Nikki Haley does Insurance industry bidding, damages people of Virginia, then lies about it.

This is the Republican approach to health care policy.

Gov. Nikki Haley dictated the conclusions of a committee charged with deciding how the state should implement federal health care reform before the group ever held its first meeting, public documents show.

Now, some of those involved in the dozens of meetings are calling the entire planning process a sham that wasted their time and part of a $1 million federal grant.

In a March 31 email thread that included Haley, her top advisers and the committee member who eventually wrote the report, Haley wrote, "The whole point of this commission should be to figure out how to opt out and how to avoid a federal takeover, NOT create a state exchange," which is eventually what happened.

A central part of the federal health care overhaul, an exchange is a marketplace where various insurance plans eventually will be sold.

[...]

The most recent progress reports filed with the federal government show the administration used about $109,000 of the $1 million grant through the end of November.

Crangle said the exercise was "not in good faith" and called it "an abuse of federal funds." State money also is at issue because state employees were on state time when they attended dozens of exchange planning meetings, he said.

Sue Berkowitz, an advocate for the uninsured who participated in planning discussions as executive director of S.C. Appleseed Legal Justice Center, said time was wasted.

"We came together and sat down for a lot of meetings in good faith that we'd explore every option and discuss what is in the best interests of the state," she said. "I'm frustrated that we were being used for something that wasn't an open, transparent discussion."

[...]

Insurance exchanges are the state- or federally-run marketplaces where health coverage will be sold to individuals and small business employees beginning in 2014. They are a key part of the federal health law.

Envisioned as the "Expedia" for health insurance, exchanges are intended to make purchasing health care easier and more affordable by allowing customers to compare options side-by-side.

They also are intended to be the place where residents who make between 133 percent and 400 percent of the poverty level will apply for and collect federal tax credits to buy coverage.

A state panel established by Gov. Nikki Haley recommended last month the state should not manage its own exchange. If Haley accepts the recommendations, South Carolina will join a handful of other states that already have declined to set up exchanges.

States that do not set up exchanges by 2014 will be subject to federally run exchanges.

In short, Nikki Haley does not want a competitive market in health insurance. She is governor of Virginia in part to ensure that Virginians have to buy health insurance from an oligopoly that already exists and wants no competition.

Here's a summary of the Affordable Care Act -- what do the conservatives have to offer? Nothing!

Here is Slate on the health care initiatives in both Massachusetts and the recently passed federal plan.

...both proposals stand on a "three-legged stool": preventing insurance companies from denying coverage for pre-existing conditions, requiring universal coverage to eliminate "free riding," and subsidizing insurance plans to make them affordable to all. This "incremental universalism," fixing the existing system instead of starting from scratch, appeals to Republicans for its private-sector involvement and to Democrats for its universal coverage. That's what made both "Romneycare" and "Obamacare" possible.

Both plans were first modeled in

...Gruber['s] Micro-Simulation Model, which—well, let's use Gruber's words: It "takes two sets of inputs, fixed information on individuals and varying information on policy parameters, to predict the effect of health market interventions on the movement of people and dollars within the U.S. healthcare system." For the first time, policy makers were able to see whether they could actually afford their health-reform bills and what impact they would have on the behavior of both employers and individuals.

Then more from the architect of the plan, Jonathon Gruber:

Gruber emphasizes, the federal reform is more ambitious and less affordable than the state law was. We've successfully addressed the coverage side of health care, he says. Now, it's time to take a look at the price tag: Do people choose the most cost-effective health care plan? What factors drive their choices? How can we help them choose the best plan? What's the best way to compensate medical providers: paying them for each service or paying them a fixed amount? And what will happen to our health if we pay them less? Ultimately, we need to find a way to slow down the exponential growth of health care costs.

So the federal plan is one that (1) builds on the existing health insurance industry, (2) establishes universal healthcare (which will reduce the massive costs involved in unplanned for provision of health services for large groups of people for whom the actual costs are clearly predictable using insurance principles and the Law of Large Numbers) and (3) sets the stage for a system that will slow down the current runaway health costs.

The Republicans want to abandon the ACA but offer absolutely nothing to replace it. Which means that if the Republicans have their way, the average family will be priced out of health care within a very few years. The Republicans are not problem solvers. They are power mad power mongers.

Ryan's Medicare proposal is dead already. Good riddance.

Does anyone really think that Paul Ryan's Vouchers-for-Medicare plan can work? Ask the insurance industry which companies want to offer health insurance to the over age 65 demographic. This is from Benjy Sarlin at Talking Points Memo.

Unlike the Affordable Care Act, which mandated that millions of young and healthy Americans purchase insurance with government subsidies, the Paul Ryan plan would instead bring the oldest, sickest, and least profitable demographic to the table. And with the CBO projecting that the average senior would be on the hook for over two-thirds of their health care costs within just 10 years of the plan's adoption -- a proportion that is projected to worsen in the long run --- the government subsidies backing them up may not bring in enough profitable customers to make things worthwhile.

