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Mary Brainerd: ‘the ultimate aim: better health and more accessible, affordable health care’

Editor’s note: This is the first in a series of occasional Q&A’s with thought leaders on their best hopes and worst fears for health reform.

Best hopes, worst fears for health reform

HealthPartners CEO Mary Brainerd would like to see universal health coverage in the United States but worries how the nation will pay for it.

Brainerd, who joined HealthPartners in 1992, oversees a 52-year-old nonprofit system that insures 1.25 million patients nationwide. Bloomington-based HealthPartners operates about 70 clinics as well as St. Paul’s Regions Hospital, one of two safety-net hospitals in the Twin Cities (Hennepin County Medical Center is the other one).

While national reform offers the potential of universal care, state reform seems to be sliding backward with cutbacks to public aid programs, Brainerd says. Minnesota has been a standout with one of the lowest uninsured rates in the nation because of its public aid programs.

“I’d say we’re not moving from just the top five or six — we’re moving to a position in the bottom half” of the nation, Brainerd says in a Q&A with MinnPost. Here are her thoughts about health reform.

MinnPost: What are your best hopes and worst fears for health care reform at both the national and state levels?

Mary Brainerd:
My best hope would certainly be that we have coverage for anyone and through that make sure everyone had access to our health-care system. A second would be that we would be able to have more affordable health care and third would be that as we look at health care reform that we change the way we pay for it. … Under the umbrella that we want better health for people in our country, we don’t measure up as well as we might against health-care outcomes in some other parts of the world and other places. So, that’s the ultimate aim: better health and more accessible, affordable health care.

MP: Your worst fears?

MB:
My worst fears are that we will extend access without figuring out how to make health care more affordable and that it will lead to an unsustainable system. The second is the specific concern for Minnesota that some of the current inequities in the Medicare [federal coverage for age 65-plus] payment system will get baked into health-care reform, and that’s a bad deal for Minnesotans. 

MP: Can you be more specific?

Mary Brainerd
Mary Brainerd

MB: Sure. Medicare currently pays dramatically less for care in Minnesota than it does in some other parts of the country. Our current private financing system subsidizes those low Medicare payment rates. So, continuing to build on the Medicare payment rate and on the Medicare fee-for-service system, which incents volume and procedures, are two things that are broken from our perspective.

MP: How has your thinking changed about reform during your career in health insurance and since health reform rose to the top of the domestic agenda?

MB:
Twenty years ago, I don’t think there was as much awareness or understanding about the no access [to health coverage] that so many Americans are experiencing. I think a better understanding about the issues associated with having a larger uninsured population and the disadvantages of that are clearer to me.

Something that I wouldn’t have known as much about, or had as many concerns about, is health disparities. We clearly have lots of disparities based on race and ethnicity and the ability to speak English, which result in poor health outcomes within the health care system.

I’m much more clear than I used to be about the fact that health care and health are not the same thing and that, in fact, health has a lot to do with what your socioeconomic status is: how healthy and livable your community is, what your environmental surroundings are like — and that a lot of those are connected, including even educational status, as determinants of health.

I think I have a real clear awareness, in part because of Regions Hospital being part of our system, how differently we treat mental illness care than we do more traditional physical illness care and the challenges in that area.

I think mental illness is still a set of health conditions and diseases that have a lot of stigma associated with them, where the investment of community resources is not as good as it needs to be. I think that lack of investment, and the fact that payment for health services is still so low, is a manifestation of the stigma associated with that disease. We don’t value it, so therefore we don’t support the care organizations and the providers who deliver the care to people who have mental illness.

We clearly are using a model that says, “We’ll provide care when you are in crisis but we are not going to figure out how to support you in a healthy and stable living situation.”

MP: HealthPartners came out with a strong statement against Gov. Tim Pawlenty’s line-item veto of General Assistance Medical Care for childless adults. We’re one of six states providing such public health care for these adults. Between the legislative cuts and this veto, do you think Minnesota’s health care safety net is being dismantled?

MB:
I think the elimination of General Assistance is a big step backwards and it will affect everyone because our safety net organizations are the most dramatically affected by the cuts. A large percentage of our patients in our mental health facility at Regions are on General Assistance. When that program goes [GAMC is scheduled for elimination in 2010], they no longer have coverage. Those individuals will only be able to enter the health-care system through the safety net and the crisis system we have today, which is the emergency room. And that’s not an optimal way, not even an adequate way, to get care for chronic mental illness. It’s also a very expensive way to deliver care.

