Michael O. Leavitt

Transparency is not all it is made out to be….

In an open letter to CEOs, Secretary of the U.S. Department of Health Human Services Michael O. Leavitt wrote:

“I am writing to invite you to play a leadership role in the
movement toward transparency…”
(See:www.hhs.gov/transparency/employers/ceo.html)

The article infers that this information will be available in some useful way, soon. Unfortunately, not soon enough. Transparency is not all it is made up to be. The basis behind transparency is paved with good intentions. Americans need to know the prices for the services that we access. But, if Americans really understand how provider contracting is often negotiated, we would easily see the holes that lead to erroneous information designed to protect the best negotiators, not the sick who are in need.

Size matters. We all know that. However, size is not necessarily a fair reflection on quality. Price doesn’t always determine quality, especially in medical care. What happens when the price for a service among several doctor’s hospitals or providers is the same? Who is the best choice? How are we to judge, then? What criteria will lead Americans to make a better health care decision? Cost is still the largest stumbling block to access US healthcare. Will this information change that? Americans want more value for their money. Excuse me for emphasizing that Transparency is more useful to the insured population because the idea is designed for payers. Whether healthcare is accessed through employer sponsored or individual health insurance or is accessed inefficiently by the uninsured, tax paying citizens ought to be concerned about price. Americans who contribute to the tax system are paying for the uninsured already.

They just woke up to the fact that they have been paying more for medical services…

What is Uncle Sam doing to make sure that, as the largest payer of health insurance claims, they are protecting tax payers and securing the best deal? They are not doing much. They just woke up to the fact that they have been paying more for medical services than the privately insured sector for our socialized programs like Medicare and Medicaid. Private health insurers consistently negotiate the most cost effective reimbursement levels for medical delivery services. There will always be some consumers who will find that they can live with the values tied to the retail discount “Wal-Mart’s” of medicine. Others will find that the highly specialized providers, akin to the overpriced “Neiman Marcus’s” of medicine, are worth the difference in cost.

Is there truly a quality difference? There may be…but differentiating and understanding how to use the data that is being shared with us to make that decision, is a mystery to most Americans in need of medical services.

Is Transparency going to change or influence behavior?

Professionals are having a hard time perusing through the data to determine if publishing certain facts will be confusing or helpful. The concept of pay for performance is truly an embraceable one. Although it is unlikely that this incentive can create better healthcare outcomes alone, it is a start. This information is likely to be especially useful in our times of need when it is easily accessible and the codes to determine appropriateness are clearly delineated. Once Americans understand how to use the distribution of this new data, they can be armed to make more appropriate decisions for protecting the health of themselves or loved ones. It will certainly be an improvement on just word of mouth decision making. Americans want to be empowered by information. Will it cost less? Maybe. Is Transparency going to change or influence behavior? Yes. Consumers crave more information. Can this information help bring down the price of medical services? It is one small cog in the wheel that turns the fragmented US Health Care System. We don’t need socialized medicine. It will create more of a mess. We need to fix what we have, first.

United Health Group

Where Does the US Government Draw the Line on Corporate Greed…

Where Does the US Government Draw the Line on Corporate Greed, when it comes to America’s most talked about social problem…Health Insurance?

United Health Group, the largest US health insurance company continues to reward shareholders at the expense of its commercial and Medicare customers. This earnings report demonstrates the US Government’s level of tolerance for letting corporate giants in Health Insurance get away with unethical standards that seem to apply only to them. A 35% profit margin in health insurance is obscene by most standards. No wonder there are so many without health insurance. Where is all of that money going?

It is certainly not going in to medical care for members of their health plans. Many of UHC’s members are burdened by the accelerated cost shifting in the consumer driven plans that they are a market leaders in, while UHC continues to reap huge profits. This is doing nothing to resolve problems within the US Health Care System.

