In 2012 Preview, Pawlenty Takes Aim at RomneyCare

In today's Washington Post, Tim Pawlenty has an op-ed urging Washington to learn from health care reform experiences at the state level. Not surprisingly, he touts reform efforts in Minnesota, but it's also noteworthy that he takes aim at the Massachusetts overhaul that was led by Mitt Romney (though he doesn't mention Romney by name). Not that Pawlenty is a free market puritan on health care -- he supported SCHIP, for example -- but the disastrous results of Romney's health care plan in Massachusetts could prove a big obstacle for him during the 2012 Republican primaries in which at the moment, he's viewed as the very early frontrunner.

Romney has tried to have it both ways on health care. On the one hand, he points to health care as an example of his ability as an executive to get things done, yet at the same time he blames the Democratic legislature for changing his original plan (even though he signed it with changes, knowing that he wouldn't be around to oversee its implementation and that his successor would likely be a Democrat). He wants to take credit for the fact that his plan expanded coverage, but doesn't want to accept blame for the endless wait times for doctors, skyrocketing costs and the fiscal crisis that went along with that expanded coverage. He claims that his plan is a free market alternative to a government takeover of health care, and yet it's a plan that expanded Medicaid rolls, forced individuals to purchase insurance or pay a tax, and had government provide subsidies to people to purchase a government-run insurance on a government-run exchange. Anybody worried about life under ObamaCare should not be a fan of RomneyCare -- other than the absence of a government plan in the exchange, both plans are structurally very similar.

By Philip Klein on 8.3.09 @ 10:20AM

Replicating Massachusetts’ Health Reform on a National Level

Massachusetts’ innovative approach to health care reform, adopted in 2006, has become the focus of substantial national attention as Congress and the Administration in Washington focus intense attention on health reform. Many federal proposals build on elements that have been implemented in Massachusetts. Two questions are of interest in this regard: can the federal government adopt the Massachusetts approach, and, failing federal reform, can Massachusetts serve as a model for other States?

For background, the key elements of the Massachusetts program can be summarized very generally as follows: An individual mandate requiring most residents to have insurance; assessments on certain employers who do not make adequate insurance available to their employees; a “health care connector” that links individuals and small businesses to insurance products; and State-subsidized insurance for persons who are not eligible for Medicaid with incomes up to 300% of the Federal poverty level (the “CommonwealthCare” program).

The individual mandate is key to achieving near universal coverage, and other components of the reform facilitate access to “affordable” coverage. The reform’s approach is to move uninsured people into insured status, and to reduce reliance by safety net hospitals on disproportionate share and supplemental Medicaid payments by providing them an insured population in lieu of uninsured individuals.

Many of these elements appear in the various federal proposals, including the individual mandate, the connector and imposing some form of assessment on employers. As to other elements of federal proposals, Massachusetts does not include a public plan option, although CommonwealthCare could be viewed as a workable alternative.

However, in creating the coalition that secured passage of the reform, political and policy leaders deliberately chose to address access first and defer dealing with how the program would be paid for. This of course is not an option for the federal government, which is struggling with how reform will be funded.

Massachusetts could defer the cost issue because the amount of new State dollars needed at the outset was relatively small. This was so because of: (a) CMS’ willingness to grant a waiver allowing federal Medicaid matching funds for the CommonwealthCare subsidies; (b) the generous level of State dollars that was already flowing into the health care system through Medicaid and the State’s uncompensated care pool; and (c) the relatively larger number of large and small business that already provided some coverage for their employees.

Of course, the economy and serious budget problems are now affecting CommonwealthCare’s financing. This year for the first time there will be some restrictions on who can enroll, and some adjustments to available benefits. Massachusetts did try to address health care cost through legislation in 2008, but the focus was more on long-term structural changes, such as incentives to promote more primary care physicians (one of the downsides of improving access in Massachusetts was to make worse an already bad situation of too few primary care physicians), supporting the greater use of nurse practitioners and effectively mandating that hospitals and physicians move toward adoption of electronic medical records and CPOE systems. The legislation, however, is not generating immediate cost savings.

In summary, Massachusetts’ program has many elements that could work at the federal level and could be adapted for use in other States. Two critical points need to be kept in mind, however: First, the creation of a coalition that included Government (including a Republican Governor and an overwhelmingly Democratic legislature), consumer advocates, employers and insurers and the willingness of each of the groups to compromise (an individual mandate balanced against some employer assessments, for example) got the reform enacted but is not easy to replicate.

