Stupid Comparisons

I've been hearing quite often from Democrats and liberals about how we're running a gulag and comparing our troops to the Nazis. Recently Dick Durbin made comments along these lines. In describing the treatment of prisoners witnessed by an FBI agent he stated

If I read this to you and did not tell you that it was an FBI agent describing what Americans had done to prisoners in their control, you would most certainly believe this must have been done by Nazis, Soviets in their gulags, or some mad regime — Pol Pot or others — that had no concern for human beings...

These comparisons are inappropriate and way off base. The Nazis, Soviets and people like Pol Pot and Saddam Hussein systematically killed thousands, even millions of people. They had a policy which had the explicit goal of killing a certain group of people in mass amounts. At the worst a few isolated incidents of American troops killing individuals have been discovered. There is no systematic policy where thousands of people are lined up and killed. Even though he was trying to point out the inappropriate handling of prisoners by using this comparison the images that most people will think of are the mass killings of those regimes, not how they treated prisoners.

I have no problem with disagreeing with how the military is handling interrogations or incarcerations. I don't agree with much of what they're doing. But to compare the actions of American troops to the mass murdering regimes of the past serves no useful purpose and is grossly out of line. Are liberals so devoid of debating skills that they have to resort to this kind of idiocy? No wonder they lost control of the legislative and executive branches of government. If they keep this crap up they're only going to dig themselves a bigger hole and cede even more power to the Republicans.

Teri Schiavo Autopsy

Just this morning the autopsy results for Teri Shiavo were made public. Listening to some of the report it appeared that there was no evidence that Teri suffered from any kind of physical abuse from her husband. There were reports during this fiasco that her husband had abused her while she was paralyzed and that some of her bones were broken due to this. The spokesman reporting the results indicated that all bone deterioration and fractures were consistent with patient's in her state. She appears to have suffered from osteoporosis, which weakened her bones and joints, and caused compression fractures during physical therapy. You can view an article on the autopsy here.

This just reminds us of why politicians should not get involved in family decisions like this. The far-right took this family tragedy and twisted it to their own ends. This poor girl COULD NOT SEE!!!! The video of her watching the balloon and smiling at people was pitiful to watch, but was misleading. It made it appear she was seeing these things but from the autopsy there is no possibility she could have seen this because the part of her brain that registers signals from the eyes was dead. The part of her brain that controls awareness and cognitive functions was dead. This poor woman had no chance of ever recovering from this tragedy. According to Jon Thogmartin during the press conference :

"The brain weighed 615 grams, roughly half of the expected weight of a human brain. ... This damage was irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."

There are a lot of people in the Republican party, talk radio and conservative blogs who owe Michael Shiavo a huge apology. But you won't see it. It was never really about Teri in the first place. It was about advancing the Far-Right's political agenda.

Drawbacks of the Single Payor system

I would like to briefly discuss the drawbacks to a single payor system, such as an expansion of Medicare.

First, the lack of competition would mean that whatever Congress decided to pass regarding coverage and payment schedules would be law. If a doctor's office didn't like what they were getting paid...tough. Presumably they could opt out, but ask any doctor's office how much they enjoy collecting payment directly from patients and you'll see how attractive this option is. Without competition there would be no reason for Medicare to try to improve efficiencies or speed up payments to doctors and hospitals.

Another drawback is in the approval of expensive services. In other countries where the government pays for healthcare you need to schedule MRI's and other diagnostic services like that sometimes months in advance. Many Canadians cross the border to have these services done and pay for them themselves due to the waiting list back in Canada being too long.

And finally, to me one of the most important reasons is that its the government running it. I have yet to see a system or program run by the government that is actaully efficient, effective and cost what they expected. Take whatever cost projections they make for taking over the payment for all health services and AT LEAST triple it. See the Medicare Rx plan for evidence of this. Never has any government program cost what they estimated or less. Whether its the military or Human Service programs, the government is never able to stay within a projected budget. In order to cover the huge cost of this program taxes would have to be raised a very large amount. In an age where most people demand tax cuts from their politicians without thought of what programs to cut adding this behomoth to the federal government is a disaster in the making.

We all know that the current system is broken and unsustainable. But the government is not the answer. It hardly ever is.

Flag Day

Today is Flag Day. In honor of this day drop by the VFW to check out the U.S. Flag Code.

Single Payor (aka socialized) Healthcare

I've recently read a post over at Centerfield regarding the benefits of a single payor health care system. As I work for Wellpoint, Inc., the largest health insurer in the country, I have some knowledge in this area. I'm attaching an article which discusses the administrative costs for both private insurers and medicare. Its a bit long but is very detailed about actual admin costs using specific examples and costs. Tomorrow I'll talk about the drawbacks to Single Payor systems.