You’re using the example of six states in the country that offer programs [for childless adults]. But another 18 to 20 states have a program that specifically supports their safety-net facilities. They don’t provide coverage to individuals. I frankly think it’s very important to provide coverage to individuals so they can access care in the community at the clinic level — not just through the hospital. Another 18 to 20 states have made the decision that they at least need to provide special support for their safety-net facilities because of the challenges of caring for the uninsured. And we haven’t done that. So I’d say we’re not moving from just the top five or six — we’re moving to a position in the bottom half.

MP: There seems to be broad consensus that universal coverage is needed, but broad disagreement over how to achieve it. Why is the health insurance industry opposed to a public option when our nation already has taxpayer-funded programs like Medicaid, Medicare and other entities or exchanges to cover the military and federal employees?

MB:
I think that the discussion is how broad a role do you want the government to play? There are folks on the side of that discussion who say they’d like a single-payer system only, which is a move to government-only, although frankly that’s not even the case for Medicare. Most Medicare folks have a HealthPartners card or a Blue Cross card or a UnitedHealth Care or an AARP card. The same holds true for people in the Medicaid program. I think, in general, people are saying, “We want more choices than only a government plan.”

So, on the continuum of a completely private or a completely public system, where will reform land? My concern for Minnesota, again, is that Medicare, if a public plan is based on Medicare payment rates, those rates are so low in our state that the private payers — that means individuals and businesses — are paying higher rates to cover that cost. And that means private plans wouldn’t be able to compete with a Medicare [type plan].

We all want lower health-care costs but that kind of shift wouldn’t just affect the health plans, it would affect our delivery systems very dramatically. I think our congressional delegation gets this point. I know some of them would love to see a public plan but I know they’re very concerned that our delivery systems, our hospitals and our medical groups in Minnesota and some other states can’t make it on the very low Medicare payment rate.

So, expanding use of that Medicare fee-for-payment approach in our state and others like us is a big issue. It would be a different discussion if we were New York or Florida or California. Then you’d be debating the topic on a different set of criteria. But in Minnesota, we can’t make it on a 34-dollar fee-for-service payment rate that Medicare pays here.

MP: What could the nation learn from Minnesota’s track record in health care and the fact that it has one of the lowest uninsured rates in the nation?

MB:
I actually think the best things to learn from Minnesota are that we have had a focus on quality care. We’ve done a lot in this state to promote best practices and use the scientific evidence to deliver care. We have a good history of collaboration including things like quality reporting in which Minnesota is a national leader. We’ve had more organized systems of care instead of really fragmented care organizations and we have good health care outcomes to show for it. So, if you look at health care quality in Minnesota, we’re way up at the top and we tend to do that in a little bit less expensive way.

I’d say what Minnesota demonstrates, in terms of having a low percentage of uninsured, is when you have more affordable health care, it pays off. A larger percentage of small businesses in Minnesota offer more coverage than in other states and I think that’s because historically we’ve been a place where health care — although it is increasingly unaffordable here — has been an asset compared to some other states.

The other thing is we’ve put together a sort of patchwork quilt of programs to keep people covered. But having that done at the state level is a challenge, and that’s where I think there’s some opportunity for federal reform to be effective. We have this high percentage of small businesses offering coverage. We’ve had pretty good rules of the road for insurance coverage behavior. … We’ve had a plan (Minnesota Comprehensive Health Association) for people who have pre-existing health conditions. We’ve had MinnesotaCare, and we’ve had the General Assistance program. So, we’ve put all that together and knitted it in a way that we’ve ended up with a high percentage of the population that has coverage. Looking at that you can see how it might be used nationally to create insurance reform and coverage for all.

MP: Could you comment about the nonprofit requirements in the state? Could that work nationally?

MB:
I do think that having a not-for-profit system is an asset in Minnesota. We have both not-for-profit plans and not-for-profit delivery systems, and I think it has reduced some of the hurdles that stand in the way of collaborating on a little bit better value and doing things for the community benefit. I think … having not-for-profit systems that are community-based is a big deal. We don’t have absentee landlords here for our health-care systems and I think that’s an asset. I don’t know that that is the only solution but I sure do hope it’s a solution that is protected and hopefully advanced as we do health-care reform. It would be every easy to slide into a world of thinking that all insurers and a lot of hospitals nationally need to be for-profit systems, and I think that would be a step in the wrong direction.
 
