Regence campaign: Consumers must make choices to reduce health care costs

By Paul Beebe
The Salt Lake Tribune
November 14, 2009
As the battle over health care reform rages in Congress, Regence BlueCross BlueShield is using a slick Internet site, social media and billboards to say that consumers bear much of the blame for high premiums.
The message isn’t that bald, but it’s there.
“It really is about motivating people about the real cost of health care and how the choices they make each day impact those costs. To motivate consumers to take action is really what it’s all about,” Regence spokeswoman Georganne Benjamin said Wednesday.
“Cost is a big factor in this debate, and we need to address the high rate of medical spending, or we will not have meaningful health care transformation. This campaign does play a role in that,” she said.
The heart of Regence’s campaign is an interactive Web site (What’s the Real Cost?). But if a visitor overlooks or doesn’t click on a link next to a navigation button, he won’t easily discern that the site was put up by (Regence BlueCross BlueShield).
Regence is also using traditional tactics.
It has erected billboards along Interstate 15 that display two messages: “Health care hums like a machine with no off button because we don’t question it” and “Should ‘Because it’s covered’ be guiding health care?”
http://www.sltrib.com/business/ci_13562042
What’s the Real Cost? (a game):
http://www.whatstherealcost.org

How many people do you know that request health care that they know they don’t need but they want to have “because it’s covered”? In over thirty years of my very busy family practice, I cannot recall one single patient with such a request. Yet the thrust of this Regence BlueCross BlueShield campaign is to blame the patient for requesting too much health care.
We know the primary sources of the very high costs for health care in the United States. First, the administrative excesses of our fragmented financing system waste hundreds of billions of dollars each year (about four trillion in the next ten years, reformers please note). Also our prices are much higher than in other nations. Although technological advances have increased costs, they do not account for our excess spending since the level of use is comparable to that of most other nations.
So what about the excess of unnecessary care? Health care decisions are predominantly supply-side, provider-driven decisions. In spite of the plethora of anecdotes of patients demanding too much care, very few health care decisions are demand-side, patient-driven decisions. Regence couldn’t be further off target with this campaign.
Regence BlueCross BlueShield is a not-for-profit insurer, theoretically a traditional Blues plan. But it, like the other not-for-profits, has adopted the market innovations of the other Blues such as WellPoint that have converted to for-profit for the primary purpose of making money, with patient service being only a secondary necessity.
Regence BlueCross BlueShield is part of the reason for our outrageous health care costs, both for the administrative waste from its own activities and the administrative burden placed on providers, plus its ineffectiveness in improving value by improving the allocation of our health care dollars. For Regence to place the blame with the patients for demanding too much care is the ultimate of chutzpah.

By Paul Beebe
The Salt Lake Tribune
November 14, 2009

As the battle over health care reform rages in Congress, Regence BlueCross BlueShield is using a slick Internet site, social media and billboards to say that consumers bear much of the blame for high premiums.

The message isn’t that bald, but it’s there.

“It really is about motivating people about the real cost of health care and how the choices they make each day impact those costs. To motivate consumers to take action is really what it’s all about,” Regence spokeswoman Georganne Benjamin said Wednesday.

“Cost is a big factor in this debate, and we need to address the high rate of medical spending, or we will not have meaningful health care transformation. This campaign does play a role in that,” she said.

The heart of Regence’s campaign is an interactive Web site (What’s the Real Cost?). But if a visitor overlooks or doesn’t click on a link next to a navigation button, he won’t easily discern that the site was put up by (Regence BlueCross BlueShield).

Regence is also using traditional tactics.

It has erected billboards along Interstate 15 that display two messages: “Health care hums like a machine with no off button because we don’t question it” and “Should ‘Because it’s covered’ be guiding health care?”

http://www.sltrib.com/business/ci_13562042

What’s the Real Cost? (a game):
http://www.whatstherealcost.org

Comment:

By Don McCanne, MD

How many people do you know that request health care that they know they don’t need but they want to have “because it’s covered”? In over thirty years of my very busy family practice, I cannot recall one single patient with such a request. Yet the thrust of this Regence BlueCross BlueShield campaign is to blame the patient for requesting too much health care.

We know the primary sources of the very high costs for health care in the United States. First, the administrative excesses of our fragmented financing system waste hundreds of billions of dollars each year (about four trillion in the next ten years, reformers please note). Also our prices are much higher than in other nations. Although technological advances have increased costs, they do not account for our excess spending since the level of use is comparable to that of most other nations.

So what about the excess of unnecessary care? Health care decisions are predominantly supply-side, provider-driven decisions. In spite of the plethora of anecdotes of patients demanding too much care, very few health care decisions are demand-side, patient-driven decisions. Regence couldn’t be further off target with this campaign.

