Following the forum, Mr. Wingle assured me that Health Connector Board has some of the finest and toughest lawyers in the state and would not back down on the data reporting requirments that the insurance companies should be fulfilling. Nevertheless, if one has ever tried to fight an insurance company in or out of court, one has become acutely aware that insurance company lawyers are masterful at exploiting possible loopholes in an insurance policy and state law and regulations and/or finding, at least, one of the more than a handful of corporate-friendly, hack state judges in MA who are eager to issue a legal ruling that forecloses the operation of a fair, balanced, and open operation of the health insurance industry in Massachusetts. Never bet against the power of the private insurance industry in Massachusetts to protect successfully its own narrow economic self-interest against the consumer interests of their politically unsophisticated subscribers, even when the latter are supported by “the best and brightest” state lawyers AG Martha Coakley can find.
i know i know i know — that is a trigger for some commenters to post thousands of words about single payer. gotcha.
<
p>
my question is more: what do we do in reali life?
And have careful oversight of whether they’re actually marketing to the right people. Or, have the state take over the marketing itself.
it’s the consumers responsibilty to find and choose their healthcare.
<
p>
outreach and the increased enrollment that would result from that is a practical and pragmatic goal. but really, it’s hard to claim as moral failing poor marketing. whatever that is.
<
p>
i had a wonderful 2 hours this morning cruising through health plan options that are now suddenly affordable for me. personally, i was thrilled to seek out the information. i have been waiting for this day my entire adult life.
<
p>
and the connector has actually done a pretty good job of consolidating and making available information about various plans options. before, it would be necessary to call up the sales office at blue cross, the sales office at fallon, the sales office at harvard-pilgrim, the sales office at tufts, the sales office at vanguard, and on and on. so not only can one get all of the benefits/costs overviews directly from the connector, you (or at least i) have some peace of mind that there now exists an oversight and regulatory party. whereas before, shopping for health insurance felt like being thrown into a shark tank.
As a self-employed guy, I’ve been more like a pilot-fish for decades, looking for “groups” (chamber of commerce, professional organizations…) to glom onto for health insurance.
<
p>
Now, with products coming out of the connector, soon, self-employed individuals can shop for insurance, just like you shop for fire insurance, long term care insurance, workers’ comp…
<
p>
Similar reform is in the cards for auto insurance.
i did it today!
<
p>
(and gary, does this mean we might actually have something in common?)
looks like you’re being used as one already.
<
p>
keep us skeptics posted on how it goes, will ya?
and though i’m not planning on being anyones poster boy, i actually like giving credit where credit is due.
and, like it or not, you are being used as a “poster boy” both on the HCFA blog and by charlie on the front page here at bmg.
<
p>
in your words, “giving credit where credit’s due” will be used strategically to create the very useful — to some groups — effect of giving political cover for the major flaws in the new law and for stymieing efforts for addtitional needed reforms. Establishing clear rules with public accountability for how our hc dollars are spent is a priority reform area.
<
p>
these flaws are referred to in more informal circles as “how the new law reinforces and worsens the ways we’re all getting screwed royally in our current hc financing system”.
<
p>
to build on the cross-posting theme, rhondda lays it out
<
p>
<
blockquote>On NPR-WBUR’s Commonhealth blog
<
p>
Chapter 58 is simply unaffordable. At $7,200 per capita, the U.S. currently spends twice as much as other advanced nations on healthcare and yet does very poorly on healthcare outcomes in comparison with these same nations.
<
p>
Massachusetts currently spends $9,100 per capita, more than any entity in the world. The current Chapter 58 patchwork fix will only add to that burden and will never achieve universal coverage. By adopting this bill, Massachusetts has only added further complexity at increased cost to a system which will continue to ration healthcare benefits by income. Those at the bottom of the income scale who require the most support will have to cope with high out-of-pocket costs as a result of being mandated to purchase plans with barebones benefits, plans which may cause them to go into bankruptcy.
<
p>
Under a single-payer plan, we would be able to reduce the huge administrative costs of both the public and private insurance systems in Massachusetts and no longer subsidize the huge amounts of money now spent by private insurance companies on the marketing and administrative costs of competition. The money saved would then enable us to provide everyone with a comprehensive, affordable healthcare plan funded by a Massachusetts Healthcare Trust to which everyone would contribute.
<
p>
Under such a plan risk would be spread over a large and diverse population, thereby reducing the claims volatility currently experienced by both employer-provided and private plans. The result would be the elimination of the volatile inflationary premium increases we now experience from year to year in our present private/public insurance systems.