MP: Anything else you’d like to say that I haven’t asked you?

MB:
I think there is still great potential in improving health and not just looking at it as a medical system. We know that about 25 percent of health-care costs are actually associated with conditions that are determined by your own health behaviors: whether you smoke, whether you’re physically active, how well you eat. I believe one of the things, not the only thing, to help make health care more affordable is to help make our lives healthier. And that doesn’t happen in hospitals; that happens in schools and parks and the way we structure our cities. I think there is work to be done there. 

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix [at] minnpost [dot] com.

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Comments (21)

  1. Submitted by Glenn Mesaros on 07/16/2009 - 08:26 am.

    If there is to be real health-care reform, in this country, HMOs must be banned and the nation returned to the 1946 Hill-Burton standards of provision of medical infrastructure for every part of the country. This afternoon, Sen. Bernie Sanders (I-Vt.), during a markup session of the Kennedy health-reform bill, provided what amounts to a bill of indictment against the private insurance business, in the context of an amendment relative to a discussion on single-payer health care. Using data from a recent Congressional Quarterly investigative article, Sanders reported that the insurance sector and pharmaceutical industries spend the “unbelievable” sum of $1.4 million a day on lobbying the Congress and on campaign contributions. The drug companies, he reported, spent $200 million last year, to influence federal policy—more than any other sector—and HMOs spent $62 million in the first quarter of this year. He called this effort “dangerous to democracy” and added that “they use it to make sure we don’t do what we should to protect the American people.”

    All of this lobbying spending is to protect a system that increased profits to private insurance companies by 170 percent from 2003 to 2007 and pays the top executives of the top seven insurance companies an average of $414.2 million per year. That profit is generated by a massive bureaucracy, dedicated to denying payments to health-care providers, that costs 30 percent of every dollar that goes into health care and that “grows” administrative workers at a rate 25 times faster than new doctors are produced! Sanders cited the example of Duke University Hospital having to employ 900 billing clerks to fight with the insurers over denied payments. Duke is a 900 bed hospital, so that amounts to one billing clerk per bed!

    Sanders’ amendment to allow states which choose to do so to implement a state-wide single-payer system, was voted down by the committee on a 19-to-4 vote.

  2. Submitted by Paul Udstrand on 07/16/2009 - 10:29 am.

    Why doesn’t anyone ever ask these executives to explain why they charge so much for health care and how they have contributed to the rising costs? I mean there’s a fundamental disconnect- on one hand they want government to control costs, they want government plans to be funded, but on the other they claim public plans can’t do it? And who exactly are these “people” who say they want choice? When people talk about choice they’re talking about health care choices, which doctor, hospital, medications, not insurance companies. People don’t care who the middle man is, they just want to get to the doctor. And how come no one ever asks them why private reimbursement rates are higher? And how much more if any they spend collecting from private insurers than they do form Medicare? They may technically collect more per dollar, but they frequently spend more fighting denials and wait longer for payment. These guys act like rising costs are just some kind of unexplained phenomena and no one ever calls them on it.

    By the way, I used to work for Fairview Hospital, which was a Group Health hospital, you can’t trust anything these guys tell you about budgets. I’m not saying anyone’s lying, I don’t know that, but unless you see the books, you just can’t trust them. They used tell us that they only collected 52 cents for every dollar billed and that’s why they had to cut staff. For some reason it’s always something two cents, 42, 52, 62. Even when they were rolling in dough these guys claimed they were losing money. When we pointed out that according the yearly statement they’d seen increased profits (yes, not-for-profits make profits) for three years in a row… they stopped sending out the yearly statements!

  3. Anonymous Submitted by Anonymous on 07/16/2009 - 12:10 pm.

    Kudos for admitting that our health care lags behind other countries. That is a definite step in the right direction!

    The problem with cost is the insurance companies themselves. She discusses how medicare pays low fees, but in mental health, Health Partners pays some of the lowest fees. Few mental health providers even accept health Partners, limiting consumer choice. I have employee coverage that is Health partners, so I have no choices. It costs my employer about $9000 for me and if I wanted to add my family it would cost about $10,000 more out of pocket. All of that just to be stuck with $40 co-pays and only 80% coverage. The problem with health case in this country is Health Partners. You pay through the nose for limited or no choices whatsoever.