Regence BlueCross BlueShield is a not-for-profit insurer, theoretically a traditional Blues plan. But it, like the other not-for-profits, has adopted the market innovations of the other Blues such as WellPoint that have converted to for-profit for the primary purpose of making money, with patient service being only a secondary necessity.

Regence BlueCross BlueShield is part of the reason for our outrageous health care costs, both for the administrative waste from its own activities and the administrative burden placed on providers, plus its ineffectiveness in improving value by improving the allocation of our health care dollars. For Regence to place the blame with the patients for demanding too much care is the ultimate of chutzpah.

Insurer ends health program rather than pay out big

By William Ehart
The Washington Times
October 14, 2009
Ian Pearl has fought for his life every day of his 37 years. Confined to a wheelchair and hooked to a breathing tube, the muscular dystrophy victim refuses to give up.
But his insurance company already has.
Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl’s.
In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl “dogs” that the company could “get rid of.”
“The insurance companies are cheating in order to have obscene profits,” (Mr. Pearl’s father) said.
Guardian, a 150-year-old mutual company, reported profits of $437 million last year, a 50 percent increase over $292 million in 2007. It paid dividends of $723 million to policyholders and had $4.3 billion in capital reserves, according to its annual report. The company’s investment income totaled $1.5 billion that year, a small increase from the year earlier.
http://washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/

Although the individual private insurance market is infamous for discriminating against individuals with a potential for high health care costs, regulations largely prohibit group plans from singling out individuals for exclusion.
When private group plans prove to be unprofitable, they can often legally skirt the regulations by shutting down the entire plan or by withdrawing from unprofitable markets, often leaving the previously insured with very difficult or near-impossible choices. No matter how well regulated, the current proposed insurance exchanges cannot prevent an insurer that is failing in a market from shutting down. Even with guaranteed issue, other insurers would also shun unprofitable markets and unprofitable plans.
This problem is much more common than many realize. Look at the Medicare Advantage programs. This year many have declined to submit bids for renewal and will withdraw from unprofitable markets. Even this highly regulated option to Medicare can abandon patients, yet Medicare can’t. This is one more important reason why we should question the wisdom of Congress in insisting that reform be based on a market of private plans instead of an improved Medicare program for all of us.
Ian Pearl’s story has a couple of other important lessons for those supporting a public option as part of the reform package. Although private plans must always protect their business interests above the interests of the patients, a public option would have a mission requiring it to place patients first. The public option would be a victim of adverse selection since it would have to function as the safety net. Attempts to adjust risk would drive private insurers out of the exchange, leaving high-cost individuals with only very expensive options.
What about private co-ops instead, owned by the beneficiaries? That would prevent insurers from “cheating in order to have obscene profits,” as Mr. Pearl Sr said. Oops. Look at the profit statement of Guardian. It is a mutual company, and the profits are returned to the policyholders as dividends. That is essentially what a co-op is! Yet that did not prevent Guardian from jerking the rug out from under Ian Pearl. Private plans with their own segregated risk pools will always use any means legal (and sometimes illegal) to protect their reserves from being spent on health care.
Creating a public option and then throwing it into the amoral, dysfunctional private insurance marketplace to have it compete on the same perverse terms as the private insurers is a very sick solution for our health care crisis.
Single payer anyone?

By William Ehart
The Washington Times
October 14, 2009

Ian Pearl has fought for his life every day of his 37 years. Confined to a wheelchair and hooked to a breathing tube, the muscular dystrophy victim refuses to give up.

But his insurance company already has.

Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl’s.

In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl “dogs” that the company could “get rid of.”

“The insurance companies are cheating in order to have obscene profits,” (Mr. Pearl’s father) said.

Guardian, a 150-year-old mutual company, reported profits of $437 million last year, a 50 percent increase over $292 million in 2007. It paid dividends of $723 million to policyholders and had $4.3 billion in capital reserves, according to its annual report. The company’s investment income totaled $1.5 billion that year, a small increase from the year earlier.

http://washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/

Comment:

By Don McCanne, MD

Although the individual private insurance market is infamous for discriminating against individuals with a potential for high health care costs, regulations largely prohibit group plans from singling out individuals for exclusion.

When private group plans prove to be unprofitable, they can often legally skirt the regulations by shutting down the entire plan or by withdrawing from unprofitable markets, often leaving the previously insured with very difficult or near-impossible choices. No matter how well regulated, the current proposed insurance exchanges cannot prevent an insurer that is failing in a market from shutting down. Even with guaranteed issue, other insurers would also shun unprofitable markets and unprofitable plans.

