PNHP

Making Tough Choices: Adults with Disabilities Prioritize their Medi-Cal Options

Making Tough Choices: Adults with Disabilities Prioritize their Medi-Cal Options

By Marjorie Ginsburg and Kathy Glasmire
California HealthCare Foundation – December 2004

In January, 2004, Governor Arnold Schwarzenegger proposed a major overhaul of Medi-Cal to contain costs… …the state requested assistance from the California HealthCare Foundation and The California Endowment to solicit, receive, and organize public input…

…Sacramento Healthcare Decisions… developed a simulation project to ask adult disabled Medi-Cal beneficiaries to design their own health benefits package when there were more options than dollars.

The project used CHAT (Choosing Healthplans All Together), a computer-based program developed by the University of Michigan and the National Institutes of Health. CHAT is a tool that engages individuals in the challenges of choosing health care benefits when choices exceed available resources.

The basic CHAT board is a pie chart consisting of up to 16 categories (with two or three tiers in each category). Each category tier costs a specific number of markers based on the proportional cost of that service… Altogether there were a total of 123 marker spaces on the CHAT board. Choosing all services at the current (Medi-Cal) level required 114 markers, but participants had only 100 markers to use in picking their benefits.

>From the findings:

* Given the nature of their health status, adult disabled Medi-Cal beneficiaries are often highly dependent on medical and supportive services. The CHAT decisions they make are heavily influenced by this basic fact.

* Maintaining a full range of Medi-Cal services is the most important consideration when CHAT participants design coverage that affects all disabled Medi-Cal beneficiaries.

* Having sufficient choice and availability of providers is essential for beneficiaries to feel secure about their health care services and confident that quality care is attainable.

Comparing CHAT responses between Medi-Cal beneficiaries and the privately insured:

* While health care plays a major role in the lives of disabled Medi-Cal beneficiaries, it is usually not central to the lives of most privately insured employees.

* Compromising on a benefits package was easier for privately insured employees than it was for those on Medi-Cal.

* Moderate cost sharing was more acceptable to privately insured employees than it was to those on Medi-Cal.

* Both groups felt that having a full range of health care services was the most important criterion for their coverage.

* Both groups consider choice to be the cornerstone of a quality health care system.

>From the Conclusion:
Agreeing to make trade-offs during the CHAT process is not the same as accepting those cutbacks in real life.

>From the perspective of the participants, there is no low-hanging fruit in Medi-Cal. Every service category has its advocate; every higher level tier has its promoter. While many acknowledged that Medi-Cal may have to change in response to California’s budget problems, participants were concerned that the state will make life considerably harder for them than it is now.

http://www.chcf.org/documents/policy/MediCalCHAT.pdf

Comment: Today, more attention is being given to health care costs than to other concerns such as the growing numbers of uninsured. The CHAT tool was developed to assist in providing consumer input into the debate over the perceived need to reduce health care spending.

The problem with CHAT is that it begins with the presumption that health care spending must be reduced, and it can be done so only by decreasing benefits and increasing individual cost sharing. The obvious risk of this approach is that policymakers will use it to further reduce the financial protection afforded by health care coverage.

California ranks at the bottom of funding in it’s Medicaid (Medi-Cal) program, yet Gov. Schwarzenegger wants to use the CHAT process to slash Medi-Cal spending even more. But when there is no place to cut, distributing 100 markers for 123 spaces cannot ever result in rational health policy decisions.

It is very instructive to look at the CHAT game board in the original article (link above). Nowhere on the board can you find rational choices for cost containment. Reducing administrative waste, enhancing a higher quality and lower cost primary care base, reducing supply side technological excesses that fail to provide benefit, and establishing an integrated information technology system are only a few of the measures that would tackle health care costs while actually improving benefits and coverage.

When we approach the patient-consumer for input on addressing health care costs, shouldn’t we provide them with information on beneficial options, or should we merely continue to expose them to the CHAT game and use the results as an excuse to slash and burn what we do have?

A National Health Insurance Program for the U.S.