Consumer driven plans have impacted utilization patterns of members…

Instead of doing the right thing, as the largest player in the field, UHC’s greed to squeeze profits is placing an enormous financial burden on members of their plans. Consumer driven plans have impacted utilization patterns of members. Perhaps members are not accessing unnecessary medical care. However, what if members are avoiding care because of high deductibles? We already know that avoiding care leads to more significant costs later on. Is this really helping anyone? Do consumer driven plans do anything more than increase insurance company profits? In the long run, maybe yes.
Health insurance companies want to change their insured’s behavior towards accessing medical care. Why aren’t health insurance companies lowering premiums significantly for those that are more risk tolerant by electing consumer driven plans, when there is so much profit to be made? Is it greed? If UHC and its competitors are trying to change the medical utilization patterns of members, where is the reward for the premium paying members?

Will Healthcare and Health Insurance be the deciding factor in our upcoming Presidential elections?

Socializing the whole system does not deal directly with…

There are an overwhelming number of issues to address. The key is to embrace change and to execute potential solutions. Talk is cheap. We must resolve issues now, in order to avoid a future crisis. How is that going to happen?

Socializing the whole system does not deal directly with all of the moving pieces that make up the best and most sophisticated medical delivery system in the world.

Presidential candidates ought to be thinking about several immediate and long term solutions to the current “crisis” within the US Healthcare system.

What is wrong with our US Healthcare System?

What is wrong with our US Healthcare System? Escalating costs, cost shifting, the growing number of the uninsured, inefficiencies in medical delivery, avoidable medical errors, frivolous lawsuits, confusion about benefits and utilization, just to name a few.

Typically in any industry, better technology comes at a higher cost that can lead to lower costs over time. Escalating costs are no one’s fault, but can be addressed.

What role do doctors, hospitals, pharmaceutical companies and other providers of medical services play in the evolving of a more cost efficient system?

What can the US Government do to incentive private industry?

Health insurance is not a right

Immediate gratification to those who favor socialized medicine is much sexier than innovation to correct the issues within our current medical delivery system. Healthcare is a right that all humans are born with. Health insurance is not a right. It is simply the transfer of financial risk to an insurance company for protection against catastrophic financial loss due to sickness. It comes at a price whether it is a subsidized by the US Government or accessed through our current system. When the US Government becomes the health insurer of last resort, are we really addressing the issues?

Lifestyle choices probably have a larger impact on the medical services we access throughout our lives than we care to admit. Many studies support this idea. Education can lead us to making the right choices; choices that have positive consequences.

Questions for all Presidential candidates:

What incentives can the US Government provide to help Americans make healthier lifestyle choices?

How can the US Government help more Americans access the current US Healthcare system?

If Medicaid’s income allowance were to double, how many more uninsured children would be covered?

Besides money, what could the US Government do to help low income families automatically be covered through our current socialized programs? (Medicaid and Medicare)

Where will the money come from? All potential solutions have a cost associated with them. Will these solutions ultimately lead to lower costs in the future?

How can the US Government stop the runaway costs associated with health care? Are technology and innovation driving the majority of those costs?

What about access to preventive care instead of crisis oriented care? What role can the US Government play in addressing this issue?

What role or responsibilities must the American people have in order to preserve the best aspects of our current medical delivery system and to stay healthy?

If good healthcare is the most important gift that we are born with, why is staying healthy not our first priority? Why do we take our health for granted and expect someone else to take care of it for free, when we get sick? It is never free. Someone is always paying for it.

What can be done to eliminate medical errors within the system?

What future does the internet play in reducing overall costs?

What role can technology play in fixing the inefficiencies within the system?

What types of incentives will change behaviors and impact daily living choices towards healthier lifestyles?

What incentives can the Federal Government impose upon private enterprise to act in the best interests of all Americans?

Why would a socialized US medical system, taking Medicare and Medicaid as an example (our current socialized system) be a less expensive alternative to Employer sponsored private health insurance?

Are our socialized systems working well enough to extend that model of coverage to all Americans?

So, Presidential candidates ask yourself these questions and tell us what you would do if you were elected President of the United States?