  4. Submitted by Thomas Swift on 07/16/2009 - 12:30 pm.

    Mary’s worst fear, that “we will extend access without figuring out how to make health care more affordable and that it will lead to an unsustainable system.” is a reality in every country that has socialized it’s health care system.

    And, they’ve all fallen back on the same tools to try and dig themselves out of the holes they’ve dug.

    1. Rationing.
    Canadians wait months for non-elective procedures, especially for procedures that involve the use of expensive, high tech equipment (such as CAT or MRI) which their system has precious little of.

    2. Re-introduction of private insurance companies and clinics.

    In Canada it is actually against the law for a doctor to open his own, private clinic. But many are doing so because they are confident that the government won’t prosecute them, because they are taking some of the heat off the failing government system.

    In Germany and England it is the same story.

    So, ironically, by socializing their systems, leftists have actuality created the two tiered system they so loath.

    Those that can afford to pay for top notch health care, get it. Those that can’t afford to pay for both the government system and a private alternative are stuck with long waits for guaranteed access to third rate medical care.

  5. Submitted by Gerald Abrahamson on 07/16/2009 - 12:43 pm.

    A retired actuary analyzed the cost to doctors of filing paperwork for the various insurance companies. The ANNUAL savings to be realized by cutting out the thousands of insurance companies and going “single payer”–$200+B. Seems Mary didn’t like that number much–but it shouldn’t hurt them because they are supposed to be healthcare “providers”–not an insurance company (or are they…???). Combined with a guaranteed payment for treatments provided, costs would drop even more (because doctors KNOW they will get paid for treating people–not “hope” they will get paid). Thus, medical costs/rates will drop significantly over time. The only ones that won’t change are the “make me pretty” cosmetic doctors–because those are vanity procedures.

  6. Submitted by David Thompson on 07/16/2009 - 12:45 pm.

    Casey Selix — Thank you for an interesting interview! I agree with Mary Brainerd that a nonprofit health insurance system has worked well for Minnesota. I wish it were possible to replicate the HealthPartners model (member-owned, incentives to get healthy and stay healthy, 2% “profit”, low administrative costs) in every state of the union.

  7. Submitted by Virginia Martin on 07/16/2009 - 01:01 pm.

    Tom swift has not bothered to check any of his facts. Just look it up. There’s this thing called the internet that has all kinds of information, such as, to begin with, it would be socialized medicine only if the medical providers worked for the government. They do not. They continue to work for the patient.
    If health care in Canada and every other industrialized country is so bad, why does every nation except the U.S have it? And despite the flaws and problems in Canada and probably elsewhere, about 74% of Canadians want their health care system. In the United States, 82% of Americans think our system needs a major overhaul. And about 76% want a public option.
    swift’s post is just riddled with inaccuracies, starting with his version of “socialism.”

  8. Submitted by Paul Udstrand on 07/16/2009 - 01:12 pm.

    I don’t know why people keep saying MN has cheaper health care? We had a higher percentage of insured, but not because of HMOs, that was because of public programs. Once Pawlenty’s unallotment kicks in we’ll back in the pack despite our HMOs. At any rate I’ve never seen anything that demonstrates that medical procedures in MN at GH or otherwise are cheaper than they are anywhere else. Are mammograms in MN cheaper than mammograms in WI? We know our medications aren’t cheaper. For a while MN’s costs increased at a slower rate but all of our figures have slid along with funding cuts.

    By the way, if you really believe GH is only making 2% profit I’ve got some really nice bridges in New Zealand for sale. They’re having a bad year, but 2% pffff.

  9. Submitted by Bernice Vetsch on 07/16/2009 - 01:17 pm.

    I believe it is Switzerland that uses private insurers BUT requires that they be non-profit entities and that all provide the same specified coverage to each person they insure. Their system works well, unlike ours where insurance companies raise their premiums each year without adding value, employ several million people whose job it is to find reasons to deny payment, refuse to insure people who are likely to get sick, and drop those who do get sick when they are able to do so.

