Health Care Reform: Insurers Mostly Getting Their Way
Dom
Health Care Reform: Insurers Mostly Getting Their Way
By NOAM N. LEVEY and LISA GIRION
Los Angeles Times October 26, 2009
WASHINGTON
As President Barack Obama's push for health care overhaul moves toward
its final act, the health insurance industry is on the verge of seeing
a plan enacted that largely protects its financial interests.
That achievement, should it stand up in the final legislation, would
be the capstone of a lobbying and strategic campaign that began even
before Obama was elected president.
The specifics of the health care legislation are still being hashed
out on Capitol Hill, and key details will evolve in the days ahead.
Even so, there is broad agreement that the final plan will require
Americans to buy health coverage for the first time, with taxpayer
subsidies for millions who cannot afford it.
For the health insurance industry, that means millions of new paying
customers. What's more, there are likely to be no limits on what
insurers can charge, while at the same time the plan is expected to
limit competition from any new national government insurance plan that
lawmakers create.
These anticipated wins — from an initiative that has at times been
portrayed as doomsday for health insurers — is the result of a
strategy developed by one of Washington's savviest lobbyists, Karen
Ignagni.Under Ignagni's leadership, the industry group America's
Health Insurance Plans adopted the goal of universal coverage while
setting out to shape it in a way that benefited insurers — a critical
move that aligned their interests with those of other groups,
including consumers and hospitals.
Insurers poured campaign donations into the coffers of key sympathetic
members in the House and Senate, and loaded up on lobbyists. And when
Obama and other Democrats began attacking the industry, insurers made
a strategic choice not to walk away from the negotiating table.
"While so many in this town have been playing checkers, Karen has been
playing chess," said Mark Merritt, a veteran lobbyist who heads the
Pharmaceutical Care Management Association.
In broad terms, the health care reform legislation is expected to
require all Americans to buy health insurance. Insurance companies, in
turn, would be barred from canceling policies of sick people or
denying coverage to those with pre-existing conditions.
What's still not clear is whether the legislation would create some
form of a "public option," or government insurance program, which
health insurers steadfastly oppose.
In addition to fighting the public option, insurers that offer
Medicare HMOs are battling more than $100 billion in cuts in federal
payments to that program. And they are trying to beat back a move by
Democrats to go after the industry's decades-old exemption from anti-
trust law.
But in Washington, many marvel that lawmakers have not wrung more from
an industry that, surveys show, is held in low regard by the public.
"The industry is really in no position to be making demands," said
Celinda Lake, a longtime Democratic pollster.
It's not by accident.
For much of the past three years, industry leaders have been laying
the groundwork for this battle. Amid horror stories about insurers
dumping sick patients, denying coverage for medical treatment and
cherry-picking customers, Ignagni and a few insurance company
executives pushed the idea within America's Health Insurance Plans
that the industry risked political catastrophe if it did not move
proactively.
The first public sign of the industry's shifting stance came in
November 2006 when the trade group came out in favor of universal
coverage with its Roadmap for Reform.
That built on the breakthrough idea, propelled early on by Blue Shield
of California's Bruce Bodaken and Kaiser Permanente's George
Halvorson, that universal coverage was key to the future of the
industry.
It was a 180-degree turn for insurers, who were long content to
compete against one another to cover the healthiest consumers and to
avoid those with pre-existing conditions and high medical costs.
It was also a significant departure for an industry that in the early
1990s orchestrated the defeat of the Clinton administration's push for
broader coverage.
"They decided that they had a responsibility to contribute to the
process and to bring real and substantial reforms to the table,"
Ignagni said.
America's Health Insurance Plans followed up with more overtures,
endorsing new rules that would prohibit insurers from denying
coverage.
It paid dividends, as insurance executives were invited to the table
when senior Democrats in Congress began developing health care
legislation earlier this year.
Dom
> http://courant.com/news/politics/hc-health-care-assess1026.artoct26,0...
>
> Health Care Reform: Insurers Mostly Getting Their Way
> By NOAM N. LEVEY and LISA GIRION
>
> Los Angeles Times October 26, 2009
>
> WASHINGTON
>
> As President Barack Obama's push for health care overhaul moves toward
> its final act, the health insurance industry is on the verge of seeing
> a plan enacted that largely protects its financial interests.