This problem is much more common than many realize. Look at the Medicare Advantage programs. This year many have declined to submit bids for renewal and will withdraw from unprofitable markets. Even this highly regulated option to Medicare can abandon patients, yet Medicare can’t. This is one more important reason why we should question the wisdom of Congress in insisting that reform be based on a market of private plans instead of an improved Medicare program for all of us.

Ian Pearl’s story has a couple of other important lessons for those supporting a public option as part of the reform package. Although private plans must always protect their business interests above the interests of the patients, a public option would have a mission requiring it to place patients first. The public option would be a victim of adverse selection since it would have to function as the safety net. Attempts to adjust risk would drive private insurers out of the exchange, leaving high-cost individuals with only very expensive options.

What about private co-ops instead, owned by the beneficiaries? That would prevent insurers from “cheating in order to have obscene profits,” as Mr. Pearl Sr said. Oops. Look at the profit statement of Guardian. It is a mutual company, and the profits are returned to the policyholders as dividends. That is essentially what a co-op is! Yet that did not prevent Guardian from jerking the rug out from under Ian Pearl. Private plans with their own segregated risk pools will always use any means legal (and sometimes illegal) to protect their reserves from being spent on health care.

Creating a public option and then throwing it into the amoral, dysfunctional private insurance marketplace to have it compete on the same perverse terms as the private insurers is a very sick solution for our health care crisis.

Single payer anyone?

Insurer ends health program rather than pay out big

By William Ehart
The Washington Times
October 14, 2009

Ian Pearl has fought for his life every day of his 37 years. Confined to a wheelchair and hooked to a breathing tube, the muscular dystrophy victim refuses to give up.

But his insurance company already has.

Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl’s.

In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl “dogs” that the company could “get rid of.”

“The insurance companies are cheating in order to have obscene profits,” (Mr. Pearl’s father) said.

Guardian, a 150-year-old mutual company, reported profits of $437 million last year, a 50 percent increase over $292 million in 2007. It paid dividends of $723 million to policyholders and had $4.3 billion in capital reserves, according to its annual report. The company’s investment income totaled $1.5 billion that year, a small increase from the year earlier.

http://washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/

Comment:

By Don McCanne, MD

Although the individual private insurance market is infamous for discriminating against individuals with a potential for high health care costs, regulations largely prohibit group plans from singling out individuals for exclusion.

When private group plans prove to be unprofitable, they can often legally skirt the regulations by shutting down the entire plan or by withdrawing from unprofitable markets, often leaving the previously insured with very difficult or near-impossible choices. No matter how well regulated, the current proposed insurance exchanges cannot prevent an insurer that is failing in a market from shutting down. Even with guaranteed issue, other insurers would also shun unprofitable markets and unprofitable plans.

This problem is much more common than many realize. Look at the Medicare Advantage programs. This year many have declined to submit bids for renewal and will withdraw from unprofitable markets. Even this highly regulated option to Medicare can abandon patients, yet Medicare can’t. This is one more important reason why we should question the wisdom of Congress in insisting that reform be based on a market of private plans instead of an improved Medicare program for all of us.

Ian Pearl’s story has a couple of other important lessons for those supporting a public option as part of the reform package. Although private plans must always protect their business interests above the interests of the patients, a public option would have a mission requiring it to place patients first. The public option would be a victim of adverse selection since it would have to function as the safety net. Attempts to adjust risk would drive private insurers out of the exchange, leaving high-cost individuals with only very expensive options.

What about private co-ops instead, owned by the beneficiaries? That would prevent insurers from “cheating in order to have obscene profits,” as Mr. Pearl Sr said. Oops. Look at the profit statement of Guardian. It is a mutual company, and the profits are returned to the policyholders as dividends. That is essentially what a co-op is! Yet that did not prevent Guardian from jerking the rug out from under Ian Pearl. Private plans with their own segregated risk pools will always use any means legal (and sometimes illegal) to protect their reserves from being spent on health care.

Creating a public option and then throwing it into the amoral, dysfunctional private insurance marketplace to have it compete on the same perverse terms as the private insurers is a very sick solution for our health care crisis.

Single payer anyone?

“Uncomplicated” Primary Care?