    The system(s) being considered in Washington are modeled on the wildly over-budget Massachusetts Plan, described as “A Failed Model for Health Care Reform” by neurologist Dr. Rachel Nardin and primary care physicians David Himmelstein and Steffie Woolhandler. (See http://www.pnhp.org/mass_report_Final.pdf)

    Yesterday or the day before, Massachusetts said it would cut 30,000 legal, taxpaying immigrants from those its program would cover. And the Boston Globe reports that a major hospital is suing the state for failure to pay enough for it to remain open.

    We surely don’t want that plan extended to 50 states, but many in the Congress are writing Mass-Plan-like legislation with the “help” of many lobbyists. The Washington Post (July 5) notes that 350 of them are “former government staff members and retired members of Congress.”

  10. Submitted by Michael Friedman on 07/16/2009 - 01:25 pm.

    When my small nonprofit business put our medical benefits up for bid, my employee who had a serious car accident in the 1980’s was called by an underwriter (can’t remember if it was Ms. Brainerd’s) to see what kind of shape he is in 25 years later. This is competition in today’s medical insurance industry, profit or so-called nonprofit — competition not to insure (and thus, not provide private health care) to patients who may have the highest health needs. Other employees got calls as well.

    Any small business owner can show a more than 100% increase in medical insurance costs over the last 15 years, if not greater. Whatever the comparative rhetoric about our rah rah hometown Minnesota nonprofits against the big national insurers, the bottom line is they all had their chance, they all failed to control costs, and they should not be sustained. (Ms. Brainerd, typical of the industry, implicates people’s poor health for the cost problem. That explains doubling of costs in 15 years? Our collective health has worsened by 50%?)

    A great elaboration of the problem is the guest column in the Star Tribune a few days ago from an Edina bankruptcy lawyer. There are more bankruptcies due to medical debt than anything else. And the majority of those have been for insured patients, so having your Health Partners is not truly having “insurance”, as that product once was defined.

    There is no credible research to suggest single payer systems with comparative funding inputs do worse than private or nonprofit insurance; there’s only industry talking points and cooked public relations. (I urge readers to google Wendell Potter, a former insurance PR man for the industry, who has testified in Congress and written how insurer propagandists create the misinformation gifted to ideological soldiers — like Mr. Swift.)

  11. Submitted by Karen Sandness on 07/16/2009 - 02:23 pm.

    As a middle-aged, self-employed person with a Health Partners policy, I could barely get through the interview without gagging.

    Since moving here in 2003, I have had to raise my deductible from $1,000 to $5,000 to keep my policy affordable. This is with a 20% copay AFTER I’ve reached my deductible, with an out-of-pocket maximum of $10,000. However, if I should be so silly as to need medical care out of network, the maximum rises to $25,000.

    I have NEVER used up my deductible, and yet my premium (for less coverage) has doubled in the past six years. Last month, I received a birthday present in the form of a 13% increase in my premium.

    I challenge people to think of any other product or service that has doubled in price while decreasing in quality.

    I had a minor injury treated recently, and even though I paid the “insured” rates for treatment, a close examination of the bills reveals that I “saved” less than I pay per month in premiums.

    Health Partners sends out colored brochures that state how “concerned” it is about about its enrollees and frequently reminds me to get expensive screening tests (which it doesn’t pay for and which together would take up a month’s income).

    When I inquired about changing to a different Health Partners plan that paid for more for only a slightly higher price, the representative told me that I had to reapply from scratch, even though Health Partners has all my medical records from the past six years.

    I’ve looked into other insurance companies, and they all offer essentially the same products. It makes me angry that I have to put up with these self-enriching hypocrites, when my friends and relatives in other countries don’t.

    Yes, Minnesota health insurance companies are non-profit all right, but it’s easy to make a company look non-profit on paper while rewarding its executives and board members very handsomely indeed.

    I don’t want “something for nothing,” as right-wingers are fond of saying. Other countries either tax or assess their citizens for universal coverage. But I don’t think it’s unreasonable to want something for something.

  12. Submitted by Thomas Swift on 07/16/2009 - 03:18 pm.

    Bitter complaints of insurance company abuses are legend, and in many, if not most cases completely justified.

    However whenever I read comments from people using such tales of woe to extol the virtues of Government Health Care, Inc., I cannot help but recall the old “cutting your nose off to spite your face” bromide.

    Those who are really expecting a superior system are doomed to dissapointment. Socialized health care only meets the expectations of those for whom government control is an end unto itself.