"If reimbursement rates are too low to provide basic benefits, they'll tell the government, 'You do it,'" one insurance lobbyist told TPM. "I don't think they can require they lose money, they'd just pull out."

Dan Boston, a veteran lobbyist for health care providers and co-owner of Health Policy Source, said in an interview with TPM that he was taking a "wait and see" approach on the GOP budget before judging its value. (The American Hospital Association opposes the plan). But he cautioned that a major concern would be whether hospitals and private insurers would be left on the hook for low-income seniors eligible for both Medicare and Medicaid, who could run up significant costs with little hope of ever paying them off.

"I think everyone is going to be looking at the viability of the funding," he said.

Any so-called insurance company that tried to offer policies to the Medicare demographic would not last two years.

Ryan's plan is a perfect example of the crap that Republicans and much of the MSM call thoughtful and innovative. Ann Rand would have loved this stuff.

[Cross-posted at Social Security & Medicare Notes.]

Massachusetts Health Care administrator supports single payer

From Massachusetts we get this endorsement of single payer health care from a guy who should know:

A senior Patrick administration health care official said Friday that a single payer system may work more effectively and efficiently than Massachusetts’s existing insurance market, a high-profile endorsement that raised eyebrows at a legislative hearing.

“I like the market, but the more and more I stay in it, the more and more I think that maybe a single payer would be better,” said Terry Dougherty, director of MassHealth – the state-run Medicaid plan that insures nearly 1.3 million Massachusetts residents – when lawmakers asked for his “personal view” on a single payer system.

Dougherty’s comment, made during a budget hearing at the Boston Public Library, prompted his boss, Secretary of Health and Human Services JudyAnn Bigby, to interject: “That’s his personal opinion.”

Dougherty noted that MassHealth, by far the largest program in state government, spends just 1.5 percent of its $10-billion-a-year budget on administrative costs – compared to about 9.5 percent by the private market, according to studies by the state Division of Health Care Finance and Policy. That figure won plaudits from several lawmakers on the panel, including some who have supported implementing a statewide single payer system.

After his remarks, Dougherty told the News Service that he’s learned to appreciate “elements of single payer” during his 30 years in health care.

“It’s got to be better than this devil-may-be marketplace,” he said. “We don’t build big buildings. We don’t have high salaries. We don’t have a lot of marketing, which makes, to some extent, some of the things that we do easier and less costly than some things that happen in the marketplace. Overall, my point is, we have individuals who work in state government in MassHealth ... who are just as smart, just as tactile, just as creative as people who work in the private sector, but they work for a lot less money.”

A single payer system would replace the state’s patchwork of nonprofit and private insurers with a single, public insurer through which all health care dollars would flow to hospitals, doctors and other health care providers. Supporters say it would eliminate administrative waste and ensure that all residents receive adequate coverage.

So - no fancy buildings and the money that is wasted on excessive salaries is instead spent on providing health care. What's not to like - unless you are a health insurance executive drinking excessively from the health care teat.

America could learn a lot from the French health care system

Even when (or if) the Affordable Healthcare Act is implemented, it will not solve all of America's problems of providing health care to the population in an affordable way. But Bloomberg Businessweek writes approvingly of the French health care financing system.

In Sicko, [Michael] Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the U.S. model that reforms based on France's experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. "The French approach suggests it is possible to solve the problem of financing universal coverage...[without] reorganizing the entire system," says Victor G. Rodwin, professor of health policy and management at New York University.

France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France's infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

That's not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.

To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population. French medicine is based on a widely held value that the healthy should pay for care of the sick. Everyone has access to the same basic coverage through national insurance funds, to which every employer and employee contributes. The government picks up the tab for the unemployed who cannot gain coverage through a family member.

This is, of course, a report from a business publication rather than a political publication. Most of what we political wonks on-line look at are political publications and they focus on the he-said - he-said of party politics. The business publications have a focus on the bottom line, so they can sometimes report that one side or the other in an argument is right and the other is wrong. Providing health care to the population and to the workforce may be one of those situations. Read the rest of this report for a very interesting view on health care.

One more point - will the five conservative Catholics on Supreme Court vote to declare the mandatory buy-in required by the Affordable healthcare Act (ACA) is unconstitutional if the business community objects? Especially the health care companies who expect to get an additional 45 to 50 million paying customers under the ACA?

Health Insurance industry has another PR failure

Right on the heels of the disaster the health insurance industry suffered when AHIP released it's attack report propaganda piece right before the Senate Finance Committee vote on the health care bill, they now have a second PR disaster. Greg Sargent reports:

CNN has acknowledged in a statement to me that a high-profile Republican commentator who frequently discusses health care on the air is also the media buyer for one of the ad campaigns bankrolled by America’s Health Insurance Plans, the major industry trade group currently waging war against the White House and Dem reform proposals.