Unfortunately, the health industry cartels in the U.S. have bought
enough votes in Congress that NONE of the following possible solutions
will be considered.
======================
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Press Release:
FRONTLINE presents
SICK AROUND THE WORLD
Tuesday, April 15, 2008, at 9 P.M. ET on PBS
FRONTLINE TRAVELS TO FIVE COUNTRIES IN SEARCH OF A UNIVERSAL HEALTH
CARE SYSTEM THAT COULD WORK IN THE U.S.
FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for
The Washington Post, to find out how five other capitalist
democracies--United Kingdom, Japan, Germany, Taiwan and Switzerland--
deliver health care and what the United States might learn from their
successes and their failures. In Sick Around the World, airing
Tuesday, April 15, 2008, at 9 P.M. ET on PBS (check local listings),
Reid turns up remarkable differences in how these countries handle
health care--from Japan, where a night in a hospital can cost as
little as $10, to Switzerland, where the president of the country
tells Reid it would be a "huge scandal" if someone were to go bankrupt
from medical bills.
Reid's first stop is the U.K.--a system very different from ours,
where the government-run National Health Service is funded through
taxes. According to Whittington Hospital CEO David Sloman, "Every
single person who's born in the U.K. will use the NHS ... and none of
them will be presented a bill at any point during that time." Reid is
surprised to find the system often dismissed as "socialized medicine."
The U.K. is now trying free-market tactics like "pay-for-performance,"
where some doctors are paid more if they get good results controlling
chronic diseases like diabetes, and patient choice, in which hospitals
compete head to head. While such initiatives have helped reduce
waiting times for elective surgeries, the London Times' medical
correspondent Nigel Hawkes tells Reid the NHS hasn't made enough
progress. "We're now in a world in which people are much more
demanding, and I think that the NHS is not very effective at
delivering in that modern, market-orientated world."
Reid reports next from Japan, the world's second largest economy and
the country boasting the best health statistics. The Japanese go to
the doctor three times as often as Americans, have more than twice as
many MRIs, use more drugs, and spend more days in the hospital, yet
Japan spends about half as much per capita as the United States. Reid
finds out the secrets of the nation's success: By law, everyone must
buy health insurance--either through an employer or a community plan--
and unlike in the U.S., insurers cannot turn down a patient for a pre-
existing illness, nor are they allowed to make a profit.
Reid's journey then takes him to Germany, the country that invented
the concept of a national health care system. For it's 80 million
people, Germany offers universal health care, including medical,
dental, mental health, homeopathy and spa treatment. Professor Karl
Lauterbach, M.D., a member of the German parliament, describes it as
"a system where the rich pay for the poor and where the ill are
covered by the healthy. It is ... highly accepted by the population."
As they do in Japan, medical providers must charge standard prices
which are negotiated with the government every year. As a consequence,
physicians in Germany earn between half and two-thirds as much as
their U.S. counterparts.
Taiwan researched many health care systems before settling on one
where the government runs the financing, but Reid finds the delivery
of health care is left to the market. Taiwanese health care offers
medical, dental, mental and Chinese medicine, with no waiting time and
for less that half of what we pay in the United States. Every person
in Taiwan has a "smart card" containing all of his or her relevant
health information, and bills are paid automatically. But what Reid
finds is that the Taiwanese spend too little to sustain their health
care system. According to Princeton's Tsung-Mei Cheng, who advised the
Taiwanese government, "As we speak, the government is borrowing from
banks to pay what there isn't enough to pay the providers."
Reid's final destination is Switzerland, a country whose health care
system suffered from some America's problems until, in 1994, the
country attempted a major reform. Despite a huge private insurance
business, a law called LAMal was passed, which set up a universal
health care system that, among other things, restricted insurance
companies from making a profit on basic medical care. Today, Swiss
politicians from the political right and left enthusiastically support
universal health care. Pascal Couchepin, the president of the Swiss
Federation, argues: "Everybody has a right to health care. ... It is a
profound need for people to be sure that if they are struck by
destiny ... they can have a good health system."