Friday, June 12, 2009

Health care reform mirror state vs. federal

I sit on the board with Utah association of Health underwriters and as well as for health insurance reform. Several interesting changes took place with H.B. 188 passage earlier this year that seems all too familiar on the federal level. The spirit of the bill allows private market place remedies. It essentially guarantees insurance providers a "no loss" or "no gain" over competing carriers in the insurance exchange portal which is On the surface it seems not to be attractive to participating carriers (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees. That can be accomplished now. The other half of the equation is providers and their billing practices that need to be reformed. That is on the agenda. Keep an eye on Utah because the national health care debate seems much the same ground we have already covered.
In which is the beginning of a state sponsored program addresses issues on a local state level that the federal level might look at. Coming from an underwriting background I know where the dime falls. I am of the opinion that large waste occurs from providers billing for procedures that developed "no outcome". Insurance carriers are not the only bad guys on the block. In most of our purchasing decisions....don't we pay ONLY when we know that we will get a desired outcome? Why is it if you ask the doctor how much a particular test or procedure is he doesn't know? Shouldn't providers be held to a transparent cost standard?
You must be in the health care business from some interaction point to make statements of fact in the face of historical changes. When you are in the system from any touch point (insurance, provider, hospital, Medicare or patient) you get the “real issues” because of real time experience.
I often quote the Switzerland health care system as an example of tough questions that we will have to face at some point down the time line. Did you know that premature babies are not resuscitate upon birth if they cannot draw breath? Did you also know that is the same with “senior care” experiencing system failure or failures? They don't extend life of a senior with multiple failures like intubation as example. Anyone in the business of paying claims knows that the single most expensive bills in what we call “shock loss” is within NICU for newborns and seniors in acute / intensive care / hospital.
The Swiss apparently made decisions made based upon cost vs. quality outcome. Are we as a nation prepared to make that type of decision or to define when to incubate, resuscitate a newborn or a senior? To define the conditions and rules of practice? With a litigious society I think not. This is why we need tort reform. Without tort reform medical provider costs will never drop. Liability costs with medical providers are nearly half of operating expenses. With health insurance carriers it translates to about 10% of every premium dollar collected.
I don't think we are hearing about tort reform because most of the house and senate on the federal level are lawyers and have practicing law firm interests / ownership. In the healthcare system there is no total innocence. Insurance executives with bonuses, doctors overbilling, hospitals overbilling because the street gang thug got dropped at their door with no insurance. The lawyers are there to stir the pot and promise lavish fortune at the end of the PERCEIVED misery chain. Am I saying we don’t need them? No, but I am saying there is clear and documented abuse of the legal system that awards outlandish claims in the millions for a $20,000 mistake. Ambulance chasers being the most abusive. What about those that educate their clients on defraud and then use the legal system to pirate insurers?