<
p>
Not only would we have a healthier population under a single-payer system, we would be able spend more of our tax dollars on other state priorities such as education. – Rhondda Tewes
… but some economists won a prize (I think about 10 years ago or so) for showing that, although competetive choice is supposed to be an opportunity for consumers to maximize purchasing power, there comes a point at which too much choice actually creats problems… that is they showed that after a certain ‘critical mass’ of information and choices consumers started to show an inability to select the best option.
<
p>
Companies have taken this information overload phenomenon and used it in their buisiness plans. All you have to do is open up your phone bill or any credit card contract to see.
<
p>
Have a listen:
http://www.npr.org/t…
by having mandatory coverage levels set by the state, each of the 4 commonwealthcare and 6 (i think) commonwealthchoice plans put up by the private insurers offer basically the same thing. generally speaking it’s a rather clear cut package. there is a little variation (ie a $10 office visit co-pay here vs. $20 there) between the different carriers, but it’s really not that much to wade through.
ultimately it’s the consumers responsibilty to find and choose their healthcare.
<
p>
I’m assuming you mean “choose their healthcare insurance”. Note that the addition of that last word changes a lot. For example, I agree that consumers should be in charge of choosing their healthcare. But should they have to choose their healthcare insurance?
<
p>
Well, we should look at this issue right here. Should this be the case? Is this the right way of doing things? I’m not saying yes, I’m not saying no, but this is a question worth examining.
<
p>
What should be done, and how do we get to there from here?
hmmm… does this mean that every industrialized country in the world where they all use some form of single payer financing (including Canada where it started one Province at a time in the ’60’s), do not represent “real life”?
<
p>
Are Jamie Eldridge, candidate for Congress and Ted Kennedy, a US Senator, not “real life”?
<
p>
Learn more and get involved in real life at MassCare. Thanks.
My politics tend to be more center-left than left, but health care is one issue where the left is right. Our piecemeal market-driven health care system doesn’t work. Working Americans (who are insured) end up paying for their own insurance through premiums and co-pays, then their tax dollars end up paying for uninsured and the underinsured. I look at my paycheck and see how much I pay for my family’s coverage, how much I pay for Medicare, and how much I pay to the state and federal governments so that they can cover those without coverage. Ridiculous. To sound right-wing for a moment, that’s my money being blown to maintain an inefficient and exclusionary health care system that keeps out over 40 million Americans on the backs of those who are fortunate to have a job that provides coverage, who pay ever-increasing costs so that the market can profit. DUMB!
<
p>
Single-payer is the only smart and cost-effective way to finance universal coverage for all Americans and still ensure quality and choice in health care. The government would not deliver health care, just fund it. The federal government has proven very efficient in administering other universal programs. Social Security and Medicare’s administrative costs are around 2% of total outlays. You don’t get that kind of efficiency from private insurers.
<
p>
In the end, whether it’s a premium or a tax, it’s still money. I would rather have my money be better spent and promote the greater good than use it to perpetuate a broken machine.
<
p>
And, dammit, we’re Americans! Let’s beat the Canadians at their own game!!!
I say we must seize the day and re-chart the course for sensible affordable universal healthcare reform that uses streamlined single payer financing and a high quality private delivery system. Let’s reject forward momentum to adverse selection and to further bankrupting our state with wasteful hc spending.
<
p>
Lots of other thoughtful people share this view and many have posted interesting comments up on the NPR-WBUR hc reform blog called “Commonhealth”. In one guest post there was a call for votes on Single Payer Reform and the results so far are about 30 Yes and 1 “Not politically feasible”. They’re a good read and you can enter your own vote too by clicking here for “Let’s Give Them Something to Talk About ? How About Single Payer” by Elmer Freeman”
<
p>
eddicoyle has explained some important details — thanks — that reveal some of the serious flaws in the new MA law’s approach to expanding health insurance coverage. For a 180 degree different take on the new law, check out what the CEO of Tufts HMO James Roosevelt has to say about it. He writes today What the public needs to know about HC reform. A note of caution, reading it word for word may cause severe nausea and/or feelings of extreme anger.
<
p>
Lastly, it’s a bummer that the NPR Commonhealth blog only allows for invited posts and that the invited posters are about 80% male. I’ve suggested a number of additional women-run organizations that would have excellent knowledgeable guest posters but that suggestion has been ignored. So far.
<
p>
You and GGW are a team right?
by Elmer Freeman, CEO, CCHERS Program, Northeastern U
posted on Commonhealth Saturday, April 21st, 2007
click here to read post & comments.
<
p>
2. “What the Public Needs to Know About Health Care Reform”
by James Roosevelt, Jr., CEO, Tufts Health Plan
posted on Commonhealth, Tuesday, May 1st, 2007
click here to read post & comments.
<
p>
If you do visit the Commonhealth blog site please consider making your own comment there; NPR journalist Martha Bebinger is contacting some commentors for her work on this topic…
I’m “Paul Leo.” Actually, my name is Paul Wingle. I did speak to someone about this issue following my participation on the MassINC panel. That someone was “eddiecoyle,” I now suspect.