A National Health Insurance Program for the United States – The country must abandon its fragmented system
By Don R. McCanne
PLoS Medicine – November 2004

The continuing deterioration of affordability, coverage, and quality in health care makes it imperative that United States policymakers broaden their reform efforts beyond the ineffectual tinkering of incrementalism. A universal, single-payer, publicly funded and publicly administered program of social insurance would ensure access to affordable, comprehensive, high-quality health care for all. It should be the standard by which any other proposals are judged. If a better proposal can be crafted, now is the time to do it. People are dying while we delay.

http://medicine.plosjournals.org/archive/1549-1676/1/2/pdf/10.1371_journal.pmed.0010039-S.pdf

Comment: This article discusses the characteristics of the U.S. health care system that result in mediocrity in spite of our very high spending. And then it discusses options for reform.

As an open access journal, readers are encouraged to download articles and use them for their own purposes. Some may find this article to be useful in educating the public on the rationale of national health insurance.

This is the second issue of PLoS Medicine, a peer reviewed, open access, international, multidisciplinary journal of medicine from the Public Library of Science, founded by Nobel Laureate Harold Varmus and his colleagues. Their goal is to have PLoS Medicine become recognized as a premier journal of medicine, but with an important difference. All published material will be immediately available online without cost to anyone. This ensures that the very latest information and research in medicine is always available, without financial barriers, even to poor third world countries.

For more information, including free online subscribing:
http://medicine.plosjournals.org/perlserv/?request=index-html

Uwe Reinhardt on what makes America great

Uwe Reinhardt, Ph.D., Professor of Economics and Public Affairs, Princeton
University (personal communication):

Don: Attached is a portrait of what makes America great. Instead of using the coercive power of government to make you and me pay for her dental
care, this lady uses a pair of pliers to pull her own tooth. One just has to admire it. It keeps our tax rate (as % of GDP) the lowest in the OECD and our economy strong.

Best,

Uwe

(Rather than being included as an attachment to this message, the photograph can be viewed at this link to The New York Times:
http://www.nytimes.com/2004/12/28/business/28dental.html)

Comment: It is astounding that, in the world’s wealthiest nation, aversion to taxes is a more important driver of policy than is the health of its people. This is particularly troublesome as we witness the debate over the “stinginess” of our response to the unfathomable tragedy of the Tsunami.

In his Christmas message to the nation, President Bush said, “By volunteering our time and talents where they are needed most, we help heal the sick, comfort those who suffer, and bring hope to those who despair, one heart and one soul at a time.”

And today the president said, “In this case, I think it’s very important for Americans who want to give to provide cash to organizations that will be able to focus resources and assets to meet specific needs,” and, “There are many NGOs now involved that understand what is specifically needed to meet the needs of these countries.”

Volunteers and nongovermental organizations (NGO) do play an important role
in society and are to be praised for their very noble efforts. But they can never replace the duty of the government to make every effort to adequately address these very vital issues. The impact of charity and volunteerism remains miniscule when compared to the capability of a wealthy nation and its government resources.

We can bring hope to one heart and one soul at a time by volunteering to lend our pliers when the need is great. Or we can adopt national policies that would bring hope to all hearts and all souls. With tax rates in line with other OECD nations, we would still have the greatest personal wealth, but would also have the capability to do much more to ensure the health of all of our citizens and of the citizens of the world.

Addendum: On a positive note, the article, “U.S. Health Care Spending In An
International Context” by Uwe E. Reinhardt, Peter S. Hussey and Gerard F.
Anderson, tops the list as the most frequently viewed article on the Health
Affairs website. At least the health policy community is interested in learning why we spend so much and receive such mediocrity in health care. The article can be accessed at: http://content.healthaffairs.org/cgi/content/abstract/23/3/10

There is hope.

This year, Ontario may pass Michigan in making vehicles

The New York Times
November 27, 2004
This Year, Ontario May Pass Michigan in Making Vehicles
By Danny Hakim

Michigan has been the heart of the auto industry since Henry Ford started mass-producing the Model T a century ago, but the Midwestern state is poised to be surpassed by Ontario.

The Canadian province is on course to pass Michigan this year and become the
biggest auto-producing state or province in North America, according to Ward’s Automotive, which tracks auto production data.

Canada is attractive, in part, because of its nationalized health care system, which negates perhaps the largest competitive burden faced by domestic manufacturers. G.M. spends roughly $1,400 a vehicle produced in the United States on health care, more than it spends on steel.

Comment: Old news. The costs of the health benefit programs of U.S. auto
manufacturers result in less competitive pricing of their products. But this remains in the news because the saga grows worse day by day.

How long will U.S. businesses continue to tolerate this burden?

—————————————————————————–

Message: 2
Date: Tue, 30 Nov 2004
Subject: PLoS Medicine – National Health Insurance for the United States

PLoS Medicine
November 2004
A National Health Insurance Program for the United States
The country must abandon its fragmented system
By Don R. McCanne

The continuing deterioration of affordability, coverage, and quality in health care makes it imperative that United States policymakers broaden their reform efforts beyond the ineffectual tinkering of incrementalism. A universal, single-payer, publicly funded and publicly administered program of social insurance would ensure access to affordable, comprehensive, high-quality health care for all. It should be the standard by which any other proposals are judged. If a better proposal can be crafted, now is the time to do it. People are dying while we delay.

http://medicine.plosjournals.org/archive/1549-1676/1/2/pdf/10.1371_journal.pmed.0010039-S.pdf

Comment: This article discusses the characteristics of the U.S. health care system that result in mediocrity in spite of our very high spending. And then it discusses options for reform.

As an open access journal, readers are encouraged to download articles and use them for their own purposes. Some may find this article to be useful in educating the public on the rationale of national health insurance.

This is the second issue of PLoS Medicine, a peer reviewed, open access, international, multidisciplinary journal of medicine from the Public Library of Science, founded by Nobel Laureate Harold Varmus and his colleagues. Their goal is to have PLoS Medicine become recognized as a premier journal of medicine, but with an important difference. All published material will be immediately available online without cost to anyone. This ensures that
the very latest information and research in medicine is always available, without financial barriers, even to poor third world countries.

For more information, including free online subscribing:
http://medicine.plosjournals.org/perlserv/?request=index-html

Employers try shifting health costs

The Boston Globe
November 25, 2004
Employers try shifting health costs
Plans ease sting for those at lower end of pay scale
By Kimberly Blanton

To make healthcare more affordable to employees of all incomes, companies like Wachovia Corp… are adopting what are called salary-based health plans. Under the plans, employers pass on more of their rising healthcare costs to well- compensated executives than they pass on to lower-paid workers who can’t absorb the dramatic premium increases. Beginning Jan. 1, Wachovia will pass on larger premium increases to its executives around the country than to, say, its bank tellers.

Liberty Mutual is putting in place a salary component in an overhaul of its entire employee health plan designed to rein in future health expenses… Employees on the family plan who earn less than $50,000 will pay a $300 annual deductible, and their out-of-pocket costs for treatments will be capped at $1,500 per year. If their salaries fall between $50,000 and $99,999, the family deductible rises to $750, and maximum out-of-pocket costs rise to $2,250.

Executives earning $100,000 or more pay the most for a family plan: a $1,500 deductible and $4,500 out-of-pocket. In contrast to Liberty, most employers use tiered salaries only to set premium levels or annual premium increases.

“We wanted something that would not be way out there in terms of peoples’ ability to pay,” said Helen Sayles, senior vice president of human resources. “We felt it was the right thing to do.”

http://www.boston.com/business/articles/2004/11/25/employers_try_shifting_health_costs/

Comment: One of the more important goals of comprehensive health care reform is that the funding of health care should be equitable. Considering the relatively high costs of health care today, lower income individuals are not able to fully fund their portion of an appropriate level of health care utilization. To achieve equity, higher income individuals would pay more into the system.

It is certainly admirable that employers are attempting to establish equity within our fragmented system of funding care. Unfortunately, these efforts within small microcosms will amount to only a tiny mini-step towards health care equity for all of us.

