IN THIS ISSUE:
? How Americans Feel About the Uninsured
? “Employers Are Screaming Out There”
? Chamber Meeting in Florida Shows Employers Alternatives
? So. Carolina/NAIC Host Meeting on Health Reform
? Young Adults in New York Going Without Coverage
? Hospitals See Rise in Bad Debts in South Dakota
? Singapore to Publish Hospital Charges on Net
How Americans Feel About the Uninsured
“Health Affairs” published a cluster of articles on the uninsured this month. The most interesting was by Bob Blendon and colleagues on “Americans’ View of the Uninsured: An Era for Hybrid Proposals.” The article looks at the changes in public opinion over the past ten years and discovers that even among those Americans who are concerned about the problem of the uninsured, there is little agreement on what to do about it. The article notes that the political climate isn’t as keen on major reform as it was ten years ago, although dissatisfaction has been rising recently. A couple of interesting statistics:
? Only 15% named health care as one of the two “most important issues for government to address,” substantially down from the early 1990s. But this may understate the concern, since war/defense has eclipsed health care as the second most important issue.
? Dissatisfaction with the availability and affordability of health care has risen to 66% from 53% three years ago, but not as high as in 1993, when 77% expressed dissatisfaction.
? When asked whether cost, quality, or the uninsured is the most important issue, 44% said costs, 38% said the uninsured, and only 16% said quality.
? At the same time people think costs are the most important issue, 74% also say the United States isn’t spending enough on health care.
? Seventy-four percent said “a law to provide health insurance for most of the uninsured” during the next year was an extremely or very important priority for the federal government.
? But when asked what the government should do, the results were mixed, with 80% supporting expanding state government programs, 77% supporting an employer mandate, and 73% supporting tax deductions and tax credits. Only 46% supported a national health plan.
This is a remarkable contrast from the past in which single payer usually ended up in a three-way tie with employer mandates, and some vague market-based approach. This is the first time I’ve seen tax credits and deductions move up in the public consciousness to one of the “big three” alternatives. It is also the first time I’ve seen “state programs” eclipse a federal approach. The article also notes that a majority of Americans (52%) oppose a “substantial increase in taxes” to pay for the uninsured. The authors conclude that the most likely policy solution is a “hybrid” approach that combines several elements of the options, without raising taxes substantially.
Other articles in the series include essays by Uwe Reinhardt, Jonathan Oberlander, Jack Meyer and Sharon Silow-Carroll, and Lynn Etheredge and Judith Moore.
“Employers Are Screaming Out There”
The “Indianapolis Star” reports on a recent meeting of the state NFIB chapter. It says health insurance kept coming up as the number one concern of these employers. “Employers are just screaming out there,” said one observer. A survey by the state group found that 25% of its members had to drop coverage because of rising costs. One employer is quoted as saying, “I don’t know what the hell to do. When I get around other business people, we don’t talk about the war in Iraq, we don’t talk about the war on terrorism, we talk about how the hell we’re going to pay for health care.” This level of concern is what has prompted Association Health Plan legislation that has passed in the U.S. House but is stalled in the Senate due to opposition from insurers and regulators. The article also discusses HRAs as an alternative strategy.
Chamber Meeting in Florida Shows Employers Alternatives
The Lakeland, FL Chamber of Commerce sponsored a “small business health insurance” forum to discuss the issues small employers face. Insurance Director Kevin McCarty said, “Employers can only take so much money out of their businesses and remain competitive.” The article in the Lakeland “Ledger” by Adrian Zawada says, “The emerging consumer-driven health insurance movement became a dominant theme among the speakers.” Director McCarty said, “People have been conditioned over the years that health care isn’t expensive. When people become aware of the true costs, their habits begin to change.” Business owners found the meeting worthwhile. One said she “hates health insurance,” but found an agent she will work with in the future. A physician with 18 employees discovered MSAs at the meeting. The Chamber is thinking of making this forum an annual event.
So. Carolina/NAIC Host Meeting on Health Reform
The South Carolina Department of Insurance and the NAIC cosponsored a two-day session in Charleston, SC, on insurance reform. I gave both my “100 Years of Market Distortions” and my “New Tools” presentations. Congressman Jim DeMint (R-SC) was the keynote speaker, and other speakers included CAHI’s Merrill Matthews, HIAA’s Don Young, Mathematica’s Deborah Chollet, Georgetown University’s Mila Kofman, KFF’s Gary Claxton, Lee Tooman of Golden Rule, Rod Turner of American Republic, and regulators from Arkansas, Mississippi, Kentucky, Massachusetts, Utah, Maine, and Louisiana. Consumerism was a hot topic at this meeting, with South Carolina Commissioner Ernst Csiszar being quoted in the local paper as saying demand for services is by far the biggest cause of health care inflation. “Controlling utilization can only be done if patients are in some way responsible for the costs.”
Young Adults in New York Going Without Coverage
The “Buffalo (NY) News” includes a major article on the problem of young people without insurance coverage. Staff writer Holly Auer notes that nearly half of young adults between the ages of 19 and 29 were uninsured for at least some part of the year 2000, twice the rate of older adults. The article interviews a number of people about how they cope without coverage and says that some of them might be eligible for various state programs, though few are aware of it. Absent from the article is any mention of the biggest problem facing young New Yorkers – that state’s community rating law that requires a 25 year-old to pay the exact same premiums as a 55 year-old. The younger person simply doesn’t find value in the cost of the coverage.
Hospitals See Rise in Bad Debts in South Dakota
Writing in the “Sioux Falls (SD) Argus Leader,” Jay Kirschenmann claims that hospitals are seeing a growing problem of bad debts from people who can’t afford their hospital bills. The article sees this as the result of a rising number of uninsured, but also of insurers who simply refuse to pay for services. The article goes on to discuss the growing phenomenon of HRAs, MSAs, and other “defined contribution” approaches to health care financing. But it also includes a warning from Helen Darling of the Washington Business Group on Health that such plans should include a risk adjustment mechanism so that the seriously ill are not left out. There is no mention in the article of the growing problem of hospitals charging uninsured or cash-paying patients far more than they would charge a patient with insurance coverage.
SOURCE: The article was published on August 23, so isn’t available in the seven day archives. E-mail the author at email@example.com
Singapore to Publish Hospital Charges on Net
While American hospitals may put the screws to patients who pay their own bills, Singapore is encouraging it. Writing in “World Markets Analysis” Gareth Leather reports that Singapore’s Health Minister is requiring hospitals to “publish the price of different treatments ? on the internet. The increase in price transparency? should help to boost competition and ensure that prices remain low.” The article says this “should ensure the Singapore remains competitive in the area of ‘healthcare tourism’ amid rising competition from its neighbors, especially Thailand.” The article also mentions how much better Singapore is doing “in comparison to its main Asian rival Hong Kong, where a commitment by the State to provide subsidized healthcare for all – regardless of income – has led to major inefficiencies?.”
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