<
p>
Since there were no notebooks in sight during our conversation, we are left to memory here. Here is my recollection:
<
p>
I said that the Connector is aware of the reporting requirements on health plans.
<
p>
As always, there are legitimate and longstanding concerns about how to put enrollment data or profiles out there. As always, those include concerns about proprietary information.
<
p>
Public reporting of enrollment data or subscriber profiles always raises concerns from organizations that operate in a competitive environment. That’s no surprise, but it is also not insurmountable.
<
p>
We have good people — including strong legal and regulatory talent, yes — thinking about how to best serve the requirement.
<
p>
Some might see these differences in our accounts a matter of inference or emphasis. I just want to be clear that we are not mounting the ramparts here at the Health Connector. This reporting requirement has not developed into a pitched conflict between the Health Connector and the health plans.
Although the original conspiratorial version sounded much more exciting.
Am I summarizing Paul Leo’s speech correctly?
<
p>
Insurance companies MAY–but haven’t yet–balk at turning over information pursuant to Regs THAT HAVEN’T BEEN WRITTEN. They haven’t balked because there are no regs, because, again, they haven’t been written.
<
p>
The law, Chapter 58, provides for statutory regs. The law, by itself, has no guidance what data is sought. None whatsoever. That’s up to the Connector to write the regs.
<
p>
And the reason the insurance companies MAY balk at the Regs THAT HAVEN’T BEEN WRITTEN is because insurance companies MAY have a nefarious profit motive.
<
p>
But, not to worry, IF the regs are written in the future, and IF the insurance companies indeed don’t obey the regs that haven’t yet been written, then tough state lawyers, that haven’t been hired, will do their job, that doesn’t yet exist. And insurance company lawyers will do their job. And Martha Coakely finds good lawyers.
<
p>
Helleva speech. Who’s Paul Leo guy?
<
p>
BTW, I thought in the industry what Paul Leo described was known as cherry-picking. Creaming? I think that’s … er … another industry.
the masses want some cheap BMG approved thrills
I apologize for misidentifying Mr. Wingle’s last name as Mr. Leo. That was my error and I apologize to Mr. Wingle for this basic reporting error.
<
p>
In addition, I would like to clarify that my conversation after the MASS INC meeting with Mr. Wingle last Thursday was NOT the original source of my reporting that the Health Connector Board has failed to reach an agreement with the individual health insurance companies over their fulfillment of data reporting requirements contained in the state health care law. This data collection and reporting dispute with the private insurance companies was revealed in the public testimony of the General Counsel of the Health Connector Authority at the Board’s meeting on April 12, 2007 in Boston. I trust that the minutes of Health Conncector Board’s meeting will verify my reporting that a protracted legal dispute with the private insurance compaines over the data collection and reporting requirements of the state health insurance law had yet to be resolved by the time of the April 12 meeting. I maintain that Mr. Wingle confirmed to me after the MASS INC forum last week that the dispute with the health insurance compaines continued to be the subject of difficult negotiations between lawyers representing the insurance industry and the state. I invite the General Counsel of the Health Connector Authority, Jamie Katz, to update the public about the current status of these data reporting and collection negotiations with these private insurance companies.
<
p>
Finally, it remains a serious policy implementation problem if the private insurance companies offering these regulated health insurance plans plans are still balking at fulfilling major elements of their statutorily-mandated data collection and reporting requirements ON THE DAY that their health insurance plans are being rolled out to the uninsured public for purchase. If the state cannot resolve this dispute with the private insurance companies in a way that provides the state and public interest groups with the data necessary to evaluate the effectiveness, comprehensiveness, and unbiased nature of the marketing and subscription activites of the private insurance companies, then Massachusetts citizens have NO way of being assured that “creaming” or “cherry-picking” of uninsured population is not taking place. In addition, this reporting data remains vital for the state to possess when it negotiates effectively when these health insurance companies next year when new rates, deductibles, and coverage plans for Commonwealth Choice must be negotiated between the state and the private health insurance plans. I know that data collection and reporting requirments are NOT sexy issues when discussing health care. Nevertheless, if some of the key stakeholders to the “near universal” health insurance coverage experiment in MA are denied legally mandated access to critical financial and demographic reporting data, then the for-profit private insurance companies will exert their substantial and potentially adverse influence on key access, coverage, and cost components of the state health care reform law. Citizens of Massachusetts as well as the well-intentioned professionals working for the Connector Board, like Mr. Wingle, need to remain vigilant about this key policy implementation as they go forward in trying to meet the challenge of successfully implementing the state’s complex and dubious “near universal” health insurance access law.