Second, as noted above, financing could be deferred because the marginal dollars needed to fund the reform initially were not so great. (Shortly after enactment of Massachusetts’ reform, a California study concluded that implementing the same program there would cost that State an additional $12 billion.) The key issue for the federal government is how to fund reforms. Massachusetts may be a good model but the particular financial circumstances that existed when its reform was enacted may make the model difficult to replicate elsewhere.

Stephen M. Weiner, Esq serves as President of the national nonprofit HealthWell Foundation (www.healthwellfoundation.org), which provides financial assistance to underinsured patients coping with serious and chronic conditions. He is also Chair of the Health Law practice for Mintz Levin and has over thirty years of health care experience as a policy maker, educator and attorney.

Source: Physician News Digest

There are many better options out there that do not include:

• a public option that will lead to a single payer socialized medicine
• rationing
• duty to die aspects for seniors
• forced mandates for all physicians to perform abortions
• government being involved in what should be doctor-patient decisions
• a national database giving government access to everyone’s health records

What we need is

• regulation and over-sight by the government… of Insurance Companies, Big Pharma, the AMA and no more
• overhaul of Medicare, Medicaid, Veteran’s Health, Indian Reservation Health (government has done a terrible job with these programs… and that should speak for itself)
• tort reform
• allow companies and individuals to go across state lines to purchase insurance
• allow individuals and and small business to form co-ops to purchase insurance.
• portable health insurance
• attention and a stop to fraud in all the government-run programs and by the insurance companies and Big Pharma
• no more exclusion by insurance companies of people who have pre-existing conditions.

Source: True Health Is True Wealth

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Posted: Daily Thought Pad

Economists Point to Rising Debt as Next Crisis

Yanina Manolova / AP

The soaring national debt is recorded on the National Debt Clock in New York. The national debt was $11,518,472,742,288 on Wednesday, according to the Treasury Department, but could actually be as high as $184,000, explained below.

WASHINGTON - The Founding Fathers left one legacy not celebrated on Independence Day but which affects us all. It's the national debt.

The country first got into debt to help pay for the Revolutionary War. Growing ever since, the debt stands today at a staggering $11.4 trillion — equivalent to about $37,000 for each and every American. And it's expanding by over $1 trillion a year.

The mountain of debt easily could become the next full-fledged economic crisis without firm action from Washington, economists of all stripes warn.

"Unless we demonstrate a strong commitment to fiscal sustainability in the longer term, we will have neither financial stability nor healthy economic growth," Federal Reserve Chairman Ben Bernanke recently told Congress.

Higher taxes, or reduced federal benefits and services — or a combination of both — may be the inevitable consequences.

The debt is complicating efforts by President Barack Obama and Congress to cope with the worst recession in decades as stimulus and bailout spending combine with lower tax revenues to widen the gap.

Interest payments on the debt alone cost $452 billion last year — the largest federal spending category after Medicare-Medicaid, Social Security and defense. It's quickly crowding out all other government spending. And the Treasury is finding it harder to find new lenders.

U.S. has been debt-free only once, in 1834-35
The United States went into the red the first time in 1790 when it assumed $75 million in the war debts of the Continental Congress.

Alexander Hamilton, the first treasury secretary, said, "A national debt, if not excessive, will be to us a national blessing."

Some blessing.

Since then, the nation has only been free of debt once, in 1834-1835.

The national debt has expanded during times of war and usually contracted in times of peace, while staying on a generally upward trajectory. Over the past several decades, it has climbed sharply — except for a respite from 1998 to 2000, when there were annual budget surpluses, reflecting in large part what turned out to be an overheated economy.

Middle East wars helped 'break' the debt clock
The debt soared with the wars in Iraq and Afghanistan and economic stimulus spending under President George W. Bush and now Obama. And although Obama inherited a large debt and economic problems from Bush, he has already quadrupled Bush’s debt over the next 10-years, after less than 6-months in office.

The odometer-style "debt clock" near Times Square — put in place in 1989 when the debt was a mere $2.7 trillion — ran out of numbers and had to be shut down when the debt surged past $10 trillion in 2008.

The clock has since been refurbished so higher numbers fit. There are several debt clocks on Web sites maintained by public interest groups that let you watch hundreds, thousands, millions zip by in a matter of seconds.

