Editor’s note: the story goes on (if you go to the link) to talk about the impact health care costs are having in keeping people in the workforce longer.
According to findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey, the labor-force participation rate is increasing for those age 55 and older. The percentage of civilian non-institutionalized Americans age 55 or older who were in the labor force declined from 34.6 percent 1975 to 29.4 percent in 1993. However, since 1993, the labor-force participation rate has steadily increased, reaching 39.4 percent in 2008—the highest level over the 1975–2008 period. For those ages 55–64 (the near elderly), this is being driven almost exclusively by the increase of women in the work force; the male participation rate is flat to declining. However, among those age 65 and older (the elderly), labor-force participation is increasing for both males and females. Education is a strong factor in an individual’s participation in the labor force at older ages: Individuals with higher levels of education are significantly more likely to be in the labor force than those with lower levels of education.
With Washington placing insurers in their cross-hairs and proclaiming that there isn’t enough competition among insurers, I wonder if the public has thought about what more competition among health insurers might mean.
First, a few facts. The portion of the premium that is devoted to care (otherwise known as MLR or Medical Loss Ratio) runs between 78 and 82% of premium. You can find these numbers in the quarterly financial reports of the public insurers. These claims payments are a result of contracted reimbursement rates between the insurer and providers (doctors, hospitals, labs, etc.)
Back to the original question. Will more competition drive premium costs downward. If market power in terms of volume allows you to negotiate a better rate then on at least 78% of the bill the costs may go up instead of down with new entrants into the market. The insurers will not be able to negotiate the same favorable terms with providers as they are now. Unless you think they are keeping reimbursements artificially high … I doubt you could find a physician or a hospital that would agree with that.
Therefore the government must be counting on the reduction of the remaining 18-22% to not only be reduced, but to overcome any loss of market power on the contracting with providers. Since the insurers will be smaller, they will have less market power with all of their other providers of products and services as well — from phones, to facilities, and on an on.
Perhaps in this context competition isn’t such a good idea if your goal is to reduce costs.
Then again, perhaps what they are talking about at the Federal level is all of the costly mandates that the states put on insurance providers. Requirements for coverage types, lengths of stay and so on. So maybe the issue isn’t with private enterprise, but rather with government regulation.
What do you think a couple of thousand page health care bill is going to do to the volume of regulation?
Editor’s note: The big fear of the House Democrats: if the Senate requires the original bill to be signed into law before it will vote on the side car, is it possible that the side car does not get passed — or it gets changed and sent to the House for another vote and it doesn’t agree, etc. and we end up with the original Senate Bill as the law of the land?
Here is an analysis by ERIC.
THE ERISA INDUSTRY COMMITTEE
Advocating the Employee Benefit and Compensation Interests of America’s Major Employers
March 16, 2010
Healthcare reform is now in the root canal stage of the process, where pain and procedures seem to be dwarfing more substantive considerations. At the moment, all eyes are focused on the House, where Speaker Nancy Pelosi (D-CA) must come up with 216 votes to approve the healthcare legislation passed by the Senate last December as well as a “sidecar” bill that would make enough changes to the Senate bill to assure an “aye” vote in the House for the legislative package as a whole.
House action: Yesterday the House Budget Committee got the ball rolling by approving a “placeholder” bill that has now been sent to the House Rules Committee. The Rules Committee will substitute the “real” reform language for the fake language and then have a vote on a “rule” for the bill – i.e., how it will be packaged, how many amendments can be offered, how long debate can last, etc.; a vote in the Rules Committee could take place Wednesday or Thursday.
If all goes as planned and the House Rules Committee reports out the legislation, a vote on the overall reform package in the House could occur Friday or, more likely, late Saturday afternoon. At this point it is not entirely clear what this package will entail, i.e., if the Rules committee will keep the Senate legislation and a House sidecar bill separate or whether the two will be combined. In the latter scenario, a vote to approve the sidecar would be “deemed” to also be a vote for the Senate bill.
One potential sticking point in all of this is that the Congressional Budget Office has still not released its final “score” on the legislative package; this score is important because a bill that bursts the $1 trillion optical ceiling for the cost of the legislation will have a harder time picking up stray votes in the House.
Note: the legislative language for the sidecar bill also has yet not been released.
Senate action: If the House summons 216 votes to approve this new healthcare reform package and avoids the numerous potholes that could cause its wheels to fall off, the last stage is consideration in the Senate. At this point, the Senate bill will have been approved by both the House and the Senate and will have been sent to the president for his signature; although no definitive statement has been issued by the Senate parliamentarian, it appears that the president must sign the Senate bill into law before a reconciliation bill can amend it in the Senate. What the Senate will consider and vote on is just the sidecar reconciliation bill.
As has been made much of lately, the Senate needs only a majority vote to approve the sidecar reconciliation bill and not the 60 votes to overcome a filibuster. The trade-off, though, is that the reconciliation bill may not include any policy provisions that do not have a budgetary effect on the bill’s bottom line. (That is why Speaker Pelosi has been hamstrung in her ability to add a provision to the sidecar bar to appease anti-abortion House Democrats.)
But here’s another rub: the Senate may not necessarily want to approve the sidecar bill exactly as it was sent over by the House; the problem is that any changes to the sidecar would mean that the bill would need to go back to the House for another vote. This would probably sound the death knell for healthcare reform legislation.
Lowering BP reduces health risks at all weight levels
Data from the Perindopril Protection Against Recurrent Stroke Study showed lowering blood pressure reduced the risk of vascular disease and stroke among patients of all body weights. Overweight and obese patients, however, have a greater baseline cardiovascular risk, so they saw the biggest benefit of all study participants, researchers said. Medscape (free registration)/Heartwire (3/12)
Hospitals are changing culture of handling medical errors
Assessing blame for medical errors is difficult, and hospitals are looking to see if their own systems may be partly responsible when providers make mistakes. The National Quality Forum has developed a Care of the Caregiver standard, and the Just Culture model stresses the middle ground between blaming a physician or nurse and holding a system failure accountable. The Wall Street Journal (3/16)