  13. Submitted by Karen Sandness on 07/16/2009 - 05:30 pm.

    Tom Swift, I resent your calling my very real problems “not completely justified,” especially since you made two factual errors in your first post.

    If it weren’t for concerns of privacy, I could tell you other horror stories that have happened to friends and relatives of mine.

  14. Submitted by Richard Schulze on 07/16/2009 - 07:35 pm.

    Thomas, is it socialized medicine or leftist socialized medicine? You seem to use these two terms as if they were interchangeable… (lite snark)

    The fact that many people are without insurance, the fact insurance is not portable. Those problems all stem from a single cause. Which is that we rely on private insurers to provide health insurance. That’s a failed business model effectively for this enterprise.

    The private insurance companies imperative is to not sign up as clients, people who need medical care. They want to find healthy people or people who won’t need medical care.

    Much of their budget is devoted to identifying who is going to need care and then taking steps to exclude those people from their policy rolls.

    Another major part of their budget is based on aggressive efforts to deny reimbursement claims, so if you do have a policy and you do get a procedure and then you seek reimbursement for it. They have experts who get extra salary if they deny a higher proportion of claims.

    That is a failed business model for providing health care. That is called the adverse selection problem.

    That is why no other major economy provides health care along the lines of that model. Every other country has a universal access system that is roughly speaking a single payer system.

    I think the Obama administration will include a vigorous public plan. There will be a lot of uproar I’m sure if a bill comes out without one. Then there will be a chance for the public to choose.

    It will be a public plan that will take all comers, a public plan that you can carry with you where ever you go, a public plan that will not charge you a heavy premium if you have previous conditions. If people have access to that plan and for reasons of their own choose not to buy it, well and good.

    As long as that is part of the mix, I can think that the health care reform effort can be said to have done its job.

    We provide health care in the least efficient way of any modern industrial country. On average most countries spend half as much per capita as we do.

    People complain there are waiting lines in those countries and that’s true, in some there are. Then we could spend three quarters as much if we did it more efficiently and have no waiting lines.

    It’s up to us on how we want to spend the money. With a more elaborate plan with shorter waiting lines, or a cheaper plan with longer waiting lines.

    We have waiting lines now in effect. There are a lot of people who are denied care forever and that’s a waiting line.

    Single payer of some variation of it could very well be the impetus that the health insurance industry needs to reform their business model. To one with a reduced bureaucracy and better streamlined operations. As it exists, there is nothing nudging them to change.

  15. Submitted by Richard Schulze on 07/16/2009 - 08:29 pm.

    But then again, If I were a industry spokesperson I would simply argue that things are just fine. Why change?

    #1: We have a healthy, profitable, medical industry, growing at 12% a year for the past 30 years.

    #2: Doctors in the US enjoy the HIGHEST compensation in the world

    #3: Anyone, with a couple of years training can get a job as a nurse.

    #4: Our Pharmaceutical Industry enjoys the benefits of strong pricing; in the US, they can charge 5 times the price they get in other countries

    #5: The legal industry is also helped by highly profitable lawsuits, so many attorneys enjoy a high standard of living because of our health care industry

    #6: The insurance business makes billions per year on the health care industry

  16. Submitted by Karen Sandness on 07/17/2009 - 12:56 pm.

    The part about the pharmaceutical industry is absolutely true. I’m a Japanese-English translator, and a couple of years ago, I translated the autobiography of the head of a large Japanese pharmaceutical firm. He came right out and said that the U.S. is the cash cow for drug companies all over the world, because it’s the only Western industrialized country that doesn’t regulate or negotiate drug prices and the only one that allows advertising of prescription drugs directly to consumers.

  17. Submitted by Casey Selix on 07/17/2009 - 01:44 pm.

    Thank you for your thoughtful comments on the state of the health insurance industry. I am looking for people with individual insurance policies who are willing to be interviewed and quoted by name for a future story. If interested, please contact me at cselix@minnpost.com.

  18. Submitted by Paul Udstrand on 07/18/2009 - 10:24 am.

    There’s a lot of stories about the proposed health care plan in addition to this story out there these days. Here’s one more question I would start asking health care executives: “How much are you willing to sacrifice in order to achieve this goal of affordable, universal, quality health care”?