CNN tells me his ties to the industry will be disclosed in the future.

The CNN contributor, well-known GOP consultant Alex Castellanos, is best known for producing the racially-charged “Hands” ad, has repeatedly appeared on the network attacking Dem health care plans and the public option, which is strongly opposed by AHIP.

Castellanos’s consulting firm, National Media, also recently placed over $1 million of TV advertising for AHIP, according to info obtained by Media Matters. AHIP’s most recent $1 million ad buy attacks the health care plan as a threat to Medicare.

This connection, you’d think, should be disclosed whenever Castellanos appears on CNN discussing health care. Asked for comment, CNN spokesperson Edie Emery acknowledged the tie and promised full disclosure in the future.

The insurance industry is rapidly digging a hole that leaves them a laughing stock instead of a credible source of information. This is at a time when the entire health insurance industry is set up to be restructured.

Here's what the health care battle is all about.

The health insurance companies are in business to make profits, not to provide health care. When they have a choice between paying for health care a client expects or for making a profit, they will refuse to pay for the health care in order to increase their profit. They won't admit this, because admitting it is bad for business, but it is what they are in business to do. They collect as much money as possible and pay out as little as they can get away with.

The so-called free market for health insurance does not work to provide the best benefit at the lowest price. Effective free markets of knowledgeable sellers and buyers negotiating price and service is not possible. Since most geographic areas are provided insurance by a dominant insurer and a lot of people get only the insurance offered by their employer, there is little real price competition. Worse, most healthy people buy insurance to protect them from the unknown, so they have no idea what will really happen if they get sick or have an accident. The result is that since the insured has no idea what they are buying at the time they contract for it, price competition doesn't work. The lowest price will win most decisions even if the contract limits payments below what is needed. That results in many bankruptcies for supposedly insured people who find their insurance does not provide the protection they expected.

Right now, if you have insurance, all you have is a contract for which you have to pay rapidly increasing premiums and which you can be kicked out of at the insurance company's whim. Once you are kicked out you become uninsurable. This may be hidden from you if you get your health insurance through your employer, but it applies to you also.

If you do get sick and the expense of your illness or accident is expected to be large, then your insurance policy is much more likely to be canceled. In the meantime, the prices for all insurance and for health care services are rising uncontrollably. Many people are simply priced out of the market for insurance, or are sold policies with high deductibles, high copays, and caps on the total that will be paid out. Even if you have "insurance" if you get ill you have a high chance of being bankrupted by high medical expenses. This is exactly why you purchase health insurance - to get health care if you get ill and to avoid bankruptcy if you need health care.

Government regulations that require insurers to accept anyone who applies will keep them from selecting only the healthy and from avoiding or dropping the sick. A standardized set of benefits will permit the insured to know in advance what they are paying for, and a national regulator will give anyone the right to appeal unfair denial of payments. The public option will offer a safe and reasonably priced competitor to anyone who objects to the dominant private insurer in any given area. That completion will prevent private insurers from raising premiums unreasonably.

Is there any value in private insurers developing innovative ways to collect from the insured and paying for the services required? Not if everyone is insured. That reduces the entire process of providing health insurance to a simple administrative process of collecting the money and paying it out. Innovation needs to be done in actual provision of health care services, and insurance companies can only innovate in ways to avoid payments for health care services. That eliminates the complexity of insurance policies. Customers choose the policy they expect will offer the best services for the price, with full knowledge that they are getting real insurance against the unexpected.

That deals with fairness to people who need to buy and pay for health insurance. It also cuts down on the additional costs created when insurers fight to avoid paying for people who are sick or who should be insurance by some other insurer. What it does not do is slow the increase in medical costs.

Those have to be addressed by revising the way physicians and other health providers practice medicine and by removing the unnecessary aspects to administration in getting reimbursement for services provided. Studies of best practices and wide publication of the most effective and efficient are one answer to that. Another is to make sure that when someone needs medical care, the provider knows he or she will be paid for providing it. The cost of dealing with the uninsured is effectively eliminated by providing universal health care. If all Americans are in the insured pool, the costs of paying for the uninsured are pretty well eliminated. That means there is no excuse for cost-shifting by hospitals and health care suppliers who charge the insured more to cover the expense of people who cannot pay for the services they receive.

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Addendum 8/15/2009 9:24 am
Steve Benen has written an excellent post about what Wendell Potter is saying about how the insurance companies "put profits before patients" and how they are behind the current public attack on the effort to reform health care.

Wendell Potter was the top Public Relations Manager for one of the major health insurance companies, and was himself directly involved in killing Bill Clinton's attempt to reform the health care system.