deducted.
2. Dr. Paul’s Coercion Is Not Health Care Act of 2009 would forbid the government from enacting a health insurance mandate. There has been some speculation as to the legality of such a mandate. Congressional Democrats, along with the Obama administration, believe that it has to be part of healthcare reform legislation. Their view is that universal coverage must include the young and healthy in order for the insurance pool to afford covering those with pre-existing conditions. This interference in the free market is anathema to Paul. Incidentally, if there is no public option, such a mandate might not be necessary.
3. Finally, his Freedom From Unnecessary Litigation Act of 2009 would save money through indirect tort reform. This act would establish so-called “negative outcomes insurance”, which would pay off if a patient’s medical treatment goes wrong; it would also offer a tax credit to make the purchase more affordable. The goal is to decrease some of the unnecessary (and costly) testing done in order to avoid malpractice liability, as well as lessen the need for hospitals and physicians to carry billions of dollars in insurance.

As Paul is himself a doctor, his views on the healthcare industry are worth listening to. His opinions tend to be shortchanged in the House because he doesn’t walk in lockstep with either party’s platform, giving his bills little chance of passing.  However, many Americans–who fear socialized medicine, yet acknowledge that we need more affordable health insurance as soon as possible–could find something to applaud in his plans.

Skinner’s remarks, as reported in the Boston Globe, mainly focused on the need to protect small businesses in any healthcare reform bill. You may wonder why a massive multinational corporation such as McDonald’s cares about the plight of small business owners. Well, the vast majority of McDonald’s restaurants (85%) are owned by franchisees who operate independently, albeit with support from the corporation. He believes that while increased access to a health insurance plan is important, it shouldn’t come at the expense of small business. There is a possibility that reform might come with an undue burden on companies and franchise owners buying small group health insurance for their employees. If their savings were jeopardized, millions of Americans could lose their coverage. Clearly, this would defeat the purpose of Congress’ health care reform efforts, and would be opposed by McDonald’s.

What does Jim Skinner think about the charge that his company and other fast food restaurants are part of the problem of soaring healthcare costs by promoting obesity? He pointed out the offering of milk and fruit in some children’s Happy Meals, as well as the expansion of the menu to include healthier selections. Above all, it’s a choice to eat at McDonald’s. Although they could certainly do more to support health (i.e. post calorie counts prominently on the menu everywhere, as they are legally required to do by New York City), there is merit to Skinner’s perspective. As a franchise, McDonald’s has a unique perspective on health insurance from both the small business and large corporation side.

(Image: Official McDonald’s Corporate Website)

How do you know if you’re a victim of rationing, as opposed to a recipient of high-quality, sensible health care? In Newsweek magazine, medical school professor Christopher Moore acknowledged this dilemma. Sometimes, excess treatment can hurt the patient more than it helps. Take CT scans, for example. Admittedly, they are costly, with prices continuing to rise (and also being passed onto your family health insurance bill); but CT scanners are amazing medical technology that can identify if a head injury is life-threatening. However, studies have shown that the probability of that being the case are relatively tiny. Meanwhile, there is up to a 1-in-1,000 chance of each CT scan causing eventual death from cancer (due to the radiation involved), even more so for younger patients. The medical risks of doing a CT scan on a teenager with a concussion could outweigh the benefits, even after removing cost from the equation. Keeping a close watch on the patient might be a better bet.

So if your doctor refuses to perform an expensive test or other procedure, it’s very likely that he or she has a legitimate medical reason for it. If you get more affordable health insurance because of the reduced cost, so much the better, but that’s not the #1 priority.  Occasionally, a physician who performs the procedure might be doing it solely to avoid a malpractice lawsuit. The prospect of a government-run public option won’t stop that. Moore insists that a doctor who genuinely believes an expensive procedure is sorely needed won’t let cost concerns stop him or her from ordering it. Let’s hope so.

(Image: Akira Oghaki under CC 2.0)

It’s two-and-a-half times more expensive to transfer an extremely obese patient than one at normal weight, according to the Associated Press. Reasons for this include the need for new vehicles and helicopters with larger doors and lifts, extra-large stretchers, as well as the need to hire more emergency crew members (and have them work longer hours) to lift obese patients. Insurance companies operating in Washington and Oregon already pay increased rates to cover those extra costs, despite fat-acceptance groups considering it to be another example of weight discrimination in medical care. Other advocates of the obese, however, are appreciative of the improvements that allow them to be transported with dignity.

The cost of specialized ambulances will certainly be passed on. Increased regulation in the healthcare reform bill may prevent people from charging extremely obese patients more for a health insurance plan. Therefore, everyone’s plan will cost a little bit more.  Medicare and Medicaid are resisting increased reimbursements, but the industry is fighting for fair compensation for their services. Without it, they claim that they will be unable to provide quality care that serves the needs of a significant percentage of the nation’s people.  Promoting public health (e.g. reaching a healthy weight and not smoking) would do a lot to reduce healthcare costs, and should be part of any healthcare reform. Otherwise, the population of morbidly obese will rise from its current 5%, requiring more specialized, costly care.

(Image: NIOSH – National Institute for Occupational Safety and Health under CC 2.0)

What would medical device makers consider a more acceptable bill? One that:

• Exempt small companies, defined at those making less than $100 million
• Would be tied to specific products, presumably with more profitable products being taxed a higher rate
• Was at least partly deductible as an expense and,
• Doesn’t take effect until 2013.

As it turns out, the medical device industry was lucky. An initial Senate proposal doubled the fee to $40 million, so AdvaMed has expressed its gratefulness for the reprieve. Such a break was probably going to happen anyway, in exchange for moderate Democratic Senator’s Evan Bayh’s support. Bayh represents Indiana, a state that is the headquarters to many medical device companies. Will the goal of affordable health insurance still be achieved with this corporate giveaway?

(Image: stevendamron under CC 2.0)