The debt gap is "something that keeps me awake at night," Obama says.

He pledged to cut the budget "deficit" roughly in half by the end of his first term. But "deficit" just means the difference between government receipts and spending in a single budget year.

This year's deficit is now estimated at about $1.85 trillion.

Deficits don't reflect holdover indebtedness from previous years. Some spending items — such as emergency appropriations bills and receipts in the Social Security program — aren't included, either, although they are part of the national debt.

The national debt is a broader, and more telling, way to look at the government's balance sheets than glancing at deficits.

U.S. is more than $11 trillion in debt
According to the Treasury Department, which updates the number "to the penny" every few days, the national debt was $11,518,472,742,288 on Wednesday.

The overall debt is now slightly over 80 percent of the annual output of the entire U.S. economy, as measured by the gross domestic product.

By historical standards, it's not proportionately as high as during World War II, when it briefly rose to 120 percent of GDP. But it's still a huge liability.

Also, the United States is not the only nation struggling under a huge national debt. Among major countries, Japan, Italy, India, France, Germany and Canada have comparable debts as percentages of their GDPs.

Where does the government borrow all this money from?

Treasury securities still seen as safe investments
The debt is largely financed by the sale of Treasury bonds and bills. Even today, amid global economic turmoil, those still are seen as one of the world's safest investments.

That's one of the rare upsides of U.S. government borrowing.

Treasury securities are suitable for individual investors and popular with other countries, especially China, Japan and the Persian Gulf oil exporters, the three top foreign holders of U.S. debt.

But as the U.S. spends trillions to stabilize the recession-wracked economy, helping to force down the value of the dollar, the securities become less attractive as investments. Some major foreign lenders are already paring back on their purchases of U.S. bonds and other securities.

And if major holders of U.S. debt were to flee, it would send shock waves through the global economy — and sharply force up U.S. interest rates.

As time goes by, demographics suggest things will get worse before they get better, even after the recession ends, as more baby boomers retire and begin collecting Social Security and Medicare benefits.

Public concerned about debt's effects on future
While the president remains personally popular, polls show there is rising public concern over his handling of the economy and the government's mushrooming debt — and what it might mean for future generations.

If things can't be turned around, including establishing a more efficient health care system (which is generally not considered the one being crammed down American’s throat now by the Democrats and the Obama administration) "We are on an utterly unsustainable fiscal course," said the White House budget director, Peter Orszag.

Some budget-restraint activists claim even the debt understates the nation's true liabilities.

The Peter G. Peterson Foundation, established by a former commerce secretary and investment banker, argues that the $11.4 trillion debt figures does not take into account roughly $45 trillion in unlisted liabilities and unfunded retirement and health care commitments.

That would put the nation's full obligations (now) at $56 trillion, or roughly $184,000 per American, according to this calculation.

Source: Associated Press - updated 11:31 a.m. PT, Sat., July 4, 2009

Passing and accepting either the Cap-and-Trade or the Obama Health Care Plan in its present form, both being ramroded down American’s throats without knowing what they are getting and without their representatives being given time to read the plans or bills, would only worsen the present situation and increase the level of debt even more. Cap-and-Trade is a political power grab that wouldl interject government into every aspect of American life and would tax every American into the poor farm with virtually no affect on global warming (or climate change as it is now called), on which humans questionably have had any or little affect. And although healthcare reform including Medicare is vital, the government involved plan is the wrong path.

Cap-and-Trade is a no go… just look at Spain and other countries who have taken the “Green” route. We will lose not gain jobs; we will interject government control into all areas of our lives; and the cost of energy and everything else will skyrocket, including taxes. We need to incentivize the private sector to develop clean and efficient energy along with allowing more drilling and nuclear development as well as revisiting present restrictions and releasing patents that have been bought up by Big Oil, the Auto Industry and Unions.

ObamaCare is also a no go… Just read the stats of countries with socialized or nationalized medicine and the records of Canadians who have testified before the Senate about their care… and why they come to the U.S. if they are really sick. Again, we need to incentivize the private sector, work with or legislate change through the AMA, Big Pharma and private health insurance companies to workout a better and more affordable system and allow creative programs as well as including natural alternatives to be used and considered. We need reform not a government run system. Medicare, Social Security, Veteran’s Benefits and the Post Office are examples of government run programs. Need we say more? Let the Obama Administration fix those 4-programs first, before taking on another program that won’t work and will cost us more money for worse care for everyone while still leaving people without healthcare.