The tax system provides the most effective agency for equitable funding of health care for everyone. Tax policies such as tax deductibility or tax credits can be developed to improve equity. But if applied to our current fragmented system, we would see a perpetuation of the inequities of thousands of plan designs with varying deficiencies in coverage or even total lack of coverage. Also our fragmented system is not adept at reducing the waste of administrative excesses nor the waste of ineffectual technological excesses.

Let’s follow the example set by these compassionate employers, but go them one better. Let’s support an equitable health care system for everyone:publicly funded social insurance with simplified public administration.

Healthcare as a moral imperative

The Boston Globe, November 27, 2004
Healthcare as a moral imperative
By James J. Mongan  

This article was adapted from remarks made Nov. 16 at the Blue Cross Blue Shield Foundation Summit on Access.

AFTER AN ELECTION season in which health care took a back seat to the Iraq war and gay marriage, it is refreshing to see that universal coverage for the uninsured has moved to center stage in Massachusetts.

The most important thing to do to move the universal health insurance issue forward in Massachusetts and across the country is to start with a frank discussion about funding. And I would argue, to address the funding issue, we ought to start a real dialogue about values.

As an analysis by the Urban Institute for Blue Cross Blue Shield Foundation’s Roadmap to Coverage points out, providing universal coverage costs money, beyond what we are currently spending — in the form of taxes to pay for subsidies, or employer mandates which are in effect taxes.

The elephant in the room in this discussion is, and has been for 30 years, how to get public support for additional revenue.

This is not just a public finance issue, it is a real values issue. Specifically, in a supposed time of ascendancy for “moral values,” I’d ask what happened to “social justice” as a moral value. I’d ask why we aren’t focused on social justice issues such as poverty, retirement security, and health insurance at the same time that we focus on issues like gay marriage and abortion. You see, I think I know why social justice issues get left behind — because dealing with these issues takes money — our tax money to help other people.

As we as a nation moved beyond the Depression, World War II, and the poverty program and civil rights struggles of the 1960s, we became, over the past 30 years, a relatively affluent, consumer nation and began to focus more on our own needs and wants.

It has been an age of individualism or self-centeredness or perhaps even selfishness. This culture fed the driving political force of the past 30 years — the antitax movement.

The antitax tide swept social justice issues aside, and left them behind in its wake. As a result, in recent years, every politician from the Courthouse, to the State House, to the White House feels they must run on an antitax platform. Just look at the consequences:

Our national tax level, as a percent of the gross domestic product, is at the lowest level since 1959.

In our state, tax cuts over the past 12 years have left us with $3.8 billion less in state revenue, which could have been available for covering the uninsured. We now rank 47th out of 50 in taxes and fees paid as a share of personal income.

Let’s look at what happened in Washington three years ago, when we passed a $1.6 trillion tax cut. We could have taken another path, and passed a $1 trillion tax cut, the largest in history, and used $600 billion to fund a comprehensive health insurance program for a decade.

When Uwe Reinhart, professor of economics at Princeton University, talks about that tax cut, he says budget decisions like this are like a memo to God. Reinhart says our nation’s memo said, “Dear God, we had to decide between health insurance and a tax cut, and we took all the money as a tax cut. We hope this pleases you — signed a grateful nation.”

After 30 years of waging the battle for broader health insurance, I am convinced the debate over universal coverage is more about values than it is about specific plans. If the resources were made available, we could easily develop a plan. We should focus on the question of what happened to social justice in an era of moral values. We should all look in the mirror.

Dr. James J. Mongan, who was associate director of the White House domestic policy staff in the Carter Administration, is President and CEO of Partners HealthCare.  
            
    

 

Growth rate in health cost to employers slowed in '04

The New York Times
November 22, 2004
Growth Rate in Health Cost to Employers Slowed in ’04
By Reed Abelson

After years of double-digit cost increases, the rate of growth in what employers pay for employee health insurance slowed significantly this year, according to an annual survey to be released today.

The average employer cost for health benefits for an employee rose 7.5 percent in 2004, to $6,679, the lowest increase since 1999 in a survey of about 3,000 employers by Mercer Human Resource Consulting.

But this slowing rate was largely the result of employers shifting more of the cost onto their employees and changing the kinds of plans they offer, said Barry Schilmeister, a senior health care consultant for Mercer.

“What we’ve seen for a couple of years running now is that employers have made very significant changes to their programs to cut three to four points off that inflation rate,” he said.

The overall growth in health care costs remains a concern, Mr.Schilmeister said. “Underneath it all, while general inflation is 2 percent, medical inflation continues to be 10-plus percent,” he said. “We still have a significant problem to deal with.”

Comment: Rather than being good news for employers, this is terrible news for employees, and for the rest of us. Health care costs continue to increase, but those costs are being shifted from employers and insurers to individuals, especially those with greater health care needs. Having health insurance no longer means that you have protection against financial hardship in the event of significant medical need.

It’s not that we don’t have enough money. We have plenty. We are already spending enough to pay for comprehensive care for everyone. The problem is that we are slowly shifting away from the insurance principle wherein the many who are healthy contribute a modest amount to pay for the care of the few who are sick.

Up to the present, we have refused to enact policies that would address cost issues by reducing the profound waste in our system. At the same time we are adopting policies that will hold down the modest amounts contributed by the many who are healthy, that is, we are holding down premiums paid for coverage. This means that insurance will offer fewer benefits and will increase cost sharing. Thus, by default, we are making the few who are sick pay even greater amounts for their care.

Where is our social contract of solidarity? I guess we can cross that one off of our lists as we give thanks tomorrow. No sense wasting our “prayer capital” on that one.

Implications for Nonprofit Organizations and Those They Serve

Johns Hopkins University
Center for Civil Society Studies
Institute for Policy Studies
October, 2004

The Health Benefits Squeeze:Implications for Nonprofit Organizations and Those They Serve
By Lester M. Salamon and Richard O’Sullivan

Conclusion: The Silent Tax

Escalating health insurance premiums have emerged as a silent tax on the American workforce, offsetting by a substantial margin whatever advantage
workers received as a consequence of recent federal tax cuts and contributing to the reluctance of employers to add new workers to their rolls.

For the most part, attention to the impact of these rising healthcare costs has focused on the business sector. But as the research reported here makes clear, nonprofit organizations have not been immune to these pressures. To the contrary, there is evidence that they have been particularly hard hit, perhaps because they are generally smaller in scale or lack access to the benefit management specialists that seem so important in keeping healthcare costs in check in an increasingly complex healthcare market.

To date, nonprofit managers have succeeded in shielding those they serve from the impact of escalating healthcare costs except for a growing need to introduce or increase service fees. To do so, however, nonprofit managers have had to shift the costs on to their employees – through increased premiums, co-pays, and cost-sharing or through reduced raises or other benefits. In the process, however, they may be undermining one of the few concrete advantages of nonprofit employment – the generally benign human resource policies that nonprofits tend to provide.

How long this process can continue before serious problems of employee turnover and burnout surface is anyone’s guess. What is more, the pressures of continued health insurance cost escalation are likely to accelerate the trend toward increased nonprofit fees and charges, undermining the sector’s ability to fulfill its mission of service to those in greatest need and its broader advocacy role. The “silent tax” represented by continued rapid increases in health insurance costs thus has particularly profound implications for the nation’s nonprofit sector, implications that have been largely overlooked until now. Hopefully, the data reported here will help focus new attention on the health insurance crisis facing nonprofit employers as well.

http://www.jhu.edu/listeningpost/news/pdf/comm03.pdf

Comment: Employees of nonprofit organizations usually accept lower levels of compensation, but do so graciously, acknowledging that the social good advanced has its own rewards. Unfortunately, these organizations are not exempt from the same health care cost pressures faced by for-profit corporations. But most nonprofit entities do not have as much budgetary flexibility. It is particularly disconcerting to see these organizations being forced to use the same methods as businesses in shifting health care costs to their hard-pressed employees.

We are already paying enough to provide comprehensive care for everyone. We
could fund our system much more equitably through a national health insurance program. Then nonprofit organizations would not be faced with the current, unacceptable alternatives of either shifting more health care costs to employees, or increasing fees to the needy being served. We can do better.

Two UW professors say U.S. could afford health care for all

Two UW professors say U.S. could afford health care for all
Administrative bloat blamed for driving up costs

Jesse Hirsch- Portage Daily Register

Criticizing the large amount of “myth and knee-jerk reaction” surrounding universal health care, Chairperson Meghan Yost invited two prominent and vocal health care advocates to this week’s meeting of the Columbia County Towns Association.

Drs. Gene and Linda Farley, professors emeritus at the UW Madison Medical School, gave a rousing presentation Monday night about remedying ills in the U.S. health care system.

Gene Farley, former chairman of the school’s Department of Family Medicine, started by praising the potential of this country’s health care.

“We have some of the most fabulous resources in the world,” he said. “It’s unfortunate we also have one of the most clobbered health care systems.”

Farley’s wife then listed the two biggest things that need to be removed to get health care where it needs to be — huge overhead and the “for-profit corporatization of medicine.”

“(Doctors) feel like professionals but they try to turn us into businesses,” Gene Farley said.

The Farleys showed statistics about the huge increase in clerical and administrative workers needed to deal with complicated insurance programs, claims and billing.

For instance, they said a 900-bed hospital in Toronto, Canada, where health care is universal, has about three or four workers in the billing department. At a comparably sized hospital in Boston, they said, there are well over 300 billing employees.

The Farleys believe it is this bureaucratic waste, combined with corporate greed, which is largely responsible for the “grossly inflated” cost of health care in America.

They said that redirecting the vast amount of money spent on health care and pooling it together could create adequate resources to take care of every uninsured American.

Linda Farley cited statistics that the United States spends more tax dollars on health care, between Medicare, Medicaid and insurance for public employees and veterans, than most countries with a single payer health care system.

“U.S. public spending on health care is more than any other first-world country and it only covers 45 percent of the population,” she said.

The Farleys believe a universal health care system would actually save money and cut down on red tape, rather than the reverse. And they think the time for change is now.

According to the U.S. Census Bureau, 45 million Americans lacked health insurance in 2003, 1.4 million more than in 2002 and 5.2 million more than in 2000. In Wisconsin, the number of uninsured hovers around 500,000.

Working on a state-by-state basis is the first step, according to Gene Farley. He said the current administration is unlikely to make significant progress in overhauling our troubled system, so change will have to happen at the state level.

Farley said $7.72 billion was spent in Wisconsin in 2003 on health care administration, but that over $5 billion could have been saved with a single payer system.

“We’ve got to get out there and let our legislators know this matters to us,” he said.

After Monday’s meeting, Harlan Baumgartner, chairman of the Otsego Town Board, said he agreed with many points the Farleys made, but that change is “an uphill battle.”

“We seem to be very embedded in the way things are right now,” Baumgartner said. “The problem is how we get past people’s unwillingness to change.”

As far as biases against universal health care, Baumgartner feels this is an unnecessary complication to an already bloated problem.

“There’s a lot of prejudice in people’s minds,” he said. “To me, this is just a problem that needs to be solved.”

Taipei:Researchers discuss gaps in medicare

FAIR CARE: Academics and activists discussed changes to the health insurance program to ensure that all citizens receive medical coverage
By Cody Yiu
STAFF REPORTER
Wednesday, Nov 24, 2004,Page 4

A panel of academics and social welfare activists yesterday discussed whether National Health Insurance program should be converted into a social welfare system available to all citizens.

The panel discussion, held by the Creation Social Welfare Foundation, sought to determine why some people had not been covered by so-called universal health insurance.

According to the study, three groups of people do not receive health coverage: those who live abroad, young adults between the ages of 20 and 30 who change jobs frequently and people who cannot afford to pay insurance premiums.