Is Single Payor The Gold Standard For Administrative Overhead? By John Harkey, Ph. D, and Mike Cadger, M.B.A., for Healthleaders News, Aug. 15, 2003

Two recent reports with widely varying estimates of health plan overhead raise some hard questions about the efficiency of insurers. The reports-one by Mathematica Policy Research Inc. and the other sponsored by the Maine Association of Health Plans-reach very different conclusions:
· Mathematica's report, released in December, estimates Maine could provide coverage to all of its uninsured and still save money over the current system by moving to a smartly managed single-payor system with administrative overhead of 5 percent. The current commercial system, it suggests, is heavy on administrative costs. The report maintains the savings to be found in a single-payor system would go a long way toward paying the extra cost of coverage for the uninsured.
· The MAHP report, based on a Milliman USA analysis, questions Mathematica's estimates of overhead and maintains commercial insurer overhead is more in the range of 11-15 percent, instead of the higher Mathematica percentage (estimated at 17 percent by Milliman). But that is still well above the single-payor target of 5 percent, and a large multiple of the Medicare rate of 2.1 percent.
Source: Estimates compiled by Mathematica Policy Research Inc. from various sources. To view a copy of the Mathematica study, go to http://mail.yahoo.com/config/login?/www.mathematica-mpr.com.

So would a single-payer system be more efficient? And are health plans spending to much on the administrative services they provide?

Efficient Health Plans And Efficient Markets The accompanying chart(cut out by me to save space) shows administrative overhead for several kinds of insurers. What is most notable is the wide variation in overhead and the large difference between overhead for the "best practices" insurers... and the average overhead for life and health plans, Blues plans and HMOs ... "Best practices" insurers and HMOs are within range of 5 percent, the Maine target for single-payor. The five companies with very low overheads appear to have some special circumstances leading to low overhead.
· Economies of scale in a single state (Blue Cross Blue Shield of Alabama and Blue Cross Blue Shield of Tennessee)
· A narrow geographic focus (Capital Group, Fallon, Kaiser) · Off-loading medical management expenses to capitated medical groups or IPAs (Kaiser, Fallon, Capital Group) · Market leader position (Fallon, Capital Group, Blues of Alabama and Blues of Tennessee), lowering marketing costs
· Comparatively narrow product offering (Fallon, Capital Group, Kaiser, BCBS of Alabama)
Source: 2002 statutory filings with state departments of insurance except for the Blues average, which is from 2001 corporate annual reports. Life and health small insurers include the group business of Benicorp, Fortis, Golden Rule, The Guardian, John Alden, Nippon, and Principal. Large L&H insurers includes the group business of Aetna Life, Connecticut General and Humana. The Blues average includes 14 Blues companies including the multistate operations of Anthem and WellPoint (counted as one company each). The HMO average includes 35 of the larger HMOs (including Aetna, CIGNA, UnitedHealthcare and the Blues HMOs) in several New England and southeastern states. The averages are not weighted for premium volume.
Medicare overhead has the appearance of a gold standard: 2.1 percent overhead compared to a commercial average of 13 percent and a "best practices" company commercial average in the range of 5-8 percent. Medicare clearly has economies of scale, but its overhead figure is a bit misleading. The average per-member-per-month premium for commercial HMOs in now in the $200-$250 range, while the typical PMPM for Medicare is in the $600 range. If the Medicare PMPM were $200 rather than $600, then it would have an administrative overhead of 6.3 percent rather than 2.1 percent-still very good, but not out of the range of the very lowest-cost private insurers.
For that relatively low overhead, Medicare offers only a single product (little choice except in urban areas where Medicare+Choice is available), provides limited medical management (and that seemingly by lawsuit), conducts provider contracting by fiat (negotiations take place in Congress), and has almost no marketing costs (no competitors).
The administrative overhead of the typical commercial health plan, whether a life and health insurer, HMO, or Blues insurer, is clearly higher than that of Medicare, the Maine 5 percent target and that of "best practices" insurers." And health plans in the "best practices" administrative overhead range may operate in unique market environments often unavailable to competing carriers.
While a single-payor system can achieve low administrative overhead and has tremendous clout in negotiating provider contracts, well run commercial/Blues carriers can achieve overhead nearly to that mark while operating in a competitive environment offering product choices and generating innovation. In fact, it is competition with other insurers in a market environment that is driving the current commercial insurer attack on administrative overhead.
Rather than pointing to a single-payor system, advocates of universal coverage might instead look for better ways to employ competitive plans operating in efficient market environments.
We believe states should become laboratories for exploring new ways to create better functioning, more efficient insurance markets that meet the needs of the various consumer segments, including the currently uninsured.
If states can create more effective and efficient insurance markets, then they will have fewer citizens unable to access those markets, leading to fewer uninsured and lower Medicaid costs.
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John Harkey, Ph.D., is senior correspondent at HealthLeaders Inc., and has provided research and opinion on the healthcare industry for more than 14 years. He may be reached at http://us.f532.mail.yahoo.com/ym/Compose?To=%20john.harkey@healthleaders.com .
Michael Cadger is president of Great-West Life's southeast division. He can be reached at http://us.f532.mail.yahoo.com/ym/Compose?To=%20Michael.cadger@gwl.com