And while President Obama feels he has a good connection with the Arab World he should use it to negotiate with OPEC… Lower priced oil would made drastic a difference in our economy and debt.

Perhaps we should also ask what happened to Obama’s campaign promise of going through the budget line by line as well as reviewing government programs and jobs and streamling? He promised to cut out the fat, lower the cost of government and complete transparency… and well as no tax increases of any kind for anyone making under $250,000 a year. He also promised to used his power of line item veto. None of this has happened, spending is rampant and indirect taxes as well as huge increases for Cap-and-Trade and Healthcare are in the works.

Start calling, writing, faxing and emailing your U.S Congressperson,Senator and the White House… “NO” on Cap-and-Trade and “NO” on nationalized healthcare or any healthcare program that includes a government or single payer option… or our children and grandchildren will never dig out from the debt!! You have the power... 2010 and 2012 elections are right around the corner, in political terms, and there are grassroots movements springing up everywhere.

Remember the National Debt Clock… tick tock, tick tock, tick tock… Ask Marion~

“Taxes can be reversed, stimulus debt can eventually be repaid but if we let Cap-and-Trade and government option health care pass, the United States as we know it will be changed negatively forever!” …Dick Morris on Hannity.

Posted: Daily Thought Pad

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Safeway's Health Care Program Gets Attention

My "Citizens, heal thyselves" item Wednesday on the responsibility of individuals to reform their own health care prompted inquiries from readers wanting to know more about what I referred to as Safeway Inc.'s stick-and-carrot approach.

Based on the belief that rising health care costs are mostly driven by behavior (smoking, eating poorly, not checking your cholesterol, etc.), the Pleasanton company's Healthy Measures program uses screenings and questionnaires and offers access to prevention-related facilities like fitness clubs, along with advice and referrals to help improve behavior.

The carrot: discounted premiums or refunds for passing the screenings or showing improvement. The stick: higher premiums for failing tests and no measurable improvement in behavior. "Holding people accountable gives them incentives," said Ken Shachmut, the Safeway senior vice president who oversees the health program.

It has also kept Safeway's health care costs, amounting to $1 billion or so a year, mostly flat over the past five years, an achievement few other companies can claim, said Shachmut, who admits battling his own weight problems.

The voluntary program now covers 25,000 employees, or about three-quarters of Safeway's nonunion workforce. Elements of the program are included in contracts covering Safeway's union workers, who fall outside the company's self-insurance plan. Shachmut said most of its 200,000 union workers should be participating in the program within the next six years. The main thing that employees covered by the program seem to want, said Shachmut, is "more discounts."

In the meantime, Safeway is spreading its consumer-driven approach via the recently formed Coalition to Advance Healthcare Reform (coalition4healthcare.org), founded by company CEO Steve Burd. The 63 corporate members include Bay Area companies McKesson Corp., PG&E, Clorox Co., and Kaiser Permanente.

"This is the silver lining in the cloud of rising health costs. If we can design incentives in these core areas, we have a fighting chance of getting our arms around it," Shachmut said.

More details: You can find more on Safeway's program at links.sfgate.com/ZHIV. A Chronicle feature that ran earlier this year, is online at sfgate.com/ZHJB. Safeway CEO Burd penned on op-ed on the subject in Friday's Wall Street Journal, available at links.sfgate.com/ZHIX.

The Journal also has a news story in Friday's edition questioning the efficacy of prevention programs (links.sfgate.com/ZHIY). On the other hand, a 2007 nationwide survey of 355 human resources and health benefits managers suggested a strong correlation between wellness programs and increased productivity and market and shareholder value. (links.sfgate.com/ZHIZ).

-------

How Safeway Is Cutting Healthcare Costs

Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Martin Kozlowski

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.

By STEVEN A. BURD - Mr. Burd is CEO of Safeway Inc., and the founder of the Coalition to Advance Healthcare Reform.

Steven Burd has testified in Washington D.C. and appeared on Fox News’ Huckabee. He has caught the attention of people from Senator Barbara Boxer to Rush Limbaugh; definitely opposite ends of the spectrum!! This is a great alternative to $600 Million in additional taxes and $400 Million in cuts to Medicare and Medicaid!!

Posted: Daily Thought Pad

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