By Josh Freeman
Medicine and Social Justice
October 8, 2009
I have often written about the importance of primary care, the shortage of primary care physicians, and the fact that fewer medical students are choosing primary care careers, which will exacerbate the problem. A key part of this analysis is the large number of studies, by researchers from a variety of settings, that show that the presence of a higher proportion of primary care doctors decreases cost and increases quality.
However, not everybody agrees. In an earlier post, More Primary Care Doctors or Just More Doctors?, I discussed the position taken by Dr. Richard Cooper, former Executive Vice President and Dean of the Medical College of Wisconsin and currently Professor of Medicine and Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, who argues against this position.
Dr. Cooper and a group of equally distinguished colleagues restate this position; in particular that the value of primary care is overstated. In an excerpt from (their Physicians Foundation report) they note:
“Primary care has been a central focus of health care reform. In modeling the future workforce, the Project Team acknowledged the critical importance of primary care services and the role of generalist physicians in providing them. However, the Team rejected the claim by Starfield and others of lower mortality in regions with more family practitioners as a statistical anomaly, and it questioned the wisdom of deploying generalist physicians to take responsibility for the proposed medical homes. Indeed, faced with deep and prolonged physician shortages, it saw no need for physicians to expend effort on uncomplicated primary care.”
The American Academy of Family Physicians (AAFP) in its formal response to the Physicians Foundation report includes the following:
“This study is largely a recapitulation of the primary author’s paper in Health Affairs in January of this year. In that same issue, several researchers pointed out the fundamental flaws in this simplistic research showing that important basic adjustments showed this work to strongly support the prior studies it criticized. It continues to claim that population differences explain past findings for the value of primary care and variance in spending, when these were fully accounted for in these studies. This report does not repair those flaws. It labels several well-validated and valued studies as ‘anomalous’ and ‘simple frameworks’ without supporting evidence from other sources. We feel that such claims carry an obligation to point out specific errors of methodology or data, not just recapitulation of personal belief. The burden of proof is still overwhelmingly against the evidence upon which this reports rests. Its foundation is flimsy.”
Enough said about the lack of intellectual rigor, and essentially incorrectness about this piece. More important, I believe, the other assertion in the quote from Cooper’s paper, above, neatly packaged in the sentence “Indeed, faced with deep and prolonged physician shortages, it saw no need for physicians to expend effort on uncomplicated primary care”. What is this “uncomplicated primary care” of which you speak?
The myth is that primary care is about patients with colds and high blood pressure checks. The reality is that it is about people with multiple chronic diseases who need management of those conditions as well as coordination with whatever other specialists they are seeing; preventive services delivered; counseling and “asking for trouble” (“are you safe at home?”); discussion of whatever the other specialist may have recommended; and, of course, caring for acute complaints. This is hard, complex, time consuming and difficult.
(Joshua Freeman, MD is Professor and Chair of the Department of Family Medicine for the University of Kansas School of Medicine. He is author and editor of the Medicine and Social Justice blog.)
http://medicinesocialjustice.blogspot.com/2009/10/uncomplicated-primary-care.html

And…

Health Bills In Congress Won’t Fix Doctor Shortage

By Phil Galewitz
Kaiser Health News
October 12, 2009
Even as Congress moves to expand health insurance coverage to millions of Americans, it’s doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say.
The American Academy of Family Physicians predicts that the shortage of family doctors will reach 40,000 in the next 10 years, as medical schools send about half the needed number of graduates into primary care medicine.
A proposal backed by Senate Majority Leader Harry Reid, D-Nev., and the teaching hospital lobby to add 15,000 Medicare-funded medical residency positions — a 15 percent increase that would favor more primary care training — was considered dead on arrival because of its $10 billion price tag over a decade.
Instead, the House and Senate overhaul bills would redistribute about 1,000 unfilled residency positions to teaching hospitals that commit to creating more primary care residencies.
Proposals to significantly increase Medicare payments for primary care doctors have gone nowhere in part because the money would come from payments to higher-paid specialists — who, not surprisingly, oppose a pay cut.
Dr. Darrell Kirch, CEO of the Association of American Medical Colleges, said the extra training slots emanating from the redistribution of unfilled residency position would amount to a “drop in the bucket.”
http://www.kaiserhealthnews.org/Stories/2009/October/12/primary-care-doctor-shortage.aspx

The report by Dr. Cooper and his colleagues, cited by Dr. Freeman, was “A Report to the President and the Congress.” Since it was released only one month ago, this report likely did not influence the current legislation, but it is important because it does represent the cavalier views of all too many within and outside of the health care arena.
One of the promises of reform was to reinforce our primary care infrastructure. Although there are a few measures in the bill such as a nominal primary care bonus and a medical home pilot project, failure to train more primary care physicians will require many patients to rely on expensive care in our emergency rooms and expensive care through often inappropriate, direct self-referral to specialists.
We were promised that everyone would be covered and costs would be controlled. Neither will happen. And now the promise of providing primary care access to everyone will fall far short. Jiggling 1000 existing medical residencies just won’t do it.