“The first two groups do not have financial reasons for not being insured, the last group, which is made up of about 230,000 individuals, is not insured due to economic reasons. They may have unstable incomes, be unemployed or have a low social status,” said Lin Ji-Ping, a researcher at the Academia Sinica’s Research Center for the Humanities and Social Sciences, who participated in the study. These 230,000 individuals account for one-quarter of the total uninsured population, according to the study.

The Judicial Yuan’s Grand Justice Interpretation No. 472 (Jan. 29, 1999) stipulates that the state shall give appropriate assistance and relief to those who cannot afford to pay premiums, and shall not refuse to pay benefits, in order to fulfill the constitutional purposes of promoting national health insurance, protecting the elderly, the infirm and the financially disadvantaged.

The Council of Grand Justices provides legal interpretations of the Constitution.
Based on the interpretation, the academics said that the term national health insurance should be defined more clearly.

“In Taiwan, the emphasis of this health insurance policy is placed on the word insurance, and not on the word national [universal]. Therefore, it is an insurance system, not a social welfare system. However, what this particular interpretation by the Grand Justices says about national health insurance is in contrast with the actual practice,” said Lin Wan-I, a professor of social work at National Taiwan University.

The National Health Service (NHS) of the United Kingdom, Lin said, functions as a social welfare system.

“The NHS does not work like an insurance program, but as a social welfare system, and the focus of the UK’s system is on all,” Lin said.

Lin suggested that a portion of tax revenues be allocated to Taiwan’s national health program if the program was in fact meant to serve the entire population.

“In Sweden, about 7 percent of one’s income goes to the national health program. Taiwan could adopt this structure in which money flows out of one’s income [as tax] and into the program, instead of actually having to pay for premiums. This way, the entire population would be included in the health program,” Lin said.

Michael Chen a social welfare associate professor at National Chung Cheng University, suggested treating the three groups that fall outside the system like the unemployed in terms of insurance coverage.

Chen explained that the current national health insurance policy covered unemployed people for a maximum of 30 weeks. However, at least half of the unemployed population was actually out of work for a longer period, and therefore the policy should be re-adjusted.

http://www.taipeitimes.com/News/taiwan/archives/2004/11/24/2003212340

Growth rate in health cost to employers slowed in ’04

The New York Times
November 22, 2004
Growth Rate in Health Cost to Employers Slowed in ’04
By Reed Abelson

After years of double-digit cost increases, the rate of growth in what employers pay for employee health insurance slowed significantly this year, according to an annual survey to be released today.

The average employer cost for health benefits for an employee rose 7.5 percent in 2004, to $6,679, the lowest increase since 1999 in a survey of about 3,000 employers by Mercer Human Resource Consulting.

But this slowing rate was largely the result of employers shifting more of the cost onto their employees and changing the kinds of plans they offer, said Barry Schilmeister, a senior health care consultant for Mercer.

“What we’ve seen for a couple of years running now is that employers have made very significant changes to their programs to cut three to four points off that inflation rate,” he said.

The overall growth in health care costs remains a concern, Mr.Schilmeister said. “Underneath it all, while general inflation is 2 percent, medical inflation continues to be 10-plus percent,” he said. “We still have a significant problem to deal with.”

Comment: Rather than being good news for employers, this is terrible news for employees, and for the rest of us. Health care costs continue to increase, but those costs are being shifted from employers and insurers to individuals, especially those with greater health care needs. Having health insurance no longer means that you have protection against financial hardship in the event of significant medical need.

It’s not that we don’t have enough money. We have plenty. We are already spending enough to pay for comprehensive care for everyone. The problem is that we are slowly shifting away from the insurance principle wherein the many who are healthy contribute a modest amount to pay for the care of the few who are sick.

Up to the present, we have refused to enact policies that would address cost issues by reducing the profound waste in our system. At the same time we are adopting policies that will hold down the modest amounts contributed by the many who are healthy, that is, we are holding down premiums paid for coverage. This means that insurance will offer fewer benefits and will increase cost sharing. Thus, by default, we are making the few who are sick pay even greater amounts for their care.

Where is our social contract of solidarity? I guess we can cross that one off of our lists as we give thanks tomorrow. No sense wasting our “prayer capital” on that one.