    While all of these executives bemoan to rising costs, and complain about the 42,52,62 whatever cents they collect on the dollar billed,I’ve never seen is anyone point out that providers jack up prices to compensate for low reimbursement rates. I’ll give you an example from the early 90s. At the time the hospital I was working in charge $120 for a $19.99 egg crate mattress. At that rate even at a 50% discount they still made $60.00 on the mattress, and that’s just a mattress!

    The truth is this perverse market we’ve created has completely distorted our costs with multiple players vying for payment and profit. The reason executives are worried about public plans is because they know eventually someone’s going to look at what they charge and why. Basic arithmetic dictates that if we ever actually reduce the cost of health care, that will mean paying less. So executives like Brainerd either need to tell us how much less a year they’re willing to make in order to achieve the “dream”, or explain why we should be paying sooooo many of our health care dollars to people who have absolutely nothing to do with our health care?

    The only way to get all of these issues under one umbrella and examine them rationally is with a single payer system. Only with a national system can we even begin to investigate the real costs of health care, figure out what we should be paying, and pay it. But that’s exactly what health care executives fear most… ask yourself why?

  19. Submitted by Thomas Swift on 07/18/2009 - 07:29 pm.

    Uh, Karen?

    Read it again, dear; go slow…take your time.

    “Bitter complaints of insurance company abuses are legend, and in many, if not most cases completely justified.”

    See? I agree with you…..

    Maybe that’s why you claim I got “facts” wrong, but failed to provide any example other than your putting words in my “mouth”.

  20. Submitted by Joel Gingery on 07/20/2009 - 07:20 am.

    I’m fascinated by the many diverse viewpoints. I’m reminded of the story of the blind men trying to understand an elephant by feeling different areas of its body.

    My two cents is at:

    http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/?scp=3&sq=economix%20germany&st=cse

  21. Submitted by Paul Udstrand on 07/20/2009 - 10:22 am.

    The article Joel (#20)recommends tightly regulated private insurance system like the ones found in German, Netherlands, etc. The article ends with the question: “will US insurance accept tight regulation?”.

    These systems may work in other countries, remember they were built that way from the ground up after WWII. In the US this approach would just be the latest grand reorganization of the deck chairs designed to preserve the health care market.

    To begin with, the answer to the question is simply “no”. US insurance companies will not accept tight regulation and they’ll never have to. The countries mentioned in the article all have proportional governments and completely different election standards. In the US we have a two party fixed term system that has been captured by and large by corporate interest. We also have this insane notion that writing a check is a constitutionally protected act of speech. The result is a government populated by politicians who are dependent on corporations and wealthy individuals for re-election. This means two things: 1) tight corporate regulatory legislation never get passed in the first place (remember all those “tight” post Enron regulations that were supposed to regulate the financial sector?)Corporate lobbyists always make sure there are enough holes to drive their trucks through. 2) Even if tight regulations manage to get passed, they’re not enforced. Again, look at the recent collapse of the financial sector, people are still arguing about whether or not we need to make new rules or just enforce the old ones, and everyone agrees even the old ones were not enforced.

    The truth is the US just doesn’t do “regulations”. Our political structure makes it too easy for industries to capture their erstwhile regulators. You see massive regulatory failures in this country in every agency from the FAA to EPA. It isn’t that government can’t regulate, they certainly can. The problem is in the US wealthy and politically connected actors gain control of the agencies and avoid regulation or penalties. Not only that, but one of our two political parties simply doesn’t believe in government and is openly hostile to any form of regulation (other than moral regulation). When that party is in power as it was recently, they populate regulatory agencies with anti-regulatory principles who ignore the law and obstruct the process. We are now seeing that the party that is supposed be the opposition is just barely less hostile regulation. As often as not the only way to get regulatory agencies in this country to do what they’re supposed to do, someone has to file a lawsuit, is this how you want to do healthcare?

    Reverse engineering a regulatory approach to health care insurance in this country is simply not tenable. At best it would just add yet another layer of complexity to an already overly complex system. It would raise health care cost, I guarantee you insurance companies would spend just as much fighting regulations as they currently spend trying to deny coverage; even more of our health care dollars would be diverted from our actual health care.

    We have no examples of regulatory success that one could apply to health care. We do have several examples of successful public programs in the US. Maybe some day we’ll solve our electoral problems, create a more diverse and responsive government, and fix our campaign contribution problems. But if you think we’re going to all that and solve our health care crises in the next year or so… well that’s what